Run Date: 3/22/2023 10:18:41 AM
CDM Date Stamp: 1/9/2022

Procedure Code,Procedure Description,Price Tier,Revenue Code,CPT HCPCS Code,Modifier1,Modifier2,NDC Code,Rx Unit Multiplier,Gross Charge,Discounted Cash Price,De-identified minimum negotiated charge,De-identified maximum negotiated charge,AETNA-ALL_PLANS,ASURIS_INDIV_AND_FAMILY_NETW_PPO,ASURIS_NW_HEALTH-ALL_OTHER_PLANS,UHC-ALL_PLANS
0001A_2,Pfizer Vaccine Admin Dose 1,Outpatient,0771,0001A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0001A_2,Pfizer Vaccine Admin Dose 1,Inpatient,0771,0001A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0001A_3,Pfizer Vaccine Admin Dose 1,Inpatient,0771,0001A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0001A_3,Pfizer Vaccine Admin Dose 1,Outpatient,0771,0001A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0001F_3,HEART FAIL  ASSESS COMPOSITE,ProFee,0989,0001F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0001U_3,RBC DNA HEA 35 AG 11 BLD GRP,ProFee,0989,0001U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0002A_2,Pfizer Vaccine Admin Dose 2,Inpatient,0771,0002A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0002A_2,Pfizer Vaccine Admin Dose 2,Outpatient,0771,0002A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0002A_3,Pfizer Vaccine Admin Dose 2,Outpatient,0771,0002A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0002A_3,Pfizer Vaccine Admin Dose 2,Inpatient,0771,0002A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0002U_3,ONC CLRCT 3 UR METAB ALG PLP,ProFee,0989,0002U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0003A_2,Pfizer Vaccine Admin Dose 3,Outpatient,0771,0003A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0003A_2,Pfizer Vaccine Admin Dose 3,Inpatient,0771,0003A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0003A_3,Pfizer Vaccine Admin Dose 3,Outpatient,0771,0003A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0003A_3,Pfizer Vaccine Admin Dose 3,Inpatient,0771,0003A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0003T_3,CERVICOGRAPHY,ProFee,0989,0003T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0003U_3,ONC OVAR 5 PRTN SER ALG SCOR,ProFee,0989,0003U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0004A_2,Pfizer Vaccine Admin Booster,Outpatient,0771,0004A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0004A_2,Pfizer Vaccine Admin Booster,Inpatient,0771,0004A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0004A_3,Pfizer Vaccine Admin Booster,Inpatient,0771,0004A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0004A_3,Pfizer Vaccine Admin Booster,Outpatient,0771,0004A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0005F_3,OSTEOARTHR ASSESS COMPOSITE,ProFee,0989,0005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0005U_3,ONCO PRST8 3 GENE UR ALG,ProFee,0989,0005U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0006U_3,DETC IA MEDS 120+ ANALYTES,ProFee,0989,0006U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0007U_3,RX TEST PRSMV UR W/DEF CONF,ProFee,0989,0007U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0008T_3,UPPER GI ENDOSCOPY W/SUTURE,ProFee,0989,0008T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0008U_3,HPYLORI DETCJ ABX RSTNC DNA,ProFee,0989,0008U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0009U_3,ONC BRST CA ERBB2 AMP/NONAMP,ProFee,0989,0009U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00100_3,"ANESTH, SALIVARY GLAND",ProFee,0989,00100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00102_3,"ANESTH, REPAIR OF CLEFT LIP",ProFee,0989,00102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00103_3,"ANESTH, BLEPHAROPLASTY",ProFee,0989,00103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00104_3,"ANESTH, ELECTROSHOCK",ProFee,0989,00104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0010U_3,NFCT DS STRN TYP WHL GEN SEQ,ProFee,0989,0010U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0011A_2,Moderna Vaccine Admin Dose 1,Inpatient,0771,0011A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0011A_2,Moderna Vaccine Admin Dose 1,Outpatient,0771,0011A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0011A_3,Moderna Vaccine Admin Dose 1,Inpatient,0771,0011A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0011A_3,Moderna Vaccine Admin Dose 1,Outpatient,0771,0011A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0011U_3,RX MNTR LC-MS/MS ORAL FLUID,ProFee,0989,0011U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00120_3,"ANESTH, EAR SURGERY",ProFee,0989,00120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00124_3,"ANESTH, EAR EXAM",ProFee,0989,00124,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00126_3,"ANESTH, TYMPANOTOMY",ProFee,0989,00126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0012A_2,Moderna Vaccine Admin Dose 2,Outpatient,0771,0012A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0012A_2,Moderna Vaccine Admin Dose 2,Inpatient,0771,0012A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0012A_3,Moderna Vaccine Admin Dose 2,Outpatient,0771,0012A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0012A_3,Moderna Vaccine Admin Dose 2,Inpatient,0771,0012A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0012F_3,CAP BACTERIAL ASSESS,ProFee,0989,0012F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0012U_3,GERMLN DO GENE REARGMT DETCJ,ProFee,0989,0012U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0013A_2,Moderna Vaccine Admin Dose 3,Inpatient,0771,0013A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0013A_2,Moderna Vaccine Admin Dose 3,Outpatient,0771,0013A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0013A_3,Moderna Vaccine Admin Dose 3,Inpatient,0771,0013A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0013A_3,Moderna Vaccine Admin Dose 3,Outpatient,0771,0013A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0013U_3,ONC SLD ORG NEO GENE REARGMT,ProFee,0989,0013U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00140_3,"ANESTH, PROCEDURES ON EYE",ProFee,0989,00140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00142_3,"ANESTH, LENS SURGERY",ProFee,0989,00142,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00144_3,"ANESTH, CORNEAL TRANSPLANT",ProFee,0989,00144,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00145_3,"ANESTH, VITREORETINAL SURG",ProFee,0989,00145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00147_3,"ANESTH, IRIDECTOMY",ProFee,0989,00147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00148_3,"ANESTH, EYE EXAM",ProFee,0989,00148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0014F_3,COMP PREOP ASSESS CAT SURG,ProFee,0989,0014F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0014U_3,HEM HMTLMF NEO GENE REARGMT,ProFee,0989,0014U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0015F_3,MELAN FOLLOW-UP COMPLETE,ProFee,0989,0015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00160_3,"ANESTH, NOSE/SINUS SURGERY",ProFee,0989,00160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00162_3,"ANESTH, NOSE/SINUS SURGERY",ProFee,0989,00162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00164_3,"ANESTH, BIOPSY OF NOSE",ProFee,0989,00164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0016T_3,THERMOTX CHOROID VASC LESION,ProFee,0989,0016T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0016U_3,ONC HMTLMF NEO RNA BCR/ABL1,ProFee,0989,0016U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00170_3,"ANESTH, PROCEDURE ON MOUTH",ProFee,0989,00170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00172_3,"ANESTH, CLEFT PALATE REPAIR",ProFee,0989,00172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00174_3,"ANESTH, PHARYNGEAL SURGERY",ProFee,0989,00174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00176_3,"ANESTH, PHARYNGEAL SURGERY",ProFee,0989,00176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0017T_3,PHOTOCOAGULAT MACULAR DRUSEN,ProFee,0989,0017T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0017U_3,ONC HMTLMF NEO JAK2 MUT DNA,ProFee,0989,0017U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0018T_3,TRANSCRANIAL MAGNETIC STIMUL,ProFee,0989,0018T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0018U_3,ONC THYR 10 MICRORNA SEQ ALG,ProFee,0989,0018U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00190_3,"ANESTH, FACE/SKULL BONE SURG",ProFee,0989,00190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00192_3,"ANESTH, FACIAL BONE SURGERY",ProFee,0989,00192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0019T_3,"EXTRACORP SHOCK WAVE TX, MS",ProFee,0989,0019T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0019U_3,ONC RNA TISS PREDICT ALG,ProFee,0989,0019U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00210_3,"ANESTH, OPEN HEAD SURGERY",ProFee,0989,00210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00211_3,"ANESTH, CRAN SURG, HEMOTOMA",ProFee,0989,00211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00212_3,"ANESTH, SKULL DRAINAGE",ProFee,0989,00212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00214_3,"ANESTH, SKULL DRAINAGE",ProFee,0989,00214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00215_3,"ANESTH, SKULL REPAIR/FRACT",ProFee,0989,00215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00216_3,"ANESTH, HEAD VESSEL SURGERY",ProFee,0989,00216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00218_3,"ANESTH, SPECIAL HEAD SURGERY",ProFee,0989,00218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0021T_3,"FETAL OXIMETRY, TRNSVAG/CERV",ProFee,0989,0021T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0021U_3,ONC PRST8 DETCJ 8 AUTOANTB,ProFee,0989,0021U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00220_3,"ANESTH, INTRCRN NERVE",ProFee,0989,00220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00222_3,"ANESTH, HEAD NERVE SURGERY",ProFee,0989,00222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0022U_3,TRGT GEN SEQ DNA&RNA 23 GENE,ProFee,0989,0022U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0023U_3,ONC AML DNA DETCJ/NONDETCJ,ProFee,0989,0023U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0024T_3,TRANSCATH CARDIAC REDUCTION,ProFee,0989,0024T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0024U_3,GLYCA NUC MR SPECTRSC QUAN,ProFee,0989,0024U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0025U_3,TENOFOVIR LIQ CHROM UR QUAN,ProFee,0989,0025U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0026T_3,MEASURE REMNANT LIPOPROTEINS,ProFee,0989,0026T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0026U_3,ONC THYR DNA&MRNA 112 GENES,ProFee,0989,0026U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0027T_3,ENDOSCOPIC EPIDURAL LYSIS,ProFee,0989,0027T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0027U_3,JAK2 GENE TRGT SEQ ALYS,ProFee,0989,0027U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0028T_3,DEXA BODY COMPOSITION STUDY,ProFee,0989,0028T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0029T_3,MAGNETIC TX FOR INCONTINENCE,ProFee,0989,0029T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0029U_3,RX METAB ADVRS TRGT SEQ ALYS,ProFee,0989,0029U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00300_3,"ANESTH, HEAD/NECK/PTRUNK",ProFee,0989,00300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0030T_3,ANTIPROTHROMBIN ANTIBODY,ProFee,0989,0030T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0030U_3,RX METAB WARF TRGT SEQ ALYS,ProFee,0989,0030U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0031A_2,Jassen Vaccine Admin,Outpatient,0771,0031A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0031A_2,Jassen Vaccine Admin,Inpatient,0771,0031A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0031A_3,Jassen Vaccine Admin,Inpatient,0771,0031A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0031A_3,Jassen Vaccine Admin,Outpatient,0771,0031A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0031T_3,SPECULOSCOPY,ProFee,0989,0031T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0031U_3,CYP1A2 GENE,ProFee,0989,0031U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00320_3,"ANESTH, NECK ORGAN, 1 & OVER",ProFee,0989,00320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00322_3,"ANESTH, BIOPSY OF THYROID",ProFee,0989,00322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00326_3,"ANESTH, LARYNX/TRACH, < 1 YR",ProFee,0989,00326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0032T_3,SPECULOSCOPY W/DIRECT SAMPLE,ProFee,0989,0032T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0032U_3,COMT GENE,ProFee,0989,0032U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0033U_3,HTR2A HTR2C GENES,ProFee,0989,0033U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0034U_3,TPMT NUDT15 GENES,ProFee,0989,0034U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00350_3,"ANESTH, NECK VESSEL SURGERY",ProFee,0989,00350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00352_3,"ANESTH, NECK VESSEL SURGERY",ProFee,0989,00352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0035U_3,NEURO CSF PRION PRTN QUAL,ProFee,0989,0035U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0036U_3,XOME TUM & NML SPEC SEQ ALYS,ProFee,0989,0036U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0037U_3,TRGT GEN SEQ DNA 324 GENES,ProFee,0989,0037U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0038U_3,VITAMIN D SRM MICROSAMP QUAN,ProFee,0989,0038U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0039U_3,DNA ANTB 2STRAND HI AVIDITY,ProFee,0989,0039U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00400_3,"ANESTH, SKIN, EXT/PER/ATRUNK",ProFee,0989,00400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00402_3,"ANESTH, SURGERY OF BREAST",ProFee,0989,00402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00404_3,"ANESTH, SURGERY OF BREAST",ProFee,0989,00404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00406_3,"ANESTH, SURGERY OF BREAST",ProFee,0989,00406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0040U_3,BCR/ABL1 GENE MAJOR BP QUAN,ProFee,0989,0040U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00410_3,"ANESTH, CORRECT HEART RHYTHM",ProFee,0989,00410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0041A_2,Novavax Vaccine Admin Dose 1,Inpatient,0771,0041A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0041A_2,Novavax Vaccine Admin Dose 1,Outpatient,0771,0041A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0041A_3,Novavax Vaccine Admin Dose 1,Inpatient,0771,0041A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0041A_3,Novavax Vaccine Admin Dose 1,Outpatient,0771,0041A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0041T_3,DETECT UR INFECT AGNT W/CPAS,ProFee,0989,0041T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0041U_3,B BRGDRFERI ANTB 5 PRTN IGM,ProFee,0989,0041U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0042A_2,Novavax Vaccine Admin Dose 2,Inpatient,0771,0042A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0042A_2,Novavax Vaccine Admin Dose 2,Outpatient,0771,0042A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0042A_3,Novavax Vaccine Admin Dose 2,Inpatient,0771,0042A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0042A_3,Novavax Vaccine Admin Dose 2,Outpatient,0771,0042A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0042T_3,"CT PERFUSION W/CONTRAST, CBF",ProFee,0989,0042T,,,,0,3.00,2.25,2.25,523.50,0.00,523.50,523.50,N/A
0042U_3,B BRGDRFERI ANTB 12 PRTN IGG,ProFee,0989,0042U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0043T_3,CO EXPIRED GAS ANALYSIS,ProFee,0989,0043T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0043U_3,TBRF B GRP ANTB 4 PRTN IGM,ProFee,0989,0043U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0044T_3,WHOLE BODY PHOTOGRAPHY,ProFee,0989,0044T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0044U_3,TBRF B GRP ANTB 4 PRTN IGG,ProFee,0989,0044U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00450_3,"ANESTH, SURGERY OF SHOULDER",ProFee,0989,00450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00452_3,"ANESTH, SURGERY OF SHOULDER",ProFee,0989,00452,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
00454_3,"ANESTH, COLLAR BONE BIOPSY",ProFee,0989,00454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0045T_3,WHOLE BODY PHOTOGRAPHY,ProFee,0989,0045T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0045U_3,ONC BRST DUX CARC IS 12 GENE,ProFee,0989,0045U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0046T_3,"CATH LAVAGE, MAMMARY DUCT(S",ProFee,0989,0046T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0046U_3,FLT3 GENE ITD VARIANTS QUAN,ProFee,0989,0046U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00470_3,"ANESTH, REMOVAL OF RIB",ProFee,0989,00470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00472_3,"ANESTH, CHEST WALL REPAIR",ProFee,0989,00472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00474_3,"ANESTH, SURGERY OF RIB(S)",ProFee,0989,00474,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0047T_3,"CATH LAVAGE, MAMMARY DUCT(S)",ProFee,0989,0047T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0047U_3,ONC PRST8 MRNA 17 GENE ALG,ProFee,0989,0047U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0048T_3,IMPLANT VENTRICULAR DEVICE,ProFee,0989,0048T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0048U_3,ONC SLD ORG NEO DNA 468 GENE,ProFee,0989,0048U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0049T_3,EXTERNAL CIRCULATION ASSIST,ProFee,0989,0049T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0049U_3,NPM1 GENE ANALYSIS QUAN,ProFee,0989,0049U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00500_3,"ANESTH, ESOPHAGEAL SURGERY",ProFee,0989,00500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0050T_3,REMOVAL CIRCULATION ASSIST,ProFee,0989,0050T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0050U_3,TRGT GEN SEQ DNA 194 GENES,ProFee,0989,0050U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0051A_2,Pfizer Vaccine Admin Dose 1,Inpatient,0771,0051A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0051A_2,Pfizer Vaccine Admin Dose 1,Outpatient,0771,0051A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0051A_3,Pfizer Vaccine Admin Dose 1,Inpatient,0771,0051A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0051A_3,Pfizer Vaccine Admin Dose 1,Outpatient,0771,0051A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0051T_3,IMPLANT TOTAL HEART SYSTEM,ProFee,0989,0051T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0051U_3,RX MNTR LC-MS/MS UR 31 PNL,ProFee,0989,0051U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00520_3,"ANESTH, CHEST PROCEDURE",ProFee,0989,00520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00522_3,"ANESTH, CHEST LINING BIOPSY",ProFee,0989,00522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00524_3,"ANESTH, CHEST DRAINAGE",ProFee,0989,00524,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00528_3,"ANESTH, CHEST PARTITION VIEW",ProFee,0989,00528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00529_3,"ANESTH, CHEST PARTITION VIEW",ProFee,0989,00529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0052A_2,Pfizer Vaccine Admin Dose 2,Outpatient,0771,0052A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0052A_2,Pfizer Vaccine Admin Dose 2,Inpatient,0771,0052A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0052A_3,Pfizer Vaccine Admin Dose 2,Outpatient,0771,0052A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0052A_3,Pfizer Vaccine Admin Dose 2,Inpatient,0771,0052A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0052T_3,REPLACE COMPONENT HEART SYST,ProFee,0989,0052T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0052U_3,LPOPRTN BLD W/5 MAJ CLASSES,ProFee,0989,0052U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00530_3,"ANESTH, PACEMAKER INSERTION",ProFee,0989,00530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00532_3,"ANESTH, VASCULAR ACCESS",ProFee,0989,00532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00534_3,"ANESTH, CARDIOVERTER/DEFIB",ProFee,0989,00534,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00537_3,"ANESTH, CARDIAC ELECTROPHYS",ProFee,0989,00537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00539_3,"ANESTH, TRACH-BRONCH RECONST",ProFee,0989,00539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0053A_2,Pfizer Vaccine Admin Dose 3,Inpatient,0771,0053A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0053A_2,Pfizer Vaccine Admin Dose 3,Outpatient,0771,0053A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0053A_3,Pfizer Vaccine Admin Dose 3,Outpatient,0771,0053A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0053A_3,Pfizer Vaccine Admin Dose 3,Inpatient,0771,0053A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0053T_3,REPLACE COMPONENT HEART SYST,ProFee,0989,0053T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0053U_3,ONC PRST8 CA FISH ALYS 4 GEN,ProFee,0989,0053U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00540_3,"ANESTH, CHEST SURGERY",ProFee,0989,00540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00541_3,"ANESTH, ONE LUNG VENTILATION",ProFee,0989,00541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00542_3,"ANESTH, RELEASE OF LUNG",ProFee,0989,00542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00546_3,"ANESTH, LUNG,CHEST WALL SURG",ProFee,0989,00546,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00548_3,"ANESTH, TRACHEA,BRONCHI SURG",ProFee,0989,00548,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0054A_2,Pfizer Vaccine Admin Booster,Inpatient,0771,0054A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0054A_2,Pfizer Vaccine Admin Booster,Outpatient,0771,0054A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0054A_3,Pfizer Vaccine Admin Booster,Inpatient,0771,0054A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0054A_3,Pfizer Vaccine Admin Booster,Outpatient,0771,0054A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0054T_3,BONE SURGERY USING COMPUTER,ProFee,0989,0054T,,,,0,3.00,2.25,2.25,357.50,0.00,357.50,357.50,N/A
0054U_3,RX MNTR 14+ DRUGS & SBSTS,ProFee,0989,0054U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00550_3,"ANESTH, STERNAL DEBRIDEMENT",ProFee,0989,00550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0055T_3,BONE SURGERY USING COMPUTER,ProFee,0989,0055T,,,,0,3.00,2.25,2.25,466.50,0.00,466.50,466.50,N/A
0055U_3,CARD HRT TRNSPL 96 DNA SEQ,ProFee,0989,0055U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00560_3,"ANESTH, HEART SURG W/O PUMP",ProFee,0989,00560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00561_3,"ANESTH, HEART SURG < AGE 1",ProFee,0989,00561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00562_3,"ANESTH, HEART SURG W/PUMP",ProFee,0989,00562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00563_3,"ANESTH, HEART SURG W/ARREST",ProFee,0989,00563,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00566_3,"ANESTH, CABG W/O PUMP",ProFee,0989,00566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00567_3,"ANESTH, CABG W/PUMP",ProFee,0989,00567,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0056T_3,BONE SURGERY USING COMPUTER,ProFee,0989,0056T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0056U_3,HEM AML DNA GENE REARGMT,ProFee,0989,0056U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00580_3,"ANESTH, HEART/LUNG TRANSPLNT",ProFee,0989,00580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0058T_3,"CRYOPRESERVATION, OVARY TISS",ProFee,0989,0058T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0058U_3,ONC MERKEL CLL CARC SRM QUAN,ProFee,0989,0058U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0059T_3,"CRYOPRESERVATION, OOCYTE",ProFee,0989,0059T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0059U_3,ONC MERKEL CLL CARC SRM +/-,ProFee,0989,0059U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00600_3,"ANESTH, SPINE, CORD SURGERY",ProFee,0989,00600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00604_3,"ANESTH, SITTING PROCEDURE",ProFee,0989,00604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0060T_3,ELECTRICAL IMPEDANCE SCAN,ProFee,0989,0060T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0060U_3,TWN ZYG GEN SEQ ALYS CHRMS2,ProFee,0989,0060U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0061T_3,"DESTRUCTION OF TUMOR, BREAST",ProFee,0989,0061T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0061U_3,TC MEAS 5 BMRK SFDI M-S ALYS,ProFee,0989,0061U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00620_3,"ANESTH, SPINE, CORD SURGERY",ProFee,0989,00620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00622_3,"ANESTH, REMOVAL OF NERVES",ProFee,0989,00622,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
00625_3,ANES SPINE TRANTHOR W/O VENT,ProFee,0989,00625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00626_3,"ANES, SPINE TRANSTHOR W/VENT",ProFee,0989,00626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0062T_3,REP INTRADISC ANNULUS;1 LEV,ProFee,0989,0062T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0062U_3,AI SLE IGG&IGM ALYS 80 BMRK,ProFee,0989,0062U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00630_3,"ANESTH, SPINE, CORD SURGERY",ProFee,0989,00630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00632_3,"ANESTH, REMOVAL OF NERVES",ProFee,0989,00632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00634_3,ANESTH FOR CHEMONUCLEOLYSIS,ProFee,0989,00634,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
00635_3,"ANESTH, LUMBAR PUNCTURE",ProFee,0989,00635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0063T_3,REP INTRADISC ANNULUS;>1LEV,ProFee,0989,0063T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0063U_3,NEURO AUTISM 32 AMINES ALG,ProFee,0989,0063U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00640_3,"ANESTH, SPINE MANIPULATION",ProFee,0989,00640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0064A_2,Moderna Vaccine Admin Booster,Inpatient,0771,0064A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0064A_2,Moderna Vaccine Admin Booster,Outpatient,0771,0064A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0064A_3,Moderna Vaccine Admin Booster,Outpatient,0771,0064A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0064A_3,Moderna Vaccine Admin Booster,Inpatient,0771,0064A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0064T_3,SPECTROSCOP EVAL EXPIRED GAS,ProFee,0989,0064T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0064U_3,ANTB TP TOTAL&RPR IA QUAL,ProFee,0989,0064U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0065T_3,OCULAR PHOTOSCREEN BILAT,ProFee,0989,0065T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0065U_3,SYFLS TST NONTREPONEMAL ANTB,ProFee,0989,0065U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0066T_3,CT COLONOGRAPHY;SCREEN,ProFee,0989,0066T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0066U_3,PAMG-1 IA CERVICO-VAG FLUID,ProFee,0989,0066U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00670_3,"ANESTH, SPINE, CORD SURGERY",ProFee,0989,00670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0067T_3,CT COLONOGRAPHY;DX,ProFee,0989,0067T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0067U_3,ONC BRST IMHCHEM PRFL 4 BMRK,ProFee,0989,0067U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0068T_3,INTERP/REPT HEART SOUND,ProFee,0989,0068T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0068U_3,CANDIDA SPECIES PNL AMP PRB,ProFee,0989,0068U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0069T_3,ANALYSIS ONLY HEART SOUND,ProFee,0989,0069T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0069U_3,ONC CLRCT MICRORNA MIR-31-3P,ProFee,0989,0069U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00700_3,"ANESTH, ABDOMINAL WALL SURG",ProFee,0989,00700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00702_3,"ANESTH, FOR LIVER BIOPSY",ProFee,0989,00702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0070T_3,INTERP ONLY HEART SOUND,ProFee,0989,0070T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0070U_3,CYP2D6 GEN COM&SLCT RAR VRNT,ProFee,0989,0070U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0071A_2,Pfizer Pediatric Vaccine Admin Dose 1,Inpatient,0771,0071A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0071A_2,Pfizer Pediatric Vaccine Admin Dose 1,Outpatient,0771,0071A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0071A_3,Pfizer Pediatric Vaccine Admin Dose 1,Outpatient,0771,0071A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0071A_3,Pfizer Pediatric Vaccine Admin Dose 1,Inpatient,0771,0071A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0071T_3,U/S LEIOMYOMATA ABLATE <200,ProFee,0989,0071T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0071U_3,CYP2D6 FULL GENE SEQUENCE,ProFee,0989,0071U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0072A_2,Pfizer Pediatric Vaccine Admin Dose 2,Inpatient,0771,0072A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0072A_2,Pfizer Pediatric Vaccine Admin Dose 2,Outpatient,0771,0072A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0072A_3,Pfizer Pediatric Vaccine Admin Dose 2,Outpatient,0771,0072A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0072A_3,Pfizer Pediatric Vaccine Admin Dose 2,Inpatient,0771,0072A,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
0072T_3,U/S LEIOMYOMATA ABLATE >200,ProFee,0989,0072T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0072U_3,CYP2D6 GEN CYP2D6-2D7 HYBRID,ProFee,0989,0072U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00730_3,"ANESTH, ABDOMINAL WALL SURG",ProFee,0989,00730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00731_3,ANES UPR GI NDSC PX NOS,ProFee,0989,00731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00732_3,ANES UPR GI NDSC PX ERCP,ProFee,0989,00732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0073T_3,"DELIVERY, COMP IMRT",ProFee,0989,0073T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0073U_3,CYP2D6 GEN CYP2D7-2D6 HYBRID,ProFee,0989,0073U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00740_3,"ANESTH, UPPER GI VISUALIZE",ProFee,0989,00740,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0074T_3,ONLINE PHYSICIAN E/M,ProFee,0989,0074T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0074U_3,CYP2D6 NONDUPLICATED GENE,ProFee,0989,0074U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00750_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00752_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00752,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00754_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00754,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00756_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0075T_3,PERQ STENT/CHEST VERT ART,ProFee,0989,0075T,,,,0,3.00,2.25,2.25,889.50,0.00,889.50,889.50,N/A
0075U_3,CYP2D6 5' GENE DUP/MLT,ProFee,0989,0075U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0076T_3,S&I STENT/CHEST VERT ART,ProFee,0989,0076T,,,,0,3.00,2.25,2.25,648.00,0.00,648.00,648.00,N/A
0076U_3,CYP2D6 3' GENE DUP/MLT,ProFee,0989,0076U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00770_3,"ANESTH, BLOOD VESSEL REPAIR",ProFee,0989,00770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0077T_3,CEREB THERM PERFUSION PROBE,ProFee,0989,0077T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0077U_3,IG PARAPROTEIN QUAL BLD/UR,ProFee,0989,0077U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0078T_3,ENDOVASC AORT REPR W/DEVICE,ProFee,0989,0078T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0078U_3,PAIN MGT OPI USE GNOTYP PNL,ProFee,0989,0078U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00790_3,"ANESTH, SURG UPPER ABDOMEN",ProFee,0989,00790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00792_3,"ANESTH, HEMORR/EXCISE LIVER",ProFee,0989,00792,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00794_3,"ANESTH, PANCREAS REMOVAL",ProFee,0989,00794,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00796_3,"ANESTH, FOR LIVER TRANSPLANT",ProFee,0989,00796,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00797_3,"ANESTH, SURGERY FOR OBESITY",ProFee,0989,00797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0079T_3,ENDOVASC VISC EXTNSN REPR,ProFee,0989,0079T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0079U_3,CMPRTV DNA ALYS MLT SNPS,ProFee,0989,0079U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00800_3,"ANESTH, ABDOMINAL WALL SURG",ProFee,0989,00800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00802_3,"ANESTH, FAT LAYER REMOVAL",ProFee,0989,00802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0080T_3,ENDOVASC AORT REPR RAD S&I,ProFee,0989,0080T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0080U_3,ONC LNG 5 CLIN RSK FACTR ALG,ProFee,0989,0080U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00810_3,"ANESTH, LOW INTESTINE SCOPE",ProFee,0989,00810,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
00811_3,ANES LWR INTST NDSC NOS,ProFee,0989,00811,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00812_3,ANES LWR INTST SCR COLSC,ProFee,0989,00812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00813_3,ANES UPR LWR GI NDSC PX,ProFee,0989,00813,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0081T_3,ENDOVASC VISC EXTNSN S&I,ProFee,0989,0081T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
00820_3,"ANESTH, ABDOMINAL WALL SURG",ProFee,0989,00820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0082T_3,STEREOTACTIC RAD DELIVERY,ProFee,0989,0082T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0082U_3,RX TEST DEF 90+ RX/SBSTS UR,ProFee,0989,0082U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00830_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00832_3,"ANESTH, REPAIR OF HERNIA",ProFee,0989,00832,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00834_3,"ANESTH, HERNIA REPAIR< 1 YR",ProFee,0989,00834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00836_3,ANESTH HERNIA REPAIR PREEMIE,ProFee,0989,00836,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0083T_3,STEREOTACTIC RAD TX MNGMT,ProFee,0989,0083T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0083U_3,ONC RSPSE CHEMO CNTRST TOMOG,ProFee,0989,0083U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00840_3,"ANESTH, SURG LOWER ABDOMEN",ProFee,0989,00840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00842_3,"ANESTH, AMNIOCENTESIS",ProFee,0989,00842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00844_3,"ANESTH, PELVIS SURGERY",ProFee,0989,00844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00846_3,"ANESTH, HYSTERECTOMY",ProFee,0989,00846,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00848_3,"ANESTH, PELVIC ORGAN SURG",ProFee,0989,00848,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0084T_3,TEMP PROSTATE URETHRAL STENT,ProFee,0989,0084T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0084U_3,RBC DNA GNOTYP 10 BLD GROUPS,ProFee,0989,0084U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00851_3,"ANESTH, TUBAL LIGATION",ProFee,0989,00851,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0085T_3,BREATH TEST HEART REJECT,ProFee,0989,0085T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0085U_3,CDTB&VINCULIN IGG ANTB IA,ProFee,0989,0085U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00860_3,"ANESTH, SURGERY OF ABDOMEN",ProFee,0989,00860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00862_3,"ANESTH, KIDNEY/URETER SURG",ProFee,0989,00862,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00864_3,"ANESTH, REMOVAL OF BLADDER",ProFee,0989,00864,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00865_3,"ANESTH, REMOVAL OF PROSTATE",ProFee,0989,00865,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00866_3,"ANESTH, REMOVAL OF ADRENAL",ProFee,0989,00866,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00868_3,"ANESTH, KIDNEY TRANSPLANT",ProFee,0989,00868,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0086T_3,L VENTRICLE FILL PRESSURE,ProFee,0989,0086T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0086U_3,NFCT DS BACT&FNG ORG ID 6+,ProFee,0989,0086U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00870_3,"ANESTH, BLADDER STONE SURG",ProFee,0989,00870,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00872_3,ANESTH KIDNEY STONE DESTRUCT,ProFee,0989,00872,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00873_3,ANESTH KIDNEY STONE DESTRUCT,ProFee,0989,00873,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0087T_3,SPERM EVAL HYALURONAN,ProFee,0989,0087T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0087U_3,CRD HRT TRNSPL MRNA 1283 GEN,ProFee,0989,0087U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00880_3,"ANESTH, ABDOMEN VESSEL SURG",ProFee,0989,00880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00882_3,"ANESTH, MAJOR VEIN LIGATION",ProFee,0989,00882,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0088T_3,RF TONGUE BASE VOL REDUXN,ProFee,0989,0088T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0088U_3,TRNSPLJ KDN ALGRFT REJ 1494,ProFee,0989,0088U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0089T_3,"ACTIGRAPHY TESTING,3-DAY",ProFee,0989,0089T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0089U_3,ONC MLNMA PRAME & LINC00518,ProFee,0989,0089U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00902_3,"ANESTH, ANORECTAL SURGERY",ProFee,0989,00902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00904_3,"ANESTH, PERINEAL SURGERY",ProFee,0989,00904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00906_3,"ANESTH, REMOVAL OF VULVA",ProFee,0989,00906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00908_3,"ANESTH, REMOVAL OF PROSTATE",ProFee,0989,00908,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0090T_3,CERVICAL ARTIFIC DISC,ProFee,0989,0090T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0090U_3,ONC CUTAN MLNMA MRNA 23 GENE,ProFee,0989,0090U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00910_3,"ANESTH, BLADDER SURGERY",ProFee,0989,00910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00912_3,"ANESTH, BLADDER TUMOR SURG",ProFee,0989,00912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00914_3,"ANESTH, REMOVAL OF PROSTATE",ProFee,0989,00914,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00916_3,"ANESTH, BLEEDING CONTROL",ProFee,0989,00916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00918_3,"ANESTH, STONE REMOVAL",ProFee,0989,00918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0091T_3,LUMBAR ARTIFIC DISC,ProFee,0989,0091T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0091U_3,ONC CLRCT SCR WHL BLD ALG,ProFee,0989,0091U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00920_3,"ANESTH, GENITALIA SURGERY",ProFee,0989,00920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00921_3,"ANESTH, VASECTOMY",ProFee,0989,00921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00922_3,"ANESTH, SPERM DUCT SURGERY",ProFee,0989,00922,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00924_3,"ANESTH, TESTIS EXPLORATION",ProFee,0989,00924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00926_3,"ANESTH, REMOVAL OF TESTIS",ProFee,0989,00926,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00928_3,"ANESTH, REMOVAL OF TESTIS",ProFee,0989,00928,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0092T_3,ARTIFIC DISC ADDL,ProFee,0989,0092T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0092U_3,ONC LNG 3 PRTN BMRK PLSM ALG,ProFee,0989,0092U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00930_3,"ANESTH, TESTIS SUSPENSION",ProFee,0989,00930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00932_3,"ANESTH, AMPUTATION OF PENIS",ProFee,0989,00932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00934_3,"ANESTH, PENIS, NODES REMOVAL",ProFee,0989,00934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00936_3,"ANESTH, PENIS, NODES REMOVAL",ProFee,0989,00936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00938_3,"ANESTH, INSERT PENIS DEVICE",ProFee,0989,00938,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0093T_3,CERVICAL ARTIFIC DISKECTOMY,ProFee,0989,0093T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0093U_3,RX MNTR 65 COM DRUGS URINE,ProFee,0989,0093U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00940_3,"ANESTH, VAGINAL PROCEDURES",ProFee,0989,00940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00942_3,"ANESTH, SURG ON VAG/URETHRAL",ProFee,0989,00942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00944_3,"ANESTH, VAGINAL HYSTERECTOMY",ProFee,0989,00944,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00948_3,"ANESTH, REPAIR OF CERVIX",ProFee,0989,00948,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0094T_3,LUMBAR ARTIFIC DISKECTOMY,ProFee,0989,0094T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0094U_3,GENOME RAPID SEQUENCE ALYS,ProFee,0989,0094U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00950_3,"ANESTH, VAGINAL ENDOSCOPY",ProFee,0989,00950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
00952_3,"ANESTH, HYSTEROSCOPE/GRAPH",ProFee,0989,00952,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0095T_3,ARTIFIC DISKECTOMY ADDL,ProFee,0989,0095T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0095U_3,INFLM EE ELISA ALYS ALG,ProFee,0989,0095U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0096T_3,REV CERVICAL ARTIFIC DISC,ProFee,0989,0096T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0096U_3,HPV HI RISK TYPES MALE URINE,ProFee,0989,0096U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0097T_3,REV LUMBAR ARTIFIC DISC,ProFee,0989,0097T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0097U_3,GI PATHOGEN 22 TARGETS,ProFee,0989,0097U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0098T_3,REV ARTIFIC DISC ADDL,ProFee,0989,0098T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0098U_3,RESPIR PATHOGEN 14 TARGETS,ProFee,0989,0098U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0099T_3,IMPLANT CORNEAL RING,ProFee,0989,65785,,,,0,3.00,2.25,2.25,631.00,0.00,631.00,631.00,N/A
0099U_3,RESPIR PATHOGEN 20 TARGETS,ProFee,0989,0099U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0100T_3,PROSTH RETINA RECEIVE&GEN,ProFee,0989,0100T,,,,0,3.00,2.25,2.25,2861.50,0.00,2861.50,2861.50,N/A
0100U_3,RESPIR PATHOGEN 21 TARGETS,ProFee,0989,0100U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0101T_3,"EXTRACORP SHOCKWV TX,HI ENRG",ProFee,0989,0101T,,,,0,3.00,2.25,2.25,401.00,0.00,401.00,401.00,N/A
0101U_3,HERED COLON CA DO 15 GENES,ProFee,0989,0101U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0102T_3,"EXTRACORP SHOCKWV TX,ANESTH",ProFee,0989,0102T,,,,0,3.00,2.25,2.25,401.00,0.00,401.00,401.00,N/A
0102U_3,HERED BRST CA RLTD DO 17 GEN,ProFee,0989,0102U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0103T_3,HOLOTRANSCOBALAMIN,ProFee,0989,84999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0103U_3,HERED OVA CA PNL 24 GENES,ProFee,0989,0103U,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0104T_3,AT REST CARDIO GAS REBREATHE,ProFee,0989,0104T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0105T_3,EXERC CARDIO GAS REBREATHE,ProFee,0989,0105T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0105U_3,NEPH CKD MULT ECLIA TUM NEC,ProFee,0989,0105U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0106T_3,TOUCH QUANT SENSORY TEST,ProFee,0989,0106T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0106U_3,GSTR EMPTG 7 TIMED BRTH SPEC,ProFee,0989,0106U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0107T_3,RATE QUANT SENSORY TEST,ProFee,0989,0107T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0107U_3,C DIFF TOX AG DETCJ IA STOOL,ProFee,0989,0107U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0108T_3,COOL QUANT SENSORY TEST,ProFee,0989,0108T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0108U_3,GI BARRETT ESOPH 9 PRTN BMRK,ProFee,0989,0108U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0109T_3,HEAT QUANT SENSORY TEST,ProFee,0989,0109T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0109U_3,ID ASPERGILLUS DNA 4 SPECIES,ProFee,0989,0109U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0110T_3,NOS QUANT SENSORY TEST,ProFee,0989,0110T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0110U_3,RX MNTR 1+ORAL ONC RX&SBSTS,ProFee,0989,0110U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01112_3,"ANESTH, BONE ASPIRATE/BX",ProFee,0989,01112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0111T_3,RBC MEMBRANES FATTY ACIDS,ProFee,0989,0111T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0111U_3,ONC COLON CA KRAS&NRAS ALYS,ProFee,0989,0111U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01120_3,"ANESTH, PELVIS SURGERY",ProFee,0989,01120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0112U_3,IADI 16S&18S RRNA GENES,ProFee,0989,0112U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01130_3,"ANESTH, BODY CAST PROCEDURE",ProFee,0989,01130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0113U_3,ONC PRST8 PCA3&TMPRSS2-ERG,ProFee,0989,0113U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01140_3,"ANESTH, AMPUTATION AT PELVIS",ProFee,0989,01140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0114U_3,GI BARRETTS ESOPH VIM&CCNA1,ProFee,0989,0114U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01150_3,"ANESTH, PELVIC TUMOR SURGERY",ProFee,0989,01150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0115T_3,MED TX MNGMT 15 MIN,ProFee,0989,0115T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0115U_3,RESPIR IADNA 18 VIRAL&2 BACT,ProFee,0989,0115U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01160_3,"ANESTH, PELVIS PROCEDURE",ProFee,0989,01160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0116T_3,MED TX MNGMT SUBSQT,ProFee,0989,0116T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0116U_3,RX MNTR NZM IA 35+ORAL FLU,ProFee,0989,0116U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01170_3,"ANESTH, PELVIS SURGERY",ProFee,0989,01170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01173_3,"ANESTH, FX REPAIR, PELVIS",ProFee,0989,01173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0117T_3,MED TX MNGMT ADDL 15 MIN,ProFee,0989,0117T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0117U_3,PAIN MGMT 11 ENDOGENOUS ANAL,ProFee,0989,0117U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01180_3,"ANESTH, PELVIS NERVE REMOVAL",ProFee,0989,01180,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0118U_3,TRNSPLJ DON-DRV CLL-FR DNA,ProFee,0989,0118U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01190_3,"ANESTH, PELVIS NERVE REMOVAL",ProFee,0989,01190,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0119U_3,CRD CERAMIDES LIQ CHROM PLSM,ProFee,0989,0119U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01200_3,"ANESTH, HIP JOINT PROCEDURE",ProFee,0989,01200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01202_3,"ANESTH, ARTHROSCOPY OF HIP",ProFee,0989,01202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0120T_3,"FIBROADENOMA CRYOABLATE, EA",ProFee,0989,0120T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0120U_3,ONC B CLL LYMPHM MRNA 58 GEN,ProFee,0989,0120U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01210_3,"ANESTH, HIP JOINT SURGERY",ProFee,0989,01210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01212_3,"ANESTH, HIP DISARTICULATION",ProFee,0989,01212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01214_3,"ANESTH, HIP ARTHROPLASTY",ProFee,0989,01214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01215_3,"ANESTH, REVISE HIP REPAIR",ProFee,0989,01215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0121U_3,SC DIS VCAM-1 WHOLE BLOOD,ProFee,0989,0121U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01220_3,"ANESTH, PROCEDURE ON FEMUR",ProFee,0989,01220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0122U_3,SC DIS P-SELECTIN WHL BLOOD,ProFee,0989,0122U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01230_3,"ANESTH, SURGERY OF FEMUR",ProFee,0989,01230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01232_3,"ANESTH, AMPUTATION OF FEMUR",ProFee,0989,01232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01234_3,"ANESTH, RADICAL FEMUR SURG",ProFee,0989,01234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0123T_3,SCLERAL FISTULIZATION,ProFee,0989,66999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0123U_3,MCHNL FRAGILITY RBC PRFLG,ProFee,0989,0123U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0124T_3,CONJUNCTIVAL DRUG PLACEMENT,ProFee,0989,0124T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0124U_3,FTL CGEN ABNOR 3 ANALYTES,ProFee,0989,0124U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01250_3,"ANESTH, UPPER LEG SURGERY",ProFee,0989,01250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0125U_3,FTL CGEN ABNOR PRNT COMP 5,ProFee,0989,0125U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01260_3,"ANESTH, UPPER LEG VEINS SURG",ProFee,0989,01260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0126T_3,CHD RISK IMT STUDY,ProFee,0989,0126T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0126U_3,FTL CGEN ABNOR PRNT COMP 5 Y,ProFee,0989,0126U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01270_3,"ANESTH, THIGH ARTERIES SURG",ProFee,0989,01270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01272_3,"ANESTH, FEMORAL ARTERY SURG",ProFee,0989,01272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01274_3,"ANESTH, FEMORAL EMBOLECTOMY",ProFee,0989,01274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0127U_3,OB PE 3 ANALYTES,ProFee,0989,0127U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0128U_3,OB PE 3 ANALYTES Y CHRMSM,ProFee,0989,0128U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0129U_3,HERED BRST CA RLTD DO PANEL,ProFee,0989,0129U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0130T_3,CHRON CARE DRUG INVESTIGATN,ProFee,0989,0130T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0130U_3,HERED COLON CA DO MRNA PNL,ProFee,0989,0130U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0131U_3,HERED BRST CA RLTD DO PNL 13,ProFee,0989,0131U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01320_3,"ANESTH, KNEE AREA SURGERY",ProFee,0989,01320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0132U_3,HERED OVA CA RLTD DO PNL 17,ProFee,0989,0132U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0133T_3,ESOPHAGEAL IMPLANT INJEXN,ProFee,0989,0133T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0133U_3,HERED PRST8 CA RLTD DO 11,ProFee,0989,0133U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01340_3,"ANESTH, KNEE AREA PROCEDURE",ProFee,0989,01340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0134U_3,HERED PAN CA MRNA PNL 18 GEN,ProFee,0989,0134U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0135T_3,PERQ CRYOABLATE RENAL TUMOR,ProFee,0989,0135T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0135U_3,HERED GYN CA MRNA PNL 12 GEN,ProFee,0989,0135U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01360_3,"ANESTH, KNEE AREA SURGERY",ProFee,0989,01360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0136U_3,ATM MRNA SEQ ALYS,ProFee,0989,0136U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0137T_3,PROSTATE SATURATION SAMPLING,ProFee,0989,0137T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0137U_3,PALB2 MRNA SEQ ALYS,ProFee,0989,0137U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01380_3,"ANESTH, KNEE JOINT PROCEDURE",ProFee,0989,01380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01382_3,"ANESTH, DX KNEE ARTHROSCOPY",ProFee,0989,01382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0138U_3,BRCA1 BRCA2 MRNA SEQ ALYS,ProFee,0989,0138U,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01390_3,"ANESTH, KNEE AREA PROCEDURE",ProFee,0989,01390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01392_3,"ANESTH, KNEE AREA SURGERY",ProFee,0989,01392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01400_3,"ANESTH, KNEE JOINT SURGERY",ProFee,0989,01400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01402_3,"ANESTH, KNEE ARTHROPLASTY",ProFee,0989,01402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01404_3,"ANESTH, AMPUTATION AT KNEE",ProFee,0989,01404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0140T_3,EXHALED BREATH CONDENSATE PH,ProFee,0989,0140T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0141T_3,PERQ ISLET TRANSPLANT,ProFee,0989,0141T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01420_3,"ANESTH, KNEE JOINT CASTING",ProFee,0989,01420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0142T_3,OPEN ISLET TRANSPLANT,ProFee,0989,0142T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01430_3,"ANESTH, KNEE VEINS SURGERY",ProFee,0989,01430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01432_3,"ANESTH, KNEE VESSEL SURG",ProFee,0989,01432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0143T_3,LAPAROSCOPIC ISLET TRANSPLNT,ProFee,0989,0143T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01440_3,"ANESTH, KNEE ARTERIES SURG",ProFee,0989,01440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01442_3,"ANESTH, KNEE ARTERY SURG",ProFee,0989,01442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01444_3,"ANESTH, KNEE ARTERY REPAIR",ProFee,0989,01444,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0144T_3,CT HEART WO DYE; QUAL CALC,ProFee,0989,0144T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0145T_3,CT HEART W/WO DYE FUNCT,ProFee,0989,0145T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01462_3,"ANESTH, LOWER LEG PROCEDURE",ProFee,0989,01462,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01464_3,"ANESTH, ANKLE/FT ARTHROSCOPY",ProFee,0989,01464,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0146T_3,CCTA W/WO DYE,ProFee,0989,0146T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01470_3,"ANESTH, LOWER LEG SURGERY",ProFee,0989,01470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01472_3,"ANESTH, ACHILLES TENDON SURG",ProFee,0989,01472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01474_3,"ANESTH, LOWER LEG SURGERY",ProFee,0989,01474,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0147T_3,"CCTA W/WO, QUAN CALCIUM",ProFee,0989,0147T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01480_3,"ANESTH, LOWER LEG BONE SURG",ProFee,0989,01480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01482_3,"ANESTH, RADICAL LEG SURGERY",ProFee,0989,01482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01484_3,"ANESTH, LOWER LEG REVISION",ProFee,0989,01484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01486_3,"ANESTH, ANKLE REPLACEMENT",ProFee,0989,01486,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0148T_3,"CCTA W/WO, STRXR",ProFee,0989,0148T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01490_3,"ANESTH, LOWER LEG CASTING",ProFee,0989,01490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0149T_3,"CCTA W/WO, STRXR QUAN CALC",ProFee,0989,0149T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01500_3,"ANESTH, LEG ARTERIES SURG",ProFee,0989,01500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01502_3,"ANESTH, LWR LEG EMBOLECTOMY",ProFee,0989,01502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0150T_3,"CCTA W/WO, DISEASE STRXR",ProFee,0989,0150T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0151T_3,CT HEART FUNCT ADD-ON,ProFee,0989,0151T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01520_3,"ANESTH, LOWER LEG VEIN SURG",ProFee,0989,01520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01522_3,"ANESTH, LOWER LEG VEIN SURG",ProFee,0989,01522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0152T_3,COMPUTER CHEST ADD-ON,ProFee,0989,0152T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0153T_3,IMPLANT ANEUR SENSOR ADD-ON,ProFee,0989,0153T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0154T_3,IMPLANT ANEUR SENSOR STUDY,ProFee,0989,0154T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0155T_3,LAP IMPL GAST CURVE ELECTRD,ProFee,0989,0155T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0156T_3,LAP REMV GAST CURVE ELECTRD,ProFee,0989,0156T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0157T_3,OPEN IMPL GAST CURVE ELECTRD,ProFee,0989,0157T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0158T_3,OPEN REMV GAST CURVE ELECTRD,ProFee,0989,0158T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0159T_3,CAD BREAST MRI,ProFee,0989,0159T,,,,0,3.00,2.25,2.25,10.00,0.00,10.00,10.00,N/A
0160T_3,TCRANIAL MAGN STIM TX PLAN,ProFee,0989,0160T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01610_3,"ANESTH, SURGERY OF SHOULDER",ProFee,0989,01610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0161T_3,TCRANIAL MAGN STIM TX DELIV,ProFee,0989,0161T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01620_3,"ANESTH, SHOULDER PROCEDURE",ProFee,0989,01620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01622_3,ANES DX SHOULDER ARTHROSCOPY,ProFee,0989,01622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0162T_3,ANAL PROGRAM GAST NEUROSTIM,ProFee,0989,0162T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01630_3,"ANESTH, SURGERY OF SHOULDER",ProFee,0989,01630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01632_3,"ANESTH, SURGERY OF SHOULDER",ProFee,0989,01632,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01634_3,"ANESTH, SHOULDER JOINT AMPUT",ProFee,0989,01634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01636_3,"ANESTH, FOREQUARTER AMPUT",ProFee,0989,01636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01638_3,"ANESTH, SHOULDER REPLACEMENT",ProFee,0989,01638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0163T_3,LUMB ARTIF DISKECTOMY ADDL,ProFee,0989,0163T,,,,0,3.00,2.25,2.25,2536.50,0.00,2536.50,2536.50,N/A
0164T_3,REMOVE LUMB ARTIF DISC ADDL,ProFee,0989,0164T,,,,0,3.00,2.25,2.25,470.00,0.00,470.00,470.00,N/A
01650_3,"ANESTH, SHOULDER ARTERY SURG",ProFee,0989,01650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01652_3,"ANESTH, SHOULDER VESSEL SURG",ProFee,0989,01652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01654_3,"ANESTH, SHOULDER VESSEL SURG",ProFee,0989,01654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01656_3,"ANESTH, ARM-LEG VESSEL SURG",ProFee,0989,01656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0165T_3,REVISE LUMB ARTIF DISC ADDL,ProFee,0989,0165T,,,,0,3.00,2.25,2.25,521.00,0.00,521.00,521.00,N/A
0166T_3,TCATH VSD CLOSE W/O BYPASS,ProFee,0989,0166T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01670_3,"ANESTH, SHOULDER VEIN SURG",ProFee,0989,01670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0167T_3,TCATH VSD CLOSE W BYPASS,ProFee,0989,0167T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01680_3,"ANESTH, SHOULDER CASTING",ProFee,0989,01680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01682_3,"ANESTH, AIRPLANE CAST",ProFee,0989,01682,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0168T_3,RHINOPHOTOTX LIGHT APP BILAT,ProFee,0989,0168T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0169T_3,PLACE STEREO CATH BRAIN,ProFee,0989,0169T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0170T_3,ANORECTAL FISTULA PLUG RPR,ProFee,0989,0170T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01710_3,"ANESTH, ELBOW AREA SURGERY",ProFee,0989,01710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01712_3,"ANESTH, UPPR ARM TENDON SURG",ProFee,0989,01712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01714_3,"ANESTH, UPPR ARM TENDON SURG",ProFee,0989,01714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01716_3,"ANESTH, BICEPS TENDON REPAIR",ProFee,0989,01716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0171T_3,LUMBAR SPINE PROCES DISTRACT,ProFee,0989,0171T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0172T_3,LUMBAR SPINE PROCESS ADDL,ProFee,0989,0172T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01730_3,"ANESTH, UPPR ARM PROCEDURE",ProFee,0989,01730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01732_3,"ANESTH, DX ELBOW ARTHROSCOPY",ProFee,0989,01732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0173T_3,IOP MONIT IO PRESSURE,ProFee,0989,0173T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01740_3,"ANESTH, UPPER ARM SURGERY",ProFee,0989,01740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01742_3,"ANESTH, HUMERUS SURGERY",ProFee,0989,01742,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01744_3,"ANESTH, HUMERUS REPAIR",ProFee,0989,01744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0174T_3,CAD CXR WITH INTERP,ProFee,0989,0174T,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
01756_3,"ANESTH, RADICAL HUMERUS SURG",ProFee,0989,01756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01758_3,"ANESTH, HUMERAL LESION SURG",ProFee,0989,01758,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0175T_3,CAD CXR REMOTE,ProFee,0989,0175T,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
01760_3,"ANESTH, ELBOW REPLACEMENT",ProFee,0989,01760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0176T_3,AQU CANAL DILAT W/O RETENT,ProFee,0989,0176T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01770_3,"ANESTH, UPPR ARM ARTERY SURG",ProFee,0989,01770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01772_3,"ANESTH, UPPR ARM EMBOLECTOMY",ProFee,0989,01772,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0177T_3,AQU CANAL DILAT W RETENT,ProFee,0989,0177T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01780_3,"ANESTH, UPPER ARM VEIN SURG",ProFee,0989,01780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01782_3,"ANESTH, UPPR ARM VEIN REPAIR",ProFee,0989,01782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0178T_3,64 LEAD ECG W I&R,ProFee,0989,0178T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0179T_3,64 LEAD ECG W TRACING,ProFee,0989,0179T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0180T_3,64 LEAD ECG W I&R ONLY,ProFee,0989,0180T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01810_3,"ANESTH, LOWER ARM SURGERY",ProFee,0989,01810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0181T_3,CORNEAL HYSTERESIS,ProFee,0989,0181T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01820_3,"ANESTH, LOWER ARM PROCEDURE",ProFee,0989,01820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01829_3,"ANESTH, DX WRIST ARTHROSCOPY",ProFee,0989,01829,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0182T_3,HDR ELECT BRACHYTHERAPY,ProFee,0989,0182T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01830_3,"ANESTH, LOWER ARM SURGERY",ProFee,0989,01830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01832_3,"ANESTH, WRIST REPLACEMENT",ProFee,0989,01832,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0183T_3,WOUND ULTRASOUND,ProFee,0989,0183T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01840_3,"ANESTH, LWR ARM ARTERY SURG",ProFee,0989,01840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01842_3,"ANESTH, LWR ARM EMBOLECTOMY",ProFee,0989,01842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01844_3,"ANESTH, VASCULAR SHUNT SURG",ProFee,0989,01844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0184T_3,EXC RECTAL TUMOR ENDOSCOPIC,ProFee,0989,0184T,,,,0,3.00,2.25,2.25,1098.00,0.00,1098.00,1098.00,N/A
01850_3,"ANESTH, LOWER ARM VEIN SURG",ProFee,0989,01850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01852_3,"ANESTH, LWR ARM VEIN REPAIR",ProFee,0989,01852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0185T_3,COMPTR PROBABILITY ANALYSIS,ProFee,0989,0185T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01860_3,"ANESTH, LOWER ARM CASTING",ProFee,0989,01860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0186T_3,SUPRACHOROIDAL DRUG DELIVERY,ProFee,0989,0186T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0187T_3,OPHTHALMIC DX IMAGE ANTERIOR,ProFee,0989,0187T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0188T_3,VIDEOCONF CRIT CARE 74 MIN,ProFee,0989,0188T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0189T_3,VIDEOCONF CRIT CARE ADDL 30,ProFee,0989,0189T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01905_3,"ANES, SPINE INJECT, X-RAY/RE",ProFee,0989,01905,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0190T_3,PLACE INTRAOC RADIATION SRC,ProFee,0989,0190T,,,,0,3.00,2.25,2.25,330.50,0.00,330.50,330.50,N/A
01916_3,"ANESTH, DX ARTERIOGRAPHY",ProFee,0989,01916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0191T_3,INSERT ANT SEGMENT DRAIN INT,ProFee,0989,0191T,,,,0,3.00,2.25,2.25,1129.50,0.00,1129.50,1129.50,N/A
01920_3,"ANESTH, CATHETERIZE HEART",ProFee,0989,01920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01922_3,"ANESTH, CAT OR MRI SCAN",ProFee,0989,01922,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01924_3,"ANES, THER INTERVEN RAD, ART",ProFee,0989,01924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01925_3,"ANES, THER INTERVEN RAD, CAR",ProFee,0989,01925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01926_3,"ANES, TX INTERV RAD HRT/CRAN",ProFee,0989,01926,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0192T_3,INSERT ANT SEGMENT DRAIN EXT,ProFee,0989,0192T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01930_3,"ANES, THER INTERVEN RAD, VEI",ProFee,0989,01930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01931_3,"ANES, THER INTERVEN RAD, TIP",ProFee,0989,01931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01932_3,"ANES, TX INTERV RAD, TH VEIN",ProFee,0989,01932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01933_3,"ANES, TX INTERV RAD, CRAN V",ProFee,0989,01933,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01935_3,"ANESTH, PERC IMG DX SP PROC",ProFee,0989,01935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01936_3,"ANESTH, PERC IMG TX SP PROC",ProFee,0989,01936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0193T_3,RF BLADDER NECK MICROREMODEL,ProFee,0989,0193T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0194T_3,PROCALCITONIN (PCT),ProFee,0989,0194T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01951_3,"ANESTH, BURN, LESS 4 PERCENT",ProFee,0989,01951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01952_3,"ANESTH, BURN, 4-9 PERCENT",ProFee,0989,01952,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01953_3,"ANESTH, BURN, EACH 9 PERCENT",ProFee,0989,01953,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
01958_3,"ANESTH, ANTEPARTUM MANIPUL",ProFee,0989,01958,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0195T_3,ARTHROD PRESAC INTERBODY,ProFee,0989,0195T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01960_3,"ANESTH, VAGINAL DELIVERY",ProFee,0989,01960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01961_3,"ANESTH, CS DELIVERY",ProFee,0989,01961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01962_3,"ANESTH, EMER HYSTERECTOMY",ProFee,0989,01962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01963_3,"ANESTH, CS HYSTERECTOMY",ProFee,0989,01963,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01965_3,"ANESTH, INC/MISSED AB PROC",ProFee,0989,01965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01966_3,"ANESTH, INDUCED AB PROCEDURE",ProFee,0989,01966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01967_3,"ANESTH/ANALG, VAG DELIVERY",ProFee,0989,01967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01968_3,ANES/ANALG CS DELIVER ADD-ON,ProFee,0989,01968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01969_3,ANESTH/ANALG CS HYST ADD-ON,ProFee,0989,01969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0196T_3,ARTHROD PRESAC INTERBODY EAC,ProFee,0989,0196T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0197T_3,INTRAFRACTION TRACK MOTION,ProFee,0989,0197T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0198T_3,OCULAR BLOOD FLOW MEASURE,ProFee,0989,0198T,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
01990_3,SUPPORT FOR ORGAN DONOR,ProFee,0989,01990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01991_3,"ANESTH, NERVE BLOCK/INJ",ProFee,0989,01991,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01992_3,"ANESTH, N BLOCK/INJ, PRONE",ProFee,0989,01992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
01995_3,REGIONAL ANESTHESIA LIMB,ProFee,0989,01995,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
01996_3,HOSP MANAGE CONT DRUG ADMIN,ProFee,0989,01996,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
01999_3,UNLISTED ANESTH PROCEDURE,ProFee,0989,01999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0199T_3,PHYSIOLOGIC TREMOR RECORD,ProFee,0989,0199T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0200T_3,PERQ SACRAL AUGMT UNILAT INJ,ProFee,0989,0200T,,,,0,3.00,2.25,2.25,1257.50,0.00,1257.50,1257.50,N/A
0201T_3,PERQ SACRAL AUGMT BILAT INJ,ProFee,0989,0201T,,,,0,3.00,2.25,2.25,1731.00,0.00,1731.00,1731.00,N/A
0202T_3,POST VERT ARTHRPLST 1 LUMBAR,ProFee,0989,0202T,,,,0,3.00,2.25,2.25,2225.00,0.00,2225.00,2225.00,N/A
0203T_3,UNATTEND SLEEP STUDY W/TIME,ProFee,0989,0203T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0204T_3,UNATTENDED SLEEP STUDY,ProFee,0989,0204T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0207T_3,CLEAR EYELID GLAND W/HEAT,ProFee,0989,0207T,,,,0,3.00,2.25,2.25,27.50,0.00,27.50,27.50,N/A
0208T_3,AUTOMATED AUDIOMETRY AIR,ProFee,0989,0208T,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
0209T_3,AUTO AUDIOMETRY AIR/BONE,ProFee,0989,0209T,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
0210T_3,AUTO AUDIOMETRY SP THRESH,ProFee,0989,0210T,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
0211T_3,AUTO AUDIOMETRY SP RECOG,ProFee,0989,0211T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0212T_3,COMPREHEN AUTO AUDIOMETRY,ProFee,0989,0212T,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
0213T_3,US FACET JT INJ CERV/T 1 LEV,ProFee,0989,0213T,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
0214T_3,US FACET JT INJ CERV/T 2 LEV,ProFee,0989,0214T,,,,0,3.00,2.25,2.25,135.50,0.00,135.50,135.50,N/A
0215T_3,US FACET JT INJ CERV/T 3 LEV,ProFee,0989,0215T,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
0216T_3,US FACET JT INJ LS 1 LEVEL,ProFee,0989,0216T,,,,0,3.00,2.25,2.25,241.50,0.00,241.50,241.50,N/A
0217T_3,US FACET JT INJ LS 2 LEVEL,ProFee,0989,0217T,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
0218T_3,US FACET JT INJ LS 3 LEVEL,ProFee,0989,0218T,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
0219T_3,FUSE SPINE FACET JT CERV,ProFee,0989,0219T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0220T_3,FUSE SPINE FACET JT THOR,ProFee,0989,0220T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0221T_3,FUSE SPINE FACET JT LUMBAR,ProFee,0989,0221T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0222T_3,FUSE SPINE FACET JT ADD SEG,ProFee,0989,0222T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0223T_3,ACOUSTIC ECG W/I&R,ProFee,0989,93799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0224T_3,ACOUSTIC ECG 1+ ANALYSIS,ProFee,0989,93799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0225T_3,ACOUSTIC ECG ANALY & REPROG,ProFee,0989,93799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0226T_3,ANOSCOPY HRA W/SPEC COLLECT,ProFee,0989,0226T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0227T_3,ANOSCOPY HRA W/BIOPSY,ProFee,0989,0227T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0228T_3,NJX TFRML EPRL W/US CER/THOR,ProFee,0989,0228T,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
0229T_3,NJX TFRML EPRL W/US CER/THOR,ProFee,0989,0229T,,,,0,3.00,2.25,2.25,147.00,0.00,147.00,147.00,N/A
0230T_3,NJX TFRML EPRL W/US LUMB/SAC,ProFee,0989,0230T,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
0231T_3,NJX TFRML EPRL W/US LUMB/SAC,ProFee,0989,0231T,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
0232T_3,NJX PLATELET PLASMA,ProFee,0989,0232T,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
0233T_3,SKIN GLYCATION SPECTROSCOPY,ProFee,0989,88749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0234T_3,TRLUML PERIP ATHRC RENAL ART,ProFee,0989,0234T,,,,0,3.00,2.25,2.25,1916.00,0.00,1916.00,1916.00,N/A
0235T_3,TRLUML PERIP ATHRC VISCERAL,ProFee,0989,0235T,,,,0,3.00,2.25,2.25,1914.50,0.00,1914.50,1914.50,N/A
0236T_3,TRLUML PERIP ATHRC ABD AORTA,ProFee,0989,0236T,,,,0,3.00,2.25,2.25,1631.00,0.00,1631.00,1631.00,N/A
0237T_3,TRLUML PERIP ATHRC BRCHIOCPH,ProFee,0989,0237T,,,,0,3.00,2.25,2.25,812.50,0.00,812.50,812.50,N/A
0238T_3,TRLUML PERIP ATHRC ILIAC ART,ProFee,0989,0238T,,,,0,3.00,2.25,2.25,1104.50,0.00,1104.50,1104.50,N/A
0239T_3,BIOIMPEDANCE SPECTROSCOPY,ProFee,0989,0239T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0240T_3,ESOPH MOTILITY 3D TOPOGRAPHY,ProFee,0989,0240T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0241T_3,ESOPH MOTILITY W/STIM/PERF,ProFee,0989,0241T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0242T_3,GI TRACT TRANSIT & PRES MEAS,ProFee,0989,0242T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0243T_3,INTM MSR BRONCHODIL WHEEZE,ProFee,0989,94799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0244T_3,CONT MSR BRONCHODIL WHEEZE,ProFee,0989,94799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0245T_3,OPN TX RIB FX 1-2 RIBS,ProFee,0989,0245T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0246T_3,OPN TX RIB FX 3-4 RIBS,ProFee,0989,0246T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0247T_3,OPN TX RIB FX 5-6 RIBS,ProFee,0989,0247T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0248T_3,OPN TX RIB FX 7+ RIBS,ProFee,0989,0248T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0250T_3,INSERT BRONCHIAL VALVE,ProFee,0989,0250T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0251T_3,REMOV BRONCHIAL VALVE ADDL,ProFee,0989,0251T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0252T_3,BRONCHSCPC RMVL BRONCH VALVE,ProFee,0989,0252T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0253T_3,INSERT AQUEOUS DRAIN DEVICE,ProFee,0989,0253T,,,,0,3.00,2.25,2.25,1255.00,0.00,1255.00,1255.00,N/A
0255T_3,EVASC RPR ILIAC ART BIFR S&I,ProFee,0989,0254T,,,,0,3.00,2.25,2.25,1362.50,0.00,1362.50,1362.50,N/A
0256T_3,EVASC AORTIC HRT VALVE,ProFee,0989,0256T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0257T_3,OPN TTHRC AORTIC HRT VALVE,ProFee,0989,0257T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0258T_3,AORTIC HRT VALV W/O CARD BYP,ProFee,0989,0258T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0259T_3,AORTIC HRT VALVE W/CARD BYP,ProFee,0989,0259T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0260T_3,HYPTHRM BDY NEONATE 28D/<,ProFee,0989,0260T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0261T_3,HYPTHRM HEAD NEONATE 28D/<,ProFee,0989,0261T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0262T_3,IMPLTJ PULM VLV EVASC APPR,ProFee,0989,33477,,,,0,3.00,2.25,2.25,1982.50,0.00,1982.50,1982.50,N/A
0263T_3,IM B1 MRW CEL THER CMPL,ProFee,0989,0263T,,,,0,3.00,2.25,2.25,470.50,0.00,470.50,470.50,N/A
0264T_3,IM B1 MRW CEL THER XCL HRVST,ProFee,0989,0264T,,,,0,3.00,2.25,2.25,209.50,0.00,209.50,209.50,N/A
0265T_3,IM B1 MRW CEL THER HRVST ONL,ProFee,0989,0265T,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
0266T_3,IMPLT/RPL CRTD SNS DEV TOTAL,ProFee,0989,0266T,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
0267T_3,IMPLT/RPL CRTD SNS DEV LEAD,ProFee,0989,0267T,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
0268T_3,IMPLT/RPL CRTD SNS DEV GEN,ProFee,0989,0268T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0269T_3,REV/REMVL CRTD SNS DEV TOTAL,ProFee,0989,0269T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0270T_3,REV/REMVL CRTD SNS DEV LEAD,ProFee,0989,0270T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0271T_3,REV/REMVL CRTD SNS DEV GEN,ProFee,0989,0271T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0272T_3,INTERROGATE CRTD SNS DEV,ProFee,0989,0272T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0273T_3,INTERROGATE CRTD SNS W/PGRMG,ProFee,0989,0273T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0274T_3,PERQ LAMOT/LAM CRV/THRC,ProFee,0989,0274T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0275T_3,PERQ LAMOT/LAM LUMBAR,ProFee,0989,0275T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0276T_3,BRONCH THERMOPLASTY 1 LOBE,ProFee,0989,0276T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0277T_3,BRONCH THERMOPLASTY LOBES,ProFee,0989,0277T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0278T_3,TEMPR,ProFee,0989,0278T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0279T_3,CTC TEST,ProFee,0989,0279T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0280T_3,CTC TEST W/I & R,ProFee,0989,0280T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0281T_3,LAA CLOSURE W/IMPLANT,ProFee,0989,33340,,,,0,3.00,2.25,2.25,1154.50,0.00,1154.50,1154.50,N/A
0282T_3,PERIPH FIELD STIMUL TRIAL,ProFee,0989,0282T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0283T_3,PERIPH FIELD STIMUL PERM,ProFee,0989,0283T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0284T_3,PERIPH FIELD STIMUL REVISE,ProFee,0989,0284T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0285T_3,PERIPH FIELD STIMUL ANALYS,ProFee,0989,0285T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0286T_3,NEAR IFR SPECTRSC OF WOUNDS,ProFee,0989,0286T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0287T_3,NEAR IFR GUIDE OF VASC SITE,ProFee,0989,0287T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0288T_3,ANOSCOPY W/RF DELIVERY,ProFee,0989,0288T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0289T_3,LASER INC FOR PKP/LKP DONOR,ProFee,0989,0289T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0290T_3,LASER INC FOR PKP/LKP RECIP,ProFee,0989,0290T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0291T_3,IV OCT FOR PROC INIT VESSEL,ProFee,0989,0291T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0292T_3,IV OCT FOR PROC ADDL VESSEL,ProFee,0989,0292T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0293T_3,INS LT ATRL PRESS MONITOR,ProFee,0989,0293T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0294T_3,INS LT ATRL PRESS MONT ADDON,ProFee,0989,0294T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0295T_3,EXT ECG COMPLETE,ProFee,0989,0295T,,,,0,3.00,2.25,2.25,264.50,0.00,264.50,264.50,N/A
0296T_3,EXT ECG RECORDING,ProFee,0989,0296T,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
0297T_3,EXT ECG SCAN W/REPORT,ProFee,0989,0297T,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
0298T_3,EXT ECG REVIEW AND INTERP,ProFee,0989,0298T,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
0299T_3,ESW WOUND HEALING INIT WOUND,ProFee,0989,0299T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0300T_3,ESW WOUND HEALING ADDL WOUND,ProFee,0989,0300T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0301T_3,MW THERAPY FOR BREAST TUMOR,ProFee,0989,0301T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0308T_3,INSJ OCULAR TELESCOPE PROSTH,ProFee,0989,0308T,,,,0,3.00,2.25,2.25,2070.00,0.00,2070.00,2070.00,N/A
0312T_3,LAPS IMPLTJ NSTIM VAGUS,ProFee,0989,0312T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0313T_3,LAPS RMVL NSTIM ARRAY VAGUS,ProFee,0989,0313T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0314T_3,LAPS RMVL VGL ARRY&PLS GEN,ProFee,0989,0314T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0315T_3,RMVL VAGUS NERVE PLS GEN,ProFee,0989,0315T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0316T_3,REPLC VAGUS NERVE PLS GEN,ProFee,0989,0316T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0317T_3,ELEC ALYS VAGUS NRV PLS GEN,ProFee,0989,0317T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0329T_3,MNTR IO PRESS 24HRS/> UNI/BI,ProFee,0989,0329T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0330T_3,TEAR FILM IMG UNI/BI W/I&R,ProFee,0989,0330T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0331T_3,HEART SYMP IMAGE PLNR,ProFee,0989,0331T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0332T_3,HEART SYMP IMAGE PLNR SPECT,ProFee,0989,0332T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0333T_3,VISUAL EP SCR ACUITY AUTO,ProFee,0989,0333T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0335T_3,INSJ SINUS TARSI IMPLANT,ProFee,0989,0335T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0338T_3,TRNSCTH RENAL SYMP DENRV UNL,ProFee,0989,0338T,,,,0,3.00,2.25,2.25,1466.50,0.00,1466.50,1466.50,N/A
0339T_3,TRNSCTH RENAL SYMP DENRV BIL,ProFee,0989,0339T,,,,0,3.00,2.25,2.25,1763.00,0.00,1763.00,1763.00,N/A
0342T_3,THXP APHERESIS W/HDL DELIP,ProFee,0989,0342T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0345T_3,TRANSCATH MTRAL VLVE REPAIR,ProFee,0989,0345T,,,,0,3.00,2.25,2.25,2040.00,0.00,2040.00,2040.00,N/A
0347T_3,INS BONE DEVICE FOR RSA,ProFee,0989,0347T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0348T_3,RSA SPINE EXAM,ProFee,0989,0348T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0349T_3,RSA UPPER EXTR EXAM,ProFee,0989,0349T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0350T_3,RSA LOWER EXTR EXAM,ProFee,0989,0350T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0351T_3,INTRAOP OCT BRST/NODE SPEC,ProFee,0989,0351T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0352T_3,OCT BRST/NODE I&R PER SPEC,ProFee,0989,0352T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0353T_3,INTRAOP OCT BREAST CAVITY,ProFee,0989,0353T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0354T_3,OCT BREAST SURG CAVITY I&R,ProFee,0989,0354T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0355T_3,GI TRACT CAPSULE ENDOSCOPY,ProFee,0989,0355T,,,,0,3.00,2.25,2.25,1229.50,0.00,1229.50,1229.50,N/A
0356T_3,INSRT DRUG DEVICE FOR IOP,ProFee,0989,0356T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0358T_3,BIA WHOLE BODY,ProFee,0989,0358T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0362T_3,BHV ID SUPRT ASSMT EA 15 MIN,ProFee,0989,0362T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0373T_3,ADAPT BHV TX EA 15 MIN,ProFee,0989,0373T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0376T_3,INSERT ANT SEGMENT DRAIN INT,ProFee,0989,0376T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0378T_3,VISUAL FIELD ASSMNT REV/RPRT,ProFee,0989,0378T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0379T_3,VIS FIELD ASSMNT TECH SUPPT,ProFee,0989,0379T,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
0381T_3,EXT H RATE EPI SZ 14 DAYS,ProFee,0989,0381T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0382T_3,EXT H RATE SZ 14 DAY RI ONLY,ProFee,0989,0382T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0383T_3,EXT H RATE SZ 15-30 DAYS,ProFee,0989,0383T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0384T_3,EX H RATE SZ 15-30 DAY RI,ProFee,0989,0384T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0385T_3,EX H RATE FOR SZ OVR 30 DAY,ProFee,0989,0385T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0386T_3,EX H RATE SZ 30+ DAY RI ONLY,ProFee,0989,0386T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0394T_3,HDR ELCTRNC SKN SURF BRCHYTX,ProFee,0989,0394T,,,,0,3.00,2.25,2.25,310.00,0.00,310.00,310.00,N/A
0395T_3,HDR ELCTR NTRST/NTRCV BRCHTX,ProFee,0989,0395T,,,,0,3.00,2.25,2.25,1150.50,0.00,1150.50,1150.50,N/A
0396T_3,INTRAOP KINETIC BALNCE SENSR,ProFee,0989,0396T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0397T_3,ERCP W/OPTICAL ENDOMICROSCPY,ProFee,0989,0397T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0398T_3,MRGFUS STRTCTC LES ABLTJ,ProFee,0989,0398T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0400T_3,MLTISPECTRL DIGITAL LES ALYS,ProFee,0989,0400T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0401T_3,MLTISPECTRL DIGITAL LES ALYS,ProFee,0989,0401T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0402T_3,COLGN CROSS-LINK CRN MED SEP,ProFee,0989,0402T,,,,0,3.00,2.25,2.25,664.20,0.00,664.20,664.20,N/A
0403T_3,DIABETES PREV STANDARD CURR,ProFee,0989,0403T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0404T_3,TRNSCRV UTERIN FIBROID ABLTJ,ProFee,0989,0404T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0405T_3,OVRSGHT XTRCORP LIV ASST PAT,ProFee,0989,0405T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0408T_3,INSJ/RPLC CARDIAC MODULJ SYS,ProFee,0989,0408T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0409T_3,INSJ/RPLC CAR MODULJ PLS GN,ProFee,0989,0409T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0410T_3,INSJ/RPLC CAR MODULJ ATR ELT,ProFee,0989,0410T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0411T_3,INSJ/RPLC CAR MODULJ VNT ELT,ProFee,0989,0411T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0412T_3,RMVL CARDIAC MODULJ PLS GEN,ProFee,0989,0412T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0413T_3,RMVL CAR MODULJ TRANVNS ELT,ProFee,0989,0413T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0414T_3,RMVL & RPL CAR MODULJ PLS GN,ProFee,0989,0414T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0415T_3,REPOS CAR MODULJ TRANVNS ELT,ProFee,0989,0415T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0416T_3,RELOC SKIN POCKET PLS GEN,ProFee,0989,0416T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0417T_3,PRGRMG EVAL CARDIAC MODULJ,ProFee,0989,0417T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0418T_3,INTERRO EVAL CARDIAC MODULJ,ProFee,0989,0418T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0419T_3,DSTRJ NEUROFIBROMA XTNSV,ProFee,0989,0419T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0420T_3,DSTRJ NEUROFIBROMA XTNSV,ProFee,0989,0420T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0421T_3,WATERJET PROSTATE ABLTJ CMPL,ProFee,0989,0421T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0422T_3,TACTILE BREAST IMG UNI/BI,ProFee,0989,0422T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0423T_3,ASSAY SECRETORY TYPE II PLA2,ProFee,0989,0423T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0424T_3,INSJ/RPLC NSTIM APNEA COMPL,ProFee,0989,0424T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0425T_3,INSJ/RPLC NSTIM APNEA SEN LD,ProFee,0989,0425T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0426T_3,INSJ/RPLC NSTIM APNEA STM LD,ProFee,0989,0426T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0427T_3,INSJ/RPLC NSTIM APNEA PLS GN,ProFee,0989,0427T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0428T_3,RMVL NSTIM APNEA PLS GEN,ProFee,0989,0428T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0429T_3,RMVL NSTIM APNEA SEN LD,ProFee,0989,0429T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0430T_3,RMVL NSTIM APNEA STIMJ LD,ProFee,0989,0430T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0431T_3,RMVL/RPLC NSTIM APNEA PLS GN,ProFee,0989,0431T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0432T_3,REPOS NSTIM APNEA STIMJ LD,ProFee,0989,0432T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0433T_3,REPOS NSTIM APNEA SENSING LD,ProFee,0989,0433T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0434T_3,INTERRO EVAL NPGS APNEA,ProFee,0989,0434T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0435T_3,PRGRMG EVAL NPGS APNEA 1 SES,ProFee,0989,0435T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0436T_3,PRGRMG EVAL NPGS APNEA STUDY,ProFee,0989,0436T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0437T_3,IMPLTJ SYNTH RNFCMT ABDL WAL,ProFee,0989,0437T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0439T_3,MYOCRD CONTRAST PRFUJ ECHO,ProFee,0989,0439T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0440T_3,ABLTJ PERC UXTR/PERPH NRV,ProFee,0989,0440T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0441T_3,ABLTJ PERC LXTR/PERPH NRV,ProFee,0989,0441T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0442T_3,ABLTJ PERC PLEX/TRNCL NRV,ProFee,0989,0442T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0443T_3,R-T SPCTRL ALYS PRST8 TISS,ProFee,0989,0443T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0444T_3,1ST PLMT DRUG ELUT OC INS,ProFee,0989,0444T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0445T_3,SBSQT PLMT DRUG ELUT OC INS,ProFee,0989,0445T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0446T_3,INSJ IMPLTBL GLUCOSE SENSOR,ProFee,0989,0446T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0447T_3,RMVL IMPLTBL GLUCOSE SENSOR,ProFee,0989,0447T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0448T_3,REMVL INSJ IMPLTBL GLUC SENS,ProFee,0989,0448T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0449T_3,INSJ AQUEOUS DRAIN DEV 1ST,ProFee,0989,0449T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0450T_3,INSJ AQUEOUS DRAIN DEV EACH,ProFee,0989,0450T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0451T_3,INSJ/RPLCMT AORTIC VENTR SYS,ProFee,0989,0451T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0452T_3,INSJ/RPLCMT DEV VASC SEAL,ProFee,0989,0452T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0453T_3,INSJ/RPLCMT MECH-ELEC NTRFCE,ProFee,0989,0453T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0454T_3,INSJ/RPLCMT SUBQ ELECTRODE,ProFee,0989,0454T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0455T_3,REMVL AORTIC VENTR CMPL SYS,ProFee,0989,0455T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0456T_3,REMVL AORTIC DEV VASC SEAL,ProFee,0989,0456T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0457T_3,REMVL MECH-ELEC SKIN NTRFCE,ProFee,0989,0457T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0458T_3,REMVL SUBQ ELECTRODE,ProFee,0989,0458T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0459T_3,RELOCAJ RPLCMT AORTIC VENTR,ProFee,0989,0459T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0460T_3,REPOS AORTIC VENTR DEV ELTRD,ProFee,0989,0460T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0461T_3,REPOS AORTIC CONTRPULSJ DEV,ProFee,0989,0461T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0462T_3,PRGRMG EVAL AORTIC VENTR SYS,ProFee,0989,0462T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0463T_3,INTERROG AORTIC VENTR SYS,ProFee,0989,0463T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0464T_3,VISUAL EP TEST FOR GLAUCOMA,ProFee,0989,0464T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0465T_3,SUPCHRDL NJX RX W/O SUPPLY,ProFee,0989,0465T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0466T_3,INSJ CH WAL RESPIR ELTRD/RA,ProFee,0989,0466T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0467T_3,REVJ/RPLMNT CH RESPIR ELTRD,ProFee,0989,0467T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0468T_3,RMVL CH WAL RESPIR ELTRD/RA,ProFee,0989,0468T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0469T_3,RTA POLARIZE SCAN OC SCR BI,ProFee,0989,0469T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0470T_3,OCT SKN IMG ACQUISJ I&R 1ST,ProFee,0989,0470T,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
0471T_3,OCT SKN IMG ACQUISJ I&R ADDL,ProFee,0989,0471T,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
0472T_3,PRGRMG IO RTA ELTRD RA,ProFee,0989,0472T,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
0473T_3,REPRGRMG IO RTA ELTRD RA,ProFee,0989,0473T,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
0474T_3,INSJ AQUEOUS DRG DEV IO RSVR,ProFee,0989,0474T,,,,0,3.00,2.25,2.25,753.50,0.00,753.50,753.50,N/A
0475T_3,REC FTL CAR SGL 3 CH I&R,ProFee,0989,0475T,,,,0,3.00,2.25,2.25,200.00,0.00,200.00,200.00,N/A
0476T_3,REC FTL CAR SGL ELEC TR DATA,ProFee,0989,0476T,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
0477T_3,REC FTL CAR SGL XRTJ ALYS,ProFee,0989,0477T,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
0478T_3,REC FTL CAR 3 CH REV I&R,ProFee,0989,0478T,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
0479T_3,FXJL ABL LSR 1ST 100 SQ CM,ProFee,0989,0479T,,,,0,3.00,2.25,2.25,229.00,0.00,229.00,229.00,N/A
0480T_3,FXJL ABL LSR EA ADDL 100SQCM,ProFee,0989,0480T,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
0481T_3,NJX AUTOL WBC CONCENTRATE,ProFee,0989,0481T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0483T_3,TMVI PERCUTANEOUS APPROACH,ProFee,0989,0483T,,,,0,3.00,2.25,2.25,2068.50,0.00,2068.50,2068.50,N/A
0484T_3,TMVI TRANSTHORACIC EXPOSURE,ProFee,0989,0484T,,,,0,3.00,2.25,2.25,2936.50,0.00,2936.50,2936.50,N/A
0485T_3,OCT MID EAR I&R UNILATERAL,ProFee,0989,0485T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0486T_3,OCT MID EAR I&R BILATERAL,ProFee,0989,0486T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0487T_3,TRVG BIOMCHN MAPG W/REPRT,ProFee,0989,0487T,,,,0,3.00,2.25,2.25,172.00,0.00,172.00,172.00,N/A
0488T_3,DIABETES PREV ONLINE/ELEC,ProFee,0989,0488T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0489T_3,REGN CELL TX SCLDR HANDS,ProFee,0989,0489T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0490T_3,REGN CELL TX SCLDR H MLT INJ,ProFee,0989,0490T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0491T_3,ABL LSR OPN WND 1ST 20 SQCM,ProFee,0989,0491T,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
0492T_3,ABL LSR OPN WND ADDL 20 SQCM,ProFee,0989,0492T,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
0493T_3,NEAR IFR SPECTRSC OF WOUNDS,ProFee,0989,0493T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0494T_3,PREP & CANNULJ CDVR DON LUNG,ProFee,0989,0494T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0495T_3,MNTR CDVR DON LNG 1ST 2 HRS,ProFee,0989,0495T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0496T_3,MNTR CDVR DON LNG EA ADDL HR,ProFee,0989,0496T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0497T_3,XTRNL PT ACT ECG IN-OFF CONN,ProFee,0989,0497T,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
0498T_3,XTRNL PT ACT ECG R&I PR 30 D,ProFee,0989,0498T,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
0499T_3,CYSTO F/URTL STRIX/STENOSIS,ProFee,0989,0499T,,,,0,3.00,2.25,2.25,391.00,0.00,391.00,391.00,N/A
0500F_3,INITIAL PRENATAL CARE VISIT,ProFee,0989,0500F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0500T_3,HPV 5+ HI RISK HPV TYPES,ProFee,0989,0500T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0501F_3,PRENATAL FLOW SHEET,ProFee,0989,0501F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0501T_3,COR FFR DERIVED COR CTA DATA,ProFee,0989,0501T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0502F_3,SUBSEQUENT PRENATAL CARE,ProFee,0989,0502F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0502T_3,COR FFR DATA PREP & TRANSMIS,ProFee,0989,0502T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0503F_3,POSTPARTUM CARE VISIT,ProFee,0989,0503F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0503T_3,COR FFR ALYS GNRJ FFR MDL,ProFee,0989,0503T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0504T_3,COR FFR DATA REVIEW I&R,ProFee,0989,0504T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0505F_3,HEMODIALYSIS PLAN DOC'D,ProFee,0989,0505F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0505T_3,EV FEMPOP ARTL REVSC,ProFee,0989,0505T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0506T_3,MAC PGMT OPT DNS MEAS HFP,ProFee,0989,0506T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0507F_3,PERITON DIALYSIS PLAN DOC'D,ProFee,0989,0507F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0507T_3,NEAR IFR 2IMG MIBMN GLND I&R,ProFee,0989,0507T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0508T_3,PLS ECHO US B1 DNS MEAS TIB,ProFee,0989,0508T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0509F_3,URINE INCON PLAN DOC'D,ProFee,0989,0509F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0509T_3,PATTERN ERG W/I&R,ProFee,0989,0509T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0510T_3,RMVL SINUS TARSI IMPLANT,ProFee,0989,0510T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0511T_3,RMVL&RINSJ SINUS TARSI IMPLT,ProFee,0989,0511T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0512T_3,ESW INTEG WND HLG 1ST WND,ProFee,0989,0512T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0513F_3,ELEV BP PLAN OF CARE DO,ProFee,0989,0513F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0513T_3,ESW INTEG WND HLG EA ADDL,ProFee,0989,0513T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0514F_3,CARE PLAN HGB DOC'D ESA PT,ProFee,0989,0514F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0514T_3,INTRAOP VIS AXIS ID PT FIXJ,ProFee,0989,0514T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0515T_3,INSJ WCS LV COMPL SYS,ProFee,0989,0515T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0516F_3,ANEMIA PLAN OF CARE DOC'D,ProFee,0989,0516F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0516T_3,INSJ WCS LV ELTRD ONLY,ProFee,0989,0516T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0517F_3,GLAUCOMA PLAN OF CARE DOC'D,ProFee,0989,0517F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0517T_3,INSJ WCS LV PG COMPNT,ProFee,0989,0517T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0518F_3,FALL PLAN OF CARE DOC'D,ProFee,0989,0518F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0518T_3,RMVL PG COMPNT WCS,ProFee,0989,0518T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0519F_3,PLAN'D CHEMO DOC'D B/4 TXMNT,ProFee,0989,0519F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0519T_3,RMVL & RPLCMT PG COMPNT WCS,ProFee,0989,0519T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0520F_3,TISSUE DOSE DONE W/IN 5 DAYS,ProFee,0989,0520F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0520T_3,RMVL&RPLCMT PG WCS NEW ELTRD,ProFee,0989,0520T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0521_3,Medicare Encounter Rate,Inpatient,0521,00521,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
0521_3,Medicare Encounter Rate,Outpatient,0521,00521,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
0521F_3,PLAN OF CARE 4 PAIN DOC'D,ProFee,0989,0521F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0521T_3,INTERROG DEV EVAL WCS IP,ProFee,0989,0521T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0522T_3,PRGRMG DEV EVAL WCS IP,ProFee,0989,0522T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0523T_3,NTRAPX C FFR W/3D FUNCJL MAP,ProFee,0989,0523T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0524T_3,EV CATH DIR CHEM ABLTJ W/IMG,ProFee,0989,0524T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0525F_3,INITIAL VISIT FOR EPISODE,ProFee,0989,0525F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0525T_3,INSJ/RPLCMT COMPL IIMS,ProFee,0989,0525T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0526F_3,SUBS. VISIT FOR EPISODE,ProFee,0989,0526F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0526T_3,INSJ/RPLCMT IIMS ELTRD ONLY,ProFee,0989,0526T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0527T_3,INSJ/RPLCMT IIMS IMPLT MNTR,ProFee,0989,0527T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0528F_3,RCMND FLW-UP 10 YRS DOCD,ProFee,0989,0528F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0528T_3,PRGRMG DEV EVAL IIMS IP,ProFee,0989,0528T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0529F_3,INTRVL 3+YRS PTS CLNSCP DOCD,ProFee,0989,0529F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0529T_3,INTERROG DEV EVAL IIMS IP,ProFee,0989,0529T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0530T_3,REMOVAL COMPLETE IIMS,ProFee,0989,0530T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0531T_3,REMOVAL IIMS ELECTRODE ONLY,ProFee,0989,0531T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0532T_3,REMOVAL IIMS IMPLT MNTR ONLY,ProFee,0989,0532T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0533T_3,CONT REC MVMT DO 6-10 DAYS,ProFee,0989,0533T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0534T_3,CONT REC MVMT DO SETUP&TRAIN,ProFee,0989,0534T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0535F_3,DYSPNEA MNGMNT PLAN DOCD,ProFee,0989,0535F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0535T_3,CONT REC MVMT DO REPRT CNFIG,ProFee,0989,0535T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0536T_3,CONT REC MVMT DO DL W/I&R,ProFee,0989,0536T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0537T_3,BLD DRV T LYMPHCYT CAR-T CLL,ProFee,0989,0537T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0538T_3,BLD DRV T LYMPHCYT PREP TRNS,ProFee,0989,0538T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0539T_3,RECEIPT&PREP CAR-T CLL ADMN,ProFee,0989,0539T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0540F_3,GLUCO MNGMNT PLAN DOCD,ProFee,0989,0540F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0540T_3,CAR-T CLL ADMN AUTOLOGOUS,ProFee,0989,0540T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0541T_3,MYOCARDIAL IMAGING MCG,ProFee,0989,0541T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0542T_3,MYOCARDIAL IMAGING MCG I&R,ProFee,0989,0542T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0543T_3,TA MV RPR W/ARTIF CHORD TEND,ProFee,0989,0543T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0544T_3,TCAT MV ANNULUS RCNSTJ,ProFee,0989,0544T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0545F_3,FOLLOW UP CARE PLAN MDD DOCD,ProFee,0989,0545F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0545T_3,TCAT TV ANNULUS RCNSTJ,ProFee,0989,0545T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0546T_3,RF SPECTRSC NTRAOP MRGN ASMT,ProFee,0989,0546T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0547T_3,B1 MATRL QUAL TST MCRIND TIB,ProFee,0989,0547T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0548T_3,TPRNL BALO CNTNC DEV BI,ProFee,0989,0548T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0549T_3,TPRNL BALO CNTNC DEV UNI,ProFee,0989,0549T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0550F_3,CYTOPATH REPORT NONGYN SPCMN,ProFee,0989,0550F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0550T_3,TPRNL BALO CNTNC DEV RMVL EA,ProFee,0989,0550T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0551F_3,CYTOPATH REPORT NON ROUTINE,ProFee,0989,0551F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0551T_3,TPRNL BALO CNTNC DEV ADJMT,ProFee,0989,0551T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0552T_3,LOW-LEVEL LASER THERAPY,ProFee,0989,0552T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0553T_3,PERQ TCAT ILIAC ANAST IMPLT,ProFee,0989,0553T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0554T_3,B1 STR & FX RSK ANALYSIS,ProFee,0989,0554T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0555F_3,SYMPTOM MGMNT PLAN CARE DOCD,ProFee,0989,0555F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0555T_3,B1 STR&FX RSK TRANSMIS DATA,ProFee,0989,0555T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0556F_3,PLAN CARE LIPID CONTROL DOCD,ProFee,0989,0556F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0556T_3,B1 STR & FX RSK ASSESSMENT,ProFee,0989,0556T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0557F_3,PLAN CAREMNG ANGNL SYMPTDOCD,ProFee,0989,0557F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0557T_3,B1 STR & FX RSK I&R,ProFee,0989,0557T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0558T_3,CT SCAN F/BIOMCHN CT ALYS,ProFee,0989,0558T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0559T_3,ANTMC MDL 3D PRINT 1ST CMPNT,ProFee,0989,0559T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0560T_3,ANTMC MDL 3D PRINT EA ADDL,ProFee,0989,0560T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0561T_3,ANTMC GUIDE 3D PRINT 1ST GD,ProFee,0989,0561T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0562T_3,ANTMC GUIDE 3D PRINT EA ADDL,ProFee,0989,0562T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0563T_3,EVAC MEIBOMIAN GLND HEAT BI,ProFee,0989,0563T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0564T_3,ONC CHEMO RX CYTOTOX CSC 14,ProFee,0989,0564T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0565T_3,AUTOL CELL IMPLT ADPS HRVG,ProFee,0989,0565T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0566T_3,AUTOL CELL IMPLT ADPS NJX,ProFee,0989,0566T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0567T_3,PERM FLP TUBE OCCLS W/IMPLT,ProFee,0989,0567T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0568T_3,INTRO MIX SALINE&AIR F/SSG,ProFee,0989,0568T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0569T_3,TTVR PERQ APPR 1ST PROSTH,ProFee,0989,0569T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0570T_3,TTVR PERQ EA ADDL PROSTH,ProFee,0989,0570T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0571T_3,INSJ/RPLCMT ICDS SS ELTRD,ProFee,0989,0571T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0572T_3,INSERTION SS DFB ELECTRODE,ProFee,0989,0572T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0573T_3,REMOVAL SS DFB ELECTRODE,ProFee,0989,0573T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0574T_3,REPOS PREV SS IMPL DFB ELTRD,ProFee,0989,0574T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0575F_3,HIV RNA PLAN CARE DOCD,ProFee,0989,0575F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0575T_3,PRGRMG DEV EVAL ICDS SS IP,ProFee,0989,0575T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0576T_3,INTERROG DEV EVAL ICDS SS IP,ProFee,0989,0576T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0577T_3,EPHYS EVAL ICDS SS,ProFee,0989,0577T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0578T_3,REM INTERROG DEV ICDS PHYS,ProFee,0989,0578T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0579T_3,REM INTERROG DEV ICDS TECH,ProFee,0989,0579T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0580F_3,MULTIDISCIPLINARY CARE PLAN,ProFee,0989,0580F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0580T_3,RMVL SS IMPL DFB PG ONLY,ProFee,0989,0580T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0581F_3,PT TRNSFRD FROM ANESTH TO CC,ProFee,0989,0581F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0581T_3,ABLTJ MAL BRST TUM PERQ CRTX,ProFee,0989,0581T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0582F_3,NO TRNSFR FROM ANESTH TO CC,ProFee,0989,0582F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0582T_3,TRURL ABLTJ MAL PRST8 TISS,ProFee,0989,0582T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0583F_3,TRANSFER CARE CHECKLIST USED,ProFee,0989,0583F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0583T_3,TMPST AUTO TUBE DLVR SYS,ProFee,0989,0583T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0584F_3,NO TRANSFERCARE CHKLIST USED,ProFee,0989,0584F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
0584T_3,PERQ ISLET CELL TRANSPLANT,ProFee,0989,0584T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0585T_3,LAPS ISLET CELL TRANSPLANT,ProFee,0989,0585T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0586T_3,OPEN ISLET CELL TRANSPLANT,ProFee,0989,0586T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0587T_3,PERQ IMPLTJ/RPLCMT ISDNS PTN,ProFee,0989,0587T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0588T_3,REVISION/REMOVAL ISDNS PTN,ProFee,0989,0588T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0589T_3,ELEC ALYS SMPL PRGRMG IINS,ProFee,0989,0589T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0590T_3,ELEC ALYS CPLX PRGRMG IINS,ProFee,0989,0590T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0591T_3,HLTH&WB COACHING INDIV 1ST,ProFee,0989,0591T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0592T_3,HLTH&WB COACHING INDIV F-UP,ProFee,0989,0592T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
0593T_3,HLTH&WB COACHING GROUP,ProFee,0989,0593T,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
10004_3,FNA BX W/O IMG GDN EA ADDL,ProFee,0989,10004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10005_3,FNA BX W/US GDN 1ST LES,ProFee,0989,10005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10006_3,FNA BX W/US GDN EA ADDL,ProFee,0989,10006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10007_3,FNA BX W/FLUOR GDN 1ST LES,ProFee,0989,10007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10008_3,FNA BX W/FLUOR GDN EA ADDL,ProFee,0989,10008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10009_3,FNA BX W/CT GDN 1ST LES,ProFee,0989,10009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1000F_3,"TOBACCO USE, SMOKING, ASSESS",ProFee,0989,1000F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10010_3,FNA BX W/CT GDN EA ADDL,ProFee,0989,10010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10011_3,FNA BX W/MR GDN 1ST LES,ProFee,0989,10011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10012_3,FNA BX W/MR GDN EA ADDL,ProFee,0989,10012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1001F_3,"TOBACCO USE, NON-SMOKING",ProFee,0989,1001F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
10021_3,FNA W/O IMAGE,ProFee,0989,10021,,,,0,3.00,2.25,2.25,99.50,0.00,99.50,99.50,N/A
10022_3,FNA W/IMAGE,ProFee,0989,10022,,,,0,3.00,2.25,2.25,94.00,0.00,94.00,94.00,N/A
1002F_3,ASSESS ANGINAL SYMPTOM/LEVEL,ProFee,0989,1002F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10030_3,GUIDE CATHET FLUID DRAINAGE,ProFee,0989,10030,,,,0,3.00,2.25,2.25,199.00,0.00,199.00,199.00,N/A
10035_3,PERQ DEV SOFT TISS 1ST IMAG,ProFee,0989,10035,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
10036_3,PERQ DEV SOFT TISS ADD IMAG,ProFee,0989,10036,,,,0,3.00,2.25,2.25,61.50,0.00,61.50,61.50,N/A
1003F_3,ACTIVITY LEVEL ASSESSMENT,ProFee,0989,1003F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10040_3,ACNE SURGERY,ProFee,0989,10040,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
1004F_3,CLIN SYMPTM VOLUME OVERLOAD,ProFee,0989,1004F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1005F_3,ASTHMA ASSESSMENT,ProFee,0989,1005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10060_2,DRAINAGE OF SKIN ABSCESS,Ambulatory Surgical,0521,10060,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,0.00,228.60
10060_2,DRAINAGE OF SKIN ABSCESS,Inpatient,0521,10060,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,241.30,228.60
10060_3,DRAINAGE OF SKIN ABSCESS,Inpatient,0521,10060,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,237.50,225.00
10060_3,DRAINAGE OF SKIN ABSCESS,Ambulatory Surgical,0521,10060,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,0.00,225.00
10061_2,DRAINAGE OF SKIN ABSCESS,Inpatient,0521,10061,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
10061_2,DRAINAGE OF SKIN ABSCESS,Ambulatory Surgical,0521,10061,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
10061_3,DRAINAGE OF SKIN ABSCESS,Ambulatory Surgical,0521,10061,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
10061_3,DRAINAGE OF SKIN ABSCESS,Inpatient,0521,10061,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
1006F_3,OSTEOARTH FUNCTN ASSESSMENT,ProFee,0989,1006F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1007F_3,ANIT-INFLAM/ANALG ASSESSMENT,ProFee,0989,1007F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10080_2,DRAINAGE OF PILONIDAL CYST,Inpatient,0521,10080,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
10080_2,DRAINAGE OF PILONIDAL CYST,Ambulatory Surgical,0521,10080,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
10080_3,DRAINAGE OF PILONIDAL CYST,Ambulatory Surgical,0521,10080,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
10080_3,DRAINAGE OF PILONIDAL CYST,Inpatient,0521,10080,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
10081_3,DRAINAGE OF PILONIDAL CYST,ProFee,0989,10081,,,,0,3.00,2.25,2.25,243.50,0.00,243.50,243.50,N/A
1008F_3,NSAID RISK ASSESSMENT,ProFee,0989,1008F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1010F_3,SEVERITY ANGINA BY ACTVTY,ProFee,0989,1010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1011F_3,ANGINA PRESENT,ProFee,0989,1011F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10120_2,REMOVE FOREIGN BODY,Inpatient,0521,10120,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
10120_2,REMOVE FOREIGN BODY,Ambulatory Surgical,0521,10120,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,256.50
10120_3,REMOVE FOREIGN BODY,Inpatient,0521,10120,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
10120_3,REMOVE FOREIGN BODY,Ambulatory Surgical,0521,10120,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,252.00
10121_2,REMOVE FOREIGN BODY,Inpatient,0521,10121,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,491.15,465.30
10121_2,REMOVE FOREIGN BODY,Ambulatory Surgical,0521,10121,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,0.00,465.30
10121_3,REMOVE FOREIGN BODY,Ambulatory Surgical,0521,10121,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,0.00,454.50
10121_3,REMOVE FOREIGN BODY,Inpatient,0521,10121,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,479.75,454.50
1012F_3,ANGINA ABSENT,ProFee,0989,1012F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10140_2,DRAINAGE OF HEMATOMA/FLUID,Ambulatory Surgical,0521,10140,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
10140_2,DRAINAGE OF HEMATOMA/FLUID,Inpatient,0521,10140,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
10140_3,DRAINAGE OF HEMATOMA/FLUID,Inpatient,0521,10140,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
10140_3,DRAINAGE OF HEMATOMA/FLUID,Ambulatory Surgical,0521,10140,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
1015F_3,COPD SYMPTOMS ASSESS,ProFee,0989,1015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
10160_2,PUNCTURE DRAINAGE OF LESION,Ambulatory Surgical,0521,10160,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
10160_2,PUNCTURE DRAINAGE OF LESION,Inpatient,0521,10160,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
10160_3,PUNCTURE DRAINAGE OF LESION,Ambulatory Surgical,0521,10160,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
10160_3,PUNCTURE DRAINAGE OF LESION,Inpatient,0521,10160,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
10180_3,"COMPLEX DRAINAGE, WOUND",ProFee,0989,10180,,,,0,3.00,2.25,2.25,256.50,0.00,256.50,256.50,N/A
1018F_3,ASSESS DYSPNEA NOT PRESENT,ProFee,0989,1018F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1019F_3,ASSESS DYSPNEA PRESENT,ProFee,0989,1019F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1022F_3,PNEUMO IMM STATUS ASSESS,ProFee,0989,1022F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1026F_3,CO-MORBID CONDITION ASSESS,ProFee,0989,1026F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1030F_3,INFLUENZA IMM STATUS ASSESS,ProFee,0989,1030F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1031F_3,SMOKING & 2ND HAND ASSESSED,ProFee,0989,1031F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1032F_3,SMOKER/EXPOSED 2ND HND SMOKE,ProFee,0989,1032F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1033F_3,TOBACCO NONSMOKER NOR 2NDHND,ProFee,0989,1033F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1034F_3,CURRENT TOBACCO SMOKER,ProFee,0989,1034F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1035F_3,SMOKELESS TOBACCO USER,ProFee,0989,1035F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1036F_3,TOBACCO NON-USER,ProFee,0989,1036F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1037M_2,Provide Physical Capacity,ProFee,0989,1037M,,,,0,42.00,31.50,31.50,31.50,N/A,N/A,N/A,N/A
1037M_3,Provide Physical Capacity,ProFee,0989,1037M,,,,0,44.00,33.00,33.00,33.00,N/A,N/A,N/A,N/A
1038F_3,PERSISTENT ASTHMA,ProFee,0989,1038F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1038M_2,Review Of Job Description,ProFee,0989,1038M,,,,0,89.00,66.75,66.75,66.75,N/A,N/A,N/A,N/A
1038M_3,Review Of Job Description,ProFee,0989,1038M,,,,0,90.00,67.50,67.50,67.50,N/A,N/A,N/A,N/A
1039F_3,INTERMITTENT ASTHMA,ProFee,0989,1039F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1040F_3,DSM-IV INFO MDD DOC'D,ProFee,0989,1040F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1040M_2,Accident Form,ProFee,0989,1040M,,,,0,82.00,61.50,61.50,61.50,N/A,N/A,N/A,N/A
1040M_3,Accident Form,ProFee,0989,1040M,,,,0,83.00,62.25,62.25,62.25,N/A,N/A,N/A,N/A
1041M_2,Application To Reopen Claim,ProFee,0989,1041M,,,,0,55.00,41.25,41.25,41.25,N/A,N/A,N/A,N/A
1041M_3,Application To Reopen Claim,ProFee,0989,1041M,,,,0,57.00,42.75,42.75,42.75,N/A,N/A,N/A,N/A
1050F_3,HISTORY OF MOLE CHANGES,ProFee,0989,1050F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1052F_3,TYPE LOCATION ACTIVITYASSESS,ProFee,0989,1052F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1055F_3,VISUAL FUNCT STATUS ASSESS,ProFee,0989,1055F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1056M_2,Supplemental Medical Report,ProFee,0989,1056M,,,,0,35.00,26.25,26.25,26.25,N/A,N/A,N/A,N/A
1056M_3,Supplemental Medical Report,ProFee,0989,1056M,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
1060F_3,DOC PERM/CONT/PAROX ATR FIB,ProFee,0989,1060F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1061F_3,DOC LACK PERM+CONT+PAROX FIB,ProFee,0989,1061F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1065F_3,ISCHM STROKE SYMP LT3 HRSB/4,ProFee,0989,1065F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1066F_3,ISCHM STROKE SYMP GE3 HRSB/4,ProFee,0989,1066F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1070F_3,ALARM SYMP ASSESSED-ABSENT,ProFee,0989,1070F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1071F_3,ALARM SYMP ASSESSED-1+ PRSNT,ProFee,0989,1071F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1073M_2,APF Form,Outpatient,0521,1073M,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,0.00,58.50
1073M_2,APF Form,Inpatient,0521,1073M,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
1073M_3,APF Form,Inpatient,0521,1073M,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
1073M_3,APF Form,Outpatient,0521,1073M,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,0.00,60.30
1090F_3,PRES/ABSN URINE INCON ASSESS,ProFee,0989,1090F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1091F_3,URINE INCON CHARACTERIZED,ProFee,0989,1091F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11000_2,DEBRIDE INFECTED SKIN,Ambulatory Surgical,0521,11000,,,,0,515.00,386.25,386.25,489.25,463.50,489.25,0.00,463.50
11000_2,DEBRIDE INFECTED SKIN,Inpatient,0521,11000,,,,0,515.00,386.25,386.25,489.25,463.50,489.25,489.25,463.50
11000_3,DEBRIDE INFECTED SKIN,Ambulatory Surgical,0521,11000,,,,0,503.00,377.25,377.25,477.85,452.70,477.85,0.00,452.70
11000_3,DEBRIDE INFECTED SKIN,Inpatient,0521,11000,,,,0,503.00,377.25,377.25,477.85,452.70,477.85,477.85,452.70
11001_3,DEBRIDE INFECTED SKIN ADD-ON,ProFee,0989,11001,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
11004_3,DEBRIDE GENITALIA & PERINEUM,ProFee,0989,11004,,,,0,3.00,2.25,2.25,834.50,0.00,834.50,834.50,N/A
11005_3,DEBRIDE ABDOM WALL,ProFee,0989,11005,,,,0,3.00,2.25,2.25,1132.00,0.00,1132.00,1132.00,N/A
11006_3,DEBRIDE GENIT/PER/ABDOM WALL,ProFee,0989,11006,,,,0,3.00,2.25,2.25,1022.00,0.00,1022.00,1022.00,N/A
11008_3,REMOVE MESH FROM ABD WALL,ProFee,0989,11008,,,,0,3.00,2.25,2.25,398.00,0.00,398.00,398.00,N/A
1100F_3,PTFALLS ASSESS-DOC'D GE2+/YR,ProFee,0989,1100F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11010_3,"DEBRIDE SKIN, FX",ProFee,0989,11010,,,,0,3.00,2.25,2.25,410.00,0.00,410.00,410.00,N/A
11011_3,"DEBRIDE SKIN/MUSCLE, FX",ProFee,0989,11011,,,,0,3.00,2.25,2.25,434.00,0.00,434.00,434.00,N/A
11012_3,"DEBRIDE SKIN/MUSCLE/BONE, FX",ProFee,0989,11012,,,,0,3.00,2.25,2.25,614.00,0.00,614.00,614.00,N/A
1101F_3,PT FALLS ASSESS-DOC'D LE1/YR,ProFee,0989,1101F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11040_3,"DEBRIDE SKIN, PARTIAL",ProFee,0989,11040,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
11041_3,"DEBRIDE SKIN, FULL",ProFee,0989,11041,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
11043_3,DEBRIDE TISSUE/MUSCLE,ProFee,0989,11043,,,,0,3.00,2.25,2.25,223.50,0.00,223.50,223.50,N/A
11044_3,DEBRIDE TISSUE/MUSCLE/BONE,ProFee,0989,11044,,,,0,3.00,2.25,2.25,331.50,0.00,331.50,331.50,N/A
11045_3,DEB SUBQ TISSUE ADD-ON,ProFee,0989,11045,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
11046_3,DEB MUSC/FASCIA ADD-ON,ProFee,0989,11046,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
11047_3,DEB BONE ADD-ON,ProFee,0989,11047,,,,0,3.00,2.25,2.25,143.00,0.00,143.00,143.00,N/A
11055_2,TRIM SKIN LESION,Inpatient,0521,11055,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
11055_2,TRIM SKIN LESION,Outpatient,0521,11055,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,0.00,108.90
11055_3,TRIM SKIN LESION,Inpatient,0521,11055,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
11055_3,TRIM SKIN LESION,Outpatient,0521,11055,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,0.00,108.90
11056_2,"TRIM SKIN LESIONS, 2 TO 4",Inpatient,0521,11056,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
11056_2,"TRIM SKIN LESIONS, 2 TO 4",Outpatient,0521,11056,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
11056_3,"TRIM SKIN LESIONS, 2 TO 4",Inpatient,0521,11056,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
11056_3,"TRIM SKIN LESIONS, 2 TO 4",Outpatient,0521,11056,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
11057_2,"TRIM SKIN LESIONS, OVER 4",Inpatient,0521,11057,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
11057_2,"TRIM SKIN LESIONS, OVER 4",Ambulatory Surgical,0521,11057,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
11057_3,"TRIM SKIN LESIONS, OVER 4",Ambulatory Surgical,0521,11057,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,0.00,143.10
11057_3,"TRIM SKIN LESIONS, OVER 4",Inpatient,0521,11057,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,151.05,143.10
11100_2,"BIOPSY, SKIN LESION",Outpatient,0521,11100,,,,0,187.00,140.25,140.25,177.65,168.30,177.65,0.00,168.30
11100_2,"BIOPSY, SKIN LESION",Inpatient,0521,11100,,,,0,187.00,140.25,140.25,177.65,168.30,177.65,177.65,168.30
11100_3,"BIOPSY, SKIN LESION",Inpatient,0521,11100,,,,0,187.00,140.25,140.25,177.65,168.30,177.65,177.65,168.30
11100_3,"BIOPSY, SKIN LESION",Outpatient,0521,11100,,,,0,187.00,140.25,140.25,177.65,168.30,177.65,0.00,168.30
11102_2,"Tangential biopsy of skin (e.g., shave, scoop, sau",Inpatient,0521,11102,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
11102_2,"Tangential biopsy of skin (e.g., shave, scoop, sau",Ambulatory Surgical,0521,11102,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,0.00,172.80
11102_3,"Tangential biopsy of skin (e.g., shave, scoop, sau",Ambulatory Surgical,0521,11102,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,0.00,171.00
11102_3,"Tangential biopsy of skin (e.g., shave, scoop, sau",Inpatient,0521,11102,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,180.50,171.00
11103_2,each separate/additional lesion (List separately I,Inpatient,0521,11103,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
11103_2,each separate/additional lesion (List separately I,Outpatient,0521,11103,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
11103_3,each separate/additional lesion (List separately I,Outpatient,0521,11103,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
11103_3,each separate/additional lesion (List separately I,Inpatient,0521,11103,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
11104_2,"Punch biopsy of skin (including simple closure, wh",Ambulatory Surgical,0521,11104,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,0.00,172.80
11104_2,"Punch biopsy of skin (including simple closure, wh",Inpatient,0521,11104,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
11104_3,"Punch biopsy of skin (including simple closure, wh",Inpatient,0521,11104,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,180.50,171.00
11104_3,"Punch biopsy of skin (including simple closure, wh",Ambulatory Surgical,0521,11104,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,0.00,171.00
1110F_3,PT LFT INPT FAC W/IN 60 DAYS,ProFee,0989,1110F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1111F_3,DSCHRG MED/CURRENT MED MERGE,ProFee,0989,1111F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1116F_3,AURIC/PERI PAIN ASSESSED,ProFee,0989,1116F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1118F_3,GERD SYMPS ASSESSED 12 MONTH,ProFee,0989,1118F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1119F_3,INIT. EVAL FOR CONDITION,ProFee,0989,1119F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11200_2,REMOVAL OF SKIN TAGS,Outpatient,0521,11200,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
11200_2,REMOVAL OF SKIN TAGS,Inpatient,0521,11200,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
11200_3,REMOVAL OF SKIN TAGS,Outpatient,0521,11200,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
11200_3,REMOVAL OF SKIN TAGS,Inpatient,0521,11200,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
11201_2,REMOVE SKIN TAGS ADD-ON,Inpatient,0521,11201,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
11201_2,REMOVE SKIN TAGS ADD-ON,Outpatient,0521,11201,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,0.00,128.70
11201_3,REMOVE SKIN TAGS ADD-ON,Outpatient,0521,11201,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,0.00,127.80
11201_3,REMOVE SKIN TAGS ADD-ON,Inpatient,0521,11201,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
1121F_3,SUBS. EVAL FOR CONDITION,ProFee,0989,1121F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1123F_3,ACP DISCUSS/DSCN MKR DOC'D,ProFee,0989,1123F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1124F_3,ACP DISCUSS-NO DSCNMKR DOC'D,ProFee,0989,1124F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1125F_3,AMNT PAIN NOTED; PAIN PRSNT,ProFee,0989,1125F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1126F_3,AMNT PAIN NOTED; NONE PRSNT,ProFee,0989,1126F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1127F_3,NEW EPISODE FOR CONDITION,ProFee,0989,1127F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1128F_3,SUBS. EPISODE FOR CONDITION,ProFee,0989,1128F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11300_2,SHAVE SKIN LESION,Inpatient,0521,11300,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
11300_2,SHAVE SKIN LESION,Outpatient,0521,11300,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,144.90
11300_3,SHAVE SKIN LESION,Outpatient,0521,11300,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
11300_3,SHAVE SKIN LESION,Inpatient,0521,11300,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
11301_2,SHAVE SKIN LESION,Inpatient,0521,11301,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
11301_2,SHAVE SKIN LESION,Outpatient,0521,11301,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
11301_3,SHAVE SKIN LESION,Inpatient,0521,11301,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
11301_3,SHAVE SKIN LESION,Outpatient,0521,11301,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
11302_2,SHAVE SKIN LESION,Inpatient,0521,11302,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
11302_2,SHAVE SKIN LESION,Outpatient,0521,11302,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,0.00,187.20
11302_3,SHAVE SKIN LESION,Outpatient,0521,11302,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,0.00,184.50
11302_3,SHAVE SKIN LESION,Inpatient,0521,11302,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
11303_2,SHAVE SKIN LESION,Inpatient,0521,11303,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,241.30,228.60
11303_2,SHAVE SKIN LESION,Outpatient,0521,11303,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,0.00,228.60
11303_3,SHAVE SKIN LESION,Inpatient,0521,11303,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,237.50,225.00
11303_3,SHAVE SKIN LESION,Outpatient,0521,11303,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,0.00,225.00
11305_2,SHAVE SKIN LESION,Outpatient,0521,11305,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,144.90
11305_2,SHAVE SKIN LESION,Inpatient,0521,11305,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
11305_3,SHAVE SKIN LESION,Inpatient,0521,11305,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
11305_3,SHAVE SKIN LESION,Outpatient,0521,11305,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
11306_2,SHAVE SKIN LESION,Outpatient,0521,11306,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
11306_2,SHAVE SKIN LESION,Inpatient,0521,11306,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
11306_3,SHAVE SKIN LESION,Outpatient,0521,11306,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
11306_3,SHAVE SKIN LESION,Inpatient,0521,11306,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
11307_2,SHAVE SKIN LESION,Inpatient,0521,11307,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
11307_2,SHAVE SKIN LESION,Ambulatory Surgical,0521,11307,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,0.00,217.80
11307_3,SHAVE SKIN LESION,Ambulatory Surgical,0521,11307,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,0.00,214.20
11307_3,SHAVE SKIN LESION,Inpatient,0521,11307,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
11308_2,SHAVE SKIN LESION,Inpatient,0521,11308,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,287.85,272.70
11308_2,SHAVE SKIN LESION,Outpatient,0521,11308,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,0.00,272.70
11308_3,SHAVE SKIN LESION,Outpatient,0521,11308,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,0.00,268.20
11308_3,SHAVE SKIN LESION,Inpatient,0521,11308,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,283.10,268.20
1130F_3,BK PAIN + FXN ASSESSED,ProFee,0989,1130F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11310_3,SHAVE SKIN LESION,ProFee,0989,11310,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
11311_2,SHAVE SKIN LESION,Ambulatory Surgical,0521,11311,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,0.00,192.60
11311_2,SHAVE SKIN LESION,Inpatient,0521,11311,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,203.30,192.60
11311_3,SHAVE SKIN LESION,Inpatient,0521,11311,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,200.45,189.90
11311_3,SHAVE SKIN LESION,Ambulatory Surgical,0521,11311,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,0.00,189.90
11312_2,SHAVE SKIN LESION,Inpatient,0521,11312,,,,0,261.00,195.75,195.75,247.95,234.90,247.95,247.95,234.90
11312_2,SHAVE SKIN LESION,Ambulatory Surgical,0521,11312,,,,0,261.00,195.75,195.75,247.95,234.90,247.95,0.00,234.90
11312_3,SHAVE SKIN LESION,Inpatient,0521,11312,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,244.15,231.30
11312_3,SHAVE SKIN LESION,Ambulatory Surgical,0521,11312,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,0.00,231.30
11313_2,SHAVE SKIN LESION,Ambulatory Surgical,0521,11313,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,0.00,272.70
11313_2,SHAVE SKIN LESION,Inpatient,0521,11313,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,287.85,272.70
11313_3,SHAVE SKIN LESION,Ambulatory Surgical,0521,11313,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,0.00,268.20
11313_3,SHAVE SKIN LESION,Inpatient,0521,11313,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,283.10,268.20
1134F_3,EPSD BK PAIN FOR =< 6 WKS,ProFee,0989,1134F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1135F_3,EPSD BK PAIN FOR > 6 WKS,ProFee,0989,1135F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1136F_3,EPSD BK PAIN FOR <= 12 WKS,ProFee,0989,1136F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1137F_3,EPSD BK PAIN FOR > 12 WKS,ProFee,0989,1137F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11400_2,EXC TR-EXT B9+MARG 0.5 < CM,Inpatient,0521,11400,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,209.95,198.90
11400_2,EXC TR-EXT B9+MARG 0.5 < CM,Ambulatory Surgical,0521,11400,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,0.00,198.90
11400_3,EXC TR-EXT B9+MARG 0.5 < CM,Inpatient,0521,11400,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
11400_3,EXC TR-EXT B9+MARG 0.5 < CM,Ambulatory Surgical,0521,11400,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,0.00,196.20
11401_2,EXC TR-EXT B9+MARG 0.6-1 CM,Ambulatory Surgical,0521,11401,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
11401_2,EXC TR-EXT B9+MARG 0.6-1 CM,Inpatient,0521,11401,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
11401_3,EXC TR-EXT B9+MARG 0.6-1 CM,Inpatient,0521,11401,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
11401_3,EXC TR-EXT B9+MARG 0.6-1 CM,Ambulatory Surgical,0521,11401,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
11402_2,EXC TR-EXT B9+MARG 1.1-2 CM,Ambulatory Surgical,0521,11402,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
11402_2,EXC TR-EXT B9+MARG 1.1-2 CM,Inpatient,0521,11402,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
11402_3,EXC TR-EXT B9+MARG 1.1-2 CM,Inpatient,0521,11402,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
11402_3,EXC TR-EXT B9+MARG 1.1-2 CM,Ambulatory Surgical,0521,11402,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
11403_2,EXC TR-EXT B9+MARG 2.1-3 CM,Inpatient,0521,11403,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
11403_2,EXC TR-EXT B9+MARG 2.1-3 CM,Ambulatory Surgical,0521,11403,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
11403_3,EXC TR-EXT B9+MARG 2.1-3 CM,Inpatient,0521,11403,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
11403_3,EXC TR-EXT B9+MARG 2.1-3 CM,Ambulatory Surgical,0521,11403,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
11404_2,EXC TR-EXT B9+MARG 3.1-4 CM,Ambulatory Surgical,0521,11404,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,0.00,430.20
11404_2,EXC TR-EXT B9+MARG 3.1-4 CM,Inpatient,0521,11404,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
11404_3,EXC TR-EXT B9+MARG 3.1-4 CM,Inpatient,0521,11404,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,444.60,421.20
11404_3,EXC TR-EXT B9+MARG 3.1-4 CM,Ambulatory Surgical,0521,11404,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,0.00,421.20
11406_2,EXC TR-EXT B9+MARG > 4.0 CM,Ambulatory Surgical,0521,11406,,,,0,550.00,412.50,412.50,522.50,495.00,522.50,0.00,495.00
11406_2,EXC TR-EXT B9+MARG > 4.0 CM,Inpatient,0521,11406,,,,0,550.00,412.50,412.50,522.50,495.00,522.50,522.50,495.00
11406_3,EXC TR-EXT B9+MARG > 4.0 CM,Inpatient,0521,11406,,,,0,537.00,402.75,402.75,510.15,483.30,510.15,510.15,483.30
11406_3,EXC TR-EXT B9+MARG > 4.0 CM,Ambulatory Surgical,0521,11406,,,,0,537.00,402.75,402.75,510.15,483.30,510.15,0.00,483.30
11420_2,EXC H-F-NK-SP B9+MARG 0.5 <,Ambulatory Surgical,0521,11420,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,0.00,217.80
11420_2,EXC H-F-NK-SP B9+MARG 0.5 <,Inpatient,0521,11420,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
11420_3,EXC H-F-NK-SP B9+MARG 0.5 <,Inpatient,0521,11420,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
11420_3,EXC H-F-NK-SP B9+MARG 0.5 <,Ambulatory Surgical,0521,11420,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,0.00,214.20
11421_2,EXC H-F-NK-SP B9+MARG 0.6-1,Inpatient,0521,11421,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
11421_2,EXC H-F-NK-SP B9+MARG 0.6-1,Ambulatory Surgical,0521,11421,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
11421_3,EXC H-F-NK-SP B9+MARG 0.6-1,Inpatient,0521,11421,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
11421_3,EXC H-F-NK-SP B9+MARG 0.6-1,Ambulatory Surgical,0521,11421,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
11422_2,EXC H-F-NK-SP B9+MARG 1.1-2,Inpatient,0521,11422,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
11422_2,EXC H-F-NK-SP B9+MARG 1.1-2,Ambulatory Surgical,0521,11422,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
11422_3,EXC H-F-NK-SP B9+MARG 1.1-2,Ambulatory Surgical,0521,11422,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
11422_3,EXC H-F-NK-SP B9+MARG 1.1-2,Inpatient,0521,11422,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
11423_2,EXC H-F-NK-SP B9+MARG 2.1-3,Ambulatory Surgical,0521,11423,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,0.00,430.20
11423_2,EXC H-F-NK-SP B9+MARG 2.1-3,Inpatient,0521,11423,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
11423_3,EXC H-F-NK-SP B9+MARG 2.1-3,Inpatient,0521,11423,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,444.60,421.20
11423_3,EXC H-F-NK-SP B9+MARG 2.1-3,Ambulatory Surgical,0521,11423,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,0.00,421.20
11424_2,EXC H-F-NK-SP B9+MARG 3.1-4,Ambulatory Surgical,0521,11424,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
11424_2,EXC H-F-NK-SP B9+MARG 3.1-4,Inpatient,0521,11424,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
11424_3,EXC H-F-NK-SP B9+MARG 3.1-4,Ambulatory Surgical,0521,11424,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
11424_3,EXC H-F-NK-SP B9+MARG 3.1-4,Inpatient,0521,11424,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
11426_2,EXC H-F-NK-SP B9+MARG > 4 CM,Ambulatory Surgical,0521,11426,,,,0,659.00,494.25,494.25,626.05,593.10,626.05,0.00,593.10
11426_2,EXC H-F-NK-SP B9+MARG > 4 CM,Inpatient,0521,11426,,,,0,659.00,494.25,494.25,626.05,593.10,626.05,626.05,593.10
11426_3,EXC H-F-NK-SP B9+MARG > 4 CM,Ambulatory Surgical,0521,11426,,,,0,643.00,482.25,482.25,610.85,578.70,610.85,0.00,578.70
11426_3,EXC H-F-NK-SP B9+MARG > 4 CM,Inpatient,0521,11426,,,,0,643.00,482.25,482.25,610.85,578.70,610.85,610.85,578.70
11440_2,EXC FACE-MM B9+MARG 0.5 < CM,Inpatient,0521,11440,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
11440_2,EXC FACE-MM B9+MARG 0.5 < CM,Ambulatory Surgical,0521,11440,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
11440_3,EXC FACE-MM B9+MARG 0.5 < CM,Inpatient,0521,11440,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
11440_3,EXC FACE-MM B9+MARG 0.5 < CM,Ambulatory Surgical,0521,11440,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
11441_2,EXC FACE-MM B9+MARG 0.6-1 CM,Inpatient,0521,11441,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
11441_2,EXC FACE-MM B9+MARG 0.6-1 CM,Ambulatory Surgical,0521,11441,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
11441_3,EXC FACE-MM B9+MARG 0.6-1 CM,Ambulatory Surgical,0521,11441,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
11441_3,EXC FACE-MM B9+MARG 0.6-1 CM,Inpatient,0521,11441,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
11442_2,EXC FACE-MM B9+MARG 1.1-2 CM,Inpatient,0521,11442,,,,0,471.00,353.25,353.25,447.45,423.90,447.45,447.45,423.90
11442_2,EXC FACE-MM B9+MARG 1.1-2 CM,Ambulatory Surgical,0521,11442,,,,0,471.00,353.25,353.25,447.45,423.90,447.45,0.00,423.90
11442_3,EXC FACE-MM B9+MARG 1.1-2 CM,Ambulatory Surgical,0521,11442,,,,0,461.00,345.75,345.75,437.95,414.90,437.95,0.00,414.90
11442_3,EXC FACE-MM B9+MARG 1.1-2 CM,Inpatient,0521,11442,,,,0,461.00,345.75,345.75,437.95,414.90,437.95,437.95,414.90
11443_2,EXC FACE-MM B9+MARG 2.1-3 CM,Ambulatory Surgical,0521,11443,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
11443_2,EXC FACE-MM B9+MARG 2.1-3 CM,Inpatient,0521,11443,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
11443_3,EXC FACE-MM B9+MARG 2.1-3 CM,Ambulatory Surgical,0521,11443,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
11443_3,EXC FACE-MM B9+MARG 2.1-3 CM,Inpatient,0521,11443,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
11444_2,EXC FACE-MM B9+MARG 3.1-4 CM,Ambulatory Surgical,0521,11444,,,,0,618.00,463.50,463.50,587.10,556.20,587.10,0.00,556.20
11444_2,EXC FACE-MM B9+MARG 3.1-4 CM,Inpatient,0521,11444,,,,0,618.00,463.50,463.50,587.10,556.20,587.10,587.10,556.20
11444_3,EXC FACE-MM B9+MARG 3.1-4 CM,Ambulatory Surgical,0521,11444,,,,0,603.00,452.25,452.25,572.85,542.70,572.85,0.00,542.70
11444_3,EXC FACE-MM B9+MARG 3.1-4 CM,Inpatient,0521,11444,,,,0,603.00,452.25,452.25,572.85,542.70,572.85,572.85,542.70
11446_2,EXC FACE-MM B9+MARG > 4 CM,Ambulatory Surgical,0521,11446,,,,0,709.00,531.75,531.75,673.55,638.10,673.55,0.00,638.10
11446_2,EXC FACE-MM B9+MARG > 4 CM,Inpatient,0521,11446,,,,0,709.00,531.75,531.75,673.55,638.10,673.55,673.55,638.10
11446_3,EXC FACE-MM B9+MARG > 4 CM,Inpatient,0521,11446,,,,0,692.00,519.00,519.00,657.40,622.80,657.40,657.40,622.80
11446_3,EXC FACE-MM B9+MARG > 4 CM,Ambulatory Surgical,0521,11446,,,,0,692.00,519.00,519.00,657.40,622.80,657.40,0.00,622.80
11450_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11450,,,,0,3.00,2.25,2.25,365.00,0.00,365.00,365.00,N/A
11451_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11451,,,,0,3.00,2.25,2.25,467.00,0.00,467.00,467.00,N/A
11462_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11462,,,,0,3.00,2.25,2.25,348.50,0.00,348.50,348.50,N/A
11463_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11463,,,,0,3.00,2.25,2.25,469.50,0.00,469.50,469.50,N/A
11470_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11470,,,,0,3.00,2.25,2.25,404.50,0.00,404.50,404.50,N/A
11471_3,"REMOVAL, SWEAT GLAND LESION",ProFee,0989,11471,,,,0,3.00,2.25,2.25,503.50,0.00,503.50,503.50,N/A
1150F_3,DOC PT RSK DEATH W/IN 1YR,ProFee,0989,1150F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1151F_3,DOC NO PT RSK DEATH W/IN 1YR,ProFee,0989,1151F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1152F_3,DOC ADVNCD DIS COMFORT 1ST,ProFee,0989,1152F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1153F_3,DOC ADVNCD DIS CMFRT NOT 1ST,ProFee,0989,1153F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1157F_3,ADVNC CARE PLAN IN RCRD,ProFee,0989,1157F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1158F_3,ADVNC CARE PLAN TLK DOCD,ProFee,0989,1158F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1159F_3,MED LIST DOCD IN RCRD,ProFee,0989,1159F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11600_2,EXC TR-EXT MLG+MARG 0.5 < CM,Inpatient,0521,11600,,,,0,358.00,268.50,268.50,340.10,322.20,340.10,340.10,322.20
11600_2,EXC TR-EXT MLG+MARG 0.5 < CM,Ambulatory Surgical,0521,11600,,,,0,358.00,268.50,268.50,340.10,322.20,340.10,0.00,322.20
11600_3,EXC TR-EXT MLG+MARG 0.5 < CM,Inpatient,0521,11600,,,,0,351.00,263.25,263.25,333.45,315.90,333.45,333.45,315.90
11600_3,EXC TR-EXT MLG+MARG 0.5 < CM,Ambulatory Surgical,0521,11600,,,,0,351.00,263.25,263.25,333.45,315.90,333.45,0.00,315.90
11601_2,EXC TR-EXT MLG+MARG 0.6-1 CM,Inpatient,0521,11601,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,383.80,363.60
11601_2,EXC TR-EXT MLG+MARG 0.6-1 CM,Ambulatory Surgical,0521,11601,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,0.00,363.60
11601_3,EXC TR-EXT MLG+MARG 0.6-1 CM,Inpatient,0521,11601,,,,0,396.00,297.00,297.00,376.20,356.40,376.20,376.20,356.40
11601_3,EXC TR-EXT MLG+MARG 0.6-1 CM,Ambulatory Surgical,0521,11601,,,,0,396.00,297.00,297.00,376.20,356.40,376.20,0.00,356.40
11602_2,EXC TR-EXT MLG+MARG 1.1-2 CM,Inpatient,0521,11602,,,,0,416.00,312.00,312.00,395.20,374.40,395.20,395.20,374.40
11602_2,EXC TR-EXT MLG+MARG 1.1-2 CM,Ambulatory Surgical,0521,11602,,,,0,416.00,312.00,312.00,395.20,374.40,395.20,0.00,374.40
11602_3,EXC TR-EXT MLG+MARG 1.1-2 CM,Inpatient,0521,11602,,,,0,407.00,305.25,305.25,386.65,366.30,386.65,386.65,366.30
11602_3,EXC TR-EXT MLG+MARG 1.1-2 CM,Ambulatory Surgical,0521,11602,,,,0,407.00,305.25,305.25,386.65,366.30,386.65,0.00,366.30
11603_3,EXC TR-EXT MLG+MARG 2.1-3 CM,ProFee,0989,11603,,,,0,3.00,2.25,2.25,282.50,0.00,282.50,282.50,N/A
11604_2,EXC TR-EXT MLG+MARG 3.1-4 CM,Ambulatory Surgical,0521,11604,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,0.00,486.00
11604_2,EXC TR-EXT MLG+MARG 3.1-4 CM,Inpatient,0521,11604,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,513.00,486.00
11604_3,EXC TR-EXT MLG+MARG 3.1-4 CM,Inpatient,0521,11604,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,501.60,475.20
11604_3,EXC TR-EXT MLG+MARG 3.1-4 CM,Ambulatory Surgical,0521,11604,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,0.00,475.20
11606_2,EXC TR-EXT MLG+MARG > 4 CM,Ambulatory Surgical,0521,11606,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,0.00,644.40
11606_2,EXC TR-EXT MLG+MARG > 4 CM,Inpatient,0521,11606,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,680.20,644.40
11606_3,EXC TR-EXT MLG+MARG > 4 CM,Inpatient,0521,11606,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,664.05,629.10
11606_3,EXC TR-EXT MLG+MARG > 4 CM,Ambulatory Surgical,0521,11606,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,0.00,629.10
1160F_3,RVW MEDS BY RX/DR IN RCRD,ProFee,0989,1160F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11620_2,EXC H-F-NK-SP MLG+MARG 0.5 <,Inpatient,0521,11620,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,317.30,300.60
11620_2,EXC H-F-NK-SP MLG+MARG 0.5 <,Ambulatory Surgical,0521,11620,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,0.00,300.60
11620_3,EXC H-F-NK-SP MLG+MARG 0.5 <,Inpatient,0521,11620,,,,0,328.00,246.00,246.00,311.60,295.20,311.60,311.60,295.20
11620_3,EXC H-F-NK-SP MLG+MARG 0.5 <,Ambulatory Surgical,0521,11620,,,,0,328.00,246.00,246.00,311.60,295.20,311.60,0.00,295.20
11621_2,EXC H-F-NK-SP MLG+MARG 0.6-1,Inpatient,0521,11621,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
11621_2,EXC H-F-NK-SP MLG+MARG 0.6-1,Ambulatory Surgical,0521,11621,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
11621_3,EXC H-F-NK-SP MLG+MARG 0.6-1,Inpatient,0521,11621,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
11621_3,EXC H-F-NK-SP MLG+MARG 0.6-1,Ambulatory Surgical,0521,11621,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
11622_3,EXC H-F-NK-SP MLG+MARG 1.1-2,ProFee,0989,11622,,,,0,3.00,2.25,2.25,246.50,0.00,246.50,246.50,N/A
11623_2,EXC H-F-NK-SP MLG+MARG 2.1-3,Inpatient,0521,11623,,,,0,896.00,672.00,672.00,851.20,806.40,851.20,851.20,806.40
11623_2,EXC H-F-NK-SP MLG+MARG 2.1-3,Ambulatory Surgical,0521,11623,,,,0,896.00,672.00,672.00,851.20,806.40,851.20,0.00,806.40
11623_3,EXC H-F-NK-SP MLG+MARG 2.1-3,Inpatient,0521,11623,,,,0,873.00,654.75,654.75,829.35,785.70,829.35,829.35,785.70
11623_3,EXC H-F-NK-SP MLG+MARG 2.1-3,Ambulatory Surgical,0521,11623,,,,0,873.00,654.75,654.75,829.35,785.70,829.35,0.00,785.70
11624_2,EXC H-F-NK-SP MLG+MARG 3.1-4,Ambulatory Surgical,0521,11624,,,,0,697.00,522.75,522.75,662.15,627.30,662.15,0.00,627.30
11624_2,EXC H-F-NK-SP MLG+MARG 3.1-4,Inpatient,0521,11624,,,,0,697.00,522.75,522.75,662.15,627.30,662.15,662.15,627.30
11624_3,EXC H-F-NK-SP MLG+MARG 3.1-4,Ambulatory Surgical,0521,11624,,,,0,680.00,510.00,510.00,646.00,612.00,646.00,0.00,612.00
11624_3,EXC H-F-NK-SP MLG+MARG 3.1-4,Inpatient,0521,11624,,,,0,680.00,510.00,510.00,646.00,612.00,646.00,646.00,612.00
11626_3,EXC H-F-NK-SP MLG+MAR > 4 CM,ProFee,0989,11626,,,,0,3.00,2.25,2.25,423.50,0.00,423.50,423.50,N/A
11640_2,EXC FACE-MM MALIG+MARG 0.5 <,Ambulatory Surgical,0521,11640,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
11640_2,EXC FACE-MM MALIG+MARG 0.5 <,Inpatient,0521,11640,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
11640_3,EXC FACE-MM MALIG+MARG 0.5 <,Inpatient,0521,11640,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
11640_3,EXC FACE-MM MALIG+MARG 0.5 <,Ambulatory Surgical,0521,11640,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
11641_2,EXC FACE-MM MALIG+MARG 0.6-1,Inpatient,0521,11641,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
11641_2,EXC FACE-MM MALIG+MARG 0.6-1,Ambulatory Surgical,0521,11641,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,0.00,430.20
11641_3,EXC FACE-MM MALIG+MARG 0.6-1,Inpatient,0521,11641,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,444.60,421.20
11641_3,EXC FACE-MM MALIG+MARG 0.6-1,Ambulatory Surgical,0521,11641,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,0.00,421.20
11642_2,EXC FACE-MM MALIG+MARG 1.1-2,Ambulatory Surgical,0521,11642,,,,0,971.00,728.25,728.25,922.45,873.90,922.45,0.00,873.90
11642_2,EXC FACE-MM MALIG+MARG 1.1-2,Inpatient,0521,11642,,,,0,971.00,728.25,728.25,922.45,873.90,922.45,922.45,873.90
11642_3,EXC FACE-MM MALIG+MARG 1.1-2,Inpatient,0521,11642,,,,0,946.00,709.50,709.50,898.70,851.40,898.70,898.70,851.40
11642_3,EXC FACE-MM MALIG+MARG 1.1-2,Ambulatory Surgical,0521,11642,,,,0,946.00,709.50,709.50,898.70,851.40,898.70,0.00,851.40
11643_2,EXC FACE-MM MALIG+MARG 2.1-3,Inpatient,0521,11643,,,,0,1190.00,892.50,892.50,1130.50,1071.00,1130.50,1130.50,1071.00
11643_2,EXC FACE-MM MALIG+MARG 2.1-3,Ambulatory Surgical,0521,11643,,,,0,1190.00,892.50,892.50,1130.50,1071.00,1130.50,0.00,1071.00
11643_3,EXC FACE-MM MALIG+MARG 2.1-3,Ambulatory Surgical,0521,11643,,,,0,1159.00,869.25,869.25,1101.05,1043.10,1101.05,0.00,1043.10
11643_3,EXC FACE-MM MALIG+MARG 2.1-3,Inpatient,0521,11643,,,,0,1159.00,869.25,869.25,1101.05,1043.10,1101.05,1101.05,1043.10
11644_3,EXC FACE-MM MALIG+MARG 3.1-4,ProFee,0989,11644,,,,0,3.00,2.25,2.25,411.00,0.00,411.00,411.00,N/A
11646_3,EXC FACE-MM MLG+MARG > 4 CM,ProFee,0989,11646,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
1170F_3,FXNL STATUS ASSESSED,ProFee,0989,1170F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11719_2,TRIM NAIL(S),Outpatient,0521,11719,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,0.00,50.40
11719_2,TRIM NAIL(S),Inpatient,0521,11719,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
11719_3,TRIM NAIL(S),Outpatient,0521,11719,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,0.00,52.20
11719_3,TRIM NAIL(S),Inpatient,0521,11719,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
11720_2,"DEBRIDE NAIL, 1-5",Inpatient,0521,11720,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
11720_2,"DEBRIDE NAIL, 1-5",Outpatient,0521,11720,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,0.00,76.50
11720_3,"DEBRIDE NAIL, 1-5",Outpatient,0521,11720,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,0.00,77.40
11720_3,"DEBRIDE NAIL, 1-5",Inpatient,0521,11720,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
11721_2,"DEBRIDE NAIL, 6 OR MORE",Inpatient,0521,11721,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
11721_2,"DEBRIDE NAIL, 6 OR MORE",Outpatient,0521,11721,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,0.00,137.70
11721_3,"DEBRIDE NAIL, 6 OR MORE",Inpatient,0521,11721,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
11721_3,"DEBRIDE NAIL, 6 OR MORE",Outpatient,0521,11721,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,0.00,136.80
11730_2,REMOVAL OF NAIL PLATE,Outpatient,0521,11730,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
11730_2,REMOVAL OF NAIL PLATE,Inpatient,0521,11730,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
11730_3,REMOVAL OF NAIL PLATE,Inpatient,0521,11730,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
11730_3,REMOVAL OF NAIL PLATE,Outpatient,0521,11730,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
11732_2,"REMOVE NAIL PLATE, ADD-ON",Outpatient,0521,11732,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,0.00,117.00
11732_2,"REMOVE NAIL PLATE, ADD-ON",Inpatient,0521,11732,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
11732_3,"REMOVE NAIL PLATE, ADD-ON",Inpatient,0521,11732,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
11732_3,"REMOVE NAIL PLATE, ADD-ON",Outpatient,0521,11732,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,0.00,117.00
11740_2,DRAIN BLOOD FROM UNDER NAIL,Inpatient,0521,11740,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
11740_2,DRAIN BLOOD FROM UNDER NAIL,Outpatient,0521,11740,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,0.00,80.10
11740_3,DRAIN BLOOD FROM UNDER NAIL,Outpatient,0521,11740,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,0.00,81.00
11740_3,DRAIN BLOOD FROM UNDER NAIL,Inpatient,0521,11740,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,85.50,81.00
11750_2,REMOVAL OF NAIL BED,Inpatient,0521,11750,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
11750_2,REMOVAL OF NAIL BED,Ambulatory Surgical,0521,11750,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,0.00,292.50
11750_3,REMOVAL OF NAIL BED,Inpatient,0521,11750,,,,0,319.00,239.25,239.25,303.05,287.10,303.05,303.05,287.10
11750_3,REMOVAL OF NAIL BED,Ambulatory Surgical,0521,11750,,,,0,319.00,239.25,239.25,303.05,287.10,303.05,0.00,287.10
11752_3,REMOVE NAIL BED/FINGER TIP,ProFee,0989,11752,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
11755_3,"BIOPSY, NAIL UNIT",ProFee,0989,11755,,,,0,3.00,2.25,2.25,110.50,0.00,110.50,110.50,N/A
1175F_3,FUNCTION STAT ASSESSED RVWD,ProFee,0989,1175F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11760_2,REPAIR OF NAIL BED,Inpatient,0521,11760,,,,0,222.00,166.50,166.50,210.90,199.80,210.90,210.90,199.80
11760_2,REPAIR OF NAIL BED,Ambulatory Surgical,0521,11760,,,,0,222.00,166.50,166.50,210.90,199.80,210.90,0.00,199.80
11760_3,REPAIR OF NAIL BED,Inpatient,0521,11760,,,,0,219.00,164.25,164.25,208.05,197.10,208.05,208.05,197.10
11760_3,REPAIR OF NAIL BED,Ambulatory Surgical,0521,11760,,,,0,219.00,164.25,164.25,208.05,197.10,208.05,0.00,197.10
11762_3,RECONSTRUCTION OF NAIL BED,ProFee,0989,11762,,,,0,3.00,2.25,2.25,262.50,0.00,262.50,262.50,N/A
11765_2,"EXCISION OF NAIL FOLD, TOE",Inpatient,0521,11765,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
11765_2,"EXCISION OF NAIL FOLD, TOE",Outpatient,0521,11765,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,0.00,101.70
11765_3,"EXCISION OF NAIL FOLD, TOE",Inpatient,0521,11765,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
11765_3,"EXCISION OF NAIL FOLD, TOE",Outpatient,0521,11765,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,0.00,101.70
11770_3,REMOVAL OF PILONIDAL LESION,ProFee,0989,11770,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
11771_3,REMOVAL OF PILONIDAL LESION,ProFee,0989,11771,,,,0,3.00,2.25,2.25,627.00,0.00,627.00,627.00,N/A
11772_3,REMOVAL OF PILONIDAL LESION,ProFee,0989,11772,,,,0,3.00,2.25,2.25,827.50,0.00,827.50,827.50,N/A
1180F_3,THROMBOEMB RISK ASSESSED,ProFee,0989,1180F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1181F_3,NEUROPSYCHIA SYMPTS ASSESSED,ProFee,0989,1181F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1182F_3,NEUROPSYCHI SYMPT 1+PRESENT,ProFee,0989,1182F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1183F_3,NEUROPSYCHIATRIC SYMP ABSENT,ProFee,0989,1183F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
11900_3,INJECTION INTO SKIN LESIONS,ProFee,0989,11900,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
11901_3,ADDED SKIN LESIONS INJECTION,ProFee,0989,11901,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
11920_3,CORRECT SKIN COLOR DEFECTS,ProFee,0989,11920,,,,0,3.00,2.25,2.25,164.00,0.00,164.00,164.00,N/A
11921_3,CORRECT SKIN COLOR DEFECTS,ProFee,0989,11921,,,,0,3.00,2.25,2.25,192.00,0.00,192.00,192.00,N/A
11922_3,CORRECT SKIN COLOR DEFECTS,ProFee,0989,11922,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
11950_3,THERAPY FOR CONTOUR DEFECTS,ProFee,0989,11950,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
11951_3,THERAPY FOR CONTOUR DEFECTS,ProFee,0989,11951,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
11952_3,THERAPY FOR CONTOUR DEFECTS,ProFee,0989,11952,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
11954_3,THERAPY FOR CONTOUR DEFECTS,ProFee,0989,11954,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
11960_3,INSERT TISSUE EXPANDER(S),ProFee,0989,11960,,,,0,3.00,2.25,2.25,1367.50,0.00,1367.50,1367.50,N/A
11970_3,REPLACE TISSUE EXPANDER,ProFee,0989,11970,,,,0,3.00,2.25,2.25,875.00,0.00,875.00,875.00,N/A
11971_3,REMOVE TISSUE EXPANDER(S),ProFee,0989,11971,,,,0,3.00,2.25,2.25,456.50,0.00,456.50,456.50,N/A
11975_2,INSERT CONTRACEPTIVE CAP,Inpatient,0521,11975,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
11975_2,INSERT CONTRACEPTIVE CAP,Outpatient,0521,11975,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
11975_3,INSERT CONTRACEPTIVE CAP,Inpatient,0521,11975,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
11975_3,INSERT CONTRACEPTIVE CAP,Outpatient,0521,11975,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
11976_2,REMOVAL OF CONTRACEPTIVE CAP,Inpatient,0521,11976,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
11976_2,REMOVAL OF CONTRACEPTIVE CAP,Outpatient,0521,11976,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,0.00,147.60
11976_3,REMOVAL OF CONTRACEPTIVE CAP,Outpatient,0521,11976,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,0.00,146.70
11976_3,REMOVAL OF CONTRACEPTIVE CAP,Inpatient,0521,11976,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
11977_3,REMOVAL/REINSERT CONTRA CAP,ProFee,0989,11977,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
11980_3,IMPLANT HORMONE PELLET(S),ProFee,0989,11980,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
11981_3,INSERT DRUG IMPLANT DEVICE,ProFee,0989,11981,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
11982_3,REMOVE DRUG IMPLANT DEVICE,ProFee,0989,11982,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
11983_3,REMOVE/INSERT DRUG IMPLANT,ProFee,0989,11983,,,,0,3.00,2.25,2.25,255.50,0.00,255.50,255.50,N/A
12001_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12001,,,,0,324.00,243.00,243.00,307.80,291.60,307.80,0.00,291.60
12001_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12001,,,,0,324.00,243.00,243.00,307.80,291.60,307.80,307.80,291.60
12001_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12001,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
12001_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12001,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
12002_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12002,,,,0,392.00,294.00,294.00,372.40,352.80,372.40,0.00,352.80
12002_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12002,,,,0,392.00,294.00,294.00,372.40,352.80,372.40,372.40,352.80
12002_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12002,,,,0,384.00,288.00,288.00,364.80,345.60,364.80,0.00,345.60
12002_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12002,,,,0,384.00,288.00,288.00,364.80,345.60,364.80,364.80,345.60
12004_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12004,,,,0,3.00,2.25,2.25,104.50,0.00,104.50,104.50,N/A
12005_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12005,,,,0,525.00,393.75,393.75,498.75,472.50,498.75,498.75,472.50
12005_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12005,,,,0,525.00,393.75,393.75,498.75,472.50,498.75,0.00,472.50
12005_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12005,,,,0,513.00,384.75,384.75,487.35,461.70,487.35,0.00,461.70
12005_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12005,,,,0,513.00,384.75,384.75,487.35,461.70,487.35,487.35,461.70
12006_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12006,,,,0,3.00,2.25,2.25,167.00,0.00,167.00,167.00,N/A
12007_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12007,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,680.20,644.40
12007_2,REPAIR SUPERFICIAL WOUND(S),Ambulatory Surgical,0521,12007,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,0.00,644.40
12007_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12007,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,664.05,629.10
12007_3,REPAIR SUPERFICIAL WOUND(S),Ambulatory Surgical,0521,12007,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,0.00,629.10
1200F_3,SEIZURE TYPE(S)+ FRQ DOCD,ProFee,0989,1200F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
12011_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12011,,,,0,360.00,270.00,270.00,342.00,324.00,342.00,342.00,324.00
12011_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12011,,,,0,360.00,270.00,270.00,342.00,324.00,342.00,0.00,324.00
12011_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12011,,,,0,353.00,264.75,264.75,335.35,317.70,335.35,335.35,317.70
12011_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12011,,,,0,353.00,264.75,264.75,335.35,317.70,335.35,0.00,317.70
12013_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12013,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
12013_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12013,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
12013_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12013,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
12013_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12013,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
12014_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12014,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,0.00,430.20
12014_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12014,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
12014_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12014,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,0.00,421.20
12014_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12014,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,444.60,421.20
12015_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12015,,,,0,438.00,328.50,328.50,416.10,394.20,416.10,416.10,394.20
12015_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12015,,,,0,438.00,328.50,328.50,416.10,394.20,416.10,0.00,394.20
12015_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12015,,,,0,429.00,321.75,321.75,407.55,386.10,407.55,0.00,386.10
12015_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12015,,,,0,429.00,321.75,321.75,407.55,386.10,407.55,407.55,386.10
12016_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12016,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
12016_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12016,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
12016_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12016,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
12016_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12016,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
12017_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12017,,,,0,732.00,549.00,549.00,695.40,658.80,695.40,695.40,658.80
12017_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12017,,,,0,732.00,549.00,549.00,695.40,658.80,695.40,0.00,658.80
12017_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12017,,,,0,714.00,535.50,535.50,678.30,642.60,678.30,0.00,642.60
12017_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12017,,,,0,714.00,535.50,535.50,678.30,642.60,678.30,678.30,642.60
12018_2,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12018,,,,0,754.00,565.50,565.50,716.30,678.60,716.30,0.00,678.60
12018_2,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12018,,,,0,754.00,565.50,565.50,716.30,678.60,716.30,716.30,678.60
12018_3,REPAIR SUPERFICIAL WOUND(S),Inpatient,0521,12018,,,,0,736.00,552.00,552.00,699.20,662.40,699.20,699.20,662.40
12018_3,REPAIR SUPERFICIAL WOUND(S),Outpatient,0521,12018,,,,0,736.00,552.00,552.00,699.20,662.40,699.20,0.00,662.40
12020_3,CLOSURE OF SPLIT WOUND,ProFee,0989,12020,,,,0,3.00,2.25,2.25,270.50,0.00,270.50,270.50,N/A
12021_3,CLOSURE OF SPLIT WOUND,ProFee,0989,12021,,,,0,3.00,2.25,2.25,198.50,0.00,198.50,198.50,N/A
12031_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12031,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
12031_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12031,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,357.30
12031_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12031,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,350.10
12031_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12031,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
12034_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12034,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,513.00,486.00
12034_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12034,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,0.00,486.00
12034_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12034,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,501.60,475.20
12034_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12034,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,0.00,475.20
12035_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12035,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,513.00,486.00
12035_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12035,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,0.00,486.00
12035_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12035,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,0.00,475.20
12035_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12035,,,,0,528.00,396.00,396.00,501.60,475.20,501.60,501.60,475.20
12036_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12036,,,,0,779.00,584.25,584.25,740.05,701.10,740.05,740.05,701.10
12036_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12036,,,,0,779.00,584.25,584.25,740.05,701.10,740.05,0.00,701.10
12036_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12036,,,,0,760.00,570.00,570.00,722.00,684.00,722.00,0.00,684.00
12036_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12036,,,,0,760.00,570.00,570.00,722.00,684.00,722.00,722.00,684.00
12037_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12037,,,,0,3.00,2.25,2.25,473.00,0.00,473.00,473.00,N/A
12041_2,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12041,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
12041_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12041,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
12041_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12041,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
12041_3,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12041,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
12042_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12042,,,,0,380.00,285.00,285.00,288.50,0.00,288.50,288.50,N/A
12042_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12042,,,,0,3.00,2.25,2.25,288.50,0.00,288.50,288.50,N/A
12044_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12044,,,,0,579.00,434.25,434.25,550.05,521.10,550.05,0.00,521.10
12044_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12044,,,,0,579.00,434.25,434.25,550.05,521.10,550.05,550.05,521.10
12044_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12044,,,,0,566.00,424.50,424.50,537.70,509.40,537.70,0.00,509.40
12044_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12044,,,,0,566.00,424.50,424.50,537.70,509.40,537.70,537.70,509.40
12045_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12045,,,,0,668.00,501.00,501.00,634.60,601.20,634.60,0.00,601.20
12045_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12045,,,,0,668.00,501.00,501.00,634.60,601.20,634.60,634.60,601.20
12045_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12045,,,,0,652.00,489.00,489.00,619.40,586.80,619.40,0.00,586.80
12045_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12045,,,,0,652.00,489.00,489.00,619.40,586.80,619.40,619.40,586.80
12046_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12046,,,,0,776.00,582.00,582.00,737.20,698.40,737.20,0.00,698.40
12046_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12046,,,,0,776.00,582.00,582.00,737.20,698.40,737.20,737.20,698.40
12046_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12046,,,,0,757.00,567.75,567.75,719.15,681.30,719.15,719.15,681.30
12046_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12046,,,,0,757.00,567.75,567.75,719.15,681.30,719.15,0.00,681.30
12047_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12047,,,,0,3.00,2.25,2.25,501.00,0.00,501.00,501.00,N/A
12051_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12051,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,491.15,465.30
12051_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12051,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,0.00,465.30
12051_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12051,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,479.75,454.50
12051_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12051,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,0.00,454.50
12052_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12052,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
12052_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12052,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
12052_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12052,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
12052_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12052,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
12053_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12053,,,,0,675.00,506.25,506.25,641.25,607.50,641.25,641.25,607.50
12053_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12053,,,,0,675.00,506.25,506.25,641.25,607.50,641.25,0.00,607.50
12053_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12053,,,,0,659.00,494.25,494.25,626.05,593.10,626.05,0.00,593.10
12053_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12053,,,,0,659.00,494.25,494.25,626.05,593.10,626.05,626.05,593.10
12054_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12054,,,,0,800.00,600.00,600.00,760.00,720.00,760.00,760.00,720.00
12054_2,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12054,,,,0,800.00,600.00,600.00,760.00,720.00,760.00,0.00,720.00
12054_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12054,,,,0,780.00,585.00,585.00,741.00,702.00,741.00,741.00,702.00
12054_3,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12054,,,,0,780.00,585.00,585.00,741.00,702.00,741.00,0.00,702.00
12055_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12055,,,,0,915.00,686.25,686.25,869.25,823.50,869.25,869.25,823.50
12055_2,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12055,,,,0,915.00,686.25,686.25,869.25,823.50,869.25,0.00,823.50
12055_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12055,,,,0,892.00,669.00,669.00,847.40,802.80,847.40,847.40,802.80
12055_3,LAYER CLOSURE OF WOUND(S),Ambulatory Surgical,0521,12055,,,,0,892.00,669.00,669.00,847.40,802.80,847.40,0.00,802.80
12056_2,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12056,,,,0,1032.00,774.00,774.00,980.40,928.80,980.40,0.00,928.80
12056_2,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12056,,,,0,1032.00,774.00,774.00,980.40,928.80,980.40,980.40,928.80
12056_3,LAYER CLOSURE OF WOUND(S),Inpatient,0521,12056,,,,0,1005.00,753.75,753.75,954.75,904.50,954.75,954.75,904.50
12056_3,LAYER CLOSURE OF WOUND(S),Outpatient,0521,12056,,,,0,1005.00,753.75,753.75,954.75,904.50,954.75,0.00,904.50
12057_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12057,,,,0,3.00,2.25,2.25,621.00,0.00,621.00,621.00,N/A
1205F_3,EPI ETIOL SYND RVWD AND DOCD,ProFee,0989,1205F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1220F_3,PT SCREENED FOR DEPRESSION,ProFee,0989,1220F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
13100_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13100,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
13100_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13100,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,0.00,430.20
13100_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13100,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,444.60,421.20
13100_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13100,,,,0,468.00,351.00,351.00,444.60,421.20,444.60,0.00,421.20
13101_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13101,,,,0,610.00,457.50,457.50,579.50,549.00,579.50,0.00,549.00
13101_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13101,,,,0,610.00,457.50,457.50,579.50,549.00,579.50,579.50,549.00
13101_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13101,,,,0,596.00,447.00,447.00,566.20,536.40,566.20,0.00,536.40
13101_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13101,,,,0,596.00,447.00,447.00,566.20,536.40,566.20,566.20,536.40
13102_3,REPAIR WOUND/LESION ADD-ON,ProFee,0989,13102,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
13120_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13120,,,,0,525.00,393.75,393.75,498.75,472.50,498.75,0.00,472.50
13120_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13120,,,,0,525.00,393.75,393.75,498.75,472.50,498.75,498.75,472.50
13120_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13120,,,,0,513.00,384.75,384.75,487.35,461.70,487.35,0.00,461.70
13120_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13120,,,,0,513.00,384.75,384.75,487.35,461.70,487.35,487.35,461.70
13121_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13121,,,,0,812.00,609.00,609.00,771.40,730.80,771.40,771.40,730.80
13121_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13121,,,,0,812.00,609.00,609.00,771.40,730.80,771.40,0.00,730.80
13121_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13121,,,,0,792.00,594.00,594.00,752.40,712.80,752.40,0.00,712.80
13121_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13121,,,,0,792.00,594.00,594.00,752.40,712.80,752.40,752.40,712.80
13122_3,REPAIR WOUND/LESION ADD-ON,ProFee,0989,13122,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
13131_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13131,,,,0,610.00,457.50,457.50,579.50,549.00,579.50,579.50,549.00
13131_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13131,,,,0,610.00,457.50,457.50,579.50,549.00,579.50,0.00,549.00
13131_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13131,,,,0,596.00,447.00,447.00,566.20,536.40,566.20,0.00,536.40
13131_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13131,,,,0,596.00,447.00,447.00,566.20,536.40,566.20,566.20,536.40
13132_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13132,,,,0,1000.00,750.00,750.00,950.00,900.00,950.00,950.00,900.00
13132_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13132,,,,0,1000.00,750.00,750.00,950.00,900.00,950.00,0.00,900.00
13132_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13132,,,,0,974.00,730.50,730.50,925.30,876.60,925.30,0.00,876.60
13132_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13132,,,,0,974.00,730.50,730.50,925.30,876.60,925.30,925.30,876.60
13133_3,REPAIR WOUND/LESION ADD-ON,ProFee,0989,13133,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
13151_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13151,,,,0,812.00,609.00,609.00,771.40,730.80,771.40,771.40,730.80
13151_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13151,,,,0,812.00,609.00,609.00,771.40,730.80,771.40,0.00,730.80
13151_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13151,,,,0,792.00,594.00,594.00,752.40,712.80,752.40,0.00,712.80
13151_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13151,,,,0,792.00,594.00,594.00,752.40,712.80,752.40,752.40,712.80
13152_2,REPAIR OF WOUND OR LESION,Inpatient,0521,13152,,,,0,1191.00,893.25,893.25,1131.45,1071.90,1131.45,1131.45,1071.90
13152_2,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13152,,,,0,1191.00,893.25,893.25,1131.45,1071.90,1131.45,0.00,1071.90
13152_3,REPAIR OF WOUND OR LESION,Inpatient,0521,13152,,,,0,1160.00,870.00,870.00,1102.00,1044.00,1102.00,1102.00,1044.00
13152_3,REPAIR OF WOUND OR LESION,Ambulatory Surgical,0521,13152,,,,0,1160.00,870.00,870.00,1102.00,1044.00,1102.00,0.00,1044.00
13153_2,REPAIR WOUND/LESION ADD-ON,Inpatient,0521,13153,,,,0,574.00,430.50,430.50,545.30,516.60,545.30,545.30,516.60
13153_2,REPAIR WOUND/LESION ADD-ON,Outpatient,0521,13153,,,,0,574.00,430.50,430.50,545.30,516.60,545.30,0.00,516.60
13153_3,REPAIR WOUND/LESION ADD-ON,Inpatient,0521,13153,,,,0,561.00,420.75,420.75,532.95,504.90,532.95,532.95,504.90
13153_3,REPAIR WOUND/LESION ADD-ON,Outpatient,0521,13153,,,,0,561.00,420.75,420.75,532.95,504.90,532.95,0.00,504.90
13160_3,LATE CLOSURE OF WOUND,ProFee,0989,13160,,,,0,3.00,2.25,2.25,1149.00,0.00,1149.00,1149.00,N/A
14000_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14000,,,,0,3.00,2.25,2.25,721.00,0.00,721.00,721.00,N/A
14001_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14001,,,,0,3.00,2.25,2.25,944.00,0.00,944.00,944.00,N/A
1400F_3,PRKNS DIAG RVIEWED,ProFee,0989,1400F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
14020_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14020,,,,0,3.00,2.25,2.25,815.50,0.00,815.50,815.50,N/A
14021_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14021,,,,0,3.00,2.25,2.25,1033.00,0.00,1033.00,1033.00,N/A
14040_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14040,,,,0,3.00,2.25,2.25,908.50,0.00,908.50,908.50,N/A
14041_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14041,,,,0,3.00,2.25,2.25,1119.50,0.00,1119.50,1119.50,N/A
14060_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14060,,,,0,3.00,2.25,2.25,968.00,0.00,968.00,968.00,N/A
14061_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14061,,,,0,3.00,2.25,2.25,1197.50,0.00,1197.50,1197.50,N/A
14300_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14300,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
14301_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14301,,,,0,3.00,2.25,2.25,1267.50,0.00,1267.50,1267.50,N/A
14302_3,SKIN TISSUE REARRANGE ADD-ON,ProFee,0989,14302,,,,0,3.00,2.25,2.25,319.00,0.00,319.00,319.00,N/A
14350_3,SKIN TISSUE REARRANGEMENT,ProFee,0989,14350,,,,0,3.00,2.25,2.25,983.50,0.00,983.50,983.50,N/A
1450F_3,SYMPTOMS IMPROVED/CONSIST,ProFee,0989,1450F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1451F_3,SYMPT SHOW CLIN IMPORT DROP,ProFee,0989,1451F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1460F_3,QUAL CARD DIAG PRIOR 12 MONS,ProFee,0989,1460F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1461F_3,NO QUAL CARD DIAG PRIOR12MON,ProFee,0989,1461F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1490F_3,DEM SEVERITY CLASSIFIED MILD,ProFee,0989,1490F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1491F_3,DEM SEVERITY CLASSIFIED MOD,ProFee,0989,1491F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1493F_3,DEM SEVERITY CLASS SEVERE,ProFee,0989,1493F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1494F_3,COGNIT ASSESSED AND REVIEWED,ProFee,0989,1494F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15000_3,SKIN GRAFT,ProFee,0989,15000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15001_3,SKIN GRAFT ADD-ON,ProFee,0989,15001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15002_3,"WND PREP, CH/INF, TRK/ARM/LG",ProFee,0989,15002,,,,0,3.00,2.25,2.25,326.50,0.00,326.50,326.50,N/A
15003_3,"WND PREP, CH/INF ADDL 100 CM",ProFee,0989,15003,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
15004_3,"WND PREP CH/INF, F/N/HF/G",ProFee,0989,15004,,,,0,3.00,2.25,2.25,386.50,0.00,386.50,386.50,N/A
15005_3,"WND PREP, F/N/HF/G, ADDL CM",ProFee,0989,15005,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
1500F_3,SYMPTOM&SIGN SYMM POLYNEURO,ProFee,0989,1500F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1501F_3,NOT INITIAL EVAL FOR COND,ProFee,0989,1501F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1502F_3,PT QUERIED PAIN FXN W/ INSTR,ProFee,0989,1502F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
1503F_3,PT QUERIED SYMP RESP INSUFF,ProFee,0989,1503F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15040_3,HARVEST CULTURED SKIN GRAFT,ProFee,0989,15040,,,,0,3.00,2.25,2.25,182.00,0.00,182.00,182.00,N/A
1504F_3,PT HAS RESP INSUFFICIENCY,ProFee,0989,1504F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15050_3,SKIN PINCH GRAFT,ProFee,0989,15050,,,,0,3.00,2.25,2.25,637.00,0.00,637.00,637.00,N/A
1505F_3,PT HAS NO RESP INSUFFICIENCY,ProFee,0989,1505F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15100_3,SKIN SPLIT GRAFT,ProFee,0989,15100,,,,0,3.00,2.25,2.25,1026.50,0.00,1026.50,1026.50,N/A
15101_3,SKIN SPLIT GRAFT ADD-ON,ProFee,0989,15101,,,,0,3.00,2.25,2.25,159.50,0.00,159.50,159.50,N/A
15110_3,EPIDRM AUTOGRFT TRNK/ARM/LEG,ProFee,0989,15110,,,,0,3.00,2.25,2.25,991.00,0.00,991.00,991.00,N/A
15111_3,EPIDRM AUTOGRFT T/A/L ADD-ON,ProFee,0989,15111,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
15115_3,EPIDRM A-GRFT FACE/NCK/HF/G,ProFee,0989,15115,,,,0,3.00,2.25,2.25,981.50,0.00,981.50,981.50,N/A
15116_3,EPIDRM A-GRFT F/N/HF/G ADDL,ProFee,0989,15116,,,,0,3.00,2.25,2.25,220.50,0.00,220.50,220.50,N/A
15120_3,SKIN SPLIT GRAFT,ProFee,0989,15120,,,,0,3.00,2.25,2.25,1000.50,0.00,1000.50,1000.50,N/A
15121_3,SKIN SPLIT GRAFT ADD-ON,ProFee,0989,15121,,,,0,3.00,2.25,2.25,191.50,0.00,191.50,191.50,N/A
15130_3,"DERM AUTOGRAFT, TRNK/ARM/LEG",ProFee,0989,15130,,,,0,3.00,2.25,2.25,795.50,0.00,795.50,795.50,N/A
15131_3,DERM AUTOGRAFT T/A/L ADD-ON,ProFee,0989,15131,,,,0,3.00,2.25,2.25,132.00,0.00,132.00,132.00,N/A
15135_3,DERM AUTOGRAFT FACE/NCK/HF/G,ProFee,0989,15135,,,,0,3.00,2.25,2.25,1064.50,0.00,1064.50,1064.50,N/A
15136_3,"DERM AUTOGRAFT, F/N/HF/G ADD",ProFee,0989,15136,,,,0,3.00,2.25,2.25,132.00,0.00,132.00,132.00,N/A
15150_3,CULT EPIDERM GRFT T/ARM/LEG,ProFee,0989,15150,,,,0,3.00,2.25,2.25,912.50,0.00,912.50,912.50,N/A
15151_3,CULT EPIDERM GRFT T/A/L ADDL,ProFee,0989,15151,,,,0,3.00,2.25,2.25,160.00,0.00,160.00,160.00,N/A
15152_3,CULT EPIDERM GRAFT T/A/L +%,ProFee,0989,15152,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
15155_3,"CULT EPIDERM GRAFT, F/N/HF/G",ProFee,0989,15155,,,,0,3.00,2.25,2.25,1056.00,0.00,1056.00,1056.00,N/A
15156_3,CULT EPIDRM GRFT F/N/HFG ADD,ProFee,0989,15156,,,,0,3.00,2.25,2.25,219.00,0.00,219.00,219.00,N/A
15157_3,CULT EPIDERM GRFT F/N/HFG +%,ProFee,0989,15157,,,,0,3.00,2.25,2.25,239.50,0.00,239.50,239.50,N/A
15170_3,ACELL GRAFT TRUNK/ARMS/LEGS,ProFee,0989,15170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15171_3,ACELL GRAFT T/ARM/LEG ADD-ON,ProFee,0989,15171,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15175_3,"ACELLULAR GRAFT, F/N/HF/G",ProFee,0989,15175,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15176_3,"ACELL GRAFT, F/N/HF/G ADD-ON",ProFee,0989,15176,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15200_3,SKIN FULL GRAFT,ProFee,0989,15200,,,,0,3.00,2.25,2.25,967.50,0.00,967.50,967.50,N/A
15201_3,SKIN FULL GRAFT ADD-ON,ProFee,0989,15201,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
15220_3,SKIN FULL GRAFT,ProFee,0989,15220,,,,0,3.00,2.25,2.25,884.50,0.00,884.50,884.50,N/A
15221_3,SKIN FULL GRAFT ADD-ON,ProFee,0989,15221,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
15240_3,SKIN FULL GRAFT,ProFee,0989,15240,,,,0,3.00,2.25,2.25,1152.00,0.00,1152.00,1152.00,N/A
15241_3,SKIN FULL GRAFT ADD-ON,ProFee,0989,15241,,,,0,3.00,2.25,2.25,159.50,0.00,159.50,159.50,N/A
15260_3,SKIN FULL GRAFT,ProFee,0989,15260,,,,0,3.00,2.25,2.25,1236.50,0.00,1236.50,1236.50,N/A
15261_3,SKIN FULL GRAFT ADD-ON,ProFee,0989,15261,,,,0,3.00,2.25,2.25,201.00,0.00,201.00,201.00,N/A
15271_3,SKIN SUB GRAFT TRNK/ARM/LEG,ProFee,0989,15271,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
15272_3,SKIN SUB GRAFT T/A/L ADD-ON,ProFee,0989,15272,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
15273_3,SKIN SUB GRFT T/ARM/LG CHILD,ProFee,0989,15273,,,,0,3.00,2.25,2.25,294.00,0.00,294.00,294.00,N/A
15274_3,SKN SUB GRFT T/A/L CHILD ADD,ProFee,0989,15274,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
15275_3,SKIN SUB GRAFT FACE/NK/HF/G,ProFee,0989,15275,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
15276_3,SKIN SUB GRAFT F/N/HF/G ADDL,ProFee,0989,15276,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
15277_3,SKN SUB GRFT F/N/HF/G CHILD,ProFee,0989,15277,,,,0,3.00,2.25,2.25,331.50,0.00,331.50,331.50,N/A
15278_3,SKN SUB GRFT F/N/HF/G CH ADD,ProFee,0989,15278,,,,0,3.00,2.25,2.25,83.50,0.00,83.50,83.50,N/A
15300_3,"APPLY SKINALLOGRFT, T/ARM/LG",ProFee,0989,15300,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15301_3,APPLY SKNALLOGRFT T/A/L ADDL,ProFee,0989,15301,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15320_3,APPLY SKIN ALLOGRFT F/N/HF/G,ProFee,0989,15320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15321_3,APLY SKNALLOGRFT F/N/HFG ADD,ProFee,0989,15321,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15330_3,APLY ACELL ALOGRFT T/ARM/LEG,ProFee,0989,15330,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15331_3,APLY ACELL GRFT T/A/L ADD-ON,ProFee,0989,15331,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15335_3,"APPLY ACELL GRAFT, F/N/HF/G",ProFee,0989,15335,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15336_3,APLY ACELL GRFT F/N/HF/G ADD,ProFee,0989,15336,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15340_3,APPLY CULT SKIN SUBSTITUTE,ProFee,0989,15340,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15341_3,APPLY CULT SKIN SUB ADD-ON,ProFee,0989,15341,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15360_3,"APPLY CULT DERM SUB, T/A/L",ProFee,0989,15360,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15361_3,APLY CULT DERM SUB T/A/L ADD,ProFee,0989,15361,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15365_3,APPLY CULT DERM SUB F/N/HF/G,ProFee,0989,15365,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15366_3,APPLY CULT DERM F/HF/G ADD,ProFee,0989,15366,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15400_3,SKIN HETEROGRAFT,ProFee,0989,15400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15401_3,SKIN HETEROGRAFT ADD-ON,ProFee,0989,15401,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15420_3,"APPLY SKIN XGRAFT, F/N/HF/G",ProFee,0989,15420,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15421_3,APPLY SKN XGRFT F/N/HF/G ADD,ProFee,0989,15421,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15430_3,APPLY ACELLULAR XENOGRAFT,ProFee,0989,15430,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15431_3,APPLY ACELLULAR XGRAFT ADD,ProFee,0989,15431,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15570_3,FORM SKIN PEDICLE FLAP,ProFee,0989,15570,,,,0,3.00,2.25,2.25,1057.50,0.00,1057.50,1057.50,N/A
15572_3,FORM SKIN PEDICLE FLAP,ProFee,0989,15572,,,,0,3.00,2.25,2.25,1073.00,0.00,1073.00,1073.00,N/A
15574_3,FORM SKIN PEDICLE FLAP,ProFee,0989,15574,,,,0,3.00,2.25,2.25,1096.00,0.00,1096.00,1096.00,N/A
15576_3,FORM SKIN PEDICLE FLAP,ProFee,0989,15576,,,,0,3.00,2.25,2.25,962.50,0.00,962.50,962.50,N/A
15600_3,SKIN GRAFT,ProFee,0989,15600,,,,0,3.00,2.25,2.25,296.50,0.00,296.50,296.50,N/A
15610_3,SKIN GRAFT,ProFee,0989,15610,,,,0,3.00,2.25,2.25,346.00,0.00,346.00,346.00,N/A
15620_3,SKIN GRAFT,ProFee,0989,15620,,,,0,3.00,2.25,2.25,464.00,0.00,464.00,464.00,N/A
15630_3,SKIN GRAFT,ProFee,0989,15630,,,,0,3.00,2.25,2.25,495.50,0.00,495.50,495.50,N/A
15650_3,TRANSFER SKIN PEDICLE FLAP,ProFee,0989,15650,,,,0,3.00,2.25,2.25,548.00,0.00,548.00,548.00,N/A
15730_3,MDFC FLAP W/PRSRV VASC PEDCL,ProFee,0989,15730,,,,0,3.00,2.25,2.25,1321.00,0.00,1321.00,1321.00,N/A
15731_3,FOREHEAD FLAP W/VASC PEDICLE,ProFee,0989,15731,,,,0,3.00,2.25,2.25,1438.50,0.00,1438.50,1438.50,N/A
15732_3,"MUSCLE-SKIN GRAFT, HEAD/NECK",ProFee,0989,15733,,,,0,3.00,2.25,2.25,1508.50,0.00,1508.50,1508.50,N/A
15733_3,MUSC MYOQ/FSCQ FLP H&N PEDCL,ProFee,0989,15733,,,,0,3.00,2.25,2.25,1508.50,0.00,1508.50,1508.50,N/A
15734_3,"MUSCLE-SKIN GRAFT, TRUNK",ProFee,0989,15734,,,,0,3.00,2.25,2.25,2178.00,0.00,2178.00,2178.00,N/A
15736_3,"MUSCLE-SKIN GRAFT, ARM",ProFee,0989,15736,,,,0,3.00,2.25,2.25,1771.00,0.00,1771.00,1771.00,N/A
15738_3,"MUSCLE-SKIN GRAFT, LEG",ProFee,0989,15738,,,,0,3.00,2.25,2.25,1904.00,0.00,1904.00,1904.00,N/A
15740_3,ISLAND PEDICLE FLAP GRAFT,ProFee,0989,15740,,,,0,3.00,2.25,2.25,1221.00,0.00,1221.00,1221.00,N/A
15750_3,NEUROVASCULAR PEDICLE GRAFT,ProFee,0989,15750,,,,0,3.00,2.25,2.25,1314.00,0.00,1314.00,1314.00,N/A
15756_3,FREE MYO/SKIN FLAP MICROVASC,ProFee,0989,15756,,,,0,3.00,2.25,2.25,3311.50,0.00,3311.50,3311.50,N/A
15757_3,"FREE SKIN FLAP, MICROVASC",ProFee,0989,15757,,,,0,3.00,2.25,2.25,3256.00,0.00,3256.00,3256.00,N/A
15758_3,"FREE FASCIAL FLAP, MICROVASC",ProFee,0989,15758,,,,0,3.00,2.25,2.25,3288.50,0.00,3288.50,3288.50,N/A
15760_3,COMPOSITE SKIN GRAFT,ProFee,0989,15760,,,,0,3.00,2.25,2.25,1015.00,0.00,1015.00,1015.00,N/A
15769_3,GRFG AUTOL SOFT TISS DIR EXC,ProFee,0989,15769,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15770_3,DERMA-FAT-FASCIA GRAFT,ProFee,0989,15770,,,,0,3.00,2.25,2.25,952.50,0.00,952.50,952.50,N/A
15771_3,GRFG AUTOL FAT LIPO 50 CC/<,ProFee,0989,15771,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15772_3,GRFG AUTOL FAT LIPO EA ADDL,ProFee,0989,15772,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15773_3,GRFG AUTOL FAT LIPO 25 CC/<,ProFee,0989,15773,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15774_3,GFRG AUTOL FAT LIPO EA ADDL,ProFee,0989,15774,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15775_3,HAIR TRANSPLANT PUNCH GRAFTS,ProFee,0989,15775,,,,0,3.00,2.25,2.25,322.00,0.00,322.00,322.00,N/A
15776_3,HAIR TRANSPLANT PUNCH GRAFTS,ProFee,0989,15776,,,,0,3.00,2.25,2.25,511.00,0.00,511.00,511.00,N/A
15777_3,ACELLULAR DERM MATRIX IMPLT,ProFee,0989,15777,,,,0,3.00,2.25,2.25,312.50,0.00,312.50,312.50,N/A
15780_3,ABRASION TREATMENT OF SKIN,ProFee,0989,15780,,,,0,3.00,2.25,2.25,1024.00,0.00,1024.00,1024.00,N/A
15781_3,ABRASION TREATMENT OF SKIN,ProFee,0989,15781,,,,0,3.00,2.25,2.25,621.50,0.00,621.50,621.50,N/A
15782_3,ABRASION TREATMENT OF SKIN,ProFee,0989,15782,,,,0,3.00,2.25,2.25,621.00,0.00,621.00,621.00,N/A
15783_3,ABRASION TREATMENT OF SKIN,ProFee,0989,15783,,,,0,3.00,2.25,2.25,539.00,0.00,539.00,539.00,N/A
15786_3,"ABRASION, LESION, SINGLE",ProFee,0989,15786,,,,0,3.00,2.25,2.25,198.00,0.00,198.00,198.00,N/A
15787_3,"ABRASION, LESIONS, ADD-ON",ProFee,0989,15787,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
15788_3,"CHEMICAL PEEL, FACE, EPIDERM",ProFee,0989,15788,,,,0,3.00,2.25,2.25,353.50,0.00,353.50,353.50,N/A
15789_3,"CHEMICAL PEEL, FACE, DERMAL",ProFee,0989,15789,,,,0,3.00,2.25,2.25,598.50,0.00,598.50,598.50,N/A
15792_3,"CHEMICAL PEEL, NONFACIAL",ProFee,0989,15792,,,,0,3.00,2.25,2.25,368.50,0.00,368.50,368.50,N/A
15793_3,"CHEMICAL PEEL, NONFACIAL",ProFee,0989,15793,,,,0,3.00,2.25,2.25,527.50,0.00,527.50,527.50,N/A
15819_3,"PLASTIC SURGERY, NECK",ProFee,0989,15819,,,,0,3.00,2.25,2.25,1136.50,0.00,1136.50,1136.50,N/A
15820_3,REVISION OF LOWER EYELID,ProFee,0989,15820,,,,0,3.00,2.25,2.25,715.50,0.00,715.50,715.50,N/A
15821_3,REVISION OF LOWER EYELID,ProFee,0989,15821,,,,0,3.00,2.25,2.25,778.00,0.00,778.00,778.00,N/A
15822_3,REVISION OF UPPER EYELID,ProFee,0989,15822,,,,0,3.00,2.25,2.25,557.50,0.00,557.50,557.50,N/A
15823_3,REVISION OF UPPER EYELID,ProFee,0989,15823,,,,0,3.00,2.25,2.25,777.00,0.00,777.00,777.00,N/A
15824_3,REMOVAL OF FOREHEAD WRINKLES,ProFee,0989,15824,,,,0,3.00,2.25,2.25,1636.00,0.00,1636.00,1636.00,N/A
15825_3,REMOVAL OF NECK WRINKLES,ProFee,0989,15825,,,,0,3.00,2.25,2.25,1840.50,0.00,1840.50,1840.50,N/A
15826_3,REMOVAL OF BROW WRINKLES,ProFee,0989,15826,,,,0,3.00,2.25,2.25,1329.00,0.00,1329.00,1329.00,N/A
15828_3,REMOVAL OF FACE WRINKLES,ProFee,0989,15828,,,,0,3.00,2.25,2.25,3476.50,0.00,3476.50,3476.50,N/A
15829_3,REMOVAL OF SKIN WRINKLES,ProFee,0989,15829,,,,0,3.00,2.25,2.25,3885.50,0.00,3885.50,3885.50,N/A
15830_3,EXC SKIN ABD,ProFee,0989,15830,,,,0,3.00,2.25,2.25,1689.50,0.00,1689.50,1689.50,N/A
15831_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15831,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
15832_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15832,,,,0,3.00,2.25,2.25,1309.50,0.00,1309.50,1309.50,N/A
15833_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15833,,,,0,3.00,2.25,2.25,1251.00,0.00,1251.00,1251.00,N/A
15834_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15834,,,,0,3.00,2.25,2.25,1274.50,0.00,1274.50,1274.50,N/A
15835_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15835,,,,0,3.00,2.25,2.25,1346.00,0.00,1346.00,1346.00,N/A
15836_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15836,,,,0,3.00,2.25,2.25,1133.00,0.00,1133.00,1133.00,N/A
15837_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15837,,,,0,3.00,2.25,2.25,1034.50,0.00,1034.50,1034.50,N/A
15838_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15838,,,,0,3.00,2.25,2.25,915.00,0.00,915.00,915.00,N/A
15839_3,EXCISE EXCESSIVE SKIN TISSUE,ProFee,0989,15839,,,,0,3.00,2.25,2.25,1056.50,0.00,1056.50,1056.50,N/A
15840_3,GRAFT FOR FACE NERVE PALSY,ProFee,0989,15840,,,,0,3.00,2.25,2.25,1433.00,0.00,1433.00,1433.00,N/A
15841_3,GRAFT FOR FACE NERVE PALSY,ProFee,0989,15841,,,,0,3.00,2.25,2.25,2561.50,0.00,2561.50,2561.50,N/A
15842_3,FLAP FOR FACE NERVE PALSY,ProFee,0989,15842,,,,0,3.00,2.25,2.25,3905.00,0.00,3905.00,3905.00,N/A
15845_3,"SKIN AND MUSCLE REPAIR, FACE",ProFee,0989,15845,,,,0,3.00,2.25,2.25,1436.00,0.00,1436.00,1436.00,N/A
15847_3,EXC SKIN ABD ADD-ON,ProFee,0989,15847,,,,0,3.00,2.25,2.25,715.50,0.00,715.50,715.50,N/A
15850_3,REMOVAL OF SUTURES,ProFee,0989,15850,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
15851_3,REMOVAL OF SUTURES,ProFee,0989,15851,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
15852_3,DRESSING CHANGE NOT FOR BURN,ProFee,0989,15852,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
15860_3,TEST FOR BLOOD FLOW IN GRAFT,ProFee,0989,15860,,,,0,3.00,2.25,2.25,156.00,0.00,156.00,156.00,N/A
15876_3,SUCTION ASSISTED LIPECTOMY,ProFee,0989,15876,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15877_3,SUCTION ASSISTED LIPECTOMY,ProFee,0989,15877,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15878_3,SUCTION ASSISTED LIPECTOMY,ProFee,0989,15878,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15879_3,SUCTION ASSISTED LIPECTOMY,ProFee,0989,15879,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
15920_3,REMOVAL OF TAIL BONE ULCER,ProFee,0989,15920,,,,0,3.00,2.25,2.25,870.00,0.00,870.00,870.00,N/A
15922_3,REMOVAL OF TAIL BONE ULCER,ProFee,0989,15922,,,,0,3.00,2.25,2.25,1121.00,0.00,1121.00,1121.00,N/A
15931_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15931,,,,0,3.00,2.25,2.25,989.50,0.00,989.50,989.50,N/A
15933_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15933,,,,0,3.00,2.25,2.25,1214.00,0.00,1214.00,1214.00,N/A
15934_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15934,,,,0,3.00,2.25,2.25,1344.00,0.00,1344.00,1344.00,N/A
15935_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15935,,,,0,3.00,2.25,2.25,1566.50,0.00,1566.50,1566.50,N/A
15936_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15936,,,,0,3.00,2.25,2.25,1277.50,0.00,1277.50,1277.50,N/A
15937_3,REMOVE SACRUM PRESSURE SORE,ProFee,0989,15937,,,,0,3.00,2.25,2.25,1483.00,0.00,1483.00,1483.00,N/A
15940_3,REMOVE HIP PRESSURE SORE,ProFee,0989,15940,,,,0,3.00,2.25,2.25,1001.00,0.00,1001.00,1001.00,N/A
15941_3,REMOVE HIP PRESSURE SORE,ProFee,0989,15941,,,,0,3.00,2.25,2.25,1293.00,0.00,1293.00,1293.00,N/A
15944_3,REMOVE HIP PRESSURE SORE,ProFee,0989,15944,,,,0,3.00,2.25,2.25,1273.50,0.00,1273.50,1273.50,N/A
15945_3,REMOVE HIP PRESSURE SORE,ProFee,0989,15945,,,,0,3.00,2.25,2.25,1412.50,0.00,1412.50,1412.50,N/A
15946_3,REMOVE HIP PRESSURE SORE,ProFee,0989,15946,,,,0,3.00,2.25,2.25,2345.50,0.00,2345.50,2345.50,N/A
15950_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15950,,,,0,3.00,2.25,2.25,852.50,0.00,852.50,852.50,N/A
15951_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15951,,,,0,3.00,2.25,2.25,1260.00,0.00,1260.00,1260.00,N/A
15952_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15952,,,,0,3.00,2.25,2.25,1297.00,0.00,1297.00,1297.00,N/A
15953_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15953,,,,0,3.00,2.25,2.25,1427.00,0.00,1427.00,1427.00,N/A
15956_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15956,,,,0,3.00,2.25,2.25,1653.50,0.00,1653.50,1653.50,N/A
15958_3,REMOVE THIGH PRESSURE SORE,ProFee,0989,15958,,,,0,3.00,2.25,2.25,1690.50,0.00,1690.50,1690.50,N/A
15999_3,REMOVAL OF PRESSURE SORE,ProFee,0989,15999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
16000_2,INITIAL TREATMENT OF BURN(S),Inpatient,0521,16000,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
16000_2,INITIAL TREATMENT OF BURN(S),Outpatient,0521,16000,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
16000_3,INITIAL TREATMENT OF BURN(S),Inpatient,0521,16000,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
16000_3,INITIAL TREATMENT OF BURN(S),Outpatient,0521,16000,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
16020_2,TREATMENT OF BURN(S),Outpatient,0521,16020,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
16020_2,TREATMENT OF BURN(S),Inpatient,0521,16020,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
16020_3,TREATMENT OF BURN(S),Outpatient,0521,16020,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
16020_3,TREATMENT OF BURN(S),Inpatient,0521,16020,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
16025_2,TREATMENT OF BURN(S),Ambulatory Surgical,0521,16025,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
16025_2,TREATMENT OF BURN(S),Inpatient,0521,16025,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
16025_3,TREATMENT OF BURN(S),Inpatient,0521,16025,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
16025_3,TREATMENT OF BURN(S),Ambulatory Surgical,0521,16025,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
16030_2,TREATMENT OF BURN(S),Inpatient,0521,16030,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,491.15,465.30
16030_2,TREATMENT OF BURN(S),Ambulatory Surgical,0521,16030,,,,0,517.00,387.75,387.75,491.15,465.30,491.15,0.00,465.30
16030_3,TREATMENT OF BURN(S),Inpatient,0521,16030,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,479.75,454.50
16030_3,TREATMENT OF BURN(S),Ambulatory Surgical,0521,16030,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,0.00,454.50
16035_3,"INCISION OF BURN SCAB, INITI",ProFee,0989,16035,,,,0,3.00,2.25,2.25,280.50,0.00,280.50,280.50,N/A
16036_3,ESCHAROTOMY; ADD'L INCISION,ProFee,0989,16036,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
17000_2,DESTROY BENIGN/PREMLG LESION,Inpatient,0521,17000,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
17000_2,DESTROY BENIGN/PREMLG LESION,Outpatient,0521,17000,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
17000_3,DESTROY BENIGN/PREMLG LESION,Outpatient,0521,17000,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
17000_3,DESTROY BENIGN/PREMLG LESION,Inpatient,0521,17000,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
17003_2,"DESTROY LESIONS, 2-14",Outpatient,0521,17003,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,0.00,42.30
17003_2,"DESTROY LESIONS, 2-14",Inpatient,0521,17003,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
17003_3,"DESTROY LESIONS, 2-14",Outpatient,0521,17003,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,0.00,44.10
17003_3,"DESTROY LESIONS, 2-14",Inpatient,0521,17003,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
17004_2,"DESTROY LESIONS, 15 OR MORE",Ambulatory Surgical,0521,17004,,,,0,630.00,472.50,472.50,598.50,567.00,598.50,0.00,567.00
17004_2,"DESTROY LESIONS, 15 OR MORE",Inpatient,0521,17004,,,,0,630.00,472.50,472.50,598.50,567.00,598.50,598.50,567.00
17004_3,"DESTROY LESIONS, 15 OR MORE",Ambulatory Surgical,0521,17004,,,,0,615.00,461.25,461.25,584.25,553.50,584.25,0.00,553.50
17004_3,"DESTROY LESIONS, 15 OR MORE",Inpatient,0521,17004,,,,0,615.00,461.25,461.25,584.25,553.50,584.25,584.25,553.50
17106_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17106,,,,0,3.00,2.25,2.25,397.50,0.00,397.50,397.50,N/A
17107_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17107,,,,0,3.00,2.25,2.25,502.00,0.00,502.00,502.00,N/A
17108_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17108,,,,0,3.00,2.25,2.25,761.00,0.00,761.00,761.00,N/A
17110_2,"DESTRUCT LESION, 1-14",Outpatient,0521,17110,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
17110_2,"DESTRUCT LESION, 1-14",Inpatient,0521,17110,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
17110_3,"DESTRUCT LESION, 1-14",Outpatient,0521,17110,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
17110_3,"DESTRUCT LESION, 1-14",Inpatient,0521,17110,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
17111_2,"DESTRUCT LESION, 15 OR MORE",Inpatient,0521,17111,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
17111_2,"DESTRUCT LESION, 15 OR MORE",Outpatient,0521,17111,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
17111_3,"DESTRUCT LESION, 15 OR MORE",Outpatient,0521,17111,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
17111_3,"DESTRUCT LESION, 15 OR MORE",Inpatient,0521,17111,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
17250_3,"CHEMICAL CAUTERY, TISSUE",ProFee,0989,17250,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
17260_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17260,,,,0,3.00,2.25,2.25,100.50,0.00,100.50,100.50,N/A
17261_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17261,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
17262_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17262,,,,0,3.00,2.25,2.25,167.00,0.00,167.00,167.00,N/A
17263_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17263,,,,0,3.00,2.25,2.25,185.00,0.00,185.00,185.00,N/A
17264_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17264,,,,0,3.00,2.25,2.25,198.50,0.00,198.50,198.50,N/A
17266_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17266,,,,0,3.00,2.25,2.25,231.50,0.00,231.50,231.50,N/A
17270_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17270,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
17271_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17271,,,,0,3.00,2.25,2.25,159.00,0.00,159.00,159.00,N/A
17272_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17272,,,,0,3.00,2.25,2.25,183.50,0.00,183.50,183.50,N/A
17273_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17273,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
17274_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17274,,,,0,3.00,2.25,2.25,254.00,0.00,254.00,254.00,N/A
17276_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17276,,,,0,3.00,2.25,2.25,304.00,0.00,304.00,304.00,N/A
17280_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17280,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
17281_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17281,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
17282_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17282,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
17283_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17283,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
17284_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17284,,,,0,3.00,2.25,2.25,302.00,0.00,302.00,302.00,N/A
17286_3,DESTRUCTION OF SKIN LESIONS,ProFee,0989,17286,,,,0,3.00,2.25,2.25,403.50,0.00,403.50,403.50,N/A
17304_3,"1 STAGE MOHS, UP TO 5 SPEC",ProFee,0989,17304,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
17305_3,"2 STAGE MOHS, UP TO 5 SPEC",ProFee,0989,17305,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
17306_3,"3 STAGE MOHS, UP TO 5 SPEC",ProFee,0989,17306,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
17307_3,MOHS ADDL STAGE UP TO 5 SPEC,ProFee,0989,17307,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
17310_3,MOHS ANY STAGE > 5 SPEC EACH,ProFee,0989,17310,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
17311_3,"MOHS, 1 STAGE, H/N/HF/G",ProFee,0989,17311,,,,0,3.00,2.25,2.25,544.50,0.00,544.50,544.50,N/A
17312_3,MOHS ADDL STAGE,ProFee,0989,17312,,,,0,3.00,2.25,2.25,290.50,0.00,290.50,290.50,N/A
17313_3,"MOHS, 1 STAGE, T/A/L",ProFee,0989,17313,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
17314_3,"MOHS, ADDL STAGE, T/A/L",ProFee,0989,17314,,,,0,3.00,2.25,2.25,270.00,0.00,270.00,270.00,N/A
17315_3,"MOHS SURG, ADDL BLOCK",ProFee,0989,17315,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
17340_3,CRYOTHERAPY OF SKIN,ProFee,0989,17340,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
17360_3,SKIN PEEL THERAPY,ProFee,0989,17360,,,,0,3.00,2.25,2.25,140.50,0.00,140.50,140.50,N/A
17380_3,HAIR REMOVAL BY ELECTROLYSIS,ProFee,0989,17380,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
17999_3,SKIN TISSUE PROCEDURE,ProFee,0989,17999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
19000_3,DRAINAGE OF BREAST LESION,ProFee,0989,19000,,,,0,3.00,2.25,2.25,63.00,0.00,63.00,63.00,N/A
19001_3,DRAIN BREAST LESION ADD-ON,ProFee,0989,19001,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
19020_3,INCISION OF BREAST LESION,ProFee,0989,19020,,,,0,3.00,2.25,2.25,441.50,0.00,441.50,441.50,N/A
19030_3,INJECTION FOR BREAST X-RAY,ProFee,0989,19030,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
19081_3,BX BREAST 1ST LESION STRTCTC,ProFee,0989,19081,,,,0,3.00,2.25,2.25,242.50,0.00,242.50,242.50,N/A
19082_3,BX BREAST ADD LESION STRTCTC,ProFee,0989,19082,,,,0,3.00,2.25,2.25,122.50,0.00,122.50,122.50,N/A
19083_3,BX BREAST 1ST LESION US IMAG,ProFee,0989,19083,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
19084_3,BX BREAST ADD LESION US IMAG,ProFee,0989,19084,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
19085_3,BX BREAST 1ST LESION MR IMAG,ProFee,0989,19085,,,,0,3.00,2.25,2.25,264.50,0.00,264.50,264.50,N/A
19086_3,BX BREAST ADD LESION MR IMAG,ProFee,0989,19086,,,,0,3.00,2.25,2.25,133.00,0.00,133.00,133.00,N/A
19100_3,BX BREAST PERCUT W/O IMAGE,ProFee,0989,19100,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
19101_3,"BIOPSY OF BREAST, OPEN",ProFee,0989,19101,,,,0,3.00,2.25,2.25,318.50,0.00,318.50,318.50,N/A
19102_3,BX BREAST PERCUT W/IMAGE,ProFee,0989,19102,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19103_3,BX BREAST PERCUT W/DEVICE,ProFee,0989,19103,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19105_3,"CRYOSURG ABLATE FA, EACH",ProFee,0989,19105,,,,0,3.00,2.25,2.25,306.50,0.00,306.50,306.50,N/A
19110_3,NIPPLE EXPLORATION,ProFee,0989,19110,,,,0,3.00,2.25,2.25,493.50,0.00,493.50,493.50,N/A
19112_3,EXCISE BREAST DUCT FISTULA,ProFee,0989,19112,,,,0,3.00,2.25,2.25,449.00,0.00,449.00,449.00,N/A
19120_3,REMOVAL OF BREAST LESION,ProFee,0989,19120,,,,0,3.00,2.25,2.25,595.00,0.00,595.00,595.00,N/A
19125_3,"EXCISION, BREAST LESION",ProFee,0989,19125,,,,0,3.00,2.25,2.25,660.00,0.00,660.00,660.00,N/A
19126_3,"EXCISION, ADDL BREAST LESION",ProFee,0989,19126,,,,0,3.00,2.25,2.25,233.50,0.00,233.50,233.50,N/A
19140_3,REMOVAL OF BREAST TISSUE,ProFee,0989,19140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19160_3,PARTIAL MASTECTOMY,ProFee,0989,19160,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19162_3,P-MASTECTOMY W/LN REMOVAL,ProFee,0989,19162,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19180_3,REMOVAL OF BREAST,ProFee,0989,19180,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19182_3,REMOVAL OF BREAST,ProFee,0989,19182,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19200_3,REMOVAL OF BREAST,ProFee,0989,19200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19220_3,REMOVAL OF BREAST,ProFee,0989,19220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19240_3,REMOVAL OF BREAST,ProFee,0989,19240,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19281_3,PERQ DEVICE BREAST 1ST IMAG,ProFee,0989,19281,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
19282_3,PERQ DEVICE BREAST EA IMAG,ProFee,0989,19282,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
19283_3,PERQ DEV BREAST 1ST STRTCTC,ProFee,0989,19283,,,,0,3.00,2.25,2.25,146.50,0.00,146.50,146.50,N/A
19284_3,PERQ DEV BREAST ADD STRTCTC,ProFee,0989,19284,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
19285_3,PERQ DEV BREAST 1ST US IMAG,ProFee,0989,19285,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
19286_3,PERQ DEV BREAST ADD US IMAG,ProFee,0989,19286,,,,0,3.00,2.25,2.25,62.50,0.00,62.50,62.50,N/A
19287_3,PERQ DEV BREAST 1ST MR GUIDE,ProFee,0989,19287,,,,0,3.00,2.25,2.25,185.50,0.00,185.50,185.50,N/A
19288_3,PERQ DEV BREAST ADD MR GUIDE,ProFee,0989,19288,,,,0,3.00,2.25,2.25,93.50,0.00,93.50,93.50,N/A
19290_3,"PLACE NEEDLE WIRE, BREAST",ProFee,0989,19290,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19291_3,"PLACE NEEDLE WIRE, BREAST",ProFee,0989,19291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19294_3,PREP TUM CAV IORT PRTL MAST,ProFee,0989,19294,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
19295_3,"PLACE BREAST CLIP, PERCUT",ProFee,0989,19295,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
19296_3,PLACE PO BREAST CATH FOR RAD,ProFee,0989,19296,,,,0,3.00,2.25,2.25,304.50,0.00,304.50,304.50,N/A
19297_3,PLACE BREAST CATH FOR RAD,ProFee,0989,19297,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
19298_3,PLACE BREAST RAD TUBE/CATHS,ProFee,0989,19298,,,,0,3.00,2.25,2.25,456.50,0.00,456.50,456.50,N/A
19300_3,REMOVAL OF BREAST TISSUE,ProFee,0989,19300,,,,0,3.00,2.25,2.25,596.00,0.00,596.00,596.00,N/A
19301_3,PARTICAL MASTECTOMY,ProFee,0989,19301,,,,0,3.00,2.25,2.25,938.50,0.00,938.50,938.50,N/A
19302_3,P-MASTECTOMY W/LN REMOVAL,ProFee,0989,19302,,,,0,3.00,2.25,2.25,1294.00,0.00,1294.00,1294.00,N/A
19303_3,"MAST, SIMPLE, COMPLETE",ProFee,0989,19303,,,,0,3.00,2.25,2.25,1381.50,0.00,1381.50,1381.50,N/A
19305_3,"MAST, RADICAL",ProFee,0989,19305,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
19306_3,"MAST, RAD, URBAN TYPE",ProFee,0989,19306,,,,0,3.00,2.25,2.25,1728.50,0.00,1728.50,1728.50,N/A
19307_3,"MAST, MOD RAD",ProFee,0989,19307,,,,0,3.00,2.25,2.25,1723.00,0.00,1723.00,1723.00,N/A
19316_3,SUSPENSION OF BREAST,ProFee,0989,19316,,,,0,3.00,2.25,2.25,1106.00,0.00,1106.00,1106.00,N/A
19318_3,REDUCTION OF LARGE BREAST,ProFee,0989,19318,,,,0,3.00,2.25,2.25,1583.00,0.00,1583.00,1583.00,N/A
19324_3,ENLARGE BREAST,ProFee,0989,19324,,,,0,3.00,2.25,2.25,761.50,0.00,761.50,761.50,N/A
19325_3,ENLARGE BREAST WITH IMPLANT,ProFee,0989,19325,,,,0,3.00,2.25,2.25,922.00,0.00,922.00,922.00,N/A
19328_3,REMOVAL OF BREAST IMPLANT,ProFee,0989,19328,,,,0,3.00,2.25,2.25,712.00,0.00,712.00,712.00,N/A
19330_3,REMOVAL OF IMPLANT MATERIAL,ProFee,0989,19330,,,,0,3.00,2.25,2.25,911.00,0.00,911.00,911.00,N/A
19340_3,IMMEDIATE BREAST PROSTHESIS,ProFee,0989,19340,,,,0,3.00,2.25,2.25,1440.50,0.00,1440.50,1440.50,N/A
19342_3,DELAYED BREAST PROSTHESIS,ProFee,0989,19342,,,,0,3.00,2.25,2.25,1325.50,0.00,1325.50,1325.50,N/A
19350_3,BREAST RECONSTRUCTION,ProFee,0989,19350,,,,0,3.00,2.25,2.25,966.50,0.00,966.50,966.50,N/A
19355_3,CORRECT INVERTED NIPPLE(S),ProFee,0989,19355,,,,0,3.00,2.25,2.25,892.50,0.00,892.50,892.50,N/A
19357_3,BREAST RECONSTRUCTION,ProFee,0989,19357,,,,0,3.00,2.25,2.25,2163.50,0.00,2163.50,2163.50,N/A
19361_3,BREAST RECONSTRUCTION,ProFee,0989,19361,,,,0,3.00,2.25,2.25,2266.00,0.00,2266.00,2266.00,N/A
19364_3,BREAST RECONSTRUCTION,ProFee,0989,19364,,,,0,3.00,2.25,2.25,3969.50,0.00,3969.50,3969.50,N/A
19366_3,BREAST RECONSTRUCTION,ProFee,0989,19366,,,,0,3.00,2.25,2.25,2033.00,0.00,2033.00,2033.00,N/A
19367_3,BREAST RECONSTRUCTION,ProFee,0989,19367,,,,0,3.00,2.25,2.25,2580.00,0.00,2580.00,2580.00,N/A
19368_3,BREAST RECONSTRUCTION,ProFee,0989,19368,,,,0,3.00,2.25,2.25,3168.50,0.00,3168.50,3168.50,N/A
19369_3,BREAST RECONSTRUCTION,ProFee,0989,19369,,,,0,3.00,2.25,2.25,2940.50,0.00,2940.50,2940.50,N/A
19370_3,SURGERY OF BREAST CAPSULE,ProFee,0989,19370,,,,0,3.00,2.25,2.25,986.00,0.00,986.00,986.00,N/A
19371_3,REMOVAL OF BREAST CAPSULE,ProFee,0989,19371,,,,0,3.00,2.25,2.25,1126.00,0.00,1126.00,1126.00,N/A
19380_3,REVISE BREAST RECONSTRUCTION,ProFee,0989,19380,,,,0,3.00,2.25,2.25,1111.50,0.00,1111.50,1111.50,N/A
19396_3,DESIGN CUSTOM BREAST IMPLANT,ProFee,0989,19396,,,,0,3.00,2.25,2.25,210.00,0.00,210.00,210.00,N/A
19499_3,BREAST SURGERY PROCEDURE,ProFee,0989,19499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20000_3,INCISION OF ABSCESS,ProFee,0989,20000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20005_3,INCISION OF DEEP ABSCESS,ProFee,0989,20005,,,,0,3.00,2.25,2.25,339.00,0.00,339.00,339.00,N/A
2000F_3,"BLOOD PRESSURE, MEASURED",ProFee,0989,2000F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2001F_3,WEIGHT RECORDED,ProFee,0989,2001F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2002F_3,CLIN SIGN VOLUM OVERLOAD,ProFee,0989,2002F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2003F_3,EXAMINATION OF HEART,ProFee,0989,2003F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
2004F_3,PHYSICAL EXAMINATION  KNEE,ProFee,0989,2004F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20100_3,"EXPLORE WOUND, NECK",ProFee,0989,20100,,,,0,3.00,2.25,2.25,873.00,0.00,873.00,873.00,N/A
20101_3,"EXPLORE WOUND, CHEST",ProFee,0989,20101,,,,0,3.00,2.25,2.25,302.00,0.00,302.00,302.00,N/A
20102_3,"EXPLORE WOUND, ABDOMEN",ProFee,0989,20102,,,,0,3.00,2.25,2.25,369.00,0.00,369.00,369.00,N/A
20103_3,"EXPLORE WOUND, EXTREMITY",ProFee,0989,20103,,,,0,3.00,2.25,2.25,502.00,0.00,502.00,502.00,N/A
2010F_3,VITAL SIGNS RECORDED,ProFee,0989,2010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2014F_3,MENTAL STATUS ASSESS,ProFee,0989,2014F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20150_3,EXCISE EPIPHYSEAL BAR,ProFee,0989,20150,,,,0,3.00,2.25,2.25,1456.00,0.00,1456.00,1456.00,N/A
2015F_3,ASTHMA IMPAIRMENT ASSESSED,ProFee,0989,2015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2016F_3,ASTHMA RISK ASSESSED,ProFee,0989,2016F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2018F_3,HYDRATION STATUS ASSESS,ProFee,0989,2018F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2019F_3,DILATED MACUL EXAM DONE,ProFee,0989,2019F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20200_3,MUSCLE BIOPSY,ProFee,0989,20200,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
20205_3,DEEP MUSCLE BIOPSY,ProFee,0989,20205,,,,0,3.00,2.25,2.25,225.50,0.00,225.50,225.50,N/A
20206_3,"NEEDLE BIOPSY, MUSCLE",ProFee,0989,20206,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
2020F_3,DILATED FUNDUS EVAL DONE,ProFee,0989,2020F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2021F_3,DILAT MACUL+ EXAM DONE,ProFee,0989,2021F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20220_3,"BONE BIOPSY, TROCAR/NEEDLE",ProFee,0989,20220,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
20225_3,"BONE BIOPSY, TROCAR/NEEDLE",ProFee,0989,20225,,,,0,3.00,2.25,2.25,154.50,0.00,154.50,154.50,N/A
2022F_3,DIL RETINA EXAM INTERP REV,ProFee,0989,2022F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2023F_3,DILAT RTA XM W/O RTNOPTHY,ProFee,0989,2023F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20240_3,"BONE BIOPSY, EXCISIONAL",ProFee,0989,20240,,,,0,3.00,2.25,2.25,219.00,0.00,219.00,219.00,N/A
20245_3,"BONE BIOPSY, EXCISIONAL",ProFee,0989,20245,,,,0,3.00,2.25,2.25,508.50,0.00,508.50,508.50,N/A
2024F_3,7 FIELD PHOTO INTERP DOC REV,ProFee,0989,2024F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20250_3,OPEN BONE BIOPSY,ProFee,0989,20250,,,,0,3.00,2.25,2.25,560.00,0.00,560.00,560.00,N/A
20251_3,OPEN BONE BIOPSY,ProFee,0989,20251,,,,0,3.00,2.25,2.25,613.50,0.00,613.50,613.50,N/A
2025F_3,7 FLD RTA PHOTO W/O RTNOPTHY,ProFee,0989,2025F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
2026F_3,EYE IMAGE VALID TO DX REV,ProFee,0989,2026F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2027F_3,OPTIC NERVE HEAD EVAL DONE,ProFee,0989,2027F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2028F_3,FOOT EXAM PERFORMED,ProFee,0989,2028F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2029F_3,COMPLETE PHYS SKIN EXAM DONE,ProFee,0989,2029F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2030F_3,"H2O STAT DOC'D, NORMAL",ProFee,0989,2030F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2031F_3,"H2O STAT DOC'D, DEHYDRATED",ProFee,0989,2031F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2033F_3,EYE IMG VALID W/O RTNOPTHY,ProFee,0989,2033F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
2035F_3,TYMP MEMB MOTION EXAM'D,ProFee,0989,2035F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2040F_3,BK PN XM ON INIT VISIT DATE,ProFee,0989,2040F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
2044F_3,DOC MNTL TST B/4 BK TRXMNT,ProFee,0989,2044F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20500_3,INJECTION OF SINUS TRACT,ProFee,0989,20500,,,,0,3.00,2.25,2.25,121.00,0.00,121.00,121.00,N/A
20501_3,INJECT SINUS TRACT FOR X-RAY,ProFee,0989,20501,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
2050F_3,WOUND CHAR SIZE ETC DOCD,ProFee,0989,2050F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20520_3,REMOVAL OF FOREIGN BODY,ProFee,0989,20520,,,,0,3.00,2.25,2.25,211.00,0.00,211.00,211.00,N/A
20525_2,REMOVAL OF FOREIGN BODY,Inpatient,0521,20525,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,680.20,644.40
20525_2,REMOVAL OF FOREIGN BODY,Ambulatory Surgical,0521,20525,,,,0,716.00,537.00,537.00,680.20,644.40,680.20,0.00,644.40
20525_3,REMOVAL OF FOREIGN BODY,Ambulatory Surgical,0521,20525,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,0.00,629.10
20525_3,REMOVAL OF FOREIGN BODY,Inpatient,0521,20525,,,,0,699.00,524.25,524.25,664.05,629.10,664.05,664.05,629.10
20526_3,"THER INJECTION, CARP TUNNEL",ProFee,0989,20526,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
20527_3,INJ DUPUYTREN CORD W/ENZYME,ProFee,0989,20527,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
20551_3,INJ TENDON ORIGIN/INSERTION,ProFee,0989,20551,,,,0,3.00,2.25,2.25,61.50,0.00,61.50,61.50,N/A
20552_2,"INJ TRIGGER POINT, 1/2 MUSCL",Ambulatory Surgical,0521,20552,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,0.00,192.60
20552_2,"INJ TRIGGER POINT, 1/2 MUSCL",Inpatient,0521,20552,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,203.30,192.60
20552_3,"INJ TRIGGER POINT, 1/2 MUSCL",Inpatient,0521,20552,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,200.45,189.90
20552_3,"INJ TRIGGER POINT, 1/2 MUSCL",Ambulatory Surgical,0521,20552,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,0.00,189.90
20553_2,"INJECT TRIGGER POINTS, =/> 3",Inpatient,0521,20553,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,203.30,192.60
20553_2,"INJECT TRIGGER POINTS, =/> 3",Ambulatory Surgical,0521,20553,,,,0,214.00,160.50,160.50,203.30,192.60,203.30,0.00,192.60
20553_3,"INJECT TRIGGER POINTS, =/> 3",Ambulatory Surgical,0521,20553,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,0.00,189.90
20553_3,"INJECT TRIGGER POINTS, =/> 3",Inpatient,0521,20553,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,200.45,189.90
20555_3,PLACE NDL MUSC/TIS FOR RT,ProFee,0989,20555,,,,0,3.00,2.25,2.25,469.50,0.00,469.50,469.50,N/A
20560_3,NDL INSJ W/O NJX 1 OR 2 MUSC,ProFee,0989,20560,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20561_3,NDL INSJ W/O NJX 3+ MUSC,ProFee,0989,20561,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20600_2,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20600,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,167.20,158.40
20600_2,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20600,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,0.00,158.40
20600_3,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20600,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,0.00,156.60
20600_3,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20600,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,165.30,156.60
20604_3,DRAIN/INJ JOINT/BURSA W/US,ProFee,0989,20604,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
20605_2,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20605,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,0.00,165.60
20605_2,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20605,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
20605_3,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20605,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,172.90,163.80
20605_3,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20605,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,0.00,163.80
20606_3,DRAIN/INJ JOINT/BURSA W/US,ProFee,0989,20606,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
2060F_3,PT TALK EVAL HLTHWKR RE MDD,ProFee,0989,2060F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20610_2,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20610,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
20610_2,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20610,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
20610_3,"DRAIN/INJECT, JOINT/BURSA",Ambulatory Surgical,0521,20610,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
20610_3,"DRAIN/INJECT, JOINT/BURSA",Inpatient,0521,20610,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
20611_3,DRAIN/INJ JOINT/BURSA W/US,ProFee,0989,20611,,,,0,3.00,2.25,2.25,88.00,0.00,88.00,88.00,N/A
20612_2,ASPIRATE/INJ GANGLION CYST,Ambulatory Surgical,0521,20612,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
20612_2,ASPIRATE/INJ GANGLION CYST,Inpatient,0521,20612,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
20612_3,ASPIRATE/INJ GANGLION CYST,Inpatient,0521,20612,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
20612_3,ASPIRATE/INJ GANGLION CYST,Ambulatory Surgical,0521,20612,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
20615_3,TREATMENT OF BONE CYST,ProFee,0989,20615,,,,0,3.00,2.25,2.25,231.50,0.00,231.50,231.50,N/A
20650_3,INSERT AND REMOVE BONE PIN,ProFee,0989,20650,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
20660_3,"APPLY, REM FIXATION DEVICE",ProFee,0989,20660,,,,0,3.00,2.25,2.25,356.00,0.00,356.00,356.00,N/A
20661_3,APPLICATION OF HEAD BRACE,ProFee,0989,20661,,,,0,3.00,2.25,2.25,724.50,0.00,724.50,724.50,N/A
20662_3,APPLICATION OF PELVIS BRACE,ProFee,0989,20662,,,,0,3.00,2.25,2.25,736.00,0.00,736.00,736.00,N/A
20663_3,APPLICATION OF THIGH BRACE,ProFee,0989,20663,,,,0,3.00,2.25,2.25,675.00,0.00,675.00,675.00,N/A
20664_3,HALO BRACE APPLICATION,ProFee,0989,20664,,,,0,3.00,2.25,2.25,1263.00,0.00,1263.00,1263.00,N/A
20665_3,REMOVAL OF FIXATION DEVICE,ProFee,0989,20665,,,,0,3.00,2.25,2.25,131.00,0.00,131.00,131.00,N/A
20670_3,REMOVAL OF SUPPORT IMPLANT,ProFee,0989,20670,,,,0,3.00,2.25,2.25,210.50,0.00,210.50,210.50,N/A
20680_3,REMOVAL OF SUPPORT IMPLANT,ProFee,0989,20680,,,,0,3.00,2.25,2.25,608.50,0.00,608.50,608.50,N/A
20690_3,APPLY BONE FIXATION DEVICE,ProFee,0989,20690,,,,0,3.00,2.25,2.25,857.50,0.00,857.50,857.50,N/A
20692_3,APPLY BONE FIXATION DEVICE,ProFee,0989,20692,,,,0,3.00,2.25,2.25,1609.00,0.00,1609.00,1609.00,N/A
20693_3,ADJUST BONE FIXATION DEVICE,ProFee,0989,20693,,,,0,3.00,2.25,2.25,637.50,0.00,637.50,637.50,N/A
20694_3,REMOVE BONE FIXATION DEVICE,ProFee,0989,20694,,,,0,3.00,2.25,2.25,487.00,0.00,487.00,487.00,N/A
20696_3,COMP MULTIPLANE EXT FIXATION,ProFee,0989,20696,,,,0,3.00,2.25,2.25,1734.00,0.00,1734.00,1734.00,N/A
20697_3,COMP EXT FIXATE STRUT CHANGE,ProFee,0989,20697,,,,0,3.00,2.25,2.25,3022.50,0.00,3022.50,3022.50,N/A
20700_3,MNL PREP&INSJ DP RX DLVR DEV,ProFee,0989,20700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20701_3,RMVL DEEP RX DELIVERY DEVICE,ProFee,0989,20701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20702_3,MNL PREP&INSJ IMED RX DEV,ProFee,0989,20702,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20703_3,RMVL IMED RX DELIVERY DEVICE,ProFee,0989,20703,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20704_3,MNL PREP&INSJ I-ARTIC RX DEV,ProFee,0989,20704,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20705_3,RMVL I-ARTIC RX DELIVERY DEV,ProFee,0989,20705,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20802_3,"REPLANTATION, ARM, COMPLETE",ProFee,0989,20802,,,,0,3.00,2.25,2.25,3983.50,0.00,3983.50,3983.50,N/A
20805_3,"REPLANT FOREARM, COMPLETE",ProFee,0989,20805,,,,0,3.00,2.25,2.25,4744.00,0.00,4744.00,4744.00,N/A
20808_3,"REPLANTATION HAND, COMPLETE",ProFee,0989,20808,,,,0,3.00,2.25,2.25,5734.50,0.00,5734.50,5734.50,N/A
20816_3,"REPLANTATION DIGIT, COMPLETE",ProFee,0989,20816,,,,0,3.00,2.25,2.25,2985.50,0.00,2985.50,2985.50,N/A
20822_3,"REPLANTATION DIGIT, COMPLETE",ProFee,0989,20822,,,,0,3.00,2.25,2.25,2564.50,0.00,2564.50,2564.50,N/A
20824_3,"REPLANTATION THUMB, COMPLETE",ProFee,0989,20824,,,,0,3.00,2.25,2.25,2990.50,0.00,2990.50,2990.50,N/A
20827_3,"REPLANTATION THUMB, COMPLETE",ProFee,0989,20827,,,,0,3.00,2.25,2.25,2633.00,0.00,2633.00,2633.00,N/A
20838_3,"REPLANTATION FOOT, COMPLETE",ProFee,0989,20838,,,,0,3.00,2.25,2.25,3655.50,0.00,3655.50,3655.50,N/A
20900_3,REMOVAL OF BONE FOR GRAFT,ProFee,0989,20900,,,,0,3.00,2.25,2.25,272.00,0.00,272.00,272.00,N/A
20902_3,REMOVAL OF BONE FOR GRAFT,ProFee,0989,20902,,,,0,3.00,2.25,2.25,412.00,0.00,412.00,412.00,N/A
20910_3,REMOVE CARTILAGE FOR GRAFT,ProFee,0989,20910,,,,0,3.00,2.25,2.25,672.00,0.00,672.00,672.00,N/A
20912_3,REMOVE CARTILAGE FOR GRAFT,ProFee,0989,20912,,,,0,3.00,2.25,2.25,676.00,0.00,676.00,676.00,N/A
20920_3,REMOVAL OF FASCIA FOR GRAFT,ProFee,0989,20920,,,,0,3.00,2.25,2.25,567.50,0.00,567.50,567.50,N/A
20922_3,REMOVAL OF FASCIA FOR GRAFT,ProFee,0989,20922,,,,0,3.00,2.25,2.25,703.00,0.00,703.00,703.00,N/A
20924_3,REMOVAL OF TENDON FOR GRAFT,ProFee,0989,20924,,,,0,3.00,2.25,2.25,729.00,0.00,729.00,729.00,N/A
20930_3,SPINAL BONE ALLOGRAFT,ProFee,0989,20930,,,,0,3.00,2.25,2.25,173.50,0.00,173.50,173.50,N/A
20931_3,SPINAL BONE ALLOGRAFT,ProFee,0989,20931,,,,0,3.00,2.25,2.25,163.50,0.00,163.50,163.50,N/A
20932_3,OSTEOART ALGRFT W/SURF & B1,ProFee,0989,20932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20933_3,HEMICRT INTRCLRY ALGRFT PRTL,ProFee,0989,20933,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20934_3,INTERCALARY ALGRFT COMPL,ProFee,0989,20934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
20936_3,SPINAL BONE AUTOGRAFT,ProFee,0989,20936,,,,0,3.00,2.25,2.25,183.50,0.00,183.50,183.50,N/A
20937_3,SPINAL BONE AUTOGRAFT,ProFee,0989,20937,,,,0,3.00,2.25,2.25,245.00,0.00,245.00,245.00,N/A
20938_3,SPINAL BONE AUTOGRAFT,ProFee,0989,20938,,,,0,3.00,2.25,2.25,270.00,0.00,270.00,270.00,N/A
20939_3,BONE MARROW ASPIR BONE GRFG,ProFee,0989,20939,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
20950_3,"FLUID PRESSURE, MUSCLE",ProFee,0989,20950,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
20955_3,"FIBULA BONE GRAFT, MICROVASC",ProFee,0989,20955,,,,0,3.00,2.25,2.25,3570.00,0.00,3570.00,3570.00,N/A
20956_3,"ILIAC BONE GRAFT, MICROVASC",ProFee,0989,20956,,,,0,3.00,2.25,2.25,3831.00,0.00,3831.00,3831.00,N/A
20957_3,"MT BONE GRAFT, MICROVASC",ProFee,0989,20957,,,,0,3.00,2.25,2.25,3983.00,0.00,3983.00,3983.00,N/A
20962_3,"OTHER BONE GRAFT, MICROVASC",ProFee,0989,20962,,,,0,3.00,2.25,2.25,3855.00,0.00,3855.00,3855.00,N/A
20969_3,"BONE/SKIN GRAFT, MICROVASC",ProFee,0989,20969,,,,0,3.00,2.25,2.25,3946.50,0.00,3946.50,3946.50,N/A
20970_3,"BONE/SKIN GRAFT, ILIAC CREST",ProFee,0989,20970,,,,0,3.00,2.25,2.25,4143.50,0.00,4143.50,4143.50,N/A
20972_3,"BONE/SKIN GRAFT, METATARSAL",ProFee,0989,20972,,,,0,3.00,2.25,2.25,4136.00,0.00,4136.00,4136.00,N/A
20973_3,"BONE/SKIN GRAFT, GREAT TOE",ProFee,0989,20973,,,,0,3.00,2.25,2.25,4366.00,0.00,4366.00,4366.00,N/A
20974_3,ELECTRICAL BONE STIMULATION,ProFee,0989,20974,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
20975_3,ELECTRICAL BONE STIMULATION,ProFee,0989,20975,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
20979_3,US BONE STIMULATION,ProFee,0989,20979,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
20982_3,"ABLATE, BONE TUMOR(S) PERQ",ProFee,0989,20982,,,,0,3.00,2.25,2.25,528.00,0.00,528.00,528.00,N/A
20983_3,ABLATE BONE TUMOR(S) PERQ,ProFee,0989,20983,,,,0,3.00,2.25,2.25,519.00,0.00,519.00,519.00,N/A
20985_3,CPTR-ASST DIR MS PX,ProFee,0989,20985,,,,0,3.00,2.25,2.25,213.00,0.00,213.00,213.00,N/A
20986_3,CPTR-ASST DIR MS PX IO IMG,ProFee,0989,20986,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20987_3,CPTR-ASST DIR MS PX  PRE IMG,ProFee,0989,20987,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
20999_3,MUSCULOSKELETAL SURGERY,ProFee,0989,20999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
21010_3,INCISION OF JAW JOINT,ProFee,0989,21010,,,,0,3.00,2.25,2.25,1097.50,0.00,1097.50,1097.50,N/A
21011_3,EXC FACE LES SC < 2 CM,ProFee,0989,21011,,,,0,3.00,2.25,2.25,371.50,0.00,371.50,371.50,N/A
21012_3,EXC FACE LES SC = 2 CM,ProFee,0989,21012,,,,0,3.00,2.25,2.25,488.00,0.00,488.00,488.00,N/A
21013_3,EXC FACE TUM DEEP < 2 CM,ProFee,0989,21013,,,,0,3.00,2.25,2.25,576.50,0.00,576.50,576.50,N/A
21014_3,EXC FACE TUM DEEP = 2 CM,ProFee,0989,21014,,,,0,3.00,2.25,2.25,751.50,0.00,751.50,751.50,N/A
21015_3,RESECTION OF FACIAL TUMOR,ProFee,0989,21015,,,,0,3.00,2.25,2.25,1017.50,0.00,1017.50,1017.50,N/A
21016_3,RESECT FACE TUM = 2 CM,ProFee,0989,21016,,,,0,3.00,2.25,2.25,1458.00,0.00,1458.00,1458.00,N/A
21025_3,"EXCISION OF BONE, LOWER JAW",ProFee,0989,21025,,,,0,3.00,2.25,2.25,1077.00,0.00,1077.00,1077.00,N/A
21026_3,EXCISION OF FACIAL BONE(S),ProFee,0989,21026,,,,0,3.00,2.25,2.25,715.50,0.00,715.50,715.50,N/A
21029_3,CONTOUR OF FACE BONE LESION,ProFee,0989,21029,,,,0,3.00,2.25,2.25,919.00,0.00,919.00,919.00,N/A
21030_3,EXCISE MAX/ZYGOMA B9 TUMOR,ProFee,0989,21030,,,,0,3.00,2.25,2.25,599.00,0.00,599.00,599.00,N/A
21031_3,"REMOVE EXOSTOSIS, MANDIBLE",ProFee,0989,21031,,,,0,3.00,2.25,2.25,425.50,0.00,425.50,425.50,N/A
21032_3,"REMOVE EXOSTOSIS, MAXILLA",ProFee,0989,21032,,,,0,3.00,2.25,2.25,418.50,0.00,418.50,418.50,N/A
21034_3,EXCISE MAX/ZYGOMA MLG TUMOR,ProFee,0989,21034,,,,0,3.00,2.25,2.25,1648.00,0.00,1648.00,1648.00,N/A
21040_3,EXCISE MANDIBLE LESION,ProFee,0989,21040,,,,0,3.00,2.25,2.25,600.00,0.00,600.00,600.00,N/A
21044_3,REMOVAL OF JAW BONE LESION,ProFee,0989,21044,,,,0,3.00,2.25,2.25,1248.00,0.00,1248.00,1248.00,N/A
21045_3,EXTENSIVE JAW SURGERY,ProFee,0989,21045,,,,0,3.00,2.25,2.25,1753.00,0.00,1753.00,1753.00,N/A
21046_3,REMOVE MANDIBLE CYST COMPLEX,ProFee,0989,21046,,,,0,3.00,2.25,2.25,1603.50,0.00,1603.50,1603.50,N/A
21047_3,EXCISE LWR JAW CYST W/REPAIR,ProFee,0989,21047,,,,0,3.00,2.25,2.25,1883.50,0.00,1883.50,1883.50,N/A
21048_3,REMOVE MAXILLA CYST COMPLEX,ProFee,0989,21048,,,,0,3.00,2.25,2.25,1634.50,0.00,1634.50,1634.50,N/A
21049_3,EXCIS UPPR JAW CYST W/REPAIR,ProFee,0989,21049,,,,0,3.00,2.25,2.25,1716.50,0.00,1716.50,1716.50,N/A
21050_3,REMOVAL OF JAW JOINT,ProFee,0989,21050,,,,0,3.00,2.25,2.25,1297.00,0.00,1297.00,1297.00,N/A
21060_3,REMOVE JAW JOINT CARTILAGE,ProFee,0989,21060,,,,0,3.00,2.25,2.25,1179.00,0.00,1179.00,1179.00,N/A
21070_3,REMOVE CORONOID PROCESS,ProFee,0989,21070,,,,0,3.00,2.25,2.25,924.50,0.00,924.50,924.50,N/A
21073_3,MNPJ OF TMJ W/ANESTH,ProFee,0989,21073,,,,0,3.00,2.25,2.25,363.50,0.00,363.50,363.50,N/A
21076_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21076,,,,0,3.00,2.25,2.25,1186.00,0.00,1186.00,1186.00,N/A
21077_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21077,,,,0,3.00,2.25,2.25,3000.50,0.00,3000.50,3000.50,N/A
21079_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21079,,,,0,3.00,2.25,2.25,2002.50,0.00,2002.50,2002.50,N/A
21080_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21080,,,,0,3.00,2.25,2.25,2233.50,0.00,2233.50,2233.50,N/A
21081_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21081,,,,0,3.00,2.25,2.25,2046.50,0.00,2046.50,2046.50,N/A
21082_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21082,,,,0,3.00,2.25,2.25,1913.00,0.00,1913.00,1913.00,N/A
21083_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21083,,,,0,3.00,2.25,2.25,1777.50,0.00,1777.50,1777.50,N/A
21084_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21084,,,,0,3.00,2.25,2.25,2056.50,0.00,2056.50,2056.50,N/A
21085_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21085,,,,0,3.00,2.25,2.25,808.00,0.00,808.00,808.00,N/A
21086_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21086,,,,0,3.00,2.25,2.25,2214.00,0.00,2214.00,2214.00,N/A
21087_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21087,,,,0,3.00,2.25,2.25,2200.00,0.00,2200.00,2200.00,N/A
21088_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21088,,,,0,3.00,2.25,2.25,4273.50,0.00,4273.50,4273.50,N/A
21089_3,PREPARE FACE/ORAL PROSTHESIS,ProFee,0989,21089,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
21100_3,MAXILLOFACIAL FIXATION,ProFee,0989,21100,,,,0,3.00,2.25,2.25,587.50,0.00,587.50,587.50,N/A
21110_3,INTERDENTAL FIXATION,ProFee,0989,21110,,,,0,3.00,2.25,2.25,957.00,0.00,957.00,957.00,N/A
21116_3,"INJECTION, JAW JOINT X-RAY",ProFee,0989,21116,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
21120_3,RECONSTRUCTION OF CHIN,ProFee,0989,21120,,,,0,3.00,2.25,2.25,781.50,0.00,781.50,781.50,N/A
21121_3,RECONSTRUCTION OF CHIN,ProFee,0989,21121,,,,0,3.00,2.25,2.25,941.00,0.00,941.00,941.00,N/A
21122_3,RECONSTRUCTION OF CHIN,ProFee,0989,21122,,,,0,3.00,2.25,2.25,1142.50,0.00,1142.50,1142.50,N/A
21123_3,RECONSTRUCTION OF CHIN,ProFee,0989,21123,,,,0,3.00,2.25,2.25,1322.50,0.00,1322.50,1322.50,N/A
21125_3,"AUGMENTATION, LOWER JAW BONE",ProFee,0989,21125,,,,0,3.00,2.25,2.25,1109.00,0.00,1109.00,1109.00,N/A
21127_3,"AUGMENTATION, LOWER JAW BONE",ProFee,0989,21127,,,,0,3.00,2.25,2.25,1278.00,0.00,1278.00,1278.00,N/A
21137_3,REDUCTION OF FOREHEAD,ProFee,0989,21137,,,,0,3.00,2.25,2.25,1083.00,0.00,1083.00,1083.00,N/A
21138_3,REDUCTION OF FOREHEAD,ProFee,0989,21138,,,,0,3.00,2.25,2.25,1323.50,0.00,1323.50,1323.50,N/A
21139_3,REDUCTION OF FOREHEAD,ProFee,0989,21139,,,,0,3.00,2.25,2.25,1622.00,0.00,1622.00,1622.00,N/A
21141_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21141,,,,0,3.00,2.25,2.25,1960.50,0.00,1960.50,1960.50,N/A
21142_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21142,,,,0,3.00,2.25,2.25,2015.50,0.00,2015.50,2015.50,N/A
21143_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21143,,,,0,3.00,2.25,2.25,2115.00,0.00,2115.00,2115.00,N/A
21145_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21145,,,,0,3.00,2.25,2.25,2301.00,0.00,2301.00,2301.00,N/A
21146_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21146,,,,0,3.00,2.25,2.25,2399.00,0.00,2399.00,2399.00,N/A
21147_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21147,,,,0,3.00,2.25,2.25,2529.00,0.00,2529.00,2529.00,N/A
21150_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21150,,,,0,3.00,2.25,2.25,2378.00,0.00,2378.00,2378.00,N/A
21151_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21151,,,,0,3.00,2.25,2.25,2547.50,0.00,2547.50,2547.50,N/A
21154_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21154,,,,0,3.00,2.25,2.25,2813.50,0.00,2813.50,2813.50,N/A
21155_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21155,,,,0,3.00,2.25,2.25,3120.50,0.00,3120.50,3120.50,N/A
21159_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21159,,,,0,3.00,2.25,2.25,3739.00,0.00,3739.00,3739.00,N/A
21160_3,"RECONSTRUCT MIDFACE, LEFORT",ProFee,0989,21160,,,,0,3.00,2.25,2.25,4054.50,0.00,4054.50,4054.50,N/A
21172_3,RECONSTRUCT ORBIT/FOREHEAD,ProFee,0989,21172,,,,0,3.00,2.25,2.25,3006.50,0.00,3006.50,3006.50,N/A
21175_3,RECONSTRUCT ORBIT/FOREHEAD,ProFee,0989,21175,,,,0,3.00,2.25,2.25,3186.50,0.00,3186.50,3186.50,N/A
21179_3,RECONSTRUCT ENTIRE FOREHEAD,ProFee,0989,21179,,,,0,3.00,2.25,2.25,2188.00,0.00,2188.00,2188.00,N/A
21180_3,RECONSTRUCT ENTIRE FOREHEAD,ProFee,0989,21180,,,,0,3.00,2.25,2.25,2451.50,0.00,2451.50,2451.50,N/A
21181_3,CONTOUR CRANIAL BONE LESION,ProFee,0989,21181,,,,0,3.00,2.25,2.25,1065.50,0.00,1065.50,1065.50,N/A
21182_3,RECONSTRUCT CRANIAL BONE,ProFee,0989,21182,,,,0,3.00,2.25,2.25,3064.50,0.00,3064.50,3064.50,N/A
21183_3,RECONSTRUCT CRANIAL BONE,ProFee,0989,21183,,,,0,3.00,2.25,2.25,3339.50,0.00,3339.50,3339.50,N/A
21184_3,RECONSTRUCT CRANIAL BONE,ProFee,0989,21184,,,,0,3.00,2.25,2.25,3596.50,0.00,3596.50,3596.50,N/A
21188_3,RECONSTRUCTION OF MIDFACE,ProFee,0989,21188,,,,0,3.00,2.25,2.25,2429.50,0.00,2429.50,2429.50,N/A
21193_3,RECONST LWR JAW W/O GRAFT,ProFee,0989,21193,,,,0,3.00,2.25,2.25,1841.00,0.00,1841.00,1841.00,N/A
21194_3,RECONST LWR JAW W/GRAFT,ProFee,0989,21194,,,,0,3.00,2.25,2.25,2108.50,0.00,2108.50,2108.50,N/A
21195_3,RECONST LWR JAW W/O FIXATION,ProFee,0989,21195,,,,0,3.00,2.25,2.25,2066.50,0.00,2066.50,2066.50,N/A
21196_3,RECONST LWR JAW W/FIXATION,ProFee,0989,21196,,,,0,3.00,2.25,2.25,2129.50,0.00,2129.50,2129.50,N/A
21198_3,RECONSTR LWR JAW SEGMENT,ProFee,0989,21198,,,,0,3.00,2.25,2.25,1680.50,0.00,1680.50,1680.50,N/A
21199_3,RECONSTR LWR JAW W/ADVANCE,ProFee,0989,21199,,,,0,3.00,2.25,2.25,1554.00,0.00,1554.00,1554.00,N/A
21206_3,RECONSTRUCT UPPER JAW BONE,ProFee,0989,21206,,,,0,3.00,2.25,2.25,1726.00,0.00,1726.00,1726.00,N/A
21208_3,AUGMENTATION OF FACIAL BONES,ProFee,0989,21208,,,,0,3.00,2.25,2.25,1198.00,0.00,1198.00,1198.00,N/A
21209_3,REDUCTION OF FACIAL BONES,ProFee,0989,21209,,,,0,3.00,2.25,2.25,961.50,0.00,961.50,961.50,N/A
21210_3,FACE BONE GRAFT,ProFee,0989,21210,,,,0,3.00,2.25,2.25,1229.00,0.00,1229.00,1229.00,N/A
21215_3,LOWER JAW BONE GRAFT,ProFee,0989,21215,,,,0,3.00,2.25,2.25,1282.50,0.00,1282.50,1282.50,N/A
21230_3,RIB CARTILAGE GRAFT,ProFee,0989,21230,,,,0,3.00,2.25,2.25,1064.00,0.00,1064.00,1064.00,N/A
21235_3,EAR CARTILAGE GRAFT,ProFee,0989,21235,,,,0,3.00,2.25,2.25,808.00,0.00,808.00,808.00,N/A
21240_3,RECONSTRUCTION OF JAW JOINT,ProFee,0989,21240,,,,0,3.00,2.25,2.25,1612.00,0.00,1612.00,1612.00,N/A
21242_3,RECONSTRUCTION OF JAW JOINT,ProFee,0989,21242,,,,0,3.00,2.25,2.25,1495.50,0.00,1495.50,1495.50,N/A
21243_3,RECONSTRUCTION OF JAW JOINT,ProFee,0989,21243,,,,0,3.00,2.25,2.25,2463.50,0.00,2463.50,2463.50,N/A
21244_3,RECONSTRUCTION OF LOWER JAW,ProFee,0989,21244,,,,0,3.00,2.25,2.25,1517.00,0.00,1517.00,1517.00,N/A
21245_3,RECONSTRUCTION OF JAW,ProFee,0989,21245,,,,0,3.00,2.25,2.25,1374.00,0.00,1374.00,1374.00,N/A
21246_3,RECONSTRUCTION OF JAW,ProFee,0989,21246,,,,0,3.00,2.25,2.25,1269.50,0.00,1269.50,1269.50,N/A
21247_3,RECONSTRUCT LOWER JAW BONE,ProFee,0989,21247,,,,0,3.00,2.25,2.25,2361.50,0.00,2361.50,2361.50,N/A
21248_3,RECONSTRUCTION OF JAW,ProFee,0989,21248,,,,0,3.00,2.25,2.25,1294.00,0.00,1294.00,1294.00,N/A
21249_3,RECONSTRUCTION OF JAW,ProFee,0989,21249,,,,0,3.00,2.25,2.25,1835.00,0.00,1835.00,1835.00,N/A
21255_3,RECONSTRUCT LOWER JAW BONE,ProFee,0989,21255,,,,0,3.00,2.25,2.25,2050.00,0.00,2050.00,2050.00,N/A
21256_3,RECONSTRUCTION OF ORBIT,ProFee,0989,21256,,,,0,3.00,2.25,2.25,1793.50,0.00,1793.50,1793.50,N/A
21260_3,REVISE EYE SOCKETS,ProFee,0989,21260,,,,0,3.00,2.25,2.25,2029.50,0.00,2029.50,2029.50,N/A
21261_3,REVISE EYE SOCKETS,ProFee,0989,21261,,,,0,3.00,2.25,2.25,3588.50,0.00,3588.50,3588.50,N/A
21263_3,REVISE EYE SOCKETS,ProFee,0989,21263,,,,0,3.00,2.25,2.25,3319.50,0.00,3319.50,3319.50,N/A
21267_3,REVISE EYE SOCKETS,ProFee,0989,21267,,,,0,3.00,2.25,2.25,2376.00,0.00,2376.00,2376.00,N/A
21268_3,REVISE EYE SOCKETS,ProFee,0989,21268,,,,0,3.00,2.25,2.25,2971.50,0.00,2971.50,2971.50,N/A
21270_3,"AUGMENTATION, CHEEK BONE",ProFee,0989,21270,,,,0,3.00,2.25,2.25,1086.00,0.00,1086.00,1086.00,N/A
21275_3,"REVISION, ORBITOFACIAL BONES",ProFee,0989,21275,,,,0,3.00,2.25,2.25,1205.50,0.00,1205.50,1205.50,N/A
21280_3,REVISION OF EYELID,ProFee,0989,21280,,,,0,3.00,2.25,2.25,816.50,0.00,816.50,816.50,N/A
21282_3,REVISION OF EYELID,ProFee,0989,21282,,,,0,3.00,2.25,2.25,546.50,0.00,546.50,546.50,N/A
21295_3,REVISION OF JAW MUSCLE/BONE,ProFee,0989,21295,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
21296_3,REVISION OF JAW MUSCLE/BONE,ProFee,0989,21296,,,,0,3.00,2.25,2.25,590.00,0.00,590.00,590.00,N/A
21299_3,CRANIO/MAXILLOFACIAL SURGERY,ProFee,0989,21299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
21300_3,TREATMENT OF SKULL FRACTURE,ProFee,0989,21300,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21310_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21310,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
21315_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21315,,,,0,3.00,2.25,2.25,215.00,0.00,215.00,215.00,N/A
21320_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21320,,,,0,3.00,2.25,2.25,191.00,0.00,191.00,191.00,N/A
21325_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21325,,,,0,3.00,2.25,2.25,669.00,0.00,669.00,669.00,N/A
21330_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21330,,,,0,3.00,2.25,2.25,807.00,0.00,807.00,807.00,N/A
21335_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21335,,,,0,3.00,2.25,2.25,1026.50,0.00,1026.50,1026.50,N/A
21336_3,TREAT NASAL SEPTAL FRACTURE,ProFee,0989,21336,,,,0,3.00,2.25,2.25,915.50,0.00,915.50,915.50,N/A
21337_3,TREAT NASAL SEPTAL FRACTURE,ProFee,0989,21337,,,,0,3.00,2.25,2.25,419.50,0.00,419.50,419.50,N/A
21338_3,TREAT NASOETHMOID FRACTURE,ProFee,0989,21338,,,,0,3.00,2.25,2.25,938.50,0.00,938.50,938.50,N/A
21339_3,TREAT NASOETHMOID FRACTURE,ProFee,0989,21339,,,,0,3.00,2.25,2.25,1066.00,0.00,1066.00,1066.00,N/A
21340_3,TREATMENT OF NOSE FRACTURE,ProFee,0989,21340,,,,0,3.00,2.25,2.25,1056.00,0.00,1056.00,1056.00,N/A
21343_3,TREATMENT OF SINUS FRACTURE,ProFee,0989,21343,,,,0,3.00,2.25,2.25,1530.50,0.00,1530.50,1530.50,N/A
21344_3,TREATMENT OF SINUS FRACTURE,ProFee,0989,21344,,,,0,3.00,2.25,2.25,1964.50,0.00,1964.50,1964.50,N/A
21345_3,TREAT NOSE/JAW FRACTURE,ProFee,0989,21345,,,,0,3.00,2.25,2.25,887.00,0.00,887.00,887.00,N/A
21346_3,TREAT NOSE/JAW FRACTURE,ProFee,0989,21346,,,,0,3.00,2.25,2.25,1274.50,0.00,1274.50,1274.50,N/A
21347_3,TREAT NOSE/JAW FRACTURE,ProFee,0989,21347,,,,0,3.00,2.25,2.25,1433.50,0.00,1433.50,1433.50,N/A
21348_3,TREAT NOSE/JAW FRACTURE,ProFee,0989,21348,,,,0,3.00,2.25,2.25,1533.00,0.00,1533.00,1533.00,N/A
21355_3,TREAT CHEEK BONE FRACTURE,ProFee,0989,21355,,,,0,3.00,2.25,2.25,452.50,0.00,452.50,452.50,N/A
21356_3,TREAT CHEEK BONE FRACTURE,ProFee,0989,21356,,,,0,3.00,2.25,2.25,540.50,0.00,540.50,540.50,N/A
21360_3,TREAT CHEEK BONE FRACTURE,ProFee,0989,21360,,,,0,3.00,2.25,2.25,770.00,0.00,770.00,770.00,N/A
21365_3,TREAT CHEEK BONE FRACTURE,ProFee,0989,21365,,,,0,3.00,2.25,2.25,1597.00,0.00,1597.00,1597.00,N/A
21366_3,TREAT CHEEK BONE FRACTURE,ProFee,0989,21366,,,,0,3.00,2.25,2.25,1837.00,0.00,1837.00,1837.00,N/A
21385_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21385,,,,0,3.00,2.25,2.25,1099.00,0.00,1099.00,1099.00,N/A
21386_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21386,,,,0,3.00,2.25,2.25,1003.00,0.00,1003.00,1003.00,N/A
21387_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21387,,,,0,3.00,2.25,2.25,1146.00,0.00,1146.00,1146.00,N/A
21390_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21390,,,,0,3.00,2.25,2.25,1142.00,0.00,1142.00,1142.00,N/A
21395_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21395,,,,0,3.00,2.25,2.25,1453.00,0.00,1453.00,1453.00,N/A
21400_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21400,,,,0,3.00,2.25,2.25,225.00,0.00,225.00,225.00,N/A
21401_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21401,,,,0,3.00,2.25,2.25,462.00,0.00,462.00,462.00,N/A
21406_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21406,,,,0,3.00,2.25,2.25,825.50,0.00,825.50,825.50,N/A
21407_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21407,,,,0,3.00,2.25,2.25,922.50,0.00,922.50,922.50,N/A
21408_3,TREAT EYE SOCKET FRACTURE,ProFee,0989,21408,,,,0,3.00,2.25,2.25,1296.50,0.00,1296.50,1296.50,N/A
21421_3,TREAT MOUTH ROOF FRACTURE,ProFee,0989,21421,,,,0,3.00,2.25,2.25,893.50,0.00,893.50,893.50,N/A
21422_3,TREAT MOUTH ROOF FRACTURE,ProFee,0989,21422,,,,0,3.00,2.25,2.25,965.50,0.00,965.50,965.50,N/A
21423_3,TREAT MOUTH ROOF FRACTURE,ProFee,0989,21423,,,,0,3.00,2.25,2.25,1131.50,0.00,1131.50,1131.50,N/A
21431_3,TREAT CRANIOFACIAL FRACTURE,ProFee,0989,21431,,,,0,3.00,2.25,2.25,1032.50,0.00,1032.50,1032.50,N/A
21432_3,TREAT CRANIOFACIAL FRACTURE,ProFee,0989,21432,,,,0,3.00,2.25,2.25,1034.50,0.00,1034.50,1034.50,N/A
21433_3,TREAT CRANIOFACIAL FRACTURE,ProFee,0989,21433,,,,0,3.00,2.25,2.25,2509.00,0.00,2509.00,2509.00,N/A
21435_3,TREAT CRANIOFACIAL FRACTURE,ProFee,0989,21435,,,,0,3.00,2.25,2.25,2024.00,0.00,2024.00,2024.00,N/A
21436_3,TREAT CRANIOFACIAL FRACTURE,ProFee,0989,21436,,,,0,3.00,2.25,2.25,2945.00,0.00,2945.00,2945.00,N/A
21440_2,TREAT DENTAL RIDGE FRACTURE,Inpatient,0521,21440,,,,0,2115.00,1586.25,1586.25,2009.25,1903.50,2009.25,2009.25,1903.50
21440_2,TREAT DENTAL RIDGE FRACTURE,Ambulatory Surgical,0521,21440,,,,0,2115.00,1586.25,1586.25,2009.25,1903.50,2009.25,0.00,1903.50
21440_3,TREAT DENTAL RIDGE FRACTURE,Inpatient,0521,21440,,,,0,2057.00,1542.75,1542.75,1954.15,1851.30,1954.15,1954.15,1851.30
21440_3,TREAT DENTAL RIDGE FRACTURE,Ambulatory Surgical,0521,21440,,,,0,2057.00,1542.75,1542.75,1954.15,1851.30,1954.15,0.00,1851.30
21445_3,TREAT DENTAL RIDGE FRACTURE,ProFee,0989,21445,,,,0,3.00,2.25,2.25,899.00,0.00,899.00,899.00,N/A
21450_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21450,,,,0,3.00,2.25,2.25,663.50,0.00,663.50,663.50,N/A
21451_2,TREAT LOWER JAW FRACTURE,Inpatient,0521,21451,,,,0,954.00,715.50,715.50,906.30,858.60,906.30,906.30,858.60
21451_2,TREAT LOWER JAW FRACTURE,Ambulatory Surgical,0521,21451,,,,0,954.00,715.50,715.50,906.30,858.60,906.30,0.00,858.60
21451_3,TREAT LOWER JAW FRACTURE,Ambulatory Surgical,0521,21451,,,,0,930.00,697.50,697.50,883.50,837.00,883.50,0.00,837.00
21451_3,TREAT LOWER JAW FRACTURE,Inpatient,0521,21451,,,,0,930.00,697.50,697.50,883.50,837.00,883.50,883.50,837.00
21452_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21452,,,,0,3.00,2.25,2.25,535.50,0.00,535.50,535.50,N/A
21453_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21453,,,,0,3.00,2.25,2.25,1119.50,0.00,1119.50,1119.50,N/A
21454_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21454,,,,0,3.00,2.25,2.25,811.50,0.00,811.50,811.50,N/A
21461_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21461,,,,0,3.00,2.25,2.25,1345.00,0.00,1345.00,1345.00,N/A
21462_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21462,,,,0,3.00,2.25,2.25,1504.00,0.00,1504.00,1504.00,N/A
21465_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21465,,,,0,3.00,2.25,2.25,1338.50,0.00,1338.50,1338.50,N/A
21470_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21470,,,,0,3.00,2.25,2.25,1731.00,0.00,1731.00,1731.00,N/A
21480_3,RESET DISLOCATED JAW,ProFee,0989,21480,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
21485_3,RESET DISLOCATED JAW,ProFee,0989,21485,,,,0,3.00,2.25,2.25,913.50,0.00,913.50,913.50,N/A
21490_3,REPAIR DISLOCATED JAW,ProFee,0989,21490,,,,0,3.00,2.25,2.25,1321.00,0.00,1321.00,1321.00,N/A
21495_3,TREAT HYOID BONE FRACTURE,ProFee,0989,31584,,,,0,3.00,2.25,2.25,1956.50,0.00,1956.50,1956.50,N/A
21497_3,INTERDENTAL WIRING,ProFee,0989,21497,,,,0,3.00,2.25,2.25,811.50,0.00,811.50,811.50,N/A
21499_3,HEAD SURGERY PROCEDURE,ProFee,0989,21499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
21501_3,DRAIN NECK/CHEST LESION,ProFee,0989,21501,,,,0,3.00,2.25,2.25,461.00,0.00,461.00,461.00,N/A
21502_3,DRAIN CHEST LESION,ProFee,0989,21502,,,,0,3.00,2.25,2.25,725.00,0.00,725.00,725.00,N/A
21510_3,DRAINAGE OF BONE LESION,ProFee,0989,21510,,,,0,3.00,2.25,2.25,635.50,0.00,635.50,635.50,N/A
21550_3,BIOPSY OF NECK/CHEST,ProFee,0989,21550,,,,0,3.00,2.25,2.25,226.00,0.00,226.00,226.00,N/A
21552_3,EXC NECK LES SC = 3 CM,ProFee,0989,21552,,,,0,3.00,2.25,2.25,643.50,0.00,643.50,643.50,N/A
21554_3,EXC NECK TUM DEEP = 5 CM,ProFee,0989,21554,,,,0,3.00,2.25,2.25,1052.50,0.00,1052.50,1052.50,N/A
21555_3,"REMOVE LESION, NECK/CHEST",ProFee,0989,21555,,,,0,3.00,2.25,2.25,439.00,0.00,439.00,439.00,N/A
21556_3,"REMOVE LESION, NECK/CHEST",ProFee,0989,21556,,,,0,3.00,2.25,2.25,756.50,0.00,756.50,756.50,N/A
21557_3,"REMOVE TUMOR, NECK/CHEST",ProFee,0989,21557,,,,0,3.00,2.25,2.25,1370.50,0.00,1370.50,1370.50,N/A
21558_3,RESECT NECK TUM = 5 CM,ProFee,0989,21558,,,,0,3.00,2.25,2.25,1933.50,0.00,1933.50,1933.50,N/A
21600_3,PARTIAL REMOVAL OF RIB,ProFee,0989,21600,,,,0,3.00,2.25,2.25,795.00,0.00,795.00,795.00,N/A
21601_3,EXC CHEST WALL TUMOR W/RIBS,ProFee,0989,21601,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21602_3,EXC CH WAL TUM W/O LYMPHADEC,ProFee,0989,21602,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21603_3,EXC CH WAL TUM W/LYMPHADEC,ProFee,0989,21603,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21610_3,PARTIAL REMOVAL OF RIB,ProFee,0989,21610,,,,0,3.00,2.25,2.25,1752.50,0.00,1752.50,1752.50,N/A
21615_3,REMOVAL OF RIB,ProFee,0989,21615,,,,0,3.00,2.25,2.25,888.00,0.00,888.00,888.00,N/A
21616_3,REMOVAL OF RIB AND NERVES,ProFee,0989,21616,,,,0,3.00,2.25,2.25,1033.00,0.00,1033.00,1033.00,N/A
21620_3,PARTIAL REMOVAL OF STERNUM,ProFee,0989,21620,,,,0,3.00,2.25,2.25,726.00,0.00,726.00,726.00,N/A
21627_3,STERNAL DEBRIDEMENT,ProFee,0989,21627,,,,0,3.00,2.25,2.25,775.50,0.00,775.50,775.50,N/A
21630_3,EXTENSIVE STERNUM SURGERY,ProFee,0989,21630,,,,0,3.00,2.25,2.25,1768.50,0.00,1768.50,1768.50,N/A
21632_3,EXTENSIVE STERNUM SURGERY,ProFee,0989,21632,,,,0,3.00,2.25,2.25,1740.50,0.00,1740.50,1740.50,N/A
21685_3,HYOID MYOTOMY & SUSPENSION,ProFee,0989,21685,,,,0,3.00,2.25,2.25,1405.00,0.00,1405.00,1405.00,N/A
21700_3,REVISION OF NECK MUSCLE,ProFee,0989,21700,,,,0,3.00,2.25,2.25,519.50,0.00,519.50,519.50,N/A
21705_3,REVISION OF NECK MUSCLE/RIB,ProFee,0989,21705,,,,0,3.00,2.25,2.25,776.50,0.00,776.50,776.50,N/A
21720_3,REVISION OF NECK MUSCLE,ProFee,0989,21720,,,,0,3.00,2.25,2.25,758.50,0.00,758.50,758.50,N/A
21725_3,REVISION OF NECK MUSCLE,ProFee,0989,21725,,,,0,3.00,2.25,2.25,779.00,0.00,779.00,779.00,N/A
21740_3,RECONSTRUCTION OF STERNUM,ProFee,0989,21740,,,,0,3.00,2.25,2.25,1492.00,0.00,1492.00,1492.00,N/A
21742_3,REPAIR STERN/NUSS W/O SCOPE,ProFee,0989,21742,,,,0,3.00,2.25,2.25,1746.50,0.00,1746.50,1746.50,N/A
21743_3,REPAIR STERNUM/NUSS W/SCOPE,ProFee,0989,21743,,,,0,3.00,2.25,2.25,2298.00,0.00,2298.00,2298.00,N/A
21750_3,REPAIR OF STERNUM SEPARATION,ProFee,0989,21750,,,,0,3.00,2.25,2.25,985.50,0.00,985.50,985.50,N/A
21800_3,TREATMENT OF RIB FRACTURE,ProFee,0989,21800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21805_3,TREATMENT OF RIB FRACTURE,ProFee,0989,21805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21810_3,TREATMENT OF RIB FRACTURE(S),ProFee,0989,21810,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
21811_3,OPTX OF RIB FX W/FIXJ SCOPE,ProFee,0989,21811,,,,0,3.00,2.25,2.25,863.50,0.00,863.50,863.50,N/A
21812_3,TREATMENT OF RIB FRACTURE,ProFee,0989,21812,,,,0,3.00,2.25,2.25,1051.50,0.00,1051.50,1051.50,N/A
21813_3,TREATMENT OF RIB FRACTURE,ProFee,0989,21813,,,,0,3.00,2.25,2.25,1433.00,0.00,1433.00,1433.00,N/A
21820_3,TREAT STERNUM FRACTURE,ProFee,0989,21820,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
21825_3,TREAT STERNUM FRACTURE,ProFee,0989,21825,,,,0,3.00,2.25,2.25,775.50,0.00,775.50,775.50,N/A
21899_3,NECK/CHEST SURGERY PROCEDURE,ProFee,0989,21899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
21920_3,BIOPSY SOFT TISSUE OF BACK,ProFee,0989,21920,,,,0,3.00,2.25,2.25,229.50,0.00,229.50,229.50,N/A
21925_3,BIOPSY SOFT TISSUE OF BACK,ProFee,0989,21925,,,,0,3.00,2.25,2.25,511.50,0.00,511.50,511.50,N/A
21930_3,"REMOVE LESION, BACK OR FLANK",ProFee,0989,21930,,,,0,3.00,2.25,2.25,525.50,0.00,525.50,525.50,N/A
21931_3,EXC BACK LES SC = 3 CM,ProFee,0989,21931,,,,0,3.00,2.25,2.25,678.00,0.00,678.00,678.00,N/A
21932_3,EXC BACK TUM DEEP < 5 CM,ProFee,0989,21932,,,,0,3.00,2.25,2.25,954.00,0.00,954.00,954.00,N/A
21933_3,EXC BACK TUM DEEP = 5 CM,ProFee,0989,21933,,,,0,3.00,2.25,2.25,1064.00,0.00,1064.00,1064.00,N/A
21935_3,"REMOVE TUMOR, BACK",ProFee,0989,21935,,,,0,3.00,2.25,2.25,1480.50,0.00,1480.50,1480.50,N/A
21936_3,RESECT BACK TUM = 5 CM,ProFee,0989,21936,,,,0,3.00,2.25,2.25,2045.00,0.00,2045.00,2045.00,N/A
22010_3,"I&D, P-SPINE, C/T/CERV-THOR",ProFee,0989,22010,,,,0,3.00,2.25,2.25,1377.00,0.00,1377.00,1377.00,N/A
22015_3,"I&D, P-SPINE, L/S/LS",ProFee,0989,22015,,,,0,3.00,2.25,2.25,1366.00,0.00,1366.00,1366.00,N/A
22100_3,REMOVE PART OF NECK VERTEBRA,ProFee,0989,22100,,,,0,3.00,2.25,2.25,1312.50,0.00,1312.50,1312.50,N/A
22101_3,"REMOVE PART, THORAX VERTEBRA",ProFee,0989,22101,,,,0,3.00,2.25,2.25,1303.00,0.00,1303.00,1303.00,N/A
22102_3,"REMOVE PART, LUMBAR VERTEBRA",ProFee,0989,22102,,,,0,3.00,2.25,2.25,1146.50,0.00,1146.50,1146.50,N/A
22103_3,REMOVE EXTRA SPINE SEGMENT,ProFee,0989,22103,,,,0,3.00,2.25,2.25,205.00,0.00,205.00,205.00,N/A
22110_3,REMOVE PART OF NECK VERTEBRA,ProFee,0989,22110,,,,0,3.00,2.25,2.25,1510.00,0.00,1510.00,1510.00,N/A
22112_3,"REMOVE PART, THORAX VERTEBRA",ProFee,0989,22112,,,,0,3.00,2.25,2.25,1632.00,0.00,1632.00,1632.00,N/A
22114_3,"REMOVE PART, LUMBAR VERTEBRA",ProFee,0989,22114,,,,0,3.00,2.25,2.25,1632.00,0.00,1632.00,1632.00,N/A
22116_3,REMOVE EXTRA SPINE SEGMENT,ProFee,0989,22116,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
22206_3,"CUT SPINE 3 COL, THOR",ProFee,0989,22206,,,,0,3.00,2.25,2.25,3545.00,0.00,3545.00,3545.00,N/A
22207_3,"CUT SPINE 3 COL, LUMB",ProFee,0989,22207,,,,0,3.00,2.25,2.25,3489.50,0.00,3489.50,3489.50,N/A
22208_3,"CUT SPINE 3 COL, ADDL SEG",ProFee,0989,22208,,,,0,3.00,2.25,2.25,866.50,0.00,866.50,866.50,N/A
22210_3,REVISION OF NECK SPINE,ProFee,0989,22210,,,,0,3.00,2.25,2.25,2601.00,0.00,2601.00,2601.00,N/A
22212_3,REVISION OF THORAX SPINE,ProFee,0989,22212,,,,0,3.00,2.25,2.25,2155.00,0.00,2155.00,2155.00,N/A
22214_3,REVISION OF LUMBAR SPINE,ProFee,0989,22214,,,,0,3.00,2.25,2.25,2160.50,0.00,2160.50,2160.50,N/A
22216_3,"REVISE, EXTRA SPINE SEGMENT",ProFee,0989,22216,,,,0,3.00,2.25,2.25,530.50,0.00,530.50,530.50,N/A
22220_3,REVISION OF NECK SPINE,ProFee,0989,22220,,,,0,3.00,2.25,2.25,2325.00,0.00,2325.00,2325.00,N/A
22222_3,REVISION OF THORAX SPINE,ProFee,0989,22222,,,,0,3.00,2.25,2.25,2545.00,0.00,2545.00,2545.00,N/A
22224_3,REVISION OF LUMBAR SPINE,ProFee,0989,22224,,,,0,3.00,2.25,2.25,2296.00,0.00,2296.00,2296.00,N/A
22226_3,"REVISE, EXTRA SPINE SEGMENT",ProFee,0989,22226,,,,0,3.00,2.25,2.25,529.50,0.00,529.50,529.50,N/A
22305_3,TREAT SPINE PROCESS FRACTURE,ProFee,0989,22305,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22310_3,TREAT SPINE FRACTURE,ProFee,0989,22310,,,,0,3.00,2.25,2.25,408.00,0.00,408.00,408.00,N/A
22315_3,TREAT SPINE FRACTURE,ProFee,0989,22315,,,,0,3.00,2.25,2.25,1111.00,0.00,1111.00,1111.00,N/A
22318_3,TREAT ODONTOID FX W/O GRAFT,ProFee,0989,22318,,,,0,3.00,2.25,2.25,2380.50,0.00,2380.50,2380.50,N/A
22319_3,TREAT ODONTOID FX W/GRAFT,ProFee,0989,22319,,,,0,3.00,2.25,2.25,2672.00,0.00,2672.00,2672.00,N/A
22325_3,TREAT SPINE FRACTURE,ProFee,0989,22325,,,,0,3.00,2.25,2.25,2089.00,0.00,2089.00,2089.00,N/A
22326_3,TREAT NECK SPINE FRACTURE,ProFee,0989,22326,,,,0,3.00,2.25,2.25,2170.50,0.00,2170.50,2170.50,N/A
22327_3,TREAT THORAX SPINE FRACTURE,ProFee,0989,22327,,,,0,3.00,2.25,2.25,2180.50,0.00,2180.50,2180.50,N/A
22328_3,TREAT EACH ADD SPINE FX,ProFee,0989,22328,,,,0,3.00,2.25,2.25,412.50,0.00,412.50,412.50,N/A
22505_3,MANIPULATION OF SPINE,ProFee,0989,22505,,,,0,3.00,2.25,2.25,190.50,0.00,190.50,190.50,N/A
22510_3,PERQ CERVICOTHORACIC INJECT,ProFee,0989,22510,,,,0,3.00,2.25,2.25,629.50,0.00,629.50,629.50,N/A
22511_3,PERQ LUMBOSACRAL INJECTION,ProFee,0989,22511,,,,0,3.00,2.25,2.25,588.50,0.00,588.50,588.50,N/A
22512_3,VERTEBROPLASTY ADDL INJECT,ProFee,0989,22512,,,,0,3.00,2.25,2.25,301.00,0.00,301.00,301.00,N/A
22513_3,PERQ VERTEBRAL AUGMENTATION,ProFee,0989,22513,,,,0,3.00,2.25,2.25,752.00,0.00,752.00,752.00,N/A
22514_3,PERQ VERTEBRAL AUGMENTATION,ProFee,0989,22514,,,,0,3.00,2.25,2.25,700.00,0.00,700.00,700.00,N/A
22515_3,PERQ VERTEBRAL AUGMENTATION,ProFee,0989,22515,,,,0,3.00,2.25,2.25,324.50,0.00,324.50,324.50,N/A
22520_3,PERCUT VERTEBROPLASTY THOR,ProFee,0989,22520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22521_3,PERCUT VERTEBROPLASTY LUMB,ProFee,0989,22521,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22522_3,PERCUT VERTEBROPLASTY ADD'L,ProFee,0989,22522,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22523_3,"PERCUT KYPHOPLASTY, THOR",ProFee,0989,22523,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22524_3,"PERCUT KYPHOPLASTY, LUMBAR",ProFee,0989,22524,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22525_3,"PERCUT KYPHOPLASTY, ADD-ON",ProFee,0989,22525,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22526_3,"IDET, SINGLE LEVEL",ProFee,0989,22526,,,,0,3.00,2.25,2.25,487.50,0.00,487.50,487.50,N/A
22527_3,"IDET, 1 OR MORE LEVELS",ProFee,0989,22527,,,,0,3.00,2.25,2.25,230.50,0.00,230.50,230.50,N/A
22532_3,LAT THORAX SPINE FUSION,ProFee,0989,22532,,,,0,3.00,2.25,2.25,2604.50,0.00,2604.50,2604.50,N/A
22533_3,LAT LUMBAR SPINE FUSION,ProFee,0989,22533,,,,0,3.00,2.25,2.25,2407.00,0.00,2407.00,2407.00,N/A
22534_3,"LAT THOR/LUMB, ADD'L SEG",ProFee,0989,22534,,,,0,3.00,2.25,2.25,526.50,0.00,526.50,526.50,N/A
22548_3,NECK SPINE FUSION,ProFee,0989,22548,,,,0,3.00,2.25,2.25,2869.50,0.00,2869.50,2869.50,N/A
22551_3,NECK SPINE FUSE&REMOVE ADDL,ProFee,0989,22551,,,,0,3.00,2.25,2.25,2485.50,0.00,2485.50,2485.50,N/A
22552_3,ADDL NECK SPINE FUSION,ProFee,0989,22552,,,,0,3.00,2.25,2.25,582.00,0.00,582.00,582.00,N/A
22554_3,NECK SPINE FUSION,ProFee,0989,22554,,,,0,3.00,2.25,2.25,1820.00,0.00,1820.00,1820.00,N/A
22556_3,THORAX SPINE FUSION,ProFee,0989,22556,,,,0,3.00,2.25,2.25,2423.50,0.00,2423.50,2423.50,N/A
22558_3,LUMBAR SPINE FUSION,ProFee,0989,22558,,,,0,3.00,2.25,2.25,2227.00,0.00,2227.00,2227.00,N/A
22585_3,ADDITIONAL SPINAL FUSION,ProFee,0989,22585,,,,0,3.00,2.25,2.25,479.00,0.00,479.00,479.00,N/A
22586_3,PRESCRL FUSE W/ INSTR L5-S1,ProFee,0989,22586,,,,0,3.00,2.25,2.25,2914.50,0.00,2914.50,2914.50,N/A
22590_3,SPINE & SKULL SPINAL FUSION,ProFee,0989,22590,,,,0,3.00,2.25,2.25,2296.00,0.00,2296.00,2296.00,N/A
22595_3,NECK SPINAL FUSION,ProFee,0989,22595,,,,0,3.00,2.25,2.25,2191.50,0.00,2191.50,2191.50,N/A
22600_3,NECK SPINE FUSION,ProFee,0989,22600,,,,0,3.00,2.25,2.25,1872.50,0.00,1872.50,1872.50,N/A
22610_3,THORAX SPINE FUSION,ProFee,0989,22610,,,,0,3.00,2.25,2.25,1835.50,0.00,1835.50,1835.50,N/A
22612_3,LUMBAR SPINE FUSION,ProFee,0989,22612,,,,0,3.00,2.25,2.25,2305.00,0.00,2305.00,2305.00,N/A
22614_3,"SPINE FUSION, EXTRA SEGMENT",ProFee,0989,22614,,,,0,3.00,2.25,2.25,571.50,0.00,571.50,571.50,N/A
22630_3,LUMBAR SPINE FUSION,ProFee,0989,22630,,,,0,3.00,2.25,2.25,2288.00,0.00,2288.00,2288.00,N/A
22632_3,"SPINE FUSION, EXTRA SEGMENT",ProFee,0989,22632,,,,0,3.00,2.25,2.25,471.00,0.00,471.00,471.00,N/A
22633_3,LUMBAR SPINE FUSION COMBINED,ProFee,0989,22633,,,,0,3.00,2.25,2.25,2693.50,0.00,2693.50,2693.50,N/A
22634_3,SPINE FUSION EXTRA SEGMENT,ProFee,0989,22634,,,,0,3.00,2.25,2.25,725.00,0.00,725.00,725.00,N/A
22800_3,FUSION OF SPINE,ProFee,0989,22800,,,,0,3.00,2.25,2.25,1959.50,0.00,1959.50,1959.50,N/A
22802_3,FUSION OF SPINE,ProFee,0989,22802,,,,0,3.00,2.25,2.25,3057.00,0.00,3057.00,3057.00,N/A
22804_3,FUSION OF SPINE,ProFee,0989,22804,,,,0,3.00,2.25,2.25,3524.00,0.00,3524.00,3524.00,N/A
22808_3,FUSION OF SPINE,ProFee,0989,22808,,,,0,3.00,2.25,2.25,2697.50,0.00,2697.50,2697.50,N/A
22810_3,FUSION OF SPINE,ProFee,0989,22810,,,,0,3.00,2.25,2.25,2862.50,0.00,2862.50,2862.50,N/A
22812_3,FUSION OF SPINE,ProFee,0989,22812,,,,0,3.00,2.25,2.25,3204.00,0.00,3204.00,3204.00,N/A
22818_3,"KYPHECTOMY, 1-2 SEGMENTS",ProFee,0989,22818,,,,0,3.00,2.25,2.25,3148.00,0.00,3148.00,3148.00,N/A
22819_3,"KYPHECTOMY, 3 OR MORE",ProFee,0989,22819,,,,0,3.00,2.25,2.25,3618.50,0.00,3618.50,3618.50,N/A
22830_3,EXPLORATION OF SPINAL FUSION,ProFee,0989,22830,,,,0,3.00,2.25,2.25,1180.00,0.00,1180.00,1180.00,N/A
22840_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22840,,,,0,3.00,2.25,2.25,1111.00,0.00,1111.00,1111.00,N/A
22841_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22841,,,,0,3.00,2.25,2.25,563.00,0.00,563.00,563.00,N/A
22842_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22842,,,,0,3.00,2.25,2.25,1115.50,0.00,1115.50,1115.50,N/A
22843_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22843,,,,0,3.00,2.25,2.25,1193.50,0.00,1193.50,1193.50,N/A
22844_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22844,,,,0,3.00,2.25,2.25,1441.50,0.00,1441.50,1441.50,N/A
22845_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22845,,,,0,3.00,2.25,2.25,1067.50,0.00,1067.50,1067.50,N/A
22846_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22846,,,,0,3.00,2.25,2.25,1108.00,0.00,1108.00,1108.00,N/A
22847_3,INSERT SPINE FIXATION DEVICE,ProFee,0989,22847,,,,0,3.00,2.25,2.25,1177.50,0.00,1177.50,1177.50,N/A
22848_3,INSERT PELV FIXATION DEVICE,ProFee,0989,22848,,,,0,3.00,2.25,2.25,525.50,0.00,525.50,525.50,N/A
22849_3,REINSERT SPINAL FIXATION,ProFee,0989,22849,,,,0,3.00,2.25,2.25,1886.50,0.00,1886.50,1886.50,N/A
22850_3,REMOVE SPINE FIXATION DEVICE,ProFee,0989,22850,,,,0,3.00,2.25,2.25,1048.00,0.00,1048.00,1048.00,N/A
22851_3,APPLY SPINE PROSTH DEVICE,ProFee,0989,22851,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
22852_3,REMOVE SPINE FIXATION DEVICE,ProFee,0989,22852,,,,0,3.00,2.25,2.25,1006.00,0.00,1006.00,1006.00,N/A
22853_3,INSJ BIOMECHANICAL DEVICE,ProFee,0989,22853,,,,0,3.00,2.25,2.25,364.50,0.00,364.50,364.50,N/A
22854_3,INSJ BIOMECHANICAL DEVICE,ProFee,0989,22854,,,,0,3.00,2.25,2.25,471.50,0.00,471.50,471.50,N/A
22855_3,REMOVE SPINE FIXATION DEVICE,ProFee,0989,22855,,,,0,3.00,2.25,2.25,1608.00,0.00,1608.00,1608.00,N/A
22856_3,CERV ARTIFIC DISKECTOMY,ProFee,0989,22856,,,,0,3.00,2.25,2.25,2378.50,0.00,2378.50,2378.50,N/A
22857_3,LUMBAR ARTIF DISKECTOMY,ProFee,0989,22857,,,,0,3.00,2.25,2.25,2455.50,0.00,2455.50,2455.50,N/A
22858_3,SECOND LEVEL CER DISKECTOMY,ProFee,0989,22858,,,,0,3.00,2.25,2.25,747.00,0.00,747.00,747.00,N/A
22859_3,INSJ BIOMECHANICAL DEVICE,ProFee,0989,22859,,,,0,3.00,2.25,2.25,471.50,0.00,471.50,471.50,N/A
22861_3,REVISE CERV ARTIFIC DISC,ProFee,0989,22861,,,,0,3.00,2.25,2.25,3407.50,0.00,3407.50,3407.50,N/A
22862_3,REVISE LUMBAR ARTIF DISC,ProFee,0989,22862,,,,0,3.00,2.25,2.25,3391.50,0.00,3391.50,3391.50,N/A
22864_3,REMOVE CERV ARTIF DISC,ProFee,0989,22864,,,,0,3.00,2.25,2.25,3039.50,0.00,3039.50,3039.50,N/A
22865_3,REMOVE LUMB ARTIF DISC,ProFee,0989,22865,,,,0,3.00,2.25,2.25,2954.50,0.00,2954.50,2954.50,N/A
22867_3,INSJ STABLJ DEV W/DCMPRN,ProFee,0989,22867,,,,0,3.00,2.25,2.25,1350.50,0.00,1350.50,1350.50,N/A
22868_3,INSJ STABLJ DEV W/DCMPRN,ProFee,0989,22868,,,,0,3.00,2.25,2.25,344.00,0.00,344.00,344.00,N/A
22869_3,INSJ STABLJ DEV W/O DCMPRN,ProFee,0989,22869,,,,0,3.00,2.25,2.25,766.50,0.00,766.50,766.50,N/A
22870_3,INSJ STABLJ DEV W/O DCMPRN,ProFee,0989,22870,,,,0,3.00,2.25,2.25,198.00,0.00,198.00,198.00,N/A
22899_3,SPINE SURGERY PROCEDURE,ProFee,0989,22899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
22900_3,REMOVE ABDOMINAL WALL LESION,ProFee,0989,22900,,,,0,3.00,2.25,2.25,814.00,0.00,814.00,814.00,N/A
22901_3,EXC BACK TUM DEEP = 5 CM,ProFee,0989,22901,,,,0,3.00,2.25,2.25,961.00,0.00,961.00,961.00,N/A
22902_3,EXC ABD LES SC < 3 CM,ProFee,0989,22902,,,,0,3.00,2.25,2.25,476.00,0.00,476.00,476.00,N/A
22903_3,EXC ABD LES SC > 3 CM,ProFee,0989,22903,,,,0,3.00,2.25,2.25,633.50,0.00,633.50,633.50,N/A
22904_3,RESECT ABD TUM < 5 CM,ProFee,0989,22904,,,,0,3.00,2.25,2.25,1516.50,0.00,1516.50,1516.50,N/A
22905_3,RESECT ABD TUM > 5 CM,ProFee,0989,22905,,,,0,3.00,2.25,2.25,1925.00,0.00,1925.00,1925.00,N/A
22999_3,ABDOMEN SURGERY PROCEDURE,ProFee,0989,22999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
23000_3,REMOVAL OF CALCIUM DEPOSITS,ProFee,0989,23000,,,,0,3.00,2.25,2.25,531.00,0.00,531.00,531.00,N/A
23020_3,RELEASE SHOULDER JOINT,ProFee,0989,23020,,,,0,3.00,2.25,2.25,992.00,0.00,992.00,992.00,N/A
23030_3,DRAIN SHOULDER LESION,ProFee,0989,23030,,,,0,3.00,2.25,2.25,370.50,0.00,370.50,370.50,N/A
23031_3,DRAIN SHOULDER BURSA,ProFee,0989,23031,,,,0,3.00,2.25,2.25,311.00,0.00,311.00,311.00,N/A
23035_3,DRAIN SHOULDER BONE LESION,ProFee,0989,23035,,,,0,3.00,2.25,2.25,977.50,0.00,977.50,977.50,N/A
23040_3,EXPLORATORY SHOULDER SURGERY,ProFee,0989,23040,,,,0,3.00,2.25,2.25,1031.50,0.00,1031.50,1031.50,N/A
23044_3,EXPLORATORY SHOULDER SURGERY,ProFee,0989,23044,,,,0,3.00,2.25,2.25,814.50,0.00,814.50,814.50,N/A
23065_3,BIOPSY SHOULDER TISSUES,ProFee,0989,23065,,,,0,3.00,2.25,2.25,241.00,0.00,241.00,241.00,N/A
23066_3,BIOPSY SHOULDER TISSUES,ProFee,0989,23066,,,,0,3.00,2.25,2.25,514.50,0.00,514.50,514.50,N/A
23071_3,EXC SHOULDER LES SC > 3 CM,ProFee,0989,23071,,,,0,3.00,2.25,2.25,605.50,0.00,605.50,605.50,N/A
23073_3,EXC SHOULDER TUM DEEP > 5 CM,ProFee,0989,23073,,,,0,3.00,2.25,2.25,1001.00,0.00,1001.00,1001.00,N/A
23075_3,REMOVAL OF SHOULDER LESION,ProFee,0989,23075,,,,0,3.00,2.25,2.25,471.50,0.00,471.50,471.50,N/A
23076_3,REMOVAL OF SHOULDER LESION,ProFee,0989,23076,,,,0,3.00,2.25,2.25,777.50,0.00,777.50,777.50,N/A
23077_3,REMOVE TUMOR OF SHOULDER,ProFee,0989,23077,,,,0,3.00,2.25,2.25,1644.50,0.00,1644.50,1644.50,N/A
23078_3,RESECT SHOULDER TUM > 5 CM,ProFee,0989,23078,,,,0,3.00,2.25,2.25,2075.00,0.00,2075.00,2075.00,N/A
23100_3,BIOPSY OF SHOULDER JOINT,ProFee,0989,23100,,,,0,3.00,2.25,2.25,721.00,0.00,721.00,721.00,N/A
23101_3,SHOULDER JOINT SURGERY,ProFee,0989,23101,,,,0,3.00,2.25,2.25,656.50,0.00,656.50,656.50,N/A
23105_3,REMOVE SHOULDER JOINT LINING,ProFee,0989,23105,,,,0,3.00,2.25,2.25,918.50,0.00,918.50,918.50,N/A
23106_3,INCISION OF COLLARBONE JOINT,ProFee,0989,23106,,,,0,3.00,2.25,2.25,714.50,0.00,714.50,714.50,N/A
23107_3,EXPLORE TREAT SHOULDER JOINT,ProFee,0989,23107,,,,0,3.00,2.25,2.25,951.50,0.00,951.50,951.50,N/A
23120_3,"PARTIAL REMOVAL, COLLAR BONE",ProFee,0989,23120,,,,0,3.00,2.25,2.25,840.00,0.00,840.00,840.00,N/A
23125_3,REMOVAL OF COLLAR BONE,ProFee,0989,23125,,,,0,3.00,2.25,2.25,1021.50,0.00,1021.50,1021.50,N/A
23130_3,"REMOVE SHOULDER BONE, PART",ProFee,0989,23130,,,,0,3.00,2.25,2.25,877.00,0.00,877.00,877.00,N/A
23140_3,REMOVAL OF BONE LESION,ProFee,0989,23140,,,,0,3.00,2.25,2.25,768.50,0.00,768.50,768.50,N/A
23145_3,REMOVAL OF BONE LESION,ProFee,0989,23145,,,,0,3.00,2.25,2.25,1000.50,0.00,1000.50,1000.50,N/A
23146_3,REMOVAL OF BONE LESION,ProFee,0989,23146,,,,0,3.00,2.25,2.25,894.00,0.00,894.00,894.00,N/A
23150_3,REMOVAL OF HUMERUS LESION,ProFee,0989,23150,,,,0,3.00,2.25,2.25,954.50,0.00,954.50,954.50,N/A
23155_3,REMOVAL OF HUMERUS LESION,ProFee,0989,23155,,,,0,3.00,2.25,2.25,1142.50,0.00,1142.50,1142.50,N/A
23156_3,REMOVAL OF HUMERUS LESION,ProFee,0989,23156,,,,0,3.00,2.25,2.25,975.50,0.00,975.50,975.50,N/A
23170_3,REMOVE COLLAR BONE LESION,ProFee,0989,23170,,,,0,3.00,2.25,2.25,807.00,0.00,807.00,807.00,N/A
23172_3,REMOVE SHOULDER BLADE LESION,ProFee,0989,23172,,,,0,3.00,2.25,2.25,815.00,0.00,815.00,815.00,N/A
23174_3,REMOVE HUMERUS LESION,ProFee,0989,23174,,,,0,3.00,2.25,2.25,1091.50,0.00,1091.50,1091.50,N/A
23180_3,REMOVE COLLAR BONE LESION,ProFee,0989,23180,,,,0,3.00,2.25,2.25,941.50,0.00,941.50,941.50,N/A
23182_3,REMOVE SHOULDER BLADE LESION,ProFee,0989,23182,,,,0,3.00,2.25,2.25,943.00,0.00,943.00,943.00,N/A
23184_3,REMOVE HUMERUS LESION,ProFee,0989,23184,,,,0,3.00,2.25,2.25,1050.00,0.00,1050.00,1050.00,N/A
23190_3,PARTIAL REMOVAL OF SCAPULA,ProFee,0989,23190,,,,0,3.00,2.25,2.25,823.00,0.00,823.00,823.00,N/A
23195_3,REMOVAL OF HEAD OF HUMERUS,ProFee,0989,23195,,,,0,3.00,2.25,2.25,1088.50,0.00,1088.50,1088.50,N/A
23200_3,REMOVAL OF COLLAR BONE,ProFee,0989,23200,,,,0,3.00,2.25,2.25,2191.00,0.00,2191.00,2191.00,N/A
23210_3,REMOVAL OF SHOULDER BLADE,ProFee,0989,23210,,,,0,3.00,2.25,2.25,2575.00,0.00,2575.00,2575.00,N/A
23220_3,PARTIAL REMOVAL OF HUMERUS,ProFee,0989,23220,,,,0,3.00,2.25,2.25,2828.50,0.00,2828.50,2828.50,N/A
23221_3,PARTIAL REMOVAL OF HUMERUS,ProFee,0989,23221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
23222_3,PARTIAL REMOVAL OF HUMERUS,ProFee,0989,23222,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
23330_3,REMOVE SHOULDER FOREIGN BODY,ProFee,0989,23330,,,,0,3.00,2.25,2.25,239.50,0.00,239.50,239.50,N/A
23331_3,REMOVE SHOULDER FOREIGN BODY,ProFee,0989,23331,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
23332_3,REMOVE SHOULDER FOREIGN BODY,ProFee,0989,23332,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
23333_3,REMOVE SHOULDER FB DEEP,ProFee,0989,23333,,,,0,3.00,2.25,2.25,669.50,0.00,669.50,669.50,N/A
23334_3,SHOULDER PROSTHESIS REMOVAL,ProFee,0989,23334,,,,0,3.00,2.25,2.25,1551.00,0.00,1551.00,1551.00,N/A
23335_3,SHOULDER PROSTHESIS REMOVAL,ProFee,0989,23335,,,,0,3.00,2.25,2.25,1846.50,0.00,1846.50,1846.50,N/A
23350_3,INJECTION FOR SHOULDER X-RAY,ProFee,0989,23350,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
23395_3,"MUSCLE TRANSFER,SHOULDER/ARM",ProFee,0989,23395,,,,0,3.00,2.25,2.25,1847.00,0.00,1847.00,1847.00,N/A
23397_3,MUSCLE TRANSFERS,ProFee,0989,23397,,,,0,3.00,2.25,2.25,1638.00,0.00,1638.00,1638.00,N/A
23400_3,FIXATION OF SHOULDER BLADE,ProFee,0989,23400,,,,0,3.00,2.25,2.25,1400.00,0.00,1400.00,1400.00,N/A
23405_3,INCISION OF TENDON & MUSCLE,ProFee,0989,23405,,,,0,3.00,2.25,2.25,890.50,0.00,890.50,890.50,N/A
23406_3,INCISE TENDON(S) & MUSCLE(S),ProFee,0989,23406,,,,0,3.00,2.25,2.25,1108.00,0.00,1108.00,1108.00,N/A
23410_3,"REPAIR ROTATOR CUFF, ACUTE",ProFee,0989,23410,,,,0,3.00,2.25,2.25,1182.00,0.00,1182.00,1182.00,N/A
23412_3,"REPAIR ROTATOR CUFF, CHRONIC",ProFee,0989,23412,,,,0,3.00,2.25,2.25,1226.50,0.00,1226.50,1226.50,N/A
23415_3,RELEASE OF SHOULDER LIGAMENT,ProFee,0989,23415,,,,0,3.00,2.25,2.25,1002.50,0.00,1002.50,1002.50,N/A
23420_3,REPAIR OF SHOULDER,ProFee,0989,23420,,,,0,3.00,2.25,2.25,1396.00,0.00,1396.00,1396.00,N/A
23430_3,REPAIR BICEPS TENDON,ProFee,0989,23430,,,,0,3.00,2.25,2.25,1070.00,0.00,1070.00,1070.00,N/A
23440_3,REMOVE/TRANSPLANT TENDON,ProFee,0989,23440,,,,0,3.00,2.25,2.25,1084.50,0.00,1084.50,1084.50,N/A
23450_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23450,,,,0,3.00,2.25,2.25,1368.00,0.00,1368.00,1368.00,N/A
23455_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23455,,,,0,3.00,2.25,2.25,1436.00,0.00,1436.00,1436.00,N/A
23460_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23460,,,,0,3.00,2.25,2.25,1572.50,0.00,1572.50,1572.50,N/A
23462_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23462,,,,0,3.00,2.25,2.25,1535.00,0.00,1535.00,1535.00,N/A
23465_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23465,,,,0,3.00,2.25,2.25,1613.50,0.00,1613.50,1613.50,N/A
23466_3,REPAIR SHOULDER CAPSULE,ProFee,0989,23466,,,,0,3.00,2.25,2.25,1622.00,0.00,1622.00,1622.00,N/A
23470_3,RECONSTRUCT SHOULDER JOINT,ProFee,0989,23470,,,,0,3.00,2.25,2.25,1729.00,0.00,1729.00,1729.00,N/A
23472_3,RECONSTRUCT SHOULDER JOINT,ProFee,0989,23472,,,,0,3.00,2.25,2.25,2100.50,0.00,2100.50,2100.50,N/A
23473_3,REVIS RECONST SHOULDER JOINT,ProFee,0989,23473,,,,0,3.00,2.25,2.25,2344.50,0.00,2344.50,2344.50,N/A
23474_3,REVIS RECONST SHOULDER JOINT,ProFee,0989,23474,,,,0,3.00,2.25,2.25,2532.00,0.00,2532.00,2532.00,N/A
23480_3,REVISION OF COLLAR BONE,ProFee,0989,23480,,,,0,3.00,2.25,2.25,1183.50,0.00,1183.50,1183.50,N/A
23485_3,REVISION OF COLLAR BONE,ProFee,0989,23485,,,,0,3.00,2.25,2.25,1370.00,0.00,1370.00,1370.00,N/A
23490_3,REINFORCE CLAVICLE,ProFee,0989,23490,,,,0,3.00,2.25,2.25,1243.00,0.00,1243.00,1243.00,N/A
23491_3,REINFORCE SHOULDER BONES,ProFee,0989,23491,,,,0,3.00,2.25,2.25,1463.00,0.00,1463.00,1463.00,N/A
23500_3,TREAT CLAVICLE FRACTURE,ProFee,0989,23500,,,,0,3.00,2.25,2.25,317.00,0.00,317.00,317.00,N/A
23505_3,TREAT CLAVICLE FRACTURE,ProFee,0989,23505,,,,0,3.00,2.25,2.25,474.50,0.00,474.50,474.50,N/A
23515_3,TREAT CLAVICLE FRACTURE,ProFee,0989,23515,,,,0,3.00,2.25,2.25,1035.00,0.00,1035.00,1035.00,N/A
23520_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23520,,,,0,3.00,2.25,2.25,336.50,0.00,336.50,336.50,N/A
23525_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23525,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
23530_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23530,,,,0,3.00,2.25,2.25,823.50,0.00,823.50,823.50,N/A
23532_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23532,,,,0,3.00,2.25,2.25,898.50,0.00,898.50,898.50,N/A
23540_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23540,,,,0,3.00,2.25,2.25,326.00,0.00,326.00,326.00,N/A
23545_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23545,,,,0,3.00,2.25,2.25,443.50,0.00,443.50,443.50,N/A
23550_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23550,,,,0,3.00,2.25,2.25,808.00,0.00,808.00,808.00,N/A
23552_3,TREAT CLAVICLE DISLOCATION,ProFee,0989,23552,,,,0,3.00,2.25,2.25,940.50,0.00,940.50,940.50,N/A
23570_3,TREAT SHOULDER BLADE FX,ProFee,0989,23570,,,,0,3.00,2.25,2.25,342.00,0.00,342.00,342.00,N/A
23575_3,TREAT SHOULDER BLADE FX,ProFee,0989,23575,,,,0,3.00,2.25,2.25,539.00,0.00,539.00,539.00,N/A
23585_3,TREAT SCAPULA FRACTURE,ProFee,0989,23585,,,,0,3.00,2.25,2.25,1411.00,0.00,1411.00,1411.00,N/A
23600_3,TREAT HUMERUS FRACTURE,ProFee,0989,23600,,,,0,3.00,2.25,2.25,439.50,0.00,439.50,439.50,N/A
23605_3,TREAT HUMERUS FRACTURE,ProFee,0989,23605,,,,0,3.00,2.25,2.25,606.00,0.00,606.00,606.00,N/A
23615_3,TREAT HUMERUS FRACTURE,ProFee,0989,23615,,,,0,3.00,2.25,2.25,1273.50,0.00,1273.50,1273.50,N/A
23616_3,TREAT HUMERUS FRACTURE,ProFee,0989,23616,,,,0,3.00,2.25,2.25,1787.50,0.00,1787.50,1787.50,N/A
23620_3,TREAT HUMERUS FRACTURE,ProFee,0989,23620,,,,0,3.00,2.25,2.25,366.00,0.00,366.00,366.00,N/A
23625_3,TREAT HUMERUS FRACTURE,ProFee,0989,23625,,,,0,3.00,2.25,2.25,501.50,0.00,501.50,501.50,N/A
23630_3,TREAT HUMERUS FRACTURE,ProFee,0989,23630,,,,0,3.00,2.25,2.25,1121.50,0.00,1121.50,1121.50,N/A
23650_2,TREAT SHOULDER DISLOCATION,Inpatient,0521,23650,,,,0,794.00,595.50,595.50,754.30,714.60,754.30,754.30,714.60
23650_2,TREAT SHOULDER DISLOCATION,Ambulatory Surgical,0521,23650,,,,0,794.00,595.50,595.50,754.30,714.60,754.30,0.00,714.60
23650_3,TREAT SHOULDER DISLOCATION,Inpatient,0521,23650,,,,0,774.00,580.50,580.50,735.30,696.60,735.30,735.30,696.60
23650_3,TREAT SHOULDER DISLOCATION,Ambulatory Surgical,0521,23650,,,,0,774.00,580.50,580.50,735.30,696.60,735.30,0.00,696.60
23655_2,TREAT SHOULDER DISLOCATION,Ambulatory Surgical,0521,23655,,,,0,873.00,654.75,654.75,829.35,785.70,829.35,0.00,785.70
23655_2,TREAT SHOULDER DISLOCATION,Inpatient,0521,23655,,,,0,873.00,654.75,654.75,829.35,785.70,829.35,829.35,785.70
23655_3,TREAT SHOULDER DISLOCATION,Inpatient,0521,23655,,,,0,851.00,638.25,638.25,808.45,765.90,808.45,808.45,765.90
23655_3,TREAT SHOULDER DISLOCATION,Ambulatory Surgical,0521,23655,,,,0,851.00,638.25,638.25,808.45,765.90,808.45,0.00,765.90
23660_3,TREAT SHOULDER DISLOCATION,ProFee,0989,23660,,,,0,3.00,2.25,2.25,838.00,0.00,838.00,838.00,N/A
23665_3,TREAT DISLOCATION/FRACTURE,ProFee,0989,23665,,,,0,3.00,2.25,2.25,565.50,0.00,565.50,565.50,N/A
23670_3,TREAT DISLOCATION/FRACTURE,ProFee,0989,23670,,,,0,3.00,2.25,2.25,1258.50,0.00,1258.50,1258.50,N/A
23675_3,TREAT DISLOCATION/FRACTURE,ProFee,0989,23675,,,,0,3.00,2.25,2.25,713.50,0.00,713.50,713.50,N/A
23680_3,TREAT DISLOCATION/FRACTURE,ProFee,0989,23680,,,,0,3.00,2.25,2.25,1338.00,0.00,1338.00,1338.00,N/A
23700_3,FIXATION OF SHOULDER,ProFee,0989,23700,,,,0,3.00,2.25,2.25,282.50,0.00,282.50,282.50,N/A
23800_3,FUSION OF SHOULDER JOINT,ProFee,0989,23800,,,,0,3.00,2.25,2.25,1479.00,0.00,1479.00,1479.00,N/A
23802_3,FUSION OF SHOULDER JOINT,ProFee,0989,23802,,,,0,3.00,2.25,2.25,1853.50,0.00,1853.50,1853.50,N/A
23900_3,AMPUTATION OF ARM & GIRDLE,ProFee,0989,23900,,,,0,3.00,2.25,2.25,2005.00,0.00,2005.00,2005.00,N/A
23920_3,AMPUTATION AT SHOULDER JOINT,ProFee,0989,23920,,,,0,3.00,2.25,2.25,1627.50,0.00,1627.50,1627.50,N/A
23921_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,23921,,,,0,3.00,2.25,2.25,673.00,0.00,673.00,673.00,N/A
23929_3,SHOULDER SURGERY PROCEDURE,ProFee,0989,23929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
23930_3,DRAINAGE OF ARM LESION,ProFee,0989,23930,,,,0,3.00,2.25,2.25,312.50,0.00,312.50,312.50,N/A
23931_3,DRAINAGE OF ARM BURSA,ProFee,0989,23931,,,,0,3.00,2.25,2.25,229.50,0.00,229.50,229.50,N/A
23935_3,DRAIN ARM/ELBOW BONE LESION,ProFee,0989,23935,,,,0,3.00,2.25,2.25,725.50,0.00,725.50,725.50,N/A
24000_3,EXPLORATORY ELBOW SURGERY,ProFee,0989,24000,,,,0,3.00,2.25,2.25,685.00,0.00,685.00,685.00,N/A
24006_3,RELEASE ELBOW JOINT,ProFee,0989,24006,,,,0,3.00,2.25,2.25,1021.50,0.00,1021.50,1021.50,N/A
24065_3,BIOPSY ARM/ELBOW SOFT TISSUE,ProFee,0989,24065,,,,0,3.00,2.25,2.25,240.50,0.00,240.50,240.50,N/A
24066_3,BIOPSY ARM/ELBOW SOFT TISSUE,ProFee,0989,24066,,,,0,3.00,2.25,2.25,595.00,0.00,595.00,595.00,N/A
24071_3,EXC ARM/ELBOW LES SC = 3 CM,ProFee,0989,24071,,,,0,3.00,2.25,2.25,586.00,0.00,586.00,586.00,N/A
24073_3,EX ARM/ELBOW TUM DEEP > 5 CM,ProFee,0989,24073,,,,0,3.00,2.25,2.25,999.50,0.00,999.50,999.50,N/A
24075_3,REMOVE ARM/ELBOW LESION,ProFee,0989,24075,,,,0,3.00,2.25,2.25,475.50,0.00,475.50,475.50,N/A
24076_3,REMOVE ARM/ELBOW LESION,ProFee,0989,24076,,,,0,3.00,2.25,2.25,783.50,0.00,783.50,783.50,N/A
24077_3,REMOVE TUMOR OF ARM/ELBOW,ProFee,0989,24077,,,,0,3.00,2.25,2.25,1494.50,0.00,1494.50,1494.50,N/A
24079_3,RESECT ARM/ELBOW TUM > 5 CM,ProFee,0989,24079,,,,0,3.00,2.25,2.25,1917.50,0.00,1917.50,1917.50,N/A
24100_3,BIOPSY ELBOW JOINT LINING,ProFee,0989,24100,,,,0,3.00,2.25,2.25,600.50,0.00,600.50,600.50,N/A
24101_3,EXPLORE/TREAT ELBOW JOINT,ProFee,0989,24101,,,,0,3.00,2.25,2.25,717.00,0.00,717.00,717.00,N/A
24102_3,REMOVE ELBOW JOINT LINING,ProFee,0989,24102,,,,0,3.00,2.25,2.25,885.00,0.00,885.00,885.00,N/A
24105_3,REMOVAL OF ELBOW BURSA,ProFee,0989,24105,,,,0,3.00,2.25,2.25,503.50,0.00,503.50,503.50,N/A
24110_3,REMOVE HUMERUS LESION,ProFee,0989,24110,,,,0,3.00,2.25,2.25,843.50,0.00,843.50,843.50,N/A
24115_3,REMOVE/GRAFT BONE LESION,ProFee,0989,24115,,,,0,3.00,2.25,2.25,1062.00,0.00,1062.00,1062.00,N/A
24116_3,REMOVE/GRAFT BONE LESION,ProFee,0989,24116,,,,0,3.00,2.25,2.25,1242.50,0.00,1242.50,1242.50,N/A
24120_3,REMOVE ELBOW LESION,ProFee,0989,24120,,,,0,3.00,2.25,2.25,762.00,0.00,762.00,762.00,N/A
24125_3,REMOVE/GRAFT BONE LESION,ProFee,0989,24125,,,,0,3.00,2.25,2.25,893.00,0.00,893.00,893.00,N/A
24126_3,REMOVE/GRAFT BONE LESION,ProFee,0989,24126,,,,0,3.00,2.25,2.25,934.50,0.00,934.50,934.50,N/A
24130_3,REMOVAL OF HEAD OF RADIUS,ProFee,0989,24130,,,,0,3.00,2.25,2.25,730.50,0.00,730.50,730.50,N/A
24134_3,REMOVAL OF ARM BONE LESION,ProFee,0989,24134,,,,0,3.00,2.25,2.25,1076.50,0.00,1076.50,1076.50,N/A
24136_3,REMOVE RADIUS BONE LESION,ProFee,0989,24136,,,,0,3.00,2.25,2.25,908.00,0.00,908.00,908.00,N/A
24138_3,REMOVE ELBOW BONE LESION,ProFee,0989,24138,,,,0,3.00,2.25,2.25,971.00,0.00,971.00,971.00,N/A
24140_3,PARTIAL REMOVAL OF ARM BONE,ProFee,0989,24140,,,,0,3.00,2.25,2.25,1010.50,0.00,1010.50,1010.50,N/A
24145_3,PARTIAL REMOVAL OF RADIUS,ProFee,0989,24145,,,,0,3.00,2.25,2.25,852.00,0.00,852.00,852.00,N/A
24147_3,PARTIAL REMOVAL OF ELBOW,ProFee,0989,24147,,,,0,3.00,2.25,2.25,895.50,0.00,895.50,895.50,N/A
24149_3,RADICAL RESECTION OF ELBOW,ProFee,0989,24149,,,,0,3.00,2.25,2.25,1692.00,0.00,1692.00,1692.00,N/A
24150_3,EXTENSIVE HUMERUS SURGERY,ProFee,0989,24150,,,,0,3.00,2.25,2.25,2249.50,0.00,2249.50,2249.50,N/A
24151_3,EXTENSIVE HUMERUS SURGERY,ProFee,0989,24151,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24152_3,EXTENSIVE RADIUS SURGERY,ProFee,0989,24152,,,,0,3.00,2.25,2.25,1953.00,0.00,1953.00,1953.00,N/A
24153_3,EXTENSIVE RADIUS SURGERY,ProFee,0989,24153,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24155_3,REMOVAL OF ELBOW JOINT,ProFee,0989,24155,,,,0,3.00,2.25,2.25,1230.50,0.00,1230.50,1230.50,N/A
24160_3,REMOVE ELBOW JOINT IMPLANT,ProFee,0989,24160,,,,0,3.00,2.25,2.25,1821.00,0.00,1821.00,1821.00,N/A
24164_3,REMOVE RADIUS HEAD IMPLANT,ProFee,0989,24164,,,,0,3.00,2.25,2.25,1050.00,0.00,1050.00,1050.00,N/A
24200_3,REMOVAL OF ARM FOREIGN BODY,ProFee,0989,24200,,,,0,3.00,2.25,2.25,200.00,0.00,200.00,200.00,N/A
24201_2,REMOVAL OF ARM FOREIGN BODY,Inpatient,0521,24201,,,,0,933.00,699.75,699.75,886.35,839.70,886.35,886.35,839.70
24201_2,REMOVAL OF ARM FOREIGN BODY,Ambulatory Surgical,0521,24201,,,,0,933.00,699.75,699.75,886.35,839.70,886.35,0.00,839.70
24201_3,REMOVAL OF ARM FOREIGN BODY,Ambulatory Surgical,0521,24201,,,,0,909.00,681.75,681.75,863.55,818.10,863.55,0.00,818.10
24201_3,REMOVAL OF ARM FOREIGN BODY,Inpatient,0521,24201,,,,0,909.00,681.75,681.75,863.55,818.10,863.55,863.55,818.10
24220_3,INJECTION FOR ELBOW X-RAY,ProFee,0989,24220,,,,0,3.00,2.25,2.25,98.50,0.00,98.50,98.50,N/A
24301_3,MUSCLE/TENDON TRANSFER,ProFee,0989,24301,,,,0,3.00,2.25,2.25,1080.00,0.00,1080.00,1080.00,N/A
24305_3,ARM TENDON LENGTHENING,ProFee,0989,24305,,,,0,3.00,2.25,2.25,829.00,0.00,829.00,829.00,N/A
24310_3,REVISION OF ARM TENDON,ProFee,0989,24310,,,,0,3.00,2.25,2.25,673.00,0.00,673.00,673.00,N/A
24320_3,REPAIR OF ARM TENDON,ProFee,0989,24320,,,,0,3.00,2.25,2.25,1125.00,0.00,1125.00,1125.00,N/A
24330_3,REVISION OF ARM MUSCLES,ProFee,0989,24330,,,,0,3.00,2.25,2.25,1034.00,0.00,1034.00,1034.00,N/A
24331_3,REVISION OF ARM MUSCLES,ProFee,0989,24331,,,,0,3.00,2.25,2.25,1133.00,0.00,1133.00,1133.00,N/A
24332_3,"TENOLYSIS, TRICEPS",ProFee,0989,24332,,,,0,3.00,2.25,2.25,881.50,0.00,881.50,881.50,N/A
24340_3,REPAIR OF BICEPS TENDON,ProFee,0989,24340,,,,0,3.00,2.25,2.25,881.00,0.00,881.00,881.00,N/A
24341_3,REPAIR ARM TENDON/MUSCLE,ProFee,0989,24341,,,,0,3.00,2.25,2.25,1071.00,0.00,1071.00,1071.00,N/A
24342_3,REPAIR OF RUPTURED TENDON,ProFee,0989,24342,,,,0,3.00,2.25,2.25,1115.50,0.00,1115.50,1115.50,N/A
24343_3,REPR ELBOW LAT LIGMNT W/TISS,ProFee,0989,24343,,,,0,3.00,2.25,2.25,1015.50,0.00,1015.50,1015.50,N/A
24344_3,RECONSTRUCT ELBOW LAT LIGMNT,ProFee,0989,24344,,,,0,3.00,2.25,2.25,1586.00,0.00,1586.00,1586.00,N/A
24345_3,REPR ELBW MED LIGMNT W/TISSU,ProFee,0989,24345,,,,0,3.00,2.25,2.25,1010.00,0.00,1010.00,1010.00,N/A
24346_3,RECONSTRUCT ELBOW MED LIGMNT,ProFee,0989,24346,,,,0,3.00,2.25,2.25,1583.50,0.00,1583.50,1583.50,N/A
24350_3,REPAIR OF TENNIS ELBOW,ProFee,0989,24350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24351_3,REPAIR OF TENNIS ELBOW,ProFee,0989,24351,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24352_3,REPAIR OF TENNIS ELBOW,ProFee,0989,24352,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24354_3,REPAIR OF TENNIS ELBOW,ProFee,0989,24354,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24356_3,REVISION OF TENNIS ELBOW,ProFee,0989,24356,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
24357_3,"REPAIR ELBOW, PERC",ProFee,0989,24357,,,,0,3.00,2.25,2.25,602.50,0.00,602.50,602.50,N/A
24358_3,"REPAIR ELBOW W/DEB, OPEN",ProFee,0989,24358,,,,0,3.00,2.25,2.25,751.50,0.00,751.50,751.50,N/A
24359_3,REPAIR ELBOW DEB/ATTCH OPEN,ProFee,0989,24359,,,,0,3.00,2.25,2.25,949.00,0.00,949.00,949.00,N/A
24360_3,RECONSTRUCT ELBOW JOINT,ProFee,0989,24360,,,,0,3.00,2.25,2.25,1296.50,0.00,1296.50,1296.50,N/A
24361_3,RECONSTRUCT ELBOW JOINT,ProFee,0989,24361,,,,0,3.00,2.25,2.25,1451.00,0.00,1451.00,1451.00,N/A
24362_3,RECONSTRUCT ELBOW JOINT,ProFee,0989,24362,,,,0,3.00,2.25,2.25,1529.00,0.00,1529.00,1529.00,N/A
24363_3,REPLACE ELBOW JOINT,ProFee,0989,24363,,,,0,3.00,2.25,2.25,2101.00,0.00,2101.00,2101.00,N/A
24365_3,RECONSTRUCT HEAD OF RADIUS,ProFee,0989,24365,,,,0,3.00,2.25,2.25,920.50,0.00,920.50,920.50,N/A
24366_3,RECONSTRUCT HEAD OF RADIUS,ProFee,0989,24366,,,,0,3.00,2.25,2.25,978.00,0.00,978.00,978.00,N/A
24370_3,REVISE RECONST ELBOW JOINT,ProFee,0989,24370,,,,0,3.00,2.25,2.25,2227.50,0.00,2227.50,2227.50,N/A
24371_3,REVISE RECONST ELBOW JOINT,ProFee,0989,24371,,,,0,3.00,2.25,2.25,2598.00,0.00,2598.00,2598.00,N/A
24400_3,REVISION OF HUMERUS,ProFee,0989,24400,,,,0,3.00,2.25,2.25,1179.50,0.00,1179.50,1179.50,N/A
24410_3,REVISION OF HUMERUS,ProFee,0989,24410,,,,0,3.00,2.25,2.25,1524.00,0.00,1524.00,1524.00,N/A
24420_3,REVISION OF HUMERUS,ProFee,0989,24420,,,,0,3.00,2.25,2.25,1433.50,0.00,1433.50,1433.50,N/A
24430_3,REPAIR OF HUMERUS,ProFee,0989,24430,,,,0,3.00,2.25,2.25,1520.50,0.00,1520.50,1520.50,N/A
24435_3,REPAIR HUMERUS WITH GRAFT,ProFee,0989,24435,,,,0,3.00,2.25,2.25,1548.50,0.00,1548.50,1548.50,N/A
24470_3,REVISION OF ELBOW JOINT,ProFee,0989,24470,,,,0,3.00,2.25,2.25,966.00,0.00,966.00,966.00,N/A
24495_3,DECOMPRESSION OF FOREARM,ProFee,0989,24495,,,,0,3.00,2.25,2.25,1061.00,0.00,1061.00,1061.00,N/A
24498_3,REINFORCE HUMERUS,ProFee,0989,24498,,,,0,3.00,2.25,2.25,1247.00,0.00,1247.00,1247.00,N/A
24500_3,TREAT HUMERUS FRACTURE,ProFee,0989,24500,,,,0,3.00,2.25,2.25,466.50,0.00,466.50,466.50,N/A
24505_3,TREAT HUMERUS FRACTURE,ProFee,0989,24505,,,,0,3.00,2.25,2.25,641.00,0.00,641.00,641.00,N/A
24515_3,TREAT HUMERUS FRACTURE,ProFee,0989,24515,,,,0,3.00,2.25,2.25,1261.00,0.00,1261.00,1261.00,N/A
24516_3,TREAT HUMERUS FRACTURE,ProFee,0989,24516,,,,0,3.00,2.25,2.25,1237.50,0.00,1237.50,1237.50,N/A
24530_3,TREAT HUMERUS FRACTURE,ProFee,0989,24530,,,,0,3.00,2.25,2.25,493.00,0.00,493.00,493.00,N/A
24535_3,TREAT HUMERUS FRACTURE,ProFee,0989,24535,,,,0,3.00,2.25,2.25,815.50,0.00,815.50,815.50,N/A
24538_3,TREAT HUMERUS FRACTURE,ProFee,0989,24538,,,,0,3.00,2.25,2.25,1070.00,0.00,1070.00,1070.00,N/A
24545_3,TREAT HUMERUS FRACTURE,ProFee,0989,24545,,,,0,3.00,2.25,2.25,1339.00,0.00,1339.00,1339.00,N/A
24546_3,TREAT HUMERUS FRACTURE,ProFee,0989,24546,,,,0,3.00,2.25,2.25,1497.00,0.00,1497.00,1497.00,N/A
24560_3,TREAT HUMERUS FRACTURE,ProFee,0989,24560,,,,0,3.00,2.25,2.25,411.00,0.00,411.00,411.00,N/A
24565_3,TREAT HUMERUS FRACTURE,ProFee,0989,24565,,,,0,3.00,2.25,2.25,702.00,0.00,702.00,702.00,N/A
24566_3,TREAT HUMERUS FRACTURE,ProFee,0989,24566,,,,0,3.00,2.25,2.25,1031.50,0.00,1031.50,1031.50,N/A
24575_3,TREAT HUMERUS FRACTURE,ProFee,0989,24575,,,,0,3.00,2.25,2.25,1056.00,0.00,1056.00,1056.00,N/A
24576_3,TREAT HUMERUS FRACTURE,ProFee,0989,24576,,,,0,3.00,2.25,2.25,436.50,0.00,436.50,436.50,N/A
24577_3,TREAT HUMERUS FRACTURE,ProFee,0989,24577,,,,0,3.00,2.25,2.25,722.00,0.00,722.00,722.00,N/A
24579_3,TREAT HUMERUS FRACTURE,ProFee,0989,24579,,,,0,3.00,2.25,2.25,1202.50,0.00,1202.50,1202.50,N/A
24582_3,TREAT HUMERUS FRACTURE,ProFee,0989,24582,,,,0,3.00,2.25,2.25,1163.50,0.00,1163.50,1163.50,N/A
24586_3,TREAT ELBOW FRACTURE,ProFee,0989,24586,,,,0,3.00,2.25,2.25,1562.00,0.00,1562.00,1562.00,N/A
24587_3,TREAT ELBOW FRACTURE,ProFee,0989,24587,,,,0,3.00,2.25,2.25,1576.00,0.00,1576.00,1576.00,N/A
24600_2,TREAT ELBOW DISLOCATION,Ambulatory Surgical,0521,24600,,,,0,794.00,595.50,595.50,754.30,714.60,754.30,0.00,714.60
24600_2,TREAT ELBOW DISLOCATION,Inpatient,0521,24600,,,,0,794.00,595.50,595.50,754.30,714.60,754.30,754.30,714.60
24600_3,TREAT ELBOW DISLOCATION,Inpatient,0521,24600,,,,0,774.00,580.50,580.50,735.30,696.60,735.30,735.30,696.60
24600_3,TREAT ELBOW DISLOCATION,Ambulatory Surgical,0521,24600,,,,0,774.00,580.50,580.50,735.30,696.60,735.30,0.00,696.60
24605_3,TREAT ELBOW DISLOCATION,ProFee,0989,24605,,,,0,3.00,2.25,2.25,675.00,0.00,675.00,675.00,N/A
24615_3,TREAT ELBOW DISLOCATION,ProFee,0989,24615,,,,0,3.00,2.25,2.25,1025.50,0.00,1025.50,1025.50,N/A
24620_3,TREAT ELBOW FRACTURE,ProFee,0989,24620,,,,0,3.00,2.25,2.25,791.00,0.00,791.00,791.00,N/A
24635_3,TREAT ELBOW FRACTURE,ProFee,0989,24635,,,,0,3.00,2.25,2.25,969.00,0.00,969.00,969.00,N/A
24640_2,TREAT ELBOW DISLOCATION,Inpatient,0521,24640,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
24640_2,TREAT ELBOW DISLOCATION,Ambulatory Surgical,0521,24640,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
24640_3,TREAT ELBOW DISLOCATION,Inpatient,0521,24640,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
24640_3,TREAT ELBOW DISLOCATION,Ambulatory Surgical,0521,24640,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
24650_2,TREAT RADIUS FRACTURE,Ambulatory Surgical,0521,24650,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
24650_2,TREAT RADIUS FRACTURE,Inpatient,0521,24650,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
24650_3,TREAT RADIUS FRACTURE,Ambulatory Surgical,0521,24650,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
24650_3,TREAT RADIUS FRACTURE,Inpatient,0521,24650,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
24655_3,TREAT RADIUS FRACTURE,ProFee,0989,24655,,,,0,3.00,2.25,2.25,569.50,0.00,569.50,569.50,N/A
24665_3,TREAT RADIUS FRACTURE,ProFee,0989,24665,,,,0,3.00,2.25,2.25,939.50,0.00,939.50,939.50,N/A
24666_3,TREAT RADIUS FRACTURE,ProFee,0989,24666,,,,0,3.00,2.25,2.25,1054.00,0.00,1054.00,1054.00,N/A
24670_3,TREAT ULNAR FRACTURE,ProFee,0989,24670,,,,0,3.00,2.25,2.25,375.00,0.00,375.00,375.00,N/A
24675_3,TREAT ULNAR FRACTURE,ProFee,0989,24675,,,,0,3.00,2.25,2.25,592.00,0.00,592.00,592.00,N/A
24685_3,TREAT ULNAR FRACTURE,ProFee,0989,24685,,,,0,3.00,2.25,2.25,940.50,0.00,940.50,940.50,N/A
24800_3,FUSION OF ELBOW JOINT,ProFee,0989,24800,,,,0,3.00,2.25,2.25,1195.50,0.00,1195.50,1195.50,N/A
24802_3,FUSION/GRAFT OF ELBOW JOINT,ProFee,0989,24802,,,,0,3.00,2.25,2.25,1444.00,0.00,1444.00,1444.00,N/A
24900_3,AMPUTATION OF UPPER ARM,ProFee,0989,24900,,,,0,3.00,2.25,2.25,1065.50,0.00,1065.50,1065.50,N/A
24920_3,AMPUTATION OF UPPER ARM,ProFee,0989,24920,,,,0,3.00,2.25,2.25,1055.00,0.00,1055.00,1055.00,N/A
24925_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,24925,,,,0,3.00,2.25,2.25,806.00,0.00,806.00,806.00,N/A
24930_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,24930,,,,0,3.00,2.25,2.25,1115.50,0.00,1115.50,1115.50,N/A
24931_3,AMPUTATE UPPER ARM & IMPLANT,ProFee,0989,24931,,,,0,3.00,2.25,2.25,1345.50,0.00,1345.50,1345.50,N/A
24935_3,REVISION OF AMPUTATION,ProFee,0989,24935,,,,0,3.00,2.25,2.25,1661.50,0.00,1661.50,1661.50,N/A
24940_3,REVISION OF UPPER ARM,ProFee,0989,24940,,,,0,3.00,2.25,2.25,1537.50,0.00,1537.50,1537.50,N/A
24999_3,UPPER ARM/ELBOW SURGERY,ProFee,0989,24999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
25000_3,INCISION OF TENDON SHEATH,ProFee,0989,25000,,,,0,3.00,2.25,2.25,483.50,0.00,483.50,483.50,N/A
25001_3,INCISE FLEXOR CARPI RADIALIS,ProFee,0989,25001,,,,0,3.00,2.25,2.25,493.50,0.00,493.50,493.50,N/A
25020_3,DECOMPRESS FOREARM 1 SPACE,ProFee,0989,25020,,,,0,3.00,2.25,2.25,823.50,0.00,823.50,823.50,N/A
25023_3,DECOMPRESS FOREARM 1 SPACE,ProFee,0989,25023,,,,0,3.00,2.25,2.25,1594.00,0.00,1594.00,1594.00,N/A
25024_3,DECOMPRESS FOREARM 2 SPACES,ProFee,0989,25024,,,,0,3.00,2.25,2.25,1115.00,0.00,1115.00,1115.00,N/A
25025_3,DECOMPRESS FOREARM 2 SPACES,ProFee,0989,25025,,,,0,3.00,2.25,2.25,1749.00,0.00,1749.00,1749.00,N/A
25028_3,DRAINAGE OF FOREARM LESION,ProFee,0989,25028,,,,0,3.00,2.25,2.25,755.00,0.00,755.00,755.00,N/A
25031_3,DRAINAGE OF FOREARM BURSA,ProFee,0989,25031,,,,0,3.00,2.25,2.25,506.00,0.00,506.00,506.00,N/A
25035_3,TREAT FOREARM BONE LESION,ProFee,0989,25035,,,,0,3.00,2.25,2.25,840.50,0.00,840.50,840.50,N/A
25040_3,EXPLORE/TREAT WRIST JOINT,ProFee,0989,25040,,,,0,3.00,2.25,2.25,808.50,0.00,808.50,808.50,N/A
25065_3,BIOPSY FOREARM SOFT TISSUES,ProFee,0989,25065,,,,0,3.00,2.25,2.25,233.50,0.00,233.50,233.50,N/A
25066_3,BIOPSY FOREARM SOFT TISSUES,ProFee,0989,25066,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
25071_3,EXC FOREARM LES SC > 3 CM,ProFee,0989,25071,,,,0,3.00,2.25,2.25,612.50,0.00,612.50,612.50,N/A
25073_3,EXC FOREARM TUM DEEP = 3 CM,ProFee,0989,25073,,,,0,3.00,2.25,2.25,767.50,0.00,767.50,767.50,N/A
25075_3,REMOVAL FOREARM LESION SUBCU,ProFee,0989,25075,,,,0,3.00,2.25,2.25,455.50,0.00,455.50,455.50,N/A
25076_3,REMOVAL FOREARM LESION DEEP,ProFee,0989,25076,,,,0,3.00,2.25,2.25,745.50,0.00,745.50,745.50,N/A
25077_3,"REMOVE TUMOR, FOREARM/WRIST",ProFee,0989,25077,,,,0,3.00,2.25,2.25,1275.00,0.00,1275.00,1275.00,N/A
25078_3,RESECT FOREARM/WRIST TUM=3CM,ProFee,0989,25078,,,,0,3.00,2.25,2.25,1681.50,0.00,1681.50,1681.50,N/A
25085_3,INCISION OF WRIST CAPSULE,ProFee,0989,25085,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
25100_3,BIOPSY OF WRIST JOINT,ProFee,0989,25100,,,,0,3.00,2.25,2.25,496.50,0.00,496.50,496.50,N/A
25101_3,EXPLORE/TREAT WRIST JOINT,ProFee,0989,25101,,,,0,3.00,2.25,2.25,579.00,0.00,579.00,579.00,N/A
25105_3,REMOVE WRIST JOINT LINING,ProFee,0989,25105,,,,0,3.00,2.25,2.25,692.00,0.00,692.00,692.00,N/A
25107_3,REMOVE WRIST JOINT CARTILAGE,ProFee,0989,25107,,,,0,3.00,2.25,2.25,886.50,0.00,886.50,886.50,N/A
25109_3,EXCISE TENDON FOREARM/WRIST,ProFee,0989,25109,,,,0,3.00,2.25,2.25,773.50,0.00,773.50,773.50,N/A
25110_3,REMOVE WRIST TENDON LESION,ProFee,0989,25110,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
25111_3,REMOVE WRIST TENDON LESION,ProFee,0989,25111,,,,0,3.00,2.25,2.25,460.00,0.00,460.00,460.00,N/A
25112_3,REREMOVE WRIST TENDON LESION,ProFee,0989,25112,,,,0,3.00,2.25,2.25,555.50,0.00,555.50,555.50,N/A
25115_3,REMOVE WRIST/FOREARM LESION,ProFee,0989,25115,,,,0,3.00,2.25,2.25,1092.00,0.00,1092.00,1092.00,N/A
25116_3,REMOVE WRIST/FOREARM LESION,ProFee,0989,25116,,,,0,3.00,2.25,2.25,863.00,0.00,863.00,863.00,N/A
25118_3,EXCISE WRIST TENDON SHEATH,ProFee,0989,25118,,,,0,3.00,2.25,2.25,547.50,0.00,547.50,547.50,N/A
25119_3,PARTIAL REMOVAL OF ULNA,ProFee,0989,25119,,,,0,3.00,2.25,2.25,717.50,0.00,717.50,717.50,N/A
25120_3,REMOVAL OF FOREARM LESION,ProFee,0989,25120,,,,0,3.00,2.25,2.25,713.50,0.00,713.50,713.50,N/A
25125_3,REMOVE/GRAFT FOREARM LESION,ProFee,0989,25125,,,,0,3.00,2.25,2.25,852.50,0.00,852.50,852.50,N/A
25126_3,REMOVE/GRAFT FOREARM LESION,ProFee,0989,25126,,,,0,3.00,2.25,2.25,858.50,0.00,858.50,858.50,N/A
25130_3,REMOVAL OF WRIST LESION,ProFee,0989,25130,,,,0,3.00,2.25,2.25,641.50,0.00,641.50,641.50,N/A
25135_3,REMOVE & GRAFT WRIST LESION,ProFee,0989,25135,,,,0,3.00,2.25,2.25,803.50,0.00,803.50,803.50,N/A
25136_3,REMOVE & GRAFT WRIST LESION,ProFee,0989,25136,,,,0,3.00,2.25,2.25,709.00,0.00,709.00,709.00,N/A
25145_3,REMOVE FOREARM BONE LESION,ProFee,0989,25145,,,,0,3.00,2.25,2.25,743.50,0.00,743.50,743.50,N/A
25150_3,PARTIAL REMOVAL OF ULNA,ProFee,0989,25150,,,,0,3.00,2.25,2.25,816.00,0.00,816.00,816.00,N/A
25151_3,PARTIAL REMOVAL OF RADIUS,ProFee,0989,25151,,,,0,3.00,2.25,2.25,837.50,0.00,837.50,837.50,N/A
25170_3,EXTENSIVE FOREARM SURGERY,ProFee,0989,25170,,,,0,3.00,2.25,2.25,2136.50,0.00,2136.50,2136.50,N/A
25210_3,REMOVAL OF WRIST BONE,ProFee,0989,25210,,,,0,3.00,2.25,2.25,700.00,0.00,700.00,700.00,N/A
25215_3,REMOVAL OF WRIST BONES,ProFee,0989,25215,,,,0,3.00,2.25,2.25,888.00,0.00,888.00,888.00,N/A
25230_3,PARTIAL REMOVAL OF RADIUS,ProFee,0989,25230,,,,0,3.00,2.25,2.25,622.00,0.00,622.00,622.00,N/A
25240_3,PARTIAL REMOVAL OF ULNA,ProFee,0989,25240,,,,0,3.00,2.25,2.25,615.50,0.00,615.50,615.50,N/A
25246_3,INJECTION FOR WRIST X-RAY,ProFee,0989,25246,,,,0,3.00,2.25,2.25,108.00,0.00,108.00,108.00,N/A
25248_2,REMOVE FOREARM FOREIGN BODY,Ambulatory Surgical,0521,25248,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
25248_2,REMOVE FOREARM FOREIGN BODY,Inpatient,0521,25248,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
25248_3,REMOVE FOREARM FOREIGN BODY,Inpatient,0521,25248,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
25248_3,REMOVE FOREARM FOREIGN BODY,Ambulatory Surgical,0521,25248,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
25250_3,REMOVAL OF WRIST PROSTHESIS,ProFee,0989,25250,,,,0,3.00,2.25,2.25,762.50,0.00,762.50,762.50,N/A
25251_3,REMOVAL OF WRIST PROSTHESIS,ProFee,0989,25251,,,,0,3.00,2.25,2.25,1036.00,0.00,1036.00,1036.00,N/A
25259_3,MANIPULATE WRIST W/ANESTHES,ProFee,0989,25259,,,,0,3.00,2.25,2.25,597.00,0.00,597.00,597.00,N/A
25260_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25260,,,,0,3.00,2.25,2.25,905.00,0.00,905.00,905.00,N/A
25263_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25263,,,,0,3.00,2.25,2.25,902.00,0.00,902.00,902.00,N/A
25265_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25265,,,,0,3.00,2.25,2.25,1088.50,0.00,1088.50,1088.50,N/A
25270_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25270,,,,0,3.00,2.25,2.25,704.00,0.00,704.00,704.00,N/A
25272_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25272,,,,0,3.00,2.25,2.25,801.00,0.00,801.00,801.00,N/A
25274_3,REPAIR FOREARM TENDON/MUSCLE,ProFee,0989,25274,,,,0,3.00,2.25,2.25,968.00,0.00,968.00,968.00,N/A
25275_3,REPAIR FOREARM TENDON SHEATH,ProFee,0989,25275,,,,0,3.00,2.25,2.25,965.00,0.00,965.00,965.00,N/A
25280_3,REVISE WRIST/FOREARM TENDON,ProFee,0989,25280,,,,0,3.00,2.25,2.25,810.00,0.00,810.00,810.00,N/A
25290_3,INCISE WRIST/FOREARM TENDON,ProFee,0989,25290,,,,0,3.00,2.25,2.25,627.00,0.00,627.00,627.00,N/A
25295_3,RELEASE WRIST/FOREARM TENDON,ProFee,0989,25295,,,,0,3.00,2.25,2.25,754.00,0.00,754.00,754.00,N/A
25300_3,FUSION OF TENDONS AT WRIST,ProFee,0989,25300,,,,0,3.00,2.25,2.25,992.00,0.00,992.00,992.00,N/A
25301_3,FUSION OF TENDONS AT WRIST,ProFee,0989,25301,,,,0,3.00,2.25,2.25,925.00,0.00,925.00,925.00,N/A
25310_3,TRANSPLANT FOREARM TENDON,ProFee,0989,25310,,,,0,3.00,2.25,2.25,891.00,0.00,891.00,891.00,N/A
25312_3,TRANSPLANT FOREARM TENDON,ProFee,0989,25312,,,,0,3.00,2.25,2.25,1032.00,0.00,1032.00,1032.00,N/A
25315_3,REVISE PALSY HAND TENDON(S),ProFee,0989,25315,,,,0,3.00,2.25,2.25,1109.50,0.00,1109.50,1109.50,N/A
25316_3,REVISE PALSY HAND TENDON(S),ProFee,0989,25316,,,,0,3.00,2.25,2.25,1316.00,0.00,1316.00,1316.00,N/A
25320_3,REPAIR/REVISE WRIST JOINT,ProFee,0989,25320,,,,0,3.00,2.25,2.25,1419.50,0.00,1419.50,1419.50,N/A
25332_3,REVISE WRIST JOINT,ProFee,0989,25332,,,,0,3.00,2.25,2.25,1211.50,0.00,1211.50,1211.50,N/A
25335_3,REALIGNMENT OF HAND,ProFee,0989,25335,,,,0,3.00,2.25,2.25,1358.50,0.00,1358.50,1358.50,N/A
25337_3,RECONSTRUCT ULNA/RADIOULNAR,ProFee,0989,25337,,,,0,3.00,2.25,2.25,1284.50,0.00,1284.50,1284.50,N/A
25350_3,REVISION OF RADIUS,ProFee,0989,25350,,,,0,3.00,2.25,2.25,970.00,0.00,970.00,970.00,N/A
25355_3,REVISION OF RADIUS,ProFee,0989,25355,,,,0,3.00,2.25,2.25,1103.00,0.00,1103.00,1103.00,N/A
25360_3,REVISION OF ULNA,ProFee,0989,25360,,,,0,3.00,2.25,2.25,940.00,0.00,940.00,940.00,N/A
25365_3,REVISE RADIUS & ULNA,ProFee,0989,25365,,,,0,3.00,2.25,2.25,1317.50,0.00,1317.50,1317.50,N/A
25370_3,REVISE RADIUS OR ULNA,ProFee,0989,25370,,,,0,3.00,2.25,2.25,1449.00,0.00,1449.00,1449.00,N/A
25375_3,REVISE RADIUS & ULNA,ProFee,0989,25375,,,,0,3.00,2.25,2.25,1372.50,0.00,1372.50,1372.50,N/A
25390_3,SHORTEN RADIUS OR ULNA,ProFee,0989,25390,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
25391_3,LENGTHEN RADIUS OR ULNA,ProFee,0989,25391,,,,0,3.00,2.25,2.25,1434.50,0.00,1434.50,1434.50,N/A
25392_3,SHORTEN RADIUS & ULNA,ProFee,0989,25392,,,,0,3.00,2.25,2.25,1460.50,0.00,1460.50,1460.50,N/A
25393_3,LENGTHEN RADIUS & ULNA,ProFee,0989,25393,,,,0,3.00,2.25,2.25,1630.00,0.00,1630.00,1630.00,N/A
25394_3,"REPAIR CARPAL BONE, SHORTEN",ProFee,0989,25394,,,,0,3.00,2.25,2.25,1129.00,0.00,1129.00,1129.00,N/A
25400_3,REPAIR RADIUS OR ULNA,ProFee,0989,25400,,,,0,3.00,2.25,2.25,1156.50,0.00,1156.50,1156.50,N/A
25405_3,REPAIR/GRAFT RADIUS OR ULNA,ProFee,0989,25405,,,,0,3.00,2.25,2.25,1492.00,0.00,1492.00,1492.00,N/A
25415_3,REPAIR RADIUS & ULNA,ProFee,0989,25415,,,,0,3.00,2.25,2.25,1393.50,0.00,1393.50,1393.50,N/A
25420_3,REPAIR/GRAFT RADIUS & ULNA,ProFee,0989,25420,,,,0,3.00,2.25,2.25,1684.00,0.00,1684.00,1684.00,N/A
25425_3,REPAIR/GRAFT RADIUS OR ULNA,ProFee,0989,25425,,,,0,3.00,2.25,2.25,1386.50,0.00,1386.50,1386.50,N/A
25426_3,REPAIR/GRAFT RADIUS & ULNA,ProFee,0989,25426,,,,0,3.00,2.25,2.25,1620.50,0.00,1620.50,1620.50,N/A
25430_3,VASC GRAFT INTO CARPAL BONE,ProFee,0989,25430,,,,0,3.00,2.25,2.25,1052.50,0.00,1052.50,1052.50,N/A
25431_3,REPAIR NONUNION CARPAL BONE,ProFee,0989,25431,,,,0,3.00,2.25,2.25,1136.50,0.00,1136.50,1136.50,N/A
25440_3,REPAIR/GRAFT WRIST BONE,ProFee,0989,25440,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
25441_3,RECONSTRUCT WRIST JOINT,ProFee,0989,25441,,,,0,3.00,2.25,2.25,1349.00,0.00,1349.00,1349.00,N/A
25442_3,RECONSTRUCT WRIST JOINT,ProFee,0989,25442,,,,0,3.00,2.25,2.25,1159.00,0.00,1159.00,1159.00,N/A
25443_3,RECONSTRUCT WRIST JOINT,ProFee,0989,25443,,,,0,3.00,2.25,2.25,1124.50,0.00,1124.50,1124.50,N/A
25444_3,RECONSTRUCT WRIST JOINT,ProFee,0989,25444,,,,0,3.00,2.25,2.25,1190.00,0.00,1190.00,1190.00,N/A
25445_3,RECONSTRUCT WRIST JOINT,ProFee,0989,25445,,,,0,3.00,2.25,2.25,1038.50,0.00,1038.50,1038.50,N/A
25446_3,WRIST REPLACEMENT,ProFee,0989,25446,,,,0,3.00,2.25,2.25,1689.00,0.00,1689.00,1689.00,N/A
25447_3,REPAIR WRIST JOINT(S),ProFee,0989,25447,,,,0,3.00,2.25,2.25,1191.50,0.00,1191.50,1191.50,N/A
25449_3,REMOVE WRIST JOINT IMPLANT,ProFee,0989,25449,,,,0,3.00,2.25,2.25,1485.50,0.00,1485.50,1485.50,N/A
25450_3,REVISION OF WRIST JOINT,ProFee,0989,25450,,,,0,3.00,2.25,2.25,886.00,0.00,886.00,886.00,N/A
25455_3,REVISION OF WRIST JOINT,ProFee,0989,25455,,,,0,3.00,2.25,2.25,1043.50,0.00,1043.50,1043.50,N/A
25490_3,REINFORCE RADIUS,ProFee,0989,25490,,,,0,3.00,2.25,2.25,1035.00,0.00,1035.00,1035.00,N/A
25491_3,REINFORCE ULNA,ProFee,0989,25491,,,,0,3.00,2.25,2.25,1064.50,0.00,1064.50,1064.50,N/A
25492_3,REINFORCE RADIUS AND ULNA,ProFee,0989,25492,,,,0,3.00,2.25,2.25,1302.50,0.00,1302.50,1302.50,N/A
25500_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25500,,,,0,3.00,2.25,2.25,358.00,0.00,358.00,358.00,N/A
25505_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25505,,,,0,3.00,2.25,2.25,650.00,0.00,650.00,650.00,N/A
25515_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25515,,,,0,3.00,2.25,2.25,962.00,0.00,962.00,962.00,N/A
25520_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25520,,,,0,3.00,2.25,2.25,773.00,0.00,773.00,773.00,N/A
25525_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25525,,,,0,3.00,2.25,2.25,1128.50,0.00,1128.50,1128.50,N/A
25526_3,TREAT FRACTURE OF RADIUS,ProFee,0989,25526,,,,0,3.00,2.25,2.25,1375.50,0.00,1375.50,1375.50,N/A
25530_3,TREAT FRACTURE OF ULNA,ProFee,0989,25530,,,,0,3.00,2.25,2.25,339.50,0.00,339.50,339.50,N/A
25535_3,TREAT FRACTURE OF ULNA,ProFee,0989,25535,,,,0,3.00,2.25,2.25,644.50,0.00,644.50,644.50,N/A
25545_3,TREAT FRACTURE OF ULNA,ProFee,0989,25545,,,,0,3.00,2.25,2.25,893.50,0.00,893.50,893.50,N/A
25560_3,TREAT FRACTURE RADIUS & ULNA,ProFee,0989,25560,,,,0,3.00,2.25,2.25,359.50,0.00,359.50,359.50,N/A
25565_3,TREAT FRACTURE RADIUS & ULNA,ProFee,0989,25565,,,,0,3.00,2.25,2.25,666.50,0.00,666.50,666.50,N/A
25574_3,TREAT FRACTURE RADIUS & ULNA,ProFee,0989,25574,,,,0,3.00,2.25,2.25,968.00,0.00,968.00,968.00,N/A
25575_3,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25575,,,,0,3.00,2.25,2.25,1295.50,0.00,1295.50,1295.50,N/A
25600_3,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25600,,,,0,3.00,2.25,2.25,444.00,0.00,444.00,444.00,N/A
25605_2,TREAT FRACTURE RADIUS/ULNA,Inpatient,0521,25605,,,,0,1032.00,774.00,774.00,980.40,928.80,980.40,980.40,928.80
25605_2,TREAT FRACTURE RADIUS/ULNA,Ambulatory Surgical,0521,25605,,,,0,1032.00,774.00,774.00,980.40,928.80,980.40,0.00,928.80
25605_3,TREAT FRACTURE RADIUS/ULNA,Ambulatory Surgical,0521,25605,,,,0,1005.00,753.75,753.75,954.75,904.50,954.75,0.00,904.50
25605_3,TREAT FRACTURE RADIUS/ULNA,Inpatient,0521,25605,,,,0,1005.00,753.75,753.75,954.75,904.50,954.75,954.75,904.50
25606_3,TREAT FX DISTAL RADIAL,ProFee,0989,25606,,,,0,3.00,2.25,2.25,953.00,0.00,953.00,953.00,N/A
25607_3,TREAT FX RAD EXTRA-ARTICUL,ProFee,0989,25607,,,,0,3.00,2.25,2.25,1056.00,0.00,1056.00,1056.00,N/A
25608_3,TREAT FX RAD INTRA-ARTICUL,ProFee,0989,25608,,,,0,3.00,2.25,2.25,1185.50,0.00,1185.50,1185.50,N/A
25609_3,TREAT FX RADIAL 3+ FRAG,ProFee,0989,25609,,,,0,3.00,2.25,2.25,1507.00,0.00,1507.00,1507.00,N/A
25611_3,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25611,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
25620_3,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
25622_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25622,,,,0,3.00,2.25,2.25,398.00,0.00,398.00,398.00,N/A
25624_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25624,,,,0,3.00,2.25,2.25,624.50,0.00,624.50,624.50,N/A
25628_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25628,,,,0,3.00,2.25,2.25,1034.50,0.00,1034.50,1034.50,N/A
25630_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25630,,,,0,3.00,2.25,2.25,401.50,0.00,401.50,401.50,N/A
25635_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25635,,,,0,3.00,2.25,2.25,596.00,0.00,596.00,596.00,N/A
25645_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25645,,,,0,3.00,2.25,2.25,818.50,0.00,818.50,818.50,N/A
25650_3,TREAT WRIST BONE FRACTURE,ProFee,0989,25650,,,,0,3.00,2.25,2.25,428.00,0.00,428.00,428.00,N/A
25651_3,PIN ULNAR STYLOID FRACTURE,ProFee,0989,25651,,,,0,3.00,2.25,2.25,696.00,0.00,696.00,696.00,N/A
25652_3,TREAT FRACTURE ULNAR STYLOID,ProFee,0989,25652,,,,0,3.00,2.25,2.25,895.50,0.00,895.50,895.50,N/A
25660_3,TREAT WRIST DISLOCATION,ProFee,0989,25660,,,,0,3.00,2.25,2.25,593.50,0.00,593.50,593.50,N/A
25670_3,TREAT WRIST DISLOCATION,ProFee,0989,25670,,,,0,3.00,2.25,2.25,867.50,0.00,867.50,867.50,N/A
25671_3,PIN RADIOULNAR DISLOCATION,ProFee,0989,25671,,,,0,3.00,2.25,2.25,763.50,0.00,763.50,763.50,N/A
25675_3,TREAT WRIST DISLOCATION,ProFee,0989,25675,,,,0,3.00,2.25,2.25,563.00,0.00,563.00,563.00,N/A
25676_3,TREAT WRIST DISLOCATION,ProFee,0989,25676,,,,0,3.00,2.25,2.25,905.00,0.00,905.00,905.00,N/A
25680_3,TREAT WRIST FRACTURE,ProFee,0989,25680,,,,0,3.00,2.25,2.25,748.00,0.00,748.00,748.00,N/A
25685_3,TREAT WRIST FRACTURE,ProFee,0989,25685,,,,0,3.00,2.25,2.25,1059.00,0.00,1059.00,1059.00,N/A
25690_3,TREAT WRIST DISLOCATION,ProFee,0989,25690,,,,0,3.00,2.25,2.25,690.50,0.00,690.50,690.50,N/A
25695_3,TREAT WRIST DISLOCATION,ProFee,0989,25695,,,,0,3.00,2.25,2.25,911.00,0.00,911.00,911.00,N/A
25800_3,FUSION OF WRIST JOINT,ProFee,0989,25800,,,,0,3.00,2.25,2.25,1053.50,0.00,1053.50,1053.50,N/A
25805_3,FUSION/GRAFT OF WRIST JOINT,ProFee,0989,25805,,,,0,3.00,2.25,2.25,1216.50,0.00,1216.50,1216.50,N/A
25810_3,FUSION/GRAFT OF WRIST JOINT,ProFee,0989,25810,,,,0,3.00,2.25,2.25,1248.50,0.00,1248.50,1248.50,N/A
25820_3,FUSION OF HAND BONES,ProFee,0989,25820,,,,0,3.00,2.25,2.25,885.50,0.00,885.50,885.50,N/A
25825_3,FUSE HAND BONES WITH GRAFT,ProFee,0989,25825,,,,0,3.00,2.25,2.25,1090.50,0.00,1090.50,1090.50,N/A
25830_3,"FUSION, RADIOULNAR JNT/ULNA",ProFee,0989,25830,,,,0,3.00,2.25,2.25,1369.00,0.00,1369.00,1369.00,N/A
25900_3,AMPUTATION OF FOREARM,ProFee,0989,25900,,,,0,3.00,2.25,2.25,1015.50,0.00,1015.50,1015.50,N/A
25905_3,AMPUTATION OF FOREARM,ProFee,0989,25905,,,,0,3.00,2.25,2.25,1009.00,0.00,1009.00,1009.00,N/A
25907_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,25907,,,,0,3.00,2.25,2.25,881.50,0.00,881.50,881.50,N/A
25909_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,25909,,,,0,3.00,2.25,2.25,985.00,0.00,985.00,985.00,N/A
25915_3,AMPUTATION OF FOREARM,ProFee,0989,25915,,,,0,3.00,2.25,2.25,1690.00,0.00,1690.00,1690.00,N/A
25920_3,AMPUTATE HAND AT WRIST,ProFee,0989,25920,,,,0,3.00,2.25,2.25,1001.50,0.00,1001.50,1001.50,N/A
25922_3,AMPUTATE HAND AT WRIST,ProFee,0989,25922,,,,0,3.00,2.25,2.25,879.00,0.00,879.00,879.00,N/A
25924_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,25924,,,,0,3.00,2.25,2.25,978.50,0.00,978.50,978.50,N/A
25927_3,AMPUTATION OF HAND,ProFee,0989,25927,,,,0,3.00,2.25,2.25,1165.00,0.00,1165.00,1165.00,N/A
25929_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,25929,,,,0,3.00,2.25,2.25,858.00,0.00,858.00,858.00,N/A
25931_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,25931,,,,0,3.00,2.25,2.25,1070.50,0.00,1070.50,1070.50,N/A
25999_3,FOREARM OR WRIST SURGERY,ProFee,0989,25999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
26010_3,DRAINAGE OF FINGER ABSCESS,ProFee,0989,26010,,,,0,3.00,2.25,2.25,197.00,0.00,197.00,197.00,N/A
26011_3,DRAINAGE OF FINGER ABSCESS,ProFee,0989,26011,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
26020_3,DRAIN HAND TENDON SHEATH,ProFee,0989,26020,,,,0,3.00,2.25,2.25,622.00,0.00,622.00,622.00,N/A
26025_3,DRAINAGE OF PALM BURSA,ProFee,0989,26025,,,,0,3.00,2.25,2.25,605.50,0.00,605.50,605.50,N/A
26030_3,DRAINAGE OF PALM BURSA(S),ProFee,0989,26030,,,,0,3.00,2.25,2.25,708.50,0.00,708.50,708.50,N/A
26034_3,TREAT HAND BONE LESION,ProFee,0989,26034,,,,0,3.00,2.25,2.25,778.50,0.00,778.50,778.50,N/A
26035_3,DECOMPRESS FINGERS/HAND,ProFee,0989,26035,,,,0,3.00,2.25,2.25,1235.00,0.00,1235.00,1235.00,N/A
26037_3,DECOMPRESS FINGERS/HAND,ProFee,0989,26037,,,,0,3.00,2.25,2.25,814.00,0.00,814.00,814.00,N/A
26040_3,RELEASE PALM CONTRACTURE,ProFee,0989,26040,,,,0,3.00,2.25,2.25,447.50,0.00,447.50,447.50,N/A
26045_3,RELEASE PALM CONTRACTURE,ProFee,0989,26045,,,,0,3.00,2.25,2.25,671.00,0.00,671.00,671.00,N/A
26055_3,INCISE FINGER TENDON SHEATH,ProFee,0989,26055,,,,0,3.00,2.25,2.25,445.00,0.00,445.00,445.00,N/A
26060_3,INCISION OF FINGER TENDON,ProFee,0989,26060,,,,0,3.00,2.25,2.25,373.50,0.00,373.50,373.50,N/A
26070_3,EXPLORE/TREAT HAND JOINT,ProFee,0989,26070,,,,0,3.00,2.25,2.25,458.00,0.00,458.00,458.00,N/A
26075_3,EXPLORE/TREAT FINGER JOINT,ProFee,0989,26075,,,,0,3.00,2.25,2.25,477.50,0.00,477.50,477.50,N/A
26080_3,EXPLORE/TREAT FINGER JOINT,ProFee,0989,26080,,,,0,3.00,2.25,2.25,560.50,0.00,560.50,560.50,N/A
26100_3,BIOPSY HAND JOINT LINING,ProFee,0989,26100,,,,0,3.00,2.25,2.25,481.50,0.00,481.50,481.50,N/A
26105_3,BIOPSY FINGER JOINT LINING,ProFee,0989,26105,,,,0,3.00,2.25,2.25,484.50,0.00,484.50,484.50,N/A
26110_3,BIOPSY FINGER JOINT LINING,ProFee,0989,26110,,,,0,3.00,2.25,2.25,461.50,0.00,461.50,461.50,N/A
26111_3,EXC HAND LES SC > 1.5 CM,ProFee,0989,26111,,,,0,3.00,2.25,2.25,601.50,0.00,601.50,601.50,N/A
26113_3,EXC HAND TUM DEEP > 1.5 CM,ProFee,0989,26113,,,,0,3.00,2.25,2.25,789.50,0.00,789.50,789.50,N/A
26115_3,REMOVAL HAND LESION SUBCUT,ProFee,0989,26115,,,,0,3.00,2.25,2.25,478.50,0.00,478.50,478.50,N/A
26116_3,"REMOVAL HAND LESION, DEEP",ProFee,0989,26116,,,,0,3.00,2.25,2.25,758.50,0.00,758.50,758.50,N/A
26117_3,"REMOVE TUMOR, HAND/FINGER",ProFee,0989,26117,,,,0,3.00,2.25,2.25,1073.00,0.00,1073.00,1073.00,N/A
26118_3,EXC HAND TUM RA > 3 CM,ProFee,0989,26118,,,,0,3.00,2.25,2.25,1516.50,0.00,1516.50,1516.50,N/A
26121_3,RELEASE PALM CONTRACTURE,ProFee,0989,26121,,,,0,3.00,2.25,2.25,859.50,0.00,859.50,859.50,N/A
26123_3,RELEASE PALM CONTRACTURE,ProFee,0989,26123,,,,0,3.00,2.25,2.25,1199.50,0.00,1199.50,1199.50,N/A
26125_3,RELEASE PALM CONTRACTURE,ProFee,0989,26125,,,,0,3.00,2.25,2.25,396.00,0.00,396.00,396.00,N/A
26130_3,REMOVE WRIST JOINT LINING,ProFee,0989,26130,,,,0,3.00,2.25,2.25,661.00,0.00,661.00,661.00,N/A
26135_3,"REVISE FINGER JOINT, EACH",ProFee,0989,26135,,,,0,3.00,2.25,2.25,792.00,0.00,792.00,792.00,N/A
26140_3,"REVISE FINGER JOINT, EACH",ProFee,0989,26140,,,,0,3.00,2.25,2.25,723.50,0.00,723.50,723.50,N/A
26145_3,"TENDON EXCISION, PALM/FINGER",ProFee,0989,26145,,,,0,3.00,2.25,2.25,736.00,0.00,736.00,736.00,N/A
26160_3,REMOVE TENDON SHEATH LESION,ProFee,0989,26160,,,,0,3.00,2.25,2.25,479.50,0.00,479.50,479.50,N/A
26170_3,"REMOVAL OF PALM TENDON, EACH",ProFee,0989,26170,,,,0,3.00,2.25,2.25,584.00,0.00,584.00,584.00,N/A
26180_3,REMOVAL OF FINGER TENDON,ProFee,0989,26180,,,,0,3.00,2.25,2.25,637.00,0.00,637.00,637.00,N/A
26185_3,REMOVE FINGER BONE,ProFee,0989,26185,,,,0,3.00,2.25,2.25,792.00,0.00,792.00,792.00,N/A
26200_3,REMOVE HAND BONE LESION,ProFee,0989,26200,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
26205_3,REMOVE/GRAFT BONE LESION,ProFee,0989,26205,,,,0,3.00,2.25,2.25,865.50,0.00,865.50,865.50,N/A
26210_3,REMOVAL OF FINGER LESION,ProFee,0989,26210,,,,0,3.00,2.25,2.25,635.00,0.00,635.00,635.00,N/A
26215_3,REMOVE/GRAFT FINGER LESION,ProFee,0989,26215,,,,0,3.00,2.25,2.25,810.00,0.00,810.00,810.00,N/A
26230_3,PARTIAL REMOVAL OF HAND BONE,ProFee,0989,26230,,,,0,3.00,2.25,2.25,718.50,0.00,718.50,718.50,N/A
26235_3,"PARTIAL REMOVAL, FINGER BONE",ProFee,0989,26235,,,,0,3.00,2.25,2.25,708.00,0.00,708.00,708.00,N/A
26236_3,"PARTIAL REMOVAL, FINGER BONE",ProFee,0989,26236,,,,0,3.00,2.25,2.25,633.50,0.00,633.50,633.50,N/A
26250_3,EXTENSIVE HAND SURGERY,ProFee,0989,26250,,,,0,3.00,2.25,2.25,1544.50,0.00,1544.50,1544.50,N/A
26255_3,EXTENSIVE HAND SURGERY,ProFee,0989,26255,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
26260_3,EXTENSIVE FINGER SURGERY,ProFee,0989,26260,,,,0,3.00,2.25,2.25,1158.00,0.00,1158.00,1158.00,N/A
26261_3,EXTENSIVE FINGER SURGERY,ProFee,0989,26261,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
26262_3,PARTIAL REMOVAL OF FINGER,ProFee,0989,26262,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
26320_3,REMOVAL OF IMPLANT FROM HAND,ProFee,0989,26320,,,,0,3.00,2.25,2.25,497.50,0.00,497.50,497.50,N/A
26340_3,MANIPULATE FINGER W/ANESTH,ProFee,0989,26340,,,,0,3.00,2.25,2.25,477.50,0.00,477.50,477.50,N/A
26341_3,MANIPULAT PALM CORD POST INJ,ProFee,0989,26341,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
26350_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26350,,,,0,3.00,2.25,2.25,1008.50,0.00,1008.50,1008.50,N/A
26352_3,REPAIR/GRAFT HAND TENDON,ProFee,0989,26352,,,,0,3.00,2.25,2.25,1160.00,0.00,1160.00,1160.00,N/A
26356_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26356,,,,0,3.00,2.25,2.25,1139.50,0.00,1139.50,1139.50,N/A
26357_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26357,,,,0,3.00,2.25,2.25,1276.00,0.00,1276.00,1276.00,N/A
26358_3,REPAIR/GRAFT HAND TENDON,ProFee,0989,26358,,,,0,3.00,2.25,2.25,1413.00,0.00,1413.00,1413.00,N/A
26370_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26370,,,,0,3.00,2.25,2.25,1073.00,0.00,1073.00,1073.00,N/A
26372_3,REPAIR/GRAFT HAND TENDON,ProFee,0989,26372,,,,0,3.00,2.25,2.25,1257.00,0.00,1257.00,1257.00,N/A
26373_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26373,,,,0,3.00,2.25,2.25,1206.00,0.00,1206.00,1206.00,N/A
26390_3,REVISE HAND/FINGER TENDON,ProFee,0989,26390,,,,0,3.00,2.25,2.25,1188.50,0.00,1188.50,1188.50,N/A
26392_3,REPAIR/GRAFT HAND TENDON,ProFee,0989,26392,,,,0,3.00,2.25,2.25,1385.00,0.00,1385.00,1385.00,N/A
26410_3,REPAIR HAND TENDON,ProFee,0989,26410,,,,0,3.00,2.25,2.25,800.50,0.00,800.50,800.50,N/A
26412_3,REPAIR/GRAFT HAND TENDON,ProFee,0989,26412,,,,0,3.00,2.25,2.25,971.00,0.00,971.00,971.00,N/A
26415_3,"EXCISION, HAND/FINGER TENDON",ProFee,0989,26415,,,,0,3.00,2.25,2.25,1156.00,0.00,1156.00,1156.00,N/A
26416_3,GRAFT HAND OR FINGER TENDON,ProFee,0989,26416,,,,0,3.00,2.25,2.25,1258.00,0.00,1258.00,1258.00,N/A
26418_2,REPAIR FINGER TENDON,Ambulatory Surgical,0521,26418,,,,0,1230.00,922.50,922.50,1168.50,1107.00,1168.50,0.00,1107.00
26418_2,REPAIR FINGER TENDON,Inpatient,0521,26418,,,,0,1230.00,922.50,922.50,1168.50,1107.00,1168.50,1168.50,1107.00
26418_3,REPAIR FINGER TENDON,Ambulatory Surgical,0521,26418,,,,0,1198.00,898.50,898.50,1138.10,1078.20,1138.10,0.00,1078.20
26418_3,REPAIR FINGER TENDON,Inpatient,0521,26418,,,,0,1198.00,898.50,898.50,1138.10,1078.20,1138.10,1138.10,1078.20
26420_3,REPAIR/GRAFT FINGER TENDON,ProFee,0989,26420,,,,0,3.00,2.25,2.25,1014.50,0.00,1014.50,1014.50,N/A
26426_3,REPAIR FINGER/HAND TENDON,ProFee,0989,26426,,,,0,3.00,2.25,2.25,719.00,0.00,719.00,719.00,N/A
26428_3,REPAIR/GRAFT FINGER TENDON,ProFee,0989,26428,,,,0,3.00,2.25,2.25,1074.00,0.00,1074.00,1074.00,N/A
26432_3,REPAIR FINGER TENDON,ProFee,0989,26432,,,,0,3.00,2.25,2.25,706.00,0.00,706.00,706.00,N/A
26433_3,REPAIR FINGER TENDON,ProFee,0989,26433,,,,0,3.00,2.25,2.25,751.00,0.00,751.00,751.00,N/A
26434_3,REPAIR/GRAFT FINGER TENDON,ProFee,0989,26434,,,,0,3.00,2.25,2.25,919.00,0.00,919.00,919.00,N/A
26437_3,REALIGNMENT OF TENDONS,ProFee,0989,26437,,,,0,3.00,2.25,2.25,882.50,0.00,882.50,882.50,N/A
26440_3,RELEASE PALM/FINGER TENDON,ProFee,0989,26440,,,,0,3.00,2.25,2.25,877.50,0.00,877.50,877.50,N/A
26442_3,RELEASE PALM & FINGER TENDON,ProFee,0989,26442,,,,0,3.00,2.25,2.25,1368.50,0.00,1368.50,1368.50,N/A
26445_3,RELEASE HAND/FINGER TENDON,ProFee,0989,26445,,,,0,3.00,2.25,2.25,816.50,0.00,816.50,816.50,N/A
26449_3,RELEASE FOREARM/HAND TENDON,ProFee,0989,26449,,,,0,3.00,2.25,2.25,988.50,0.00,988.50,988.50,N/A
26450_3,INCISION OF PALM TENDON,ProFee,0989,26450,,,,0,3.00,2.25,2.25,577.00,0.00,577.00,577.00,N/A
26455_3,INCISION OF FINGER TENDON,ProFee,0989,26455,,,,0,3.00,2.25,2.25,572.00,0.00,572.00,572.00,N/A
26460_3,INCISE HAND/FINGER TENDON,ProFee,0989,26460,,,,0,3.00,2.25,2.25,559.00,0.00,559.00,559.00,N/A
26471_3,FUSION OF FINGER TENDONS,ProFee,0989,26471,,,,0,3.00,2.25,2.25,873.50,0.00,873.50,873.50,N/A
26474_3,FUSION OF FINGER TENDONS,ProFee,0989,26474,,,,0,3.00,2.25,2.25,852.50,0.00,852.50,852.50,N/A
26476_3,TENDON LENGTHENING,ProFee,0989,26476,,,,0,3.00,2.25,2.25,840.50,0.00,840.50,840.50,N/A
26477_3,TENDON SHORTENING,ProFee,0989,26477,,,,0,3.00,2.25,2.25,822.50,0.00,822.50,822.50,N/A
26478_3,LENGTHENING OF HAND TENDON,ProFee,0989,26478,,,,0,3.00,2.25,2.25,875.50,0.00,875.50,875.50,N/A
26479_3,SHORTENING OF HAND TENDON,ProFee,0989,26479,,,,0,3.00,2.25,2.25,888.50,0.00,888.50,888.50,N/A
26480_3,TRANSPLANT HAND TENDON,ProFee,0989,26480,,,,0,3.00,2.25,2.25,1066.00,0.00,1066.00,1066.00,N/A
26483_3,TRANSPLANT/GRAFT HAND TENDON,ProFee,0989,26483,,,,0,3.00,2.25,2.25,1194.50,0.00,1194.50,1194.50,N/A
26485_3,TRANSPLANT PALM TENDON,ProFee,0989,26485,,,,0,3.00,2.25,2.25,1142.00,0.00,1142.00,1142.00,N/A
26489_3,TRANSPLANT/GRAFT PALM TENDON,ProFee,0989,26489,,,,0,3.00,2.25,2.25,1330.00,0.00,1330.00,1330.00,N/A
26490_3,REVISE THUMB TENDON,ProFee,0989,26490,,,,0,3.00,2.25,2.25,1131.00,0.00,1131.00,1131.00,N/A
26492_3,TENDON TRANSFER WITH GRAFT,ProFee,0989,26492,,,,0,3.00,2.25,2.25,1254.50,0.00,1254.50,1254.50,N/A
26494_3,HAND TENDON/MUSCLE TRANSFER,ProFee,0989,26494,,,,0,3.00,2.25,2.25,1136.50,0.00,1136.50,1136.50,N/A
26496_3,REVISE THUMB TENDON,ProFee,0989,26496,,,,0,3.00,2.25,2.25,1233.50,0.00,1233.50,1233.50,N/A
26497_3,FINGER TENDON TRANSFER,ProFee,0989,26497,,,,0,3.00,2.25,2.25,1230.50,0.00,1230.50,1230.50,N/A
26498_3,FINGER TENDON TRANSFER,ProFee,0989,26498,,,,0,3.00,2.25,2.25,1627.50,0.00,1627.50,1627.50,N/A
26499_3,REVISION OF FINGER,ProFee,0989,26499,,,,0,3.00,2.25,2.25,1179.00,0.00,1179.00,1179.00,N/A
26500_3,HAND TENDON RECONSTRUCTION,ProFee,0989,26500,,,,0,3.00,2.25,2.25,883.00,0.00,883.00,883.00,N/A
26502_3,HAND TENDON RECONSTRUCTION,ProFee,0989,26502,,,,0,3.00,2.25,2.25,1008.00,0.00,1008.00,1008.00,N/A
26504_3,HAND TENDON RECONSTRUCTION,ProFee,0989,26504,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
26508_3,RELEASE THUMB CONTRACTURE,ProFee,0989,26508,,,,0,3.00,2.25,2.25,893.00,0.00,893.00,893.00,N/A
26510_3,THUMB TENDON TRANSFER,ProFee,0989,26510,,,,0,3.00,2.25,2.25,843.00,0.00,843.00,843.00,N/A
26516_3,FUSION OF KNUCKLE JOINT,ProFee,0989,26516,,,,0,3.00,2.25,2.25,992.50,0.00,992.50,992.50,N/A
26517_3,FUSION OF KNUCKLE JOINTS,ProFee,0989,26517,,,,0,3.00,2.25,2.25,1171.50,0.00,1171.50,1171.50,N/A
26518_3,FUSION OF KNUCKLE JOINTS,ProFee,0989,26518,,,,0,3.00,2.25,2.25,1188.00,0.00,1188.00,1188.00,N/A
26520_3,RELEASE KNUCKLE CONTRACTURE,ProFee,0989,26520,,,,0,3.00,2.25,2.25,919.50,0.00,919.50,919.50,N/A
26525_3,RELEASE FINGER CONTRACTURE,ProFee,0989,26525,,,,0,3.00,2.25,2.25,922.50,0.00,922.50,922.50,N/A
26530_3,REVISE KNUCKLE JOINT,ProFee,0989,26530,,,,0,3.00,2.25,2.25,773.00,0.00,773.00,773.00,N/A
26531_3,REVISE KNUCKLE WITH IMPLANT,ProFee,0989,26531,,,,0,3.00,2.25,2.25,897.00,0.00,897.00,897.00,N/A
26535_3,REVISE FINGER JOINT,ProFee,0989,26535,,,,0,3.00,2.25,2.25,611.50,0.00,611.50,611.50,N/A
26536_3,REVISE/IMPLANT FINGER JOINT,ProFee,0989,26536,,,,0,3.00,2.25,2.25,1007.00,0.00,1007.00,1007.00,N/A
26540_3,REPAIR HAND JOINT,ProFee,0989,26540,,,,0,3.00,2.25,2.25,931.00,0.00,931.00,931.00,N/A
26541_3,REPAIR HAND JOINT WITH GRAFT,ProFee,0989,26541,,,,0,3.00,2.25,2.25,1136.00,0.00,1136.00,1136.00,N/A
26542_3,REPAIR HAND JOINT WITH GRAFT,ProFee,0989,26542,,,,0,3.00,2.25,2.25,960.00,0.00,960.00,960.00,N/A
26545_3,RECONSTRUCT FINGER JOINT,ProFee,0989,26545,,,,0,3.00,2.25,2.25,992.50,0.00,992.50,992.50,N/A
26546_3,REPAIR NONUNION HAND,ProFee,0989,26546,,,,0,3.00,2.25,2.25,1410.00,0.00,1410.00,1410.00,N/A
26548_3,RECONSTRUCT FINGER JOINT,ProFee,0989,26548,,,,0,3.00,2.25,2.25,1079.00,0.00,1079.00,1079.00,N/A
26550_3,CONSTRUCT THUMB REPLACEMENT,ProFee,0989,26550,,,,0,3.00,2.25,2.25,2349.50,0.00,2349.50,2349.50,N/A
26551_3,GREAT TOE-HAND TRANSFER,ProFee,0989,26551,,,,0,3.00,2.25,2.25,4736.50,0.00,4736.50,4736.50,N/A
26553_3,"SINGLE TRANSFER, TOE-HAND",ProFee,0989,26553,,,,0,3.00,2.25,2.25,4704.50,0.00,4704.50,4704.50,N/A
26554_3,"DOUBLE TRANSFER, TOE-HAND",ProFee,0989,26554,,,,0,3.00,2.25,2.25,5489.00,0.00,5489.00,5489.00,N/A
26555_3,POSITIONAL CHANGE OF FINGER,ProFee,0989,26555,,,,0,3.00,2.25,2.25,1956.00,0.00,1956.00,1956.00,N/A
26556_3,TOE JOINT TRANSFER,ProFee,0989,26556,,,,0,3.00,2.25,2.25,4887.50,0.00,4887.50,4887.50,N/A
26560_3,REPAIR OF WEB FINGER,ProFee,0989,26560,,,,0,3.00,2.25,2.25,838.00,0.00,838.00,838.00,N/A
26561_3,REPAIR OF WEB FINGER,ProFee,0989,26561,,,,0,3.00,2.25,2.25,1345.00,0.00,1345.00,1345.00,N/A
26562_3,REPAIR OF WEB FINGER,ProFee,0989,26562,,,,0,3.00,2.25,2.25,1914.50,0.00,1914.50,1914.50,N/A
26565_3,CORRECT METACARPAL FLAW,ProFee,0989,26565,,,,0,3.00,2.25,2.25,968.50,0.00,968.50,968.50,N/A
26567_3,CORRECT FINGER DEFORMITY,ProFee,0989,26567,,,,0,3.00,2.25,2.25,964.50,0.00,964.50,964.50,N/A
26568_3,LENGTHEN METACARPAL/FINGER,ProFee,0989,26568,,,,0,3.00,2.25,2.25,1279.00,0.00,1279.00,1279.00,N/A
26580_3,REPAIR HAND DEFORMITY,ProFee,0989,26580,,,,0,3.00,2.25,2.25,2160.00,0.00,2160.00,2160.00,N/A
26587_3,RECONSTRUCT EXTRA FINGER,ProFee,0989,26587,,,,0,3.00,2.25,2.25,1496.00,0.00,1496.00,1496.00,N/A
26590_3,REPAIR FINGER DEFORMITY,ProFee,0989,26590,,,,0,3.00,2.25,2.25,2010.00,0.00,2010.00,2010.00,N/A
26591_3,REPAIR MUSCLES OF HAND,ProFee,0989,26591,,,,0,3.00,2.25,2.25,618.50,0.00,618.50,618.50,N/A
26593_3,RELEASE MUSCLES OF HAND,ProFee,0989,26593,,,,0,3.00,2.25,2.25,850.00,0.00,850.00,850.00,N/A
26596_3,EXCISION CONSTRICTING TISSUE,ProFee,0989,26596,,,,0,3.00,2.25,2.25,1086.00,0.00,1086.00,1086.00,N/A
26600_3,TREAT METACARPAL FRACTURE,ProFee,0989,26600,,,,0,3.00,2.25,2.25,395.50,0.00,395.50,395.50,N/A
26605_2,TREAT METACARPAL FRACTURE,Ambulatory Surgical,0521,26605,,,,0,566.00,424.50,424.50,537.70,509.40,537.70,0.00,509.40
26605_2,TREAT METACARPAL FRACTURE,Inpatient,0521,26605,,,,0,566.00,424.50,424.50,537.70,509.40,537.70,537.70,509.40
26605_3,TREAT METACARPAL FRACTURE,Inpatient,0521,26605,,,,0,553.00,414.75,414.75,525.35,497.70,525.35,525.35,497.70
26605_3,TREAT METACARPAL FRACTURE,Ambulatory Surgical,0521,26605,,,,0,553.00,414.75,414.75,525.35,497.70,525.35,0.00,497.70
26607_3,TREAT METACARPAL FRACTURE,ProFee,0989,26607,,,,0,3.00,2.25,2.25,658.00,0.00,658.00,658.00,N/A
26608_3,TREAT METACARPAL FRACTURE,ProFee,0989,26608,,,,0,3.00,2.25,2.25,682.00,0.00,682.00,682.00,N/A
26615_3,TREAT METACARPAL FRACTURE,ProFee,0989,26615,,,,0,3.00,2.25,2.25,827.50,0.00,827.50,827.50,N/A
26641_2,TREAT THUMB DISLOCATION,Inpatient,0521,26641,,,,0,732.00,549.00,549.00,695.40,658.80,695.40,695.40,658.80
26641_2,TREAT THUMB DISLOCATION,Ambulatory Surgical,0521,26641,,,,0,732.00,549.00,549.00,695.40,658.80,695.40,0.00,658.80
26641_3,TREAT THUMB DISLOCATION,Inpatient,0521,26641,,,,0,714.00,535.50,535.50,678.30,642.60,678.30,678.30,642.60
26641_3,TREAT THUMB DISLOCATION,Ambulatory Surgical,0521,26641,,,,0,714.00,535.50,535.50,678.30,642.60,678.30,0.00,642.60
26645_3,TREAT THUMB FRACTURE,ProFee,0989,26645,,,,0,3.00,2.25,2.25,563.00,0.00,563.00,563.00,N/A
26650_3,TREAT THUMB FRACTURE,ProFee,0989,26650,,,,0,3.00,2.25,2.25,683.00,0.00,683.00,683.00,N/A
26665_3,TREAT THUMB FRACTURE,ProFee,0989,26665,,,,0,3.00,2.25,2.25,900.00,0.00,900.00,900.00,N/A
26670_3,TREAT HAND DISLOCATION,ProFee,0989,26670,,,,0,3.00,2.25,2.25,441.50,0.00,441.50,441.50,N/A
26675_3,TREAT HAND DISLOCATION,ProFee,0989,26675,,,,0,3.00,2.25,2.25,599.00,0.00,599.00,599.00,N/A
26676_3,PIN HAND DISLOCATION,ProFee,0989,26676,,,,0,3.00,2.25,2.25,718.50,0.00,718.50,718.50,N/A
26685_3,TREAT HAND DISLOCATION,ProFee,0989,26685,,,,0,3.00,2.25,2.25,828.00,0.00,828.00,828.00,N/A
26686_3,TREAT HAND DISLOCATION,ProFee,0989,26686,,,,0,3.00,2.25,2.25,896.50,0.00,896.50,896.50,N/A
26700_3,TREAT KNUCKLE DISLOCATION,ProFee,0989,26700,,,,0,3.00,2.25,2.25,433.00,0.00,433.00,433.00,N/A
26705_3,TREAT KNUCKLE DISLOCATION,ProFee,0989,26705,,,,0,3.00,2.25,2.25,542.00,0.00,542.00,542.00,N/A
26706_3,PIN KNUCKLE DISLOCATION,ProFee,0989,26706,,,,0,3.00,2.25,2.25,630.00,0.00,630.00,630.00,N/A
26715_3,TREAT KNUCKLE DISLOCATION,ProFee,0989,26715,,,,0,3.00,2.25,2.25,823.00,0.00,823.00,823.00,N/A
26720_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26720,,,,0,3.00,2.25,2.25,263.00,0.00,263.00,263.00,N/A
26725_2,"TREAT FINGER FRACTURE, EACH",Inpatient,0521,26725,,,,0,251.00,188.25,188.25,238.45,225.90,238.45,238.45,225.90
26725_2,"TREAT FINGER FRACTURE, EACH",Ambulatory Surgical,0521,26725,,,,0,251.00,188.25,188.25,238.45,225.90,238.45,0.00,225.90
26725_3,"TREAT FINGER FRACTURE, EACH",Inpatient,0521,26725,,,,0,247.00,185.25,185.25,234.65,222.30,234.65,234.65,222.30
26725_3,"TREAT FINGER FRACTURE, EACH",Ambulatory Surgical,0521,26725,,,,0,247.00,185.25,185.25,234.65,222.30,234.65,0.00,222.30
26727_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26727,,,,0,3.00,2.25,2.25,673.00,0.00,673.00,673.00,N/A
26735_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26735,,,,0,3.00,2.25,2.25,856.50,0.00,856.50,856.50,N/A
26740_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26740,,,,0,3.00,2.25,2.25,308.50,0.00,308.50,308.50,N/A
26742_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26742,,,,0,3.00,2.25,2.25,479.00,0.00,479.00,479.00,N/A
26746_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26746,,,,0,3.00,2.25,2.25,1067.00,0.00,1067.00,1067.00,N/A
26750_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26750,,,,0,3.00,2.25,2.25,263.00,0.00,263.00,263.00,N/A
26755_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26755,,,,0,3.00,2.25,2.25,389.50,0.00,389.50,389.50,N/A
26756_3,"PIN FINGER FRACTURE, EACH",ProFee,0989,26756,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
26765_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26765,,,,0,3.00,2.25,2.25,718.50,0.00,718.50,718.50,N/A
26770_3,TREAT FINGER DISLOCATION,ProFee,0989,26770,,,,0,3.00,2.25,2.25,363.50,0.00,363.50,363.50,N/A
26775_3,TREAT FINGER DISLOCATION,ProFee,0989,26775,,,,0,3.00,2.25,2.25,493.50,0.00,493.50,493.50,N/A
26776_3,PIN FINGER DISLOCATION,ProFee,0989,26776,,,,0,3.00,2.25,2.25,635.50,0.00,635.50,635.50,N/A
26785_3,TREAT FINGER DISLOCATION,ProFee,0989,26785,,,,0,3.00,2.25,2.25,785.50,0.00,785.50,785.50,N/A
26820_3,THUMB FUSION WITH GRAFT,ProFee,0989,26820,,,,0,3.00,2.25,2.25,1118.50,0.00,1118.50,1118.50,N/A
26841_3,FUSION OF THUMB,ProFee,0989,26841,,,,0,3.00,2.25,2.25,1027.50,0.00,1027.50,1027.50,N/A
26842_3,THUMB FUSION WITH GRAFT,ProFee,0989,26842,,,,0,3.00,2.25,2.25,1108.50,0.00,1108.50,1108.50,N/A
26843_3,FUSION OF HAND JOINT,ProFee,0989,26843,,,,0,3.00,2.25,2.25,1048.00,0.00,1048.00,1048.00,N/A
26844_3,FUSION/GRAFT OF HAND JOINT,ProFee,0989,26844,,,,0,3.00,2.25,2.25,1163.50,0.00,1163.50,1163.50,N/A
26850_3,FUSION OF KNUCKLE,ProFee,0989,26850,,,,0,3.00,2.25,2.25,979.50,0.00,979.50,979.50,N/A
26852_3,FUSION OF KNUCKLE WITH GRAFT,ProFee,0989,26852,,,,0,3.00,2.25,2.25,1128.00,0.00,1128.00,1128.00,N/A
26860_3,FUSION OF FINGER JOINT,ProFee,0989,26860,,,,0,3.00,2.25,2.25,800.00,0.00,800.00,800.00,N/A
26861_3,"FUSION OF FINGER JNT, ADD-ON",ProFee,0989,26861,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
26862_3,FUSION/GRAFT OF FINGER JOINT,ProFee,0989,26862,,,,0,3.00,2.25,2.25,1029.50,0.00,1029.50,1029.50,N/A
26863_3,FUSE/GRAFT ADDED JOINT,ProFee,0989,26863,,,,0,3.00,2.25,2.25,332.50,0.00,332.50,332.50,N/A
26910_3,AMPUTATE METACARPAL BONE,ProFee,0989,26910,,,,0,3.00,2.25,2.25,1026.00,0.00,1026.00,1026.00,N/A
26951_3,AMPUTATION OF FINGER/THUMB,ProFee,0989,26951,,,,0,3.00,2.25,2.25,924.00,0.00,924.00,924.00,N/A
26952_3,AMPUTATION OF FINGER/THUMB,ProFee,0989,26952,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
26989_3,HAND/FINGER SURGERY,ProFee,0989,26989,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
26990_3,DRAINAGE OF PELVIS LESION,ProFee,0989,26990,,,,0,3.00,2.25,2.25,902.00,0.00,902.00,902.00,N/A
26991_3,DRAINAGE OF PELVIS BURSA,ProFee,0989,26991,,,,0,3.00,2.25,2.25,754.50,0.00,754.50,754.50,N/A
26992_3,DRAINAGE OF BONE LESION,ProFee,0989,26992,,,,0,3.00,2.25,2.25,1379.00,0.00,1379.00,1379.00,N/A
27000_3,INCISION OF HIP TENDON,ProFee,0989,27000,,,,0,3.00,2.25,2.25,590.00,0.00,590.00,590.00,N/A
27001_3,INCISION OF HIP TENDON,ProFee,0989,27001,,,,0,3.00,2.25,2.25,774.50,0.00,774.50,774.50,N/A
27003_3,INCISION OF HIP TENDON,ProFee,0989,27003,,,,0,3.00,2.25,2.25,857.50,0.00,857.50,857.50,N/A
27005_3,INCISION OF HIP TENDON,ProFee,0989,27005,,,,0,3.00,2.25,2.25,1040.00,0.00,1040.00,1040.00,N/A
27006_3,INCISION OF HIP TENDONS,ProFee,0989,27006,,,,0,3.00,2.25,2.25,1050.00,0.00,1050.00,1050.00,N/A
27025_3,INCISION OF HIP/THIGH FASCIA,ProFee,0989,27025,,,,0,3.00,2.25,2.25,1324.00,0.00,1324.00,1324.00,N/A
27027_3,BUTTOCK FASCIOTOMY,ProFee,0989,27027,,,,0,3.00,2.25,2.25,1267.00,0.00,1267.00,1267.00,N/A
27030_3,DRAINAGE OF HIP JOINT,ProFee,0989,27030,,,,0,3.00,2.25,2.25,1348.50,0.00,1348.50,1348.50,N/A
27033_3,EXPLORATION OF HIP JOINT,ProFee,0989,27033,,,,0,3.00,2.25,2.25,1397.50,0.00,1397.50,1397.50,N/A
27035_3,DENERVATION OF HIP JOINT,ProFee,0989,27035,,,,0,3.00,2.25,2.25,1645.50,0.00,1645.50,1645.50,N/A
27036_3,EXCISION OF HIP JOINT/MUSCLE,ProFee,0989,27036,,,,0,3.00,2.25,2.25,1456.50,0.00,1456.50,1456.50,N/A
27040_3,BIOPSY OF SOFT TISSUES,ProFee,0989,27040,,,,0,3.00,2.25,2.25,286.50,0.00,286.50,286.50,N/A
27041_3,BIOPSY OF SOFT TISSUES,ProFee,0989,27041,,,,0,3.00,2.25,2.25,999.50,0.00,999.50,999.50,N/A
27043_3,EXC HIP PELVIS LES SC > 3 CM,ProFee,0989,27043,,,,0,3.00,2.25,2.25,677.00,0.00,677.00,677.00,N/A
27045_3,EXC HIP/PELV TUM DEEP > 5 CM,ProFee,0989,27045,,,,0,3.00,2.25,2.25,1075.00,0.00,1075.00,1075.00,N/A
27047_3,REMOVE HIP/PELVIS LESION,ProFee,0989,27047,,,,0,3.00,2.25,2.25,520.00,0.00,520.00,520.00,N/A
27048_3,REMOVE HIP/PELVIS LESION,ProFee,0989,27048,,,,0,3.00,2.25,2.25,879.00,0.00,879.00,879.00,N/A
27049_3,"REMOVE TUMOR, HIP/PELVIS",ProFee,0989,27049,,,,0,3.00,2.25,2.25,1937.50,0.00,1937.50,1937.50,N/A
27050_3,BIOPSY OF SACROILIAC JOINT,ProFee,0989,27050,,,,0,3.00,2.25,2.25,578.00,0.00,578.00,578.00,N/A
27052_3,BIOPSY OF HIP JOINT,ProFee,0989,27052,,,,0,3.00,2.25,2.25,834.00,0.00,834.00,834.00,N/A
27054_3,REMOVAL OF HIP JOINT LINING,ProFee,0989,27054,,,,0,3.00,2.25,2.25,984.50,0.00,984.50,984.50,N/A
27057_3,BUTTOCK FASCIOTOMY W/DBRDMT,ProFee,0989,27057,,,,0,3.00,2.25,2.25,1463.50,0.00,1463.50,1463.50,N/A
27059_3,RESECT HIP/PELV TUM > 5 CM,ProFee,0989,27059,,,,0,3.00,2.25,2.25,2632.50,0.00,2632.50,2632.50,N/A
27060_3,REMOVAL OF ISCHIAL BURSA,ProFee,0989,27060,,,,0,3.00,2.25,2.25,669.50,0.00,669.50,669.50,N/A
27062_3,REMOVE FEMUR LESION/BURSA,ProFee,0989,27062,,,,0,3.00,2.25,2.25,655.00,0.00,655.00,655.00,N/A
27065_3,REMOVAL OF HIP BONE LESION,ProFee,0989,27065,,,,0,3.00,2.25,2.25,747.00,0.00,747.00,747.00,N/A
27066_3,REMOVAL OF HIP BONE LESION,ProFee,0989,27066,,,,0,3.00,2.25,2.25,1160.50,0.00,1160.50,1160.50,N/A
27067_3,REMOVE/GRAFT HIP BONE LESION,ProFee,0989,27067,,,,0,3.00,2.25,2.25,1491.00,0.00,1491.00,1491.00,N/A
27070_3,PARTIAL REMOVAL OF HIP BONE,ProFee,0989,27070,,,,0,3.00,2.25,2.25,1216.00,0.00,1216.00,1216.00,N/A
27071_3,PARTIAL REMOVAL OF HIP BONE,ProFee,0989,27071,,,,0,3.00,2.25,2.25,1319.50,0.00,1319.50,1319.50,N/A
27075_3,EXTENSIVE HIP SURGERY,ProFee,0989,27075,,,,0,3.00,2.25,2.25,3039.50,0.00,3039.50,3039.50,N/A
27076_3,EXTENSIVE HIP SURGERY,ProFee,0989,27076,,,,0,3.00,2.25,2.25,3681.00,0.00,3681.00,3681.00,N/A
27077_3,EXTENSIVE HIP SURGERY,ProFee,0989,27077,,,,0,3.00,2.25,2.25,4106.00,0.00,4106.00,4106.00,N/A
27078_3,EXTENSIVE HIP SURGERY,ProFee,0989,27078,,,,0,3.00,2.25,2.25,2997.00,0.00,2997.00,2997.00,N/A
27079_3,EXTENSIVE HIP SURGERY,ProFee,0989,27079,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
27080_3,REMOVAL OF TAIL BONE,ProFee,0989,27080,,,,0,3.00,2.25,2.25,738.00,0.00,738.00,738.00,N/A
27086_3,REMOVE HIP FOREIGN BODY,ProFee,0989,27086,,,,0,3.00,2.25,2.25,241.50,0.00,241.50,241.50,N/A
27087_3,REMOVE HIP FOREIGN BODY,ProFee,0989,27087,,,,0,3.00,2.25,2.25,879.00,0.00,879.00,879.00,N/A
27090_3,REMOVAL OF HIP PROSTHESIS,ProFee,0989,27090,,,,0,3.00,2.25,2.25,1194.50,0.00,1194.50,1194.50,N/A
27091_3,REMOVAL OF HIP PROSTHESIS,ProFee,0989,27091,,,,0,3.00,2.25,2.25,2304.50,0.00,2304.50,2304.50,N/A
27093_3,INJECTION FOR HIP X-RAY,ProFee,0989,27093,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
27095_3,INJECTION FOR HIP X-RAY,ProFee,0989,27095,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
27096_3,INJECT SACROILIAC JOINT,ProFee,0989,27096,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
27097_3,REVISION OF HIP TENDON,ProFee,0989,27097,,,,0,3.00,2.25,2.25,981.00,0.00,981.00,981.00,N/A
27098_3,TRANSFER TENDON TO PELVIS,ProFee,0989,27098,,,,0,3.00,2.25,2.25,998.50,0.00,998.50,998.50,N/A
27100_3,TRANSFER OF ABDOMINAL MUSCLE,ProFee,0989,27100,,,,0,3.00,2.25,2.25,1190.00,0.00,1190.00,1190.00,N/A
27105_3,TRANSFER OF SPINAL MUSCLE,ProFee,0989,27105,,,,0,3.00,2.25,2.25,1249.00,0.00,1249.00,1249.00,N/A
27110_3,TRANSFER OF ILIOPSOAS MUSCLE,ProFee,0989,27110,,,,0,3.00,2.25,2.25,1397.00,0.00,1397.00,1397.00,N/A
27111_3,TRANSFER OF ILIOPSOAS MUSCLE,ProFee,0989,27111,,,,0,3.00,2.25,2.25,1296.50,0.00,1296.50,1296.50,N/A
27120_3,RECONSTRUCTION OF HIP SOCKET,ProFee,0989,27120,,,,0,3.00,2.25,2.25,1877.50,0.00,1877.50,1877.50,N/A
27122_3,RECONSTRUCTION OF HIP SOCKET,ProFee,0989,27122,,,,0,3.00,2.25,2.25,1585.50,0.00,1585.50,1585.50,N/A
27125_3,PARTIAL HIP REPLACEMENT,ProFee,0989,27125,,,,0,3.00,2.25,2.25,1635.50,0.00,1635.50,1635.50,N/A
27130_3,TOTAL HIP ARTHROPLASTY,ProFee,0989,27130,,,,0,3.00,2.25,2.25,1958.00,0.00,1958.00,1958.00,N/A
27132_3,TOTAL HIP ARTHROPLASTY,ProFee,0989,27132,,,,0,3.00,2.25,2.25,2418.00,0.00,2418.00,2418.00,N/A
27134_3,REVISE HIP JOINT REPLACEMENT,ProFee,0989,27134,,,,0,3.00,2.25,2.25,2768.00,0.00,2768.00,2768.00,N/A
27137_3,REVISE HIP JOINT REPLACEMENT,ProFee,0989,27137,,,,0,3.00,2.25,2.25,2126.50,0.00,2126.50,2126.50,N/A
27138_3,REVISE HIP JOINT REPLACEMENT,ProFee,0989,27138,,,,0,3.00,2.25,2.25,2210.00,0.00,2210.00,2210.00,N/A
27140_3,TRANSPLANT FEMUR RIDGE,ProFee,0989,27140,,,,0,3.00,2.25,2.25,1287.50,0.00,1287.50,1287.50,N/A
27146_3,INCISION OF HIP BONE,ProFee,0989,27146,,,,0,3.00,2.25,2.25,1849.50,0.00,1849.50,1849.50,N/A
27147_3,REVISION OF HIP BONE,ProFee,0989,27147,,,,0,3.00,2.25,2.25,2125.00,0.00,2125.00,2125.00,N/A
27151_3,INCISION OF HIP BONES,ProFee,0989,27151,,,,0,3.00,2.25,2.25,2301.50,0.00,2301.50,2301.50,N/A
27156_3,REVISION OF HIP BONES,ProFee,0989,27156,,,,0,3.00,2.25,2.25,2481.50,0.00,2481.50,2481.50,N/A
27158_3,REVISION OF PELVIS,ProFee,0989,27158,,,,0,3.00,2.25,2.25,2026.00,0.00,2026.00,2026.00,N/A
27161_3,INCISION OF NECK OF FEMUR,ProFee,0989,27161,,,,0,3.00,2.25,2.25,1749.50,0.00,1749.50,1749.50,N/A
27165_3,INCISION/FIXATION OF FEMUR,ProFee,0989,27165,,,,0,3.00,2.25,2.25,1976.50,0.00,1976.50,1976.50,N/A
27170_3,REPAIR/GRAFT FEMUR HEAD/NECK,ProFee,0989,27170,,,,0,3.00,2.25,2.25,1696.00,0.00,1696.00,1696.00,N/A
27175_3,TREAT SLIPPED EPIPHYSIS,ProFee,0989,27175,,,,0,3.00,2.25,2.25,960.50,0.00,960.50,960.50,N/A
27176_3,TREAT SLIPPED EPIPHYSIS,ProFee,0989,27176,,,,0,3.00,2.25,2.25,1323.50,0.00,1323.50,1323.50,N/A
27177_3,TREAT SLIPPED EPIPHYSIS,ProFee,0989,27177,,,,0,3.00,2.25,2.25,1608.50,0.00,1608.50,1608.50,N/A
27178_3,TREAT SLIPPED EPIPHYSIS,ProFee,0989,27178,,,,0,3.00,2.25,2.25,1323.50,0.00,1323.50,1323.50,N/A
27179_3,REVISE HEAD/NECK OF FEMUR,ProFee,0989,27179,,,,0,3.00,2.25,2.25,1408.00,0.00,1408.00,1408.00,N/A
27181_3,TREAT SLIPPED EPIPHYSIS,ProFee,0989,27181,,,,0,3.00,2.25,2.25,1622.00,0.00,1622.00,1622.00,N/A
27185_3,REVISION OF FEMUR EPIPHYSIS,ProFee,0989,27185,,,,0,3.00,2.25,2.25,1034.00,0.00,1034.00,1034.00,N/A
27187_3,REINFORCE HIP BONES,ProFee,0989,27187,,,,0,3.00,2.25,2.25,1428.50,0.00,1428.50,1428.50,N/A
27193_3,TREAT PELVIC RING FRACTURE,ProFee,0989,27193,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
27194_3,TREAT PELVIC RING FRACTURE,ProFee,0989,27194,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
27197_3,CLSD TX PELVIC RING FX,ProFee,0989,27197,,,,0,3.00,2.25,2.25,172.50,0.00,172.50,172.50,N/A
27198_3,CLSD TX PELVIC RING FX,ProFee,0989,27198,,,,0,3.00,2.25,2.25,432.00,0.00,432.00,432.00,N/A
27200_3,TREAT TAIL BONE FRACTURE,ProFee,0989,27200,,,,0,3.00,2.25,2.25,270.50,0.00,270.50,270.50,N/A
27202_3,TREAT TAIL BONE FRACTURE,ProFee,0989,27202,,,,0,3.00,2.25,2.25,767.50,0.00,767.50,767.50,N/A
27215_3,TREAT PELVIC FRACTURE(S),ProFee,0989,27215,,,,0,3.00,2.25,2.25,901.50,0.00,901.50,901.50,N/A
27216_3,TREAT PELVIC RING FRACTURE,ProFee,0989,27216,,,,0,3.00,2.25,2.25,1335.00,0.00,1335.00,1335.00,N/A
27217_3,TREAT PELVIC RING FRACTURE,ProFee,0989,27217,,,,0,3.00,2.25,2.25,1253.00,0.00,1253.00,1253.00,N/A
27218_3,TREAT PELVIC RING FRACTURE,ProFee,0989,27218,,,,0,3.00,2.25,2.25,1730.00,0.00,1730.00,1730.00,N/A
27220_3,TREAT HIP SOCKET FRACTURE,ProFee,0989,27220,,,,0,3.00,2.25,2.25,755.50,0.00,755.50,755.50,N/A
27222_3,TREAT HIP SOCKET FRACTURE,ProFee,0989,27222,,,,0,3.00,2.25,2.25,1401.00,0.00,1401.00,1401.00,N/A
27226_3,TREAT HIP WALL FRACTURE,ProFee,0989,27226,,,,0,3.00,2.25,2.25,1518.00,0.00,1518.00,1518.00,N/A
27227_3,TREAT HIP FRACTURE(S),ProFee,0989,27227,,,,0,3.00,2.25,2.25,2397.50,0.00,2397.50,2397.50,N/A
27228_3,TREAT HIP FRACTURE(S),ProFee,0989,27228,,,,0,3.00,2.25,2.25,2722.00,0.00,2722.00,2722.00,N/A
27230_3,TREAT THIGH FRACTURE,ProFee,0989,27230,,,,0,3.00,2.25,2.25,677.00,0.00,677.00,677.00,N/A
27232_3,TREAT THIGH FRACTURE,ProFee,0989,27232,,,,0,3.00,2.25,2.25,1072.00,0.00,1072.00,1072.00,N/A
27235_3,TREAT THIGH FRACTURE,ProFee,0989,27235,,,,0,3.00,2.25,2.25,1310.50,0.00,1310.50,1310.50,N/A
27236_3,TREAT THIGH FRACTURE,ProFee,0989,27236,,,,0,3.00,2.25,2.25,1725.00,0.00,1725.00,1725.00,N/A
27238_3,TREAT THIGH FRACTURE,ProFee,0989,27238,,,,0,3.00,2.25,2.25,661.00,0.00,661.00,661.00,N/A
27240_3,TREAT THIGH FRACTURE,ProFee,0989,27240,,,,0,3.00,2.25,2.25,1381.50,0.00,1381.50,1381.50,N/A
27244_3,TREAT THIGH FRACTURE,ProFee,0989,27244,,,,0,3.00,2.25,2.25,1776.00,0.00,1776.00,1776.00,N/A
27245_3,TREAT THIGH FRACTURE,ProFee,0989,27245,,,,0,3.00,2.25,2.25,1776.00,0.00,1776.00,1776.00,N/A
27246_3,TREAT THIGH FRACTURE,ProFee,0989,27246,,,,0,3.00,2.25,2.25,554.50,0.00,554.50,554.50,N/A
27248_3,TREAT THIGH FRACTURE,ProFee,0989,27248,,,,0,3.00,2.25,2.25,1070.50,0.00,1070.50,1070.50,N/A
27250_3,TREAT HIP DISLOCATION,ProFee,0989,27250,,,,0,3.00,2.25,2.25,259.00,0.00,259.00,259.00,N/A
27252_2,TREAT HIP DISLOCATION,Inpatient,0521,27252,,,,0,1905.00,1428.75,1428.75,1809.75,1714.50,1809.75,1809.75,1714.50
27252_2,TREAT HIP DISLOCATION,Ambulatory Surgical,0521,27252,,,,0,1905.00,1428.75,1428.75,1809.75,1714.50,1809.75,0.00,1714.50
27252_3,TREAT HIP DISLOCATION,Inpatient,0521,27252,,,,0,1853.00,1389.75,1389.75,1760.35,1667.70,1760.35,1760.35,1667.70
27252_3,TREAT HIP DISLOCATION,Ambulatory Surgical,0521,27252,,,,0,1853.00,1389.75,1389.75,1760.35,1667.70,1760.35,0.00,1667.70
27253_3,TREAT HIP DISLOCATION,ProFee,0989,27253,,,,0,3.00,2.25,2.25,1352.50,0.00,1352.50,1352.50,N/A
27254_3,TREAT HIP DISLOCATION,ProFee,0989,27254,,,,0,3.00,2.25,2.25,1832.00,0.00,1832.00,1832.00,N/A
27256_3,TREAT HIP DISLOCATION,ProFee,0989,27256,,,,0,3.00,2.25,2.25,337.50,0.00,337.50,337.50,N/A
27257_3,TREAT HIP DISLOCATION,ProFee,0989,27257,,,,0,3.00,2.25,2.25,525.00,0.00,525.00,525.00,N/A
27258_3,TREAT HIP DISLOCATION,ProFee,0989,27258,,,,0,3.00,2.25,2.25,1602.50,0.00,1602.50,1602.50,N/A
27259_3,TREAT HIP DISLOCATION,ProFee,0989,27259,,,,0,3.00,2.25,2.25,2244.50,0.00,2244.50,2244.50,N/A
27265_3,TREAT HIP DISLOCATION,ProFee,0989,27265,,,,0,3.00,2.25,2.25,572.50,0.00,572.50,572.50,N/A
27266_3,TREAT HIP DISLOCATION,ProFee,0989,27266,,,,0,3.00,2.25,2.25,835.50,0.00,835.50,835.50,N/A
27267_3,CLTX THIGH FX,ProFee,0989,27267,,,,0,3.00,2.25,2.25,621.00,0.00,621.00,621.00,N/A
27268_3,CLTX THIGH FX W/MNPJ,ProFee,0989,27268,,,,0,3.00,2.25,2.25,775.50,0.00,775.50,775.50,N/A
27269_3,OPTX THIGH FX,ProFee,0989,27269,,,,0,3.00,2.25,2.25,1794.50,0.00,1794.50,1794.50,N/A
27275_3,MANIPULATION OF HIP JOINT,ProFee,0989,27275,,,,0,3.00,2.25,2.25,263.00,0.00,263.00,263.00,N/A
27279_3,ARTHRODESIS SACROILIAC JOINT,ProFee,0989,27279,,,,0,3.00,2.25,2.25,1000.00,0.00,1000.00,1000.00,N/A
27280_3,FUSION OF SACROILIAC JOINT,ProFee,0989,27280,,,,0,3.00,2.25,2.25,1961.50,0.00,1961.50,1961.50,N/A
27282_3,FUSION OF PUBIC BONES,ProFee,0989,27282,,,,0,3.00,2.25,2.25,1233.00,0.00,1233.00,1233.00,N/A
27284_3,FUSION OF HIP JOINT,ProFee,0989,27284,,,,0,3.00,2.25,2.25,2342.00,0.00,2342.00,2342.00,N/A
27286_3,FUSION OF HIP JOINT,ProFee,0989,27286,,,,0,3.00,2.25,2.25,2390.50,0.00,2390.50,2390.50,N/A
27290_3,AMPUTATION OF LEG AT HIP,ProFee,0989,27290,,,,0,3.00,2.25,2.25,2348.50,0.00,2348.50,2348.50,N/A
27295_3,AMPUTATION OF LEG AT HIP,ProFee,0989,27295,,,,0,3.00,2.25,2.25,1827.50,0.00,1827.50,1827.50,N/A
27299_3,PELVIS/HIP JOINT SURGERY,ProFee,0989,27299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
27301_3,DRAIN THIGH/KNEE LESION,ProFee,0989,27301,,,,0,3.00,2.25,2.25,724.50,0.00,724.50,724.50,N/A
27303_3,DRAINAGE OF BONE LESION,ProFee,0989,27303,,,,0,3.00,2.25,2.25,918.50,0.00,918.50,918.50,N/A
27305_3,INCISE THIGH TENDON & FASCIA,ProFee,0989,27305,,,,0,3.00,2.25,2.25,687.50,0.00,687.50,687.50,N/A
27306_3,INCISION OF THIGH TENDON,ProFee,0989,27306,,,,0,3.00,2.25,2.25,499.00,0.00,499.00,499.00,N/A
27307_3,INCISION OF THIGH TENDONS,ProFee,0989,27307,,,,0,3.00,2.25,2.25,613.00,0.00,613.00,613.00,N/A
27310_3,EXPLORATION OF KNEE JOINT,ProFee,0989,27310,,,,0,3.00,2.25,2.25,1051.50,0.00,1051.50,1051.50,N/A
27315_3,"PARTIAL REMOVAL, THIGH NERVE",ProFee,0989,27315,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
27320_3,"PARTIAL REMOVAL, THIGH NERVE",ProFee,0989,27320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
27323_3,"BIOPSY, THIGH SOFT TISSUES",ProFee,0989,27323,,,,0,3.00,2.25,2.25,257.00,0.00,257.00,257.00,N/A
27324_3,"BIOPSY, THIGH SOFT TISSUES",ProFee,0989,27324,,,,0,3.00,2.25,2.25,576.50,0.00,576.50,576.50,N/A
27325_3,"NEURECTOMY, HAMSTRING",ProFee,0989,27325,,,,0,3.00,2.25,2.25,802.00,0.00,802.00,802.00,N/A
27326_3,"NEURECTOMY, POPLITEAL",ProFee,0989,27326,,,,0,3.00,2.25,2.25,739.50,0.00,739.50,739.50,N/A
27327_3,REMOVAL OF THIGH LESION,ProFee,0989,27327,,,,0,3.00,2.25,2.25,451.50,0.00,451.50,451.50,N/A
27328_3,REMOVAL OF THIGH LESION,ProFee,0989,27328,,,,0,3.00,2.25,2.25,896.50,0.00,896.50,896.50,N/A
27329_3,"REMOVE TUMOR, THIGH/KNEE",ProFee,0989,27329,,,,0,3.00,2.25,2.25,1496.50,0.00,1496.50,1496.50,N/A
27330_3,"BIOPSY, KNEE JOINT LINING",ProFee,0989,27330,,,,0,3.00,2.25,2.25,597.00,0.00,597.00,597.00,N/A
27331_3,EXPLORE/TREAT KNEE JOINT,ProFee,0989,27331,,,,0,3.00,2.25,2.25,681.00,0.00,681.00,681.00,N/A
27332_3,REMOVAL OF KNEE CARTILAGE,ProFee,0989,27332,,,,0,3.00,2.25,2.25,926.00,0.00,926.00,926.00,N/A
27333_3,REMOVAL OF KNEE CARTILAGE,ProFee,0989,27333,,,,0,3.00,2.25,2.25,842.50,0.00,842.50,842.50,N/A
27334_3,REMOVE KNEE JOINT LINING,ProFee,0989,27334,,,,0,3.00,2.25,2.25,983.50,0.00,983.50,983.50,N/A
27335_3,REMOVE KNEE JOINT LINING,ProFee,0989,27335,,,,0,3.00,2.25,2.25,1097.00,0.00,1097.00,1097.00,N/A
27337_3,EXC THIGH/KNEE LES SC > 3 CM,ProFee,0989,27337,,,,0,3.00,2.25,2.25,603.50,0.00,603.50,603.50,N/A
27339_3,EXC THIGH/KNEE TUM DEEP >5CM,ProFee,0989,27339,,,,0,3.00,2.25,2.25,1085.50,0.00,1085.50,1085.50,N/A
27340_3,REMOVAL OF KNEECAP BURSA,ProFee,0989,27340,,,,0,3.00,2.25,2.25,533.50,0.00,533.50,533.50,N/A
27345_3,REMOVAL OF KNEE CYST,ProFee,0989,27345,,,,0,3.00,2.25,2.25,690.00,0.00,690.00,690.00,N/A
27347_3,REMOVE KNEE CYST,ProFee,0989,27347,,,,0,3.00,2.25,2.25,760.00,0.00,760.00,760.00,N/A
27350_3,REMOVAL OF KNEECAP,ProFee,0989,27350,,,,0,3.00,2.25,2.25,937.00,0.00,937.00,937.00,N/A
27355_3,REMOVE FEMUR LESION,ProFee,0989,27355,,,,0,3.00,2.25,2.25,867.50,0.00,867.50,867.50,N/A
27356_3,REMOVE FEMUR LESION/GRAFT,ProFee,0989,27356,,,,0,3.00,2.25,2.25,1064.50,0.00,1064.50,1064.50,N/A
27357_3,REMOVE FEMUR LESION/GRAFT,ProFee,0989,27357,,,,0,3.00,2.25,2.25,1173.00,0.00,1173.00,1173.00,N/A
27358_3,REMOVE FEMUR LESION/FIXATION,ProFee,0989,27358,,,,0,3.00,2.25,2.25,404.00,0.00,404.00,404.00,N/A
27360_3,"PARTIAL REMOVAL, LEG BONE(S)",ProFee,0989,27360,,,,0,3.00,2.25,2.25,1225.00,0.00,1225.00,1225.00,N/A
27364_3,RESECT THIGH/KNEE TUM >5 CM,ProFee,0989,27364,,,,0,3.00,2.25,2.25,2261.00,0.00,2261.00,2261.00,N/A
27365_3,EXTENSIVE LEG SURGERY,ProFee,0989,27365,,,,0,3.00,2.25,2.25,2985.00,0.00,2985.00,2985.00,N/A
27369_3,NJX CNTRST KNE ARTHG/CT/MRI,ProFee,0989,27369,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
27370_3,INJECTION FOR KNEE X-RAY,ProFee,0989,27369,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
27372_3,REMOVAL OF FOREIGN BODY,ProFee,0989,27372,,,,0,3.00,2.25,2.25,572.00,0.00,572.00,572.00,N/A
27380_3,REPAIR OF KNEECAP TENDON,ProFee,0989,27380,,,,0,3.00,2.25,2.25,852.00,0.00,852.00,852.00,N/A
27381_3,REPAIR/GRAFT KNEECAP TENDON,ProFee,0989,27381,,,,0,3.00,2.25,2.25,1147.50,0.00,1147.50,1147.50,N/A
27385_3,REPAIR OF THIGH MUSCLE,ProFee,0989,27385,,,,0,3.00,2.25,2.25,825.00,0.00,825.00,825.00,N/A
27386_3,REPAIR/GRAFT OF THIGH MUSCLE,ProFee,0989,27386,,,,0,3.00,2.25,2.25,1192.50,0.00,1192.50,1192.50,N/A
27390_3,INCISION OF THIGH TENDON,ProFee,0989,27390,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
27391_3,INCISION OF THIGH TENDONS,ProFee,0989,27391,,,,0,3.00,2.25,2.25,824.00,0.00,824.00,824.00,N/A
27392_3,INCISION OF THIGH TENDONS,ProFee,0989,27392,,,,0,3.00,2.25,2.25,1026.00,0.00,1026.00,1026.00,N/A
27393_3,LENGTHENING OF THIGH TENDON,ProFee,0989,27393,,,,0,3.00,2.25,2.25,732.00,0.00,732.00,732.00,N/A
27394_3,LENGTHENING OF THIGH TENDONS,ProFee,0989,27394,,,,0,3.00,2.25,2.25,923.50,0.00,923.50,923.50,N/A
27395_3,LENGTHENING OF THIGH TENDONS,ProFee,0989,27395,,,,0,3.00,2.25,2.25,1265.50,0.00,1265.50,1265.50,N/A
27396_3,TRANSPLANT OF THIGH TENDON,ProFee,0989,27396,,,,0,3.00,2.25,2.25,886.00,0.00,886.00,886.00,N/A
27397_3,TRANSPLANTS OF THIGH TENDONS,ProFee,0989,27397,,,,0,3.00,2.25,2.25,1321.50,0.00,1321.50,1321.50,N/A
27400_3,REVISE THIGH MUSCLES/TENDONS,ProFee,0989,27400,,,,0,3.00,2.25,2.25,999.50,0.00,999.50,999.50,N/A
27403_3,REPAIR OF KNEE CARTILAGE,ProFee,0989,27403,,,,0,3.00,2.25,2.25,918.50,0.00,918.50,918.50,N/A
27405_3,REPAIR OF KNEE LIGAMENT,ProFee,0989,27405,,,,0,3.00,2.25,2.25,970.00,0.00,970.00,970.00,N/A
27407_3,REPAIR OF KNEE LIGAMENT,ProFee,0989,27407,,,,0,3.00,2.25,2.25,1141.50,0.00,1141.50,1141.50,N/A
27409_3,REPAIR OF KNEE LIGAMENTS,ProFee,0989,27409,,,,0,3.00,2.25,2.25,1391.50,0.00,1391.50,1391.50,N/A
27412_3,AUTOCHONDROCYTE IMPLANT KNEE,ProFee,0989,27412,,,,0,3.00,2.25,2.25,2391.00,0.00,2391.00,2391.00,N/A
27415_3,OSTEOCHONDRAL KNEE ALLOGRAFT,ProFee,0989,27415,,,,0,3.00,2.25,2.25,1967.00,0.00,1967.00,1967.00,N/A
27416_3,OSTEOCHONDRAL KNEE AUTOGRAFT,ProFee,0989,27416,,,,0,3.00,2.25,2.25,1414.50,0.00,1414.50,1414.50,N/A
27418_3,REPAIR DEGENERATED KNEECAP,ProFee,0989,27418,,,,0,3.00,2.25,2.25,1186.50,0.00,1186.50,1186.50,N/A
27420_3,REVISION OF UNSTABLE KNEECAP,ProFee,0989,27420,,,,0,3.00,2.25,2.25,1068.50,0.00,1068.50,1068.50,N/A
27422_3,REVISION OF UNSTABLE KNEECAP,ProFee,0989,27422,,,,0,3.00,2.25,2.25,1068.00,0.00,1068.00,1068.00,N/A
27424_3,REVISION/REMOVAL OF KNEECAP,ProFee,0989,27424,,,,0,3.00,2.25,2.25,1077.50,0.00,1077.50,1077.50,N/A
27425_3,LAT RETINACULAR RELEASE OPEN,ProFee,0989,27425,,,,0,3.00,2.25,2.25,644.00,0.00,644.00,644.00,N/A
27427_3,"RECONSTRUCTION, KNEE",ProFee,0989,27427,,,,0,3.00,2.25,2.25,1020.50,0.00,1020.50,1020.50,N/A
27428_3,"RECONSTRUCTION, KNEE",ProFee,0989,27428,,,,0,3.00,2.25,2.25,1610.50,0.00,1610.50,1610.50,N/A
27429_3,"RECONSTRUCTION, KNEE",ProFee,0989,27429,,,,0,3.00,2.25,2.25,1791.00,0.00,1791.00,1791.00,N/A
27430_3,REVISION OF THIGH MUSCLES,ProFee,0989,27430,,,,0,3.00,2.25,2.25,1063.50,0.00,1063.50,1063.50,N/A
27435_3,INCISION OF KNEE JOINT,ProFee,0989,27435,,,,0,3.00,2.25,2.25,1161.50,0.00,1161.50,1161.50,N/A
27437_3,REVISE KNEECAP,ProFee,0989,27437,,,,0,3.00,2.25,2.25,951.50,0.00,951.50,951.50,N/A
27438_3,REVISE KNEECAP WITH IMPLANT,ProFee,0989,27438,,,,0,3.00,2.25,2.25,1207.50,0.00,1207.50,1207.50,N/A
27440_3,REVISION OF KNEE JOINT,ProFee,0989,27440,,,,0,3.00,2.25,2.25,1150.50,0.00,1150.50,1150.50,N/A
27441_3,REVISION OF KNEE JOINT,ProFee,0989,27441,,,,0,3.00,2.25,2.25,1188.50,0.00,1188.50,1188.50,N/A
27442_3,REVISION OF KNEE JOINT,ProFee,0989,27442,,,,0,3.00,2.25,2.25,1251.00,0.00,1251.00,1251.00,N/A
27443_3,REVISION OF KNEE JOINT,ProFee,0989,27443,,,,0,3.00,2.25,2.25,1171.00,0.00,1171.00,1171.00,N/A
27445_3,REVISION OF KNEE JOINT,ProFee,0989,27445,,,,0,3.00,2.25,2.25,1806.50,0.00,1806.50,1806.50,N/A
27446_3,REVISION OF KNEE JOINT,ProFee,0989,27446,,,,0,3.00,2.25,2.25,1672.50,0.00,1672.50,1672.50,N/A
27447_3,TOTAL KNEE ARTHROPLASTY,ProFee,0989,27447,,,,0,3.00,2.25,2.25,1956.00,0.00,1956.00,1956.00,N/A
27448_3,INCISION OF THIGH,ProFee,0989,27448,,,,0,3.00,2.25,2.25,1118.00,0.00,1118.00,1118.00,N/A
27450_3,INCISION OF THIGH,ProFee,0989,27450,,,,0,3.00,2.25,2.25,1446.50,0.00,1446.50,1446.50,N/A
27454_3,REALIGNMENT OF THIGH BONE,ProFee,0989,27454,,,,0,3.00,2.25,2.25,1877.50,0.00,1877.50,1877.50,N/A
27455_3,REALIGNMENT OF KNEE,ProFee,0989,27455,,,,0,3.00,2.25,2.25,1358.00,0.00,1358.00,1358.00,N/A
27457_3,REALIGNMENT OF KNEE,ProFee,0989,27457,,,,0,3.00,2.25,2.25,1370.50,0.00,1370.50,1370.50,N/A
27465_3,SHORTENING OF THIGH BONE,ProFee,0989,27465,,,,0,3.00,2.25,2.25,1742.00,0.00,1742.00,1742.00,N/A
27466_3,LENGTHENING OF THIGH BONE,ProFee,0989,27466,,,,0,3.00,2.25,2.25,1709.00,0.00,1709.00,1709.00,N/A
27468_3,SHORTEN/LENGTHEN THIGHS,ProFee,0989,27468,,,,0,3.00,2.25,2.25,1939.50,0.00,1939.50,1939.50,N/A
27470_3,REPAIR OF THIGH,ProFee,0989,27470,,,,0,3.00,2.25,2.25,1695.50,0.00,1695.50,1695.50,N/A
27472_3,REPAIR/GRAFT OF THIGH,ProFee,0989,27472,,,,0,3.00,2.25,2.25,1820.50,0.00,1820.50,1820.50,N/A
27475_3,SURGERY TO STOP LEG GROWTH,ProFee,0989,27475,,,,0,3.00,2.25,2.25,952.50,0.00,952.50,952.50,N/A
27477_3,SURGERY TO STOP LEG GROWTH,ProFee,0989,27477,,,,0,3.00,2.25,2.25,1056.00,0.00,1056.00,1056.00,N/A
27479_3,SURGERY TO STOP LEG GROWTH,ProFee,0989,27479,,,,0,3.00,2.25,2.25,1327.00,0.00,1327.00,1327.00,N/A
27485_3,SURGERY TO STOP LEG GROWTH,ProFee,0989,27485,,,,0,3.00,2.25,2.25,965.00,0.00,965.00,965.00,N/A
27486_3,REVISE/REPLACE KNEE JOINT,ProFee,0989,27486,,,,0,3.00,2.25,2.25,2030.00,0.00,2030.00,2030.00,N/A
27487_3,REVISE/REPLACE KNEE JOINT,ProFee,0989,27487,,,,0,3.00,2.25,2.25,2539.00,0.00,2539.00,2539.00,N/A
27488_3,REMOVAL OF KNEE PROSTHESIS,ProFee,0989,27488,,,,0,3.00,2.25,2.25,1732.50,0.00,1732.50,1732.50,N/A
27495_3,REINFORCE THIGH,ProFee,0989,27495,,,,0,3.00,2.25,2.25,1622.50,0.00,1622.50,1622.50,N/A
27496_3,DECOMPRESSION OF THIGH/KNEE,ProFee,0989,27496,,,,0,3.00,2.25,2.25,783.00,0.00,783.00,783.00,N/A
27497_3,DECOMPRESSION OF THIGH/KNEE,ProFee,0989,27497,,,,0,3.00,2.25,2.25,839.00,0.00,839.00,839.00,N/A
27498_3,DECOMPRESSION OF THIGH/KNEE,ProFee,0989,27498,,,,0,3.00,2.25,2.25,943.50,0.00,943.50,943.50,N/A
27499_3,DECOMPRESSION OF THIGH/KNEE,ProFee,0989,27499,,,,0,3.00,2.25,2.25,1008.50,0.00,1008.50,1008.50,N/A
27500_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27500,,,,0,3.00,2.25,2.25,689.00,0.00,689.00,689.00,N/A
27501_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27501,,,,0,3.00,2.25,2.25,717.00,0.00,717.00,717.00,N/A
27502_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27502,,,,0,3.00,2.25,2.25,1091.50,0.00,1091.50,1091.50,N/A
27503_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27503,,,,0,3.00,2.25,2.25,1154.00,0.00,1154.00,1154.00,N/A
27506_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27506,,,,0,3.00,2.25,2.25,1930.00,0.00,1930.00,1930.00,N/A
27507_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27507,,,,0,3.00,2.25,2.25,1402.00,0.00,1402.00,1402.00,N/A
27508_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27508,,,,0,3.00,2.25,2.25,707.50,0.00,707.50,707.50,N/A
27509_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27509,,,,0,3.00,2.25,2.25,923.50,0.00,923.50,923.50,N/A
27510_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27510,,,,0,3.00,2.25,2.25,982.00,0.00,982.00,982.00,N/A
27511_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27511,,,,0,3.00,2.25,2.25,1437.50,0.00,1437.50,1437.50,N/A
27513_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27513,,,,0,3.00,2.25,2.25,1790.00,0.00,1790.00,1790.00,N/A
27514_3,TREATMENT OF THIGH FRACTURE,ProFee,0989,27514,,,,0,3.00,2.25,2.25,1394.00,0.00,1394.00,1394.00,N/A
27516_3,TREAT THIGH FX GROWTH PLATE,ProFee,0989,27516,,,,0,3.00,2.25,2.25,686.00,0.00,686.00,686.00,N/A
27517_3,TREAT THIGH FX GROWTH PLATE,ProFee,0989,27517,,,,0,3.00,2.25,2.25,986.50,0.00,986.50,986.50,N/A
27519_3,TREAT THIGH FX GROWTH PLATE,ProFee,0989,27519,,,,0,3.00,2.25,2.25,1287.00,0.00,1287.00,1287.00,N/A
27520_3,TREAT KNEECAP FRACTURE,ProFee,0989,27520,,,,0,3.00,2.25,2.25,421.50,0.00,421.50,421.50,N/A
27524_3,TREAT KNEECAP FRACTURE,ProFee,0989,27524,,,,0,3.00,2.25,2.25,1082.00,0.00,1082.00,1082.00,N/A
27530_3,TREAT KNEE FRACTURE,ProFee,0989,27530,,,,0,3.00,2.25,2.25,401.50,0.00,401.50,401.50,N/A
27532_3,TREAT KNEE FRACTURE,ProFee,0989,27532,,,,0,3.00,2.25,2.25,828.50,0.00,828.50,828.50,N/A
27535_3,TREAT KNEE FRACTURE,ProFee,0989,27535,,,,0,3.00,2.25,2.25,1293.00,0.00,1293.00,1293.00,N/A
27536_3,TREAT KNEE FRACTURE,ProFee,0989,27536,,,,0,3.00,2.25,2.25,1715.50,0.00,1715.50,1715.50,N/A
27538_3,TREAT KNEE FRACTURE(S),ProFee,0989,27538,,,,0,3.00,2.25,2.25,635.50,0.00,635.50,635.50,N/A
27540_3,TREAT KNEE FRACTURE,ProFee,0989,27540,,,,0,3.00,2.25,2.25,1162.50,0.00,1162.50,1162.50,N/A
27550_3,TREAT KNEE DISLOCATION,ProFee,0989,27550,,,,0,3.00,2.25,2.25,680.50,0.00,680.50,680.50,N/A
27552_3,TREAT KNEE DISLOCATION,ProFee,0989,27552,,,,0,3.00,2.25,2.25,896.00,0.00,896.00,896.00,N/A
27556_3,TREAT KNEE DISLOCATION,ProFee,0989,27556,,,,0,3.00,2.25,2.25,1265.50,0.00,1265.50,1265.50,N/A
27557_3,TREAT KNEE DISLOCATION,ProFee,0989,27557,,,,0,3.00,2.25,2.25,1514.00,0.00,1514.00,1514.00,N/A
27558_3,TREAT KNEE DISLOCATION,ProFee,0989,27558,,,,0,3.00,2.25,2.25,1727.00,0.00,1727.00,1727.00,N/A
27560_2,TREAT KNEECAP DISLOCATION,Inpatient,0521,27560,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
27560_2,TREAT KNEECAP DISLOCATION,Ambulatory Surgical,0521,27560,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
27560_3,TREAT KNEECAP DISLOCATION,Ambulatory Surgical,0521,27560,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
27560_3,TREAT KNEECAP DISLOCATION,Inpatient,0521,27560,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
27562_3,TREAT KNEECAP DISLOCATION,ProFee,0989,27562,,,,0,3.00,2.25,2.25,695.50,0.00,695.50,695.50,N/A
27566_3,TREAT KNEECAP DISLOCATION,ProFee,0989,27566,,,,0,3.00,2.25,2.25,1290.00,0.00,1290.00,1290.00,N/A
27570_3,FIXATION OF KNEE JOINT,ProFee,0989,27570,,,,0,3.00,2.25,2.25,216.50,0.00,216.50,216.50,N/A
27580_3,FUSION OF KNEE,ProFee,0989,27580,,,,0,3.00,2.25,2.25,2072.00,0.00,2072.00,2072.00,N/A
27590_3,AMPUTATE LEG AT THIGH,ProFee,0989,27590,,,,0,3.00,2.25,2.25,1153.00,0.00,1153.00,1153.00,N/A
27591_3,AMPUTATE LEG AT THIGH,ProFee,0989,27591,,,,0,3.00,2.25,2.25,1394.50,0.00,1394.50,1394.50,N/A
27592_3,AMPUTATE LEG AT THIGH,ProFee,0989,27592,,,,0,3.00,2.25,2.25,982.50,0.00,982.50,982.50,N/A
27594_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,27594,,,,0,3.00,2.25,2.25,727.00,0.00,727.00,727.00,N/A
27596_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,27596,,,,0,3.00,2.25,2.25,1039.50,0.00,1039.50,1039.50,N/A
27598_3,AMPUTATE LOWER LEG AT KNEE,ProFee,0989,27598,,,,0,3.00,2.25,2.25,1032.50,0.00,1032.50,1032.50,N/A
27599_3,LEG SURGERY PROCEDURE,ProFee,0989,27599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
27600_3,DECOMPRESSION OF LOWER LEG,ProFee,0989,27600,,,,0,3.00,2.25,2.25,582.50,0.00,582.50,582.50,N/A
27601_3,DECOMPRESSION OF LOWER LEG,ProFee,0989,27601,,,,0,3.00,2.25,2.25,644.00,0.00,644.00,644.00,N/A
27602_3,DECOMPRESSION OF LOWER LEG,ProFee,0989,27602,,,,0,3.00,2.25,2.25,701.50,0.00,701.50,701.50,N/A
27603_3,DRAIN LOWER LEG LESION,ProFee,0989,27603,,,,0,3.00,2.25,2.25,557.50,0.00,557.50,557.50,N/A
27604_3,DRAIN LOWER LEG BURSA,ProFee,0989,27604,,,,0,3.00,2.25,2.25,483.00,0.00,483.00,483.00,N/A
27605_3,INCISION OF ACHILLES TENDON,ProFee,0989,27605,,,,0,3.00,2.25,2.25,267.50,0.00,267.50,267.50,N/A
27606_3,INCISION OF ACHILLES TENDON,ProFee,0989,27606,,,,0,3.00,2.25,2.25,403.00,0.00,403.00,403.00,N/A
27607_3,TREAT LOWER LEG BONE LESION,ProFee,0989,27607,,,,0,3.00,2.25,2.25,873.00,0.00,873.00,873.00,N/A
27610_3,EXPLORE/TREAT ANKLE JOINT,ProFee,0989,27610,,,,0,3.00,2.25,2.25,934.50,0.00,934.50,934.50,N/A
27612_3,EXPLORATION OF ANKLE JOINT,ProFee,0989,27612,,,,0,3.00,2.25,2.25,807.50,0.00,807.50,807.50,N/A
27613_3,BIOPSY LOWER LEG SOFT TISSUE,ProFee,0989,27613,,,,0,3.00,2.25,2.25,234.00,0.00,234.00,234.00,N/A
27614_3,BIOPSY LOWER LEG SOFT TISSUE,ProFee,0989,27614,,,,0,3.00,2.25,2.25,586.00,0.00,586.00,586.00,N/A
27615_3,"REMOVE TUMOR, LOWER LEG",ProFee,0989,27615,,,,0,3.00,2.25,2.25,1479.00,0.00,1479.00,1479.00,N/A
27616_3,RESECT LEG/ANKLE TUM > 5 CM,ProFee,0989,27616,,,,0,3.00,2.25,2.25,1835.50,0.00,1835.50,1835.50,N/A
27618_3,REMOVE LOWER LEG LESION,ProFee,0989,27618,,,,0,3.00,2.25,2.25,444.50,0.00,444.50,444.50,N/A
27619_3,REMOVE LOWER LEG LESION,ProFee,0989,27619,,,,0,3.00,2.25,2.25,668.50,0.00,668.50,668.50,N/A
27620_3,EXPLORE/TREAT ANKLE JOINT,ProFee,0989,27620,,,,0,3.00,2.25,2.25,644.50,0.00,644.50,644.50,N/A
27625_3,REMOVE ANKLE JOINT LINING,ProFee,0989,27625,,,,0,3.00,2.25,2.25,834.50,0.00,834.50,834.50,N/A
27626_3,REMOVE ANKLE JOINT LINING,ProFee,0989,27626,,,,0,3.00,2.25,2.25,869.00,0.00,869.00,869.00,N/A
27630_3,REMOVAL OF TENDON LESION,ProFee,0989,27630,,,,0,3.00,2.25,2.25,524.00,0.00,524.00,524.00,N/A
27632_3,EXC LEG/ANKLE LES SC > 3 CM,ProFee,0989,27632,,,,0,3.00,2.25,2.25,597.00,0.00,597.00,597.00,N/A
27634_3,EXC LEG/ANKLE TUM DEEP >5 CM,ProFee,0989,27634,,,,0,3.00,2.25,2.25,982.00,0.00,982.00,982.00,N/A
27635_3,REMOVE LOWER LEG BONE LESION,ProFee,0989,27635,,,,0,3.00,2.25,2.25,842.50,0.00,842.50,842.50,N/A
27637_3,REMOVE/GRAFT LEG BONE LESION,ProFee,0989,27637,,,,0,3.00,2.25,2.25,1101.50,0.00,1101.50,1101.50,N/A
27638_3,REMOVE/GRAFT LEG BONE LESION,ProFee,0989,27638,,,,0,3.00,2.25,2.25,1114.00,0.00,1114.00,1114.00,N/A
27640_3,PARTIAL REMOVAL OF TIBIA,ProFee,0989,27640,,,,0,3.00,2.25,2.25,1198.50,0.00,1198.50,1198.50,N/A
27641_3,PARTIAL REMOVAL OF FIBULA,ProFee,0989,27641,,,,0,3.00,2.25,2.25,958.50,0.00,958.50,958.50,N/A
27645_3,EXTENSIVE LOWER LEG SURGERY,ProFee,0989,27645,,,,0,3.00,2.25,2.25,2575.00,0.00,2575.00,2575.00,N/A
27646_3,EXTENSIVE LOWER LEG SURGERY,ProFee,0989,27646,,,,0,3.00,2.25,2.25,2233.50,0.00,2233.50,2233.50,N/A
27647_3,EXTENSIVE ANKLE/HEEL SURGERY,ProFee,0989,27647,,,,0,3.00,2.25,2.25,1469.50,0.00,1469.50,1469.50,N/A
27648_3,INJECTION FOR ANKLE X-RAY,ProFee,0989,27648,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
27650_3,REPAIR ACHILLES TENDON,ProFee,0989,27650,,,,0,3.00,2.25,2.25,946.00,0.00,946.00,946.00,N/A
27652_3,REPAIR/GRAFT ACHILLES TENDON,ProFee,0989,27652,,,,0,3.00,2.25,2.25,974.50,0.00,974.50,974.50,N/A
27654_3,REPAIR OF ACHILLES TENDON,ProFee,0989,27654,,,,0,3.00,2.25,2.25,1019.00,0.00,1019.00,1019.00,N/A
27656_3,REPAIR LEG FASCIA DEFECT,ProFee,0989,27656,,,,0,3.00,2.25,2.25,571.00,0.00,571.00,571.00,N/A
27658_3,"REPAIR OF LEG TENDON, EACH",ProFee,0989,27658,,,,0,3.00,2.25,2.25,533.50,0.00,533.50,533.50,N/A
27659_3,"REPAIR OF LEG TENDON, EACH",ProFee,0989,27659,,,,0,3.00,2.25,2.25,682.00,0.00,682.00,682.00,N/A
27664_3,"REPAIR OF LEG TENDON, EACH",ProFee,0989,27664,,,,0,3.00,2.25,2.25,520.00,0.00,520.00,520.00,N/A
27665_3,"REPAIR OF LEG TENDON, EACH",ProFee,0989,27665,,,,0,3.00,2.25,2.25,593.50,0.00,593.50,593.50,N/A
27675_3,REPAIR LOWER LEG TENDONS,ProFee,0989,27675,,,,0,3.00,2.25,2.25,704.00,0.00,704.00,704.00,N/A
27676_3,REPAIR LOWER LEG TENDONS,ProFee,0989,27676,,,,0,3.00,2.25,2.25,871.50,0.00,871.50,871.50,N/A
27680_3,RELEASE OF LOWER LEG TENDON,ProFee,0989,27680,,,,0,3.00,2.25,2.25,613.00,0.00,613.00,613.00,N/A
27681_3,RELEASE OF LOWER LEG TENDONS,ProFee,0989,27681,,,,0,3.00,2.25,2.25,787.50,0.00,787.50,787.50,N/A
27685_3,REVISION OF LOWER LEG TENDON,ProFee,0989,27685,,,,0,3.00,2.25,2.25,667.50,0.00,667.50,667.50,N/A
27686_3,REVISE LOWER LEG TENDONS,ProFee,0989,27686,,,,0,3.00,2.25,2.25,793.00,0.00,793.00,793.00,N/A
27687_3,REVISION OF CALF TENDON,ProFee,0989,27687,,,,0,3.00,2.25,2.25,651.00,0.00,651.00,651.00,N/A
27690_3,REVISE LOWER LEG TENDON,ProFee,0989,27690,,,,0,3.00,2.25,2.25,913.50,0.00,913.50,913.50,N/A
27691_3,REVISE LOWER LEG TENDON,ProFee,0989,27691,,,,0,3.00,2.25,2.25,1073.50,0.00,1073.50,1073.50,N/A
27692_3,REVISE ADDITIONAL LEG TENDON,ProFee,0989,27692,,,,0,3.00,2.25,2.25,151.00,0.00,151.00,151.00,N/A
27695_3,REPAIR OF ANKLE LIGAMENT,ProFee,0989,27695,,,,0,3.00,2.25,2.25,685.00,0.00,685.00,685.00,N/A
27696_3,REPAIR OF ANKLE LIGAMENTS,ProFee,0989,27696,,,,0,3.00,2.25,2.25,804.00,0.00,804.00,804.00,N/A
27698_3,REPAIR OF ANKLE LIGAMENT,ProFee,0989,27698,,,,0,3.00,2.25,2.25,922.50,0.00,922.50,922.50,N/A
27700_3,REVISION OF ANKLE JOINT,ProFee,0989,27700,,,,0,3.00,2.25,2.25,909.00,0.00,909.00,909.00,N/A
27702_3,RECONSTRUCT ANKLE JOINT,ProFee,0989,27702,,,,0,3.00,2.25,2.25,1383.50,0.00,1383.50,1383.50,N/A
27703_3,"RECONSTRUCTION, ANKLE JOINT",ProFee,0989,27703,,,,0,3.00,2.25,2.25,1595.00,0.00,1595.00,1595.00,N/A
27704_3,REMOVAL OF ANKLE IMPLANT,ProFee,0989,27704,,,,0,3.00,2.25,2.25,820.50,0.00,820.50,820.50,N/A
27705_3,INCISION OF TIBIA,ProFee,0989,27705,,,,0,3.00,2.25,2.25,1099.50,0.00,1099.50,1099.50,N/A
27707_3,INCISION OF FIBULA,ProFee,0989,27707,,,,0,3.00,2.25,2.25,572.50,0.00,572.50,572.50,N/A
27709_3,INCISION OF TIBIA & FIBULA,ProFee,0989,27709,,,,0,3.00,2.25,2.25,1684.50,0.00,1684.50,1684.50,N/A
27712_3,REALIGNMENT OF LOWER LEG,ProFee,0989,27712,,,,0,3.00,2.25,2.25,1596.00,0.00,1596.00,1596.00,N/A
27715_3,REVISION OF LOWER LEG,ProFee,0989,27715,,,,0,3.00,2.25,2.25,1545.50,0.00,1545.50,1545.50,N/A
27720_3,REPAIR OF TIBIA,ProFee,0989,27720,,,,0,3.00,2.25,2.25,1256.50,0.00,1256.50,1256.50,N/A
27722_3,REPAIR/GRAFT OF TIBIA,ProFee,0989,27722,,,,0,3.00,2.25,2.25,1284.00,0.00,1284.00,1284.00,N/A
27724_3,REPAIR/GRAFT OF TIBIA,ProFee,0989,27724,,,,0,3.00,2.25,2.25,1825.00,0.00,1825.00,1825.00,N/A
27725_3,REPAIR OF LOWER LEG,ProFee,0989,27725,,,,0,3.00,2.25,2.25,1761.50,0.00,1761.50,1761.50,N/A
27726_3,REPAIR FIBULA NONUNION,ProFee,0989,27726,,,,0,3.00,2.25,2.25,1385.00,0.00,1385.00,1385.00,N/A
27727_3,REPAIR OF LOWER LEG,ProFee,0989,27727,,,,0,3.00,2.25,2.25,1496.00,0.00,1496.00,1496.00,N/A
27730_3,REPAIR OF TIBIA EPIPHYSIS,ProFee,0989,27730,,,,0,3.00,2.25,2.25,844.00,0.00,844.00,844.00,N/A
27732_3,REPAIR OF FIBULA EPIPHYSIS,ProFee,0989,27732,,,,0,3.00,2.25,2.25,644.00,0.00,644.00,644.00,N/A
27734_3,REPAIR LOWER LEG EPIPHYSES,ProFee,0989,27734,,,,0,3.00,2.25,2.25,945.00,0.00,945.00,945.00,N/A
27740_3,REPAIR OF LEG EPIPHYSES,ProFee,0989,27740,,,,0,3.00,2.25,2.25,1019.50,0.00,1019.50,1019.50,N/A
27742_3,REPAIR OF LEG EPIPHYSES,ProFee,0989,27742,,,,0,3.00,2.25,2.25,1121.50,0.00,1121.50,1121.50,N/A
27745_3,REINFORCE TIBIA,ProFee,0989,27745,,,,0,3.00,2.25,2.25,1088.00,0.00,1088.00,1088.00,N/A
27750_2,TREATMENT OF TIBIA FRACTURE,Inpatient,0521,27750,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,139.65,132.30
27750_2,TREATMENT OF TIBIA FRACTURE,Ambulatory Surgical,0521,27750,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,0.00,132.30
27750_3,TREATMENT OF TIBIA FRACTURE,Ambulatory Surgical,0521,27750,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,0.00,131.40
27750_3,TREATMENT OF TIBIA FRACTURE,Inpatient,0521,27750,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
27752_3,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27752,,,,0,3.00,2.25,2.25,707.50,0.00,707.50,707.50,N/A
27756_3,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27756,,,,0,3.00,2.25,2.25,833.50,0.00,833.50,833.50,N/A
27758_3,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27758,,,,0,3.00,2.25,2.25,1283.50,0.00,1283.50,1283.50,N/A
27759_3,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27759,,,,0,3.00,2.25,2.25,1439.50,0.00,1439.50,1439.50,N/A
27760_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27760,,,,0,3.00,2.25,2.25,434.50,0.00,434.50,434.50,N/A
27762_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27762,,,,0,3.00,2.25,2.25,612.00,0.00,612.00,612.00,N/A
27766_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27766,,,,0,3.00,2.25,2.25,873.50,0.00,873.50,873.50,N/A
27767_3,CLTX POST ANKLE FX,ProFee,0989,27767,,,,0,3.00,2.25,2.25,405.00,0.00,405.00,405.00,N/A
27768_3,CLTX POST ANKLE FX W/MNPJ,ProFee,0989,27768,,,,0,3.00,2.25,2.25,633.00,0.00,633.00,633.00,N/A
27769_3,OPTX POST ANKLE FX,ProFee,0989,27769,,,,0,3.00,2.25,2.25,1053.00,0.00,1053.00,1053.00,N/A
27780_3,TREATMENT OF FIBULA FRACTURE,ProFee,0989,27780,,,,0,3.00,2.25,2.25,398.50,0.00,398.50,398.50,N/A
27781_3,TREATMENT OF FIBULA FRACTURE,ProFee,0989,27781,,,,0,3.00,2.25,2.25,567.50,0.00,567.50,567.50,N/A
27784_3,TREATMENT OF FIBULA FRACTURE,ProFee,0989,27784,,,,0,3.00,2.25,2.25,1024.00,0.00,1024.00,1024.00,N/A
27786_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27786,,,,0,3.00,2.25,2.25,408.00,0.00,408.00,408.00,N/A
27788_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27788,,,,0,3.00,2.25,2.25,549.00,0.00,549.00,549.00,N/A
27792_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27792,,,,0,3.00,2.25,2.25,935.00,0.00,935.00,935.00,N/A
27808_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27808,,,,0,3.00,2.25,2.25,428.50,0.00,428.50,428.50,N/A
27810_2,TREATMENT OF ANKLE FRACTURE,Ambulatory Surgical,0521,27810,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
27810_2,TREATMENT OF ANKLE FRACTURE,Inpatient,0521,27810,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
27810_3,TREATMENT OF ANKLE FRACTURE,Ambulatory Surgical,0521,27810,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
27810_3,TREATMENT OF ANKLE FRACTURE,Inpatient,0521,27810,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
27814_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27814,,,,0,3.00,2.25,2.25,1109.00,0.00,1109.00,1109.00,N/A
27816_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27816,,,,0,3.00,2.25,2.25,412.50,0.00,412.50,412.50,N/A
27818_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27818,,,,0,3.00,2.25,2.25,620.00,0.00,620.00,620.00,N/A
27822_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27822,,,,0,3.00,2.25,2.25,1234.50,0.00,1234.50,1234.50,N/A
27823_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27823,,,,0,3.00,2.25,2.25,1398.50,0.00,1398.50,1398.50,N/A
27824_3,TREAT LOWER LEG FRACTURE,ProFee,0989,27824,,,,0,3.00,2.25,2.25,436.50,0.00,436.50,436.50,N/A
27825_3,TREAT LOWER LEG FRACTURE,ProFee,0989,27825,,,,0,3.00,2.25,2.25,711.50,0.00,711.50,711.50,N/A
27826_3,TREAT LOWER LEG FRACTURE,ProFee,0989,27826,,,,0,3.00,2.25,2.25,1215.00,0.00,1215.00,1215.00,N/A
27827_3,TREAT LOWER LEG FRACTURE,ProFee,0989,27827,,,,0,3.00,2.25,2.25,1581.50,0.00,1581.50,1581.50,N/A
27828_3,TREAT LOWER LEG FRACTURE,ProFee,0989,27828,,,,0,3.00,2.25,2.25,1890.50,0.00,1890.50,1890.50,N/A
27829_3,TREAT LOWER LEG JOINT,ProFee,0989,27829,,,,0,3.00,2.25,2.25,1000.00,0.00,1000.00,1000.00,N/A
27830_3,TREAT LOWER LEG DISLOCATION,ProFee,0989,27830,,,,0,3.00,2.25,2.25,509.50,0.00,509.50,509.50,N/A
27831_3,TREAT LOWER LEG DISLOCATION,ProFee,0989,27831,,,,0,3.00,2.25,2.25,575.50,0.00,575.50,575.50,N/A
27832_3,TREAT LOWER LEG DISLOCATION,ProFee,0989,27832,,,,0,3.00,2.25,2.25,1090.00,0.00,1090.00,1090.00,N/A
27840_3,TREAT ANKLE DISLOCATION,ProFee,0989,27840,,,,0,3.00,2.25,2.25,531.00,0.00,531.00,531.00,N/A
27842_3,TREAT ANKLE DISLOCATION,ProFee,0989,27842,,,,0,3.00,2.25,2.25,709.00,0.00,709.00,709.00,N/A
27846_3,TREAT ANKLE DISLOCATION,ProFee,0989,27846,,,,0,3.00,2.25,2.25,1034.50,0.00,1034.50,1034.50,N/A
27848_3,TREAT ANKLE DISLOCATION,ProFee,0989,27848,,,,0,3.00,2.25,2.25,1151.00,0.00,1151.00,1151.00,N/A
27860_3,FIXATION OF ANKLE JOINT,ProFee,0989,27860,,,,0,3.00,2.25,2.25,251.00,0.00,251.00,251.00,N/A
27870_3,"FUSION OF ANKLE JOINT, OPEN",ProFee,0989,27870,,,,0,3.00,2.25,2.25,1482.00,0.00,1482.00,1482.00,N/A
27871_3,FUSION OF TIBIOFIBULAR JOINT,ProFee,0989,27871,,,,0,3.00,2.25,2.25,984.50,0.00,984.50,984.50,N/A
27880_3,AMPUTATION OF LOWER LEG,ProFee,0989,27880,,,,0,3.00,2.25,2.25,1322.50,0.00,1322.50,1322.50,N/A
27881_3,AMPUTATION OF LOWER LEG,ProFee,0989,27881,,,,0,3.00,2.25,2.25,1249.00,0.00,1249.00,1249.00,N/A
27882_3,AMPUTATION OF LOWER LEG,ProFee,0989,27882,,,,0,3.00,2.25,2.25,866.00,0.00,866.00,866.00,N/A
27884_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,27884,,,,0,3.00,2.25,2.25,825.50,0.00,825.50,825.50,N/A
27886_3,AMPUTATION FOLLOW-UP SURGERY,ProFee,0989,27886,,,,0,3.00,2.25,2.25,949.00,0.00,949.00,949.00,N/A
27888_3,AMPUTATION OF FOOT AT ANKLE,ProFee,0989,27888,,,,0,3.00,2.25,2.25,974.50,0.00,974.50,974.50,N/A
27889_3,AMPUTATION OF FOOT AT ANKLE,ProFee,0989,27889,,,,0,3.00,2.25,2.25,938.00,0.00,938.00,938.00,N/A
27892_3,DECOMPRESSION OF LEG,ProFee,0989,27892,,,,0,3.00,2.25,2.25,805.50,0.00,805.50,805.50,N/A
27893_3,DECOMPRESSION OF LEG,ProFee,0989,27893,,,,0,3.00,2.25,2.25,878.00,0.00,878.00,878.00,N/A
27894_3,DECOMPRESSION OF LEG,ProFee,0989,27894,,,,0,3.00,2.25,2.25,1210.00,0.00,1210.00,1210.00,N/A
27899_3,LEG/ANKLE SURGERY PROCEDURE,ProFee,0989,27899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
28001_3,DRAINAGE OF BURSA OF FOOT,ProFee,0989,28001,,,,0,3.00,2.25,2.25,242.00,0.00,242.00,242.00,N/A
28002_3,TREATMENT OF FOOT INFECTION,ProFee,0989,28002,,,,0,3.00,2.25,2.25,455.00,0.00,455.00,455.00,N/A
28003_3,TREATMENT OF FOOT INFECTION,ProFee,0989,28003,,,,0,3.00,2.25,2.25,803.50,0.00,803.50,803.50,N/A
28005_3,TREAT FOOT BONE LESION,ProFee,0989,28005,,,,0,3.00,2.25,2.25,827.00,0.00,827.00,827.00,N/A
28008_3,INCISION OF FOOT FASCIA,ProFee,0989,28008,,,,0,3.00,2.25,2.25,422.00,0.00,422.00,422.00,N/A
28010_3,INCISION OF TOE TENDON,ProFee,0989,28010,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
28011_3,INCISION OF TOE TENDONS,ProFee,0989,28011,,,,0,3.00,2.25,2.25,410.50,0.00,410.50,410.50,N/A
28020_3,EXPLORATION OF FOOT JOINT,ProFee,0989,28020,,,,0,3.00,2.25,2.25,522.00,0.00,522.00,522.00,N/A
28022_3,EXPLORATION OF FOOT JOINT,ProFee,0989,28022,,,,0,3.00,2.25,2.25,464.50,0.00,464.50,464.50,N/A
28024_3,EXPLORATION OF TOE JOINT,ProFee,0989,28024,,,,0,3.00,2.25,2.25,437.00,0.00,437.00,437.00,N/A
28030_3,REMOVAL OF FOOT NERVE,ProFee,0989,28030,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
28035_3,DECOMPRESSION OF TIBIA NERVE,ProFee,0989,28035,,,,0,3.00,2.25,2.25,512.00,0.00,512.00,512.00,N/A
28039_3,EXC FOOT/TOE TUM SC > 1.5 CM,ProFee,0989,28039,,,,0,3.00,2.25,2.25,499.50,0.00,499.50,499.50,N/A
28041_3,EXC FOOT/TOE TUM DEEP >1.5CM,ProFee,0989,28041,,,,0,3.00,2.25,2.25,656.50,0.00,656.50,656.50,N/A
28043_3,EXCISION OF FOOT LESION,ProFee,0989,28043,,,,0,3.00,2.25,2.25,378.50,0.00,378.50,378.50,N/A
28045_3,EXCISION OF FOOT LESION,ProFee,0989,28045,,,,0,3.00,2.25,2.25,501.50,0.00,501.50,501.50,N/A
28046_3,"RESECTION OF TUMOR, FOOT",ProFee,0989,28046,,,,0,3.00,2.25,2.25,1051.50,0.00,1051.50,1051.50,N/A
28047_3,RESECT FOOT/TOE TUMOR > 3 CM,ProFee,0989,28047,,,,0,3.00,2.25,2.25,1515.50,0.00,1515.50,1515.50,N/A
28050_3,BIOPSY OF FOOT JOINT LINING,ProFee,0989,28050,,,,0,3.00,2.25,2.25,402.00,0.00,402.00,402.00,N/A
28052_3,BIOPSY OF FOOT JOINT LINING,ProFee,0989,28052,,,,0,3.00,2.25,2.25,415.00,0.00,415.00,415.00,N/A
28054_3,BIOPSY OF TOE JOINT LINING,ProFee,0989,28054,,,,0,3.00,2.25,2.25,338.50,0.00,338.50,338.50,N/A
28055_3,"NEURECTOMY, FOOT",ProFee,0989,28055,,,,0,3.00,2.25,2.25,546.50,0.00,546.50,546.50,N/A
28060_3,"PARTIAL REMOVAL, FOOT FASCIA",ProFee,0989,28060,,,,0,3.00,2.25,2.25,513.50,0.00,513.50,513.50,N/A
28062_3,REMOVAL OF FOOT FASCIA,ProFee,0989,28062,,,,0,3.00,2.25,2.25,585.50,0.00,585.50,585.50,N/A
28070_3,REMOVAL OF FOOT JOINT LINING,ProFee,0989,28070,,,,0,3.00,2.25,2.25,519.50,0.00,519.50,519.50,N/A
28072_3,REMOVAL OF FOOT JOINT LINING,ProFee,0989,28072,,,,0,3.00,2.25,2.25,474.50,0.00,474.50,474.50,N/A
28080_3,REMOVAL OF FOOT LESION,ProFee,0989,28080,,,,0,3.00,2.25,2.25,528.00,0.00,528.00,528.00,N/A
28086_3,EXCISE FOOT TENDON SHEATH,ProFee,0989,28086,,,,0,3.00,2.25,2.25,518.00,0.00,518.00,518.00,N/A
28088_3,EXCISE FOOT TENDON SHEATH,ProFee,0989,28088,,,,0,3.00,2.25,2.25,408.50,0.00,408.50,408.50,N/A
28090_3,REMOVAL OF FOOT LESION,ProFee,0989,28090,,,,0,3.00,2.25,2.25,443.00,0.00,443.00,443.00,N/A
28092_3,REMOVAL OF TOE LESIONS,ProFee,0989,28092,,,,0,3.00,2.25,2.25,387.00,0.00,387.00,387.00,N/A
28100_3,REMOVAL OF ANKLE/HEEL LESION,ProFee,0989,28100,,,,0,3.00,2.25,2.25,598.50,0.00,598.50,598.50,N/A
28102_3,REMOVE/GRAFT FOOT LESION,ProFee,0989,28102,,,,0,3.00,2.25,2.25,873.50,0.00,873.50,873.50,N/A
28103_3,REMOVE/GRAFT FOOT LESION,ProFee,0989,28103,,,,0,3.00,2.25,2.25,562.50,0.00,562.50,562.50,N/A
28104_3,REMOVAL OF FOOT LESION,ProFee,0989,28104,,,,0,3.00,2.25,2.25,509.50,0.00,509.50,509.50,N/A
28106_3,REMOVE/GRAFT FOOT LESION,ProFee,0989,28106,,,,0,3.00,2.25,2.25,615.50,0.00,615.50,615.50,N/A
28107_3,REMOVE/GRAFT FOOT LESION,ProFee,0989,28107,,,,0,3.00,2.25,2.25,500.50,0.00,500.50,500.50,N/A
28108_3,REMOVAL OF TOE LESIONS,ProFee,0989,28108,,,,0,3.00,2.25,2.25,415.00,0.00,415.00,415.00,N/A
28110_3,PART REMOVAL OF METATARSAL,ProFee,0989,28110,,,,0,3.00,2.25,2.25,417.00,0.00,417.00,417.00,N/A
28111_3,PART REMOVAL OF METATARSAL,ProFee,0989,28111,,,,0,3.00,2.25,2.25,467.50,0.00,467.50,467.50,N/A
28112_3,PART REMOVAL OF METATARSAL,ProFee,0989,28112,,,,0,3.00,2.25,2.25,450.00,0.00,450.00,450.00,N/A
28113_3,PART REMOVAL OF METATARSAL,ProFee,0989,28113,,,,0,3.00,2.25,2.25,610.00,0.00,610.00,610.00,N/A
28114_3,REMOVAL OF METATARSAL HEADS,ProFee,0989,28114,,,,0,3.00,2.25,2.25,1204.50,0.00,1204.50,1204.50,N/A
28116_3,REVISION OF FOOT,ProFee,0989,28116,,,,0,3.00,2.25,2.25,837.00,0.00,837.00,837.00,N/A
28118_3,REMOVAL OF HEEL BONE,ProFee,0989,28118,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
28119_3,REMOVAL OF HEEL SPUR,ProFee,0989,28119,,,,0,3.00,2.25,2.25,517.50,0.00,517.50,517.50,N/A
28120_3,PART REMOVAL OF ANKLE/HEEL,ProFee,0989,28120,,,,0,3.00,2.25,2.25,715.50,0.00,715.50,715.50,N/A
28122_3,PARTIAL REMOVAL OF FOOT BONE,ProFee,0989,28122,,,,0,3.00,2.25,2.25,633.50,0.00,633.50,633.50,N/A
28124_3,PARTIAL REMOVAL OF TOE,ProFee,0989,28124,,,,0,3.00,2.25,2.25,475.00,0.00,475.00,475.00,N/A
28126_3,PARTIAL REMOVAL OF TOE,ProFee,0989,28126,,,,0,3.00,2.25,2.25,358.00,0.00,358.00,358.00,N/A
28130_3,REMOVAL OF ANKLE BONE,ProFee,0989,28130,,,,0,3.00,2.25,2.25,1050.50,0.00,1050.50,1050.50,N/A
28140_3,REMOVAL OF METATARSAL,ProFee,0989,28140,,,,0,3.00,2.25,2.25,633.00,0.00,633.00,633.00,N/A
28150_3,REMOVAL OF TOE,ProFee,0989,28150,,,,0,3.00,2.25,2.25,402.00,0.00,402.00,402.00,N/A
28153_3,PARTIAL REMOVAL OF TOE,ProFee,0989,28153,,,,0,3.00,2.25,2.25,381.00,0.00,381.00,381.00,N/A
28160_3,PARTIAL REMOVAL OF TOE,ProFee,0989,28160,,,,0,3.00,2.25,2.25,385.50,0.00,385.50,385.50,N/A
28171_3,EXTENSIVE FOOT SURGERY,ProFee,0989,28171,,,,0,3.00,2.25,2.25,1612.50,0.00,1612.50,1612.50,N/A
28173_3,EXTENSIVE FOOT SURGERY,ProFee,0989,28173,,,,0,3.00,2.25,2.25,1084.50,0.00,1084.50,1084.50,N/A
28175_3,EXTENSIVE FOOT SURGERY,ProFee,0989,28175,,,,0,3.00,2.25,2.25,686.00,0.00,686.00,686.00,N/A
28190_2,REMOVAL OF FOOT FOREIGN BODY,Inpatient,0521,28190,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,421.80,399.60
28190_2,REMOVAL OF FOOT FOREIGN BODY,Ambulatory Surgical,0521,28190,,,,0,444.00,333.00,333.00,421.80,399.60,421.80,0.00,399.60
28190_3,REMOVAL OF FOOT FOREIGN BODY,Ambulatory Surgical,0521,28190,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,0.00,391.50
28190_3,REMOVAL OF FOOT FOREIGN BODY,Inpatient,0521,28190,,,,0,435.00,326.25,326.25,413.25,391.50,413.25,413.25,391.50
28192_2,REMOVAL OF FOOT FOREIGN BODY,Inpatient,0521,28192,,,,0,835.00,626.25,626.25,793.25,751.50,793.25,793.25,751.50
28192_2,REMOVAL OF FOOT FOREIGN BODY,Ambulatory Surgical,0521,28192,,,,0,835.00,626.25,626.25,793.25,751.50,793.25,0.00,751.50
28192_3,REMOVAL OF FOOT FOREIGN BODY,Inpatient,0521,28192,,,,0,814.00,610.50,610.50,773.30,732.60,773.30,773.30,732.60
28192_3,REMOVAL OF FOOT FOREIGN BODY,Ambulatory Surgical,0521,28192,,,,0,814.00,610.50,610.50,773.30,732.60,773.30,0.00,732.60
28193_3,REMOVAL OF FOOT FOREIGN BODY,ProFee,0989,28193,,,,0,3.00,2.25,2.25,530.00,0.00,530.00,530.00,N/A
28200_3,REPAIR OF FOOT TENDON,ProFee,0989,28200,,,,0,3.00,2.25,2.25,465.50,0.00,465.50,465.50,N/A
28202_3,REPAIR/GRAFT OF FOOT TENDON,ProFee,0989,28202,,,,0,3.00,2.25,2.25,615.50,0.00,615.50,615.50,N/A
28208_3,REPAIR OF FOOT TENDON,ProFee,0989,28208,,,,0,3.00,2.25,2.25,453.50,0.00,453.50,453.50,N/A
28210_3,REPAIR/GRAFT OF FOOT TENDON,ProFee,0989,28210,,,,0,3.00,2.25,2.25,603.50,0.00,603.50,603.50,N/A
28220_3,RELEASE OF FOOT TENDON,ProFee,0989,28220,,,,0,3.00,2.25,2.25,434.00,0.00,434.00,434.00,N/A
28222_3,RELEASE OF FOOT TENDONS,ProFee,0989,28222,,,,0,3.00,2.25,2.25,505.50,0.00,505.50,505.50,N/A
28225_3,RELEASE OF FOOT TENDON,ProFee,0989,28225,,,,0,3.00,2.25,2.25,376.50,0.00,376.50,376.50,N/A
28226_3,RELEASE OF FOOT TENDONS,ProFee,0989,28226,,,,0,3.00,2.25,2.25,567.50,0.00,567.50,567.50,N/A
28230_3,INCISION OF FOOT TENDON(S),ProFee,0989,28230,,,,0,3.00,2.25,2.25,407.50,0.00,407.50,407.50,N/A
28232_3,INCISION OF TOE TENDON,ProFee,0989,28232,,,,0,3.00,2.25,2.25,349.00,0.00,349.00,349.00,N/A
28234_3,INCISION OF FOOT TENDON,ProFee,0989,28234,,,,0,3.00,2.25,2.25,377.50,0.00,377.50,377.50,N/A
28238_3,REVISION OF FOOT TENDON,ProFee,0989,28238,,,,0,3.00,2.25,2.25,700.00,0.00,700.00,700.00,N/A
28240_3,RELEASE OF BIG TOE,ProFee,0989,28240,,,,0,3.00,2.25,2.25,433.50,0.00,433.50,433.50,N/A
28250_3,REVISION OF FOOT FASCIA,ProFee,0989,28250,,,,0,3.00,2.25,2.25,583.50,0.00,583.50,583.50,N/A
28260_3,RELEASE OF MIDFOOT JOINT,ProFee,0989,28260,,,,0,3.00,2.25,2.25,734.00,0.00,734.00,734.00,N/A
28261_3,REVISION OF FOOT TENDON,ProFee,0989,28261,,,,0,3.00,2.25,2.25,1155.50,0.00,1155.50,1155.50,N/A
28262_3,REVISION OF FOOT AND ANKLE,ProFee,0989,28262,,,,0,3.00,2.25,2.25,1712.00,0.00,1712.00,1712.00,N/A
28264_3,RELEASE OF MIDFOOT JOINT,ProFee,0989,28264,,,,0,3.00,2.25,2.25,1109.00,0.00,1109.00,1109.00,N/A
28270_3,RELEASE OF FOOT CONTRACTURE,ProFee,0989,28270,,,,0,3.00,2.25,2.25,482.00,0.00,482.00,482.00,N/A
28272_3,"RELEASE OF TOE JOINT, EACH",ProFee,0989,28272,,,,0,3.00,2.25,2.25,364.00,0.00,364.00,364.00,N/A
28280_3,FUSION OF TOES,ProFee,0989,28280,,,,0,3.00,2.25,2.25,502.50,0.00,502.50,502.50,N/A
28285_3,REPAIR OF HAMMERTOE,ProFee,0989,28285,,,,0,3.00,2.25,2.25,544.00,0.00,544.00,544.00,N/A
28286_3,REPAIR OF HAMMERTOE,ProFee,0989,28286,,,,0,3.00,2.25,2.25,430.00,0.00,430.00,430.00,N/A
28288_3,PARTIAL REMOVAL OF FOOT BONE,ProFee,0989,28288,,,,0,3.00,2.25,2.25,619.00,0.00,619.00,619.00,N/A
28289_3,REPAIR HALLUX RIGIDUS,ProFee,0989,28289,,,,0,3.00,2.25,2.25,666.50,0.00,666.50,666.50,N/A
28290_3,CORRECTION OF BUNION,ProFee,0989,28292,,,,0,3.00,2.25,2.25,700.50,0.00,700.50,700.50,N/A
28291_3,CORRJ HALUX RIGDUS W/IMPLT,ProFee,0989,28291,,,,0,3.00,2.25,2.25,683.00,0.00,683.00,683.00,N/A
28292_3,CORRECTION OF BUNION,ProFee,0989,28292,,,,0,3.00,2.25,2.25,700.50,0.00,700.50,700.50,N/A
28293_3,CORRECTION OF BUNION,ProFee,0989,28291,,,,0,3.00,2.25,2.25,683.00,0.00,683.00,683.00,N/A
28294_3,CORRECTION OF BUNION,ProFee,0989,28899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
28295_3,CORRECTION HALLUX VALGUS,ProFee,0989,28295,,,,0,3.00,2.25,2.25,773.00,0.00,773.00,773.00,N/A
28296_3,CORRECTION OF BUNION,ProFee,0989,28296,,,,0,3.00,2.25,2.25,741.00,0.00,741.00,741.00,N/A
28297_3,CORRECTION OF BUNION,ProFee,0989,28297,,,,0,3.00,2.25,2.25,864.50,0.00,864.50,864.50,N/A
28298_3,CORRECTION OF BUNION,ProFee,0989,28298,,,,0,3.00,2.25,2.25,715.00,0.00,715.00,715.00,N/A
28299_3,CORRECTION OF BUNION,ProFee,0989,28299,,,,0,3.00,2.25,2.25,836.50,0.00,836.50,836.50,N/A
28300_3,INCISION OF HEEL BONE,ProFee,0989,28300,,,,0,3.00,2.25,2.25,936.50,0.00,936.50,936.50,N/A
28302_3,INCISION OF ANKLE BONE,ProFee,0989,28302,,,,0,3.00,2.25,2.25,1031.50,0.00,1031.50,1031.50,N/A
28304_3,INCISION OF MIDFOOT BONES,ProFee,0989,28304,,,,0,3.00,2.25,2.25,874.50,0.00,874.50,874.50,N/A
28305_3,INCISE/GRAFT MIDFOOT BONES,ProFee,0989,28305,,,,0,3.00,2.25,2.25,962.00,0.00,962.00,962.00,N/A
28306_3,INCISION OF METATARSAL,ProFee,0989,28306,,,,0,3.00,2.25,2.25,582.50,0.00,582.50,582.50,N/A
28307_3,INCISION OF METATARSAL,ProFee,0989,28307,,,,0,3.00,2.25,2.25,645.00,0.00,645.00,645.00,N/A
28308_3,INCISION OF METATARSAL,ProFee,0989,28308,,,,0,3.00,2.25,2.25,544.00,0.00,544.00,544.00,N/A
28309_3,INCISION OF METATARSALS,ProFee,0989,28309,,,,0,3.00,2.25,2.25,1287.00,0.00,1287.00,1287.00,N/A
28310_3,REVISION OF BIG TOE,ProFee,0989,28310,,,,0,3.00,2.25,2.25,514.50,0.00,514.50,514.50,N/A
28312_3,REVISION OF TOE,ProFee,0989,28312,,,,0,3.00,2.25,2.25,456.50,0.00,456.50,456.50,N/A
28313_3,REPAIR DEFORMITY OF TOE,ProFee,0989,28313,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
28315_3,REMOVAL OF SESAMOID BONE,ProFee,0989,28315,,,,0,3.00,2.25,2.25,469.50,0.00,469.50,469.50,N/A
28320_3,REPAIR OF FOOT BONES,ProFee,0989,28320,,,,0,3.00,2.25,2.25,877.50,0.00,877.50,877.50,N/A
28322_3,REPAIR OF METATARSALS,ProFee,0989,28322,,,,0,3.00,2.25,2.25,831.50,0.00,831.50,831.50,N/A
28340_3,RESECT ENLARGED TOE TISSUE,ProFee,0989,28340,,,,0,3.00,2.25,2.25,594.00,0.00,594.00,594.00,N/A
28341_3,RESECT ENLARGED TOE,ProFee,0989,28341,,,,0,3.00,2.25,2.25,706.50,0.00,706.50,706.50,N/A
28344_3,REPAIR EXTRA TOE(S),ProFee,0989,28344,,,,0,3.00,2.25,2.25,415.50,0.00,415.50,415.50,N/A
28345_3,REPAIR WEBBED TOE(S),ProFee,0989,28345,,,,0,3.00,2.25,2.25,524.00,0.00,524.00,524.00,N/A
28360_3,RECONSTRUCT CLEFT FOOT,ProFee,0989,28360,,,,0,3.00,2.25,2.25,1565.00,0.00,1565.00,1565.00,N/A
28400_3,TREATMENT OF HEEL FRACTURE,ProFee,0989,28400,,,,0,3.00,2.25,2.25,326.00,0.00,326.00,326.00,N/A
28405_3,TREATMENT OF HEEL FRACTURE,ProFee,0989,28405,,,,0,3.00,2.25,2.25,508.00,0.00,508.00,508.00,N/A
28406_3,TREATMENT OF HEEL FRACTURE,ProFee,0989,28406,,,,0,3.00,2.25,2.25,747.50,0.00,747.50,747.50,N/A
28415_3,TREAT HEEL FRACTURE,ProFee,0989,28415,,,,0,3.00,2.25,2.25,1611.00,0.00,1611.00,1611.00,N/A
28420_3,TREAT/GRAFT HEEL FRACTURE,ProFee,0989,28420,,,,0,3.00,2.25,2.25,1825.50,0.00,1825.50,1825.50,N/A
28430_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,28430,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
28435_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,28435,,,,0,3.00,2.25,2.25,463.50,0.00,463.50,463.50,N/A
28436_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,28436,,,,0,3.00,2.25,2.25,647.50,0.00,647.50,647.50,N/A
28445_3,TREAT ANKLE FRACTURE,ProFee,0989,28445,,,,0,3.00,2.25,2.25,1520.00,0.00,1520.00,1520.00,N/A
28446_3,OSTEOCHONDRAL TALUS AUTOGRFT,ProFee,0989,28446,,,,0,3.00,2.25,2.25,1768.00,0.00,1768.00,1768.00,N/A
28450_3,"TREAT MIDFOOT FRACTURE, EACH",ProFee,0989,28450,,,,0,3.00,2.25,2.25,274.00,0.00,274.00,274.00,N/A
28455_3,"TREAT MIDFOOT FRACTURE, EACH",ProFee,0989,28455,,,,0,3.00,2.25,2.25,370.50,0.00,370.50,370.50,N/A
28456_3,TREAT MIDFOOT FRACTURE,ProFee,0989,28456,,,,0,3.00,2.25,2.25,460.00,0.00,460.00,460.00,N/A
28465_3,"TREAT MIDFOOT FRACTURE, EACH",ProFee,0989,28465,,,,0,3.00,2.25,2.25,910.00,0.00,910.00,910.00,N/A
28470_3,TREAT METATARSAL FRACTURE,ProFee,0989,28470,,,,0,3.00,2.25,2.25,292.50,0.00,292.50,292.50,N/A
28475_3,TREAT METATARSAL FRACTURE,ProFee,0989,28475,,,,0,3.00,2.25,2.25,324.00,0.00,324.00,324.00,N/A
28476_3,TREAT METATARSAL FRACTURE,ProFee,0989,28476,,,,0,3.00,2.25,2.25,503.50,0.00,503.50,503.50,N/A
28485_3,TREAT METATARSAL FRACTURE,ProFee,0989,28485,,,,0,3.00,2.25,2.25,780.00,0.00,780.00,780.00,N/A
28490_3,TREAT BIG TOE FRACTURE,ProFee,0989,28490,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
28495_3,TREAT BIG TOE FRACTURE,ProFee,0989,28495,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
28496_3,TREAT BIG TOE FRACTURE,ProFee,0989,28496,,,,0,3.00,2.25,2.25,350.00,0.00,350.00,350.00,N/A
28505_3,TREAT BIG TOE FRACTURE,ProFee,0989,28505,,,,0,3.00,2.25,2.25,719.00,0.00,719.00,719.00,N/A
28510_3,TREATMENT OF TOE FRACTURE,ProFee,0989,28510,,,,0,3.00,2.25,2.25,172.00,0.00,172.00,172.00,N/A
28515_3,TREATMENT OF TOE FRACTURE,ProFee,0989,28515,,,,0,3.00,2.25,2.25,204.00,0.00,204.00,204.00,N/A
28525_3,TREAT TOE FRACTURE,ProFee,0989,28525,,,,0,3.00,2.25,2.25,574.50,0.00,574.50,574.50,N/A
28530_3,TREAT SESAMOID BONE FRACTURE,ProFee,0989,28530,,,,0,3.00,2.25,2.25,148.50,0.00,148.50,148.50,N/A
28531_3,TREAT SESAMOID BONE FRACTURE,ProFee,0989,28531,,,,0,3.00,2.25,2.25,262.00,0.00,262.00,262.00,N/A
28540_3,TREAT FOOT DISLOCATION,ProFee,0989,28540,,,,0,3.00,2.25,2.25,249.50,0.00,249.50,249.50,N/A
28545_3,TREAT FOOT DISLOCATION,ProFee,0989,28545,,,,0,3.00,2.25,2.25,378.00,0.00,378.00,378.00,N/A
28546_3,TREAT FOOT DISLOCATION,ProFee,0989,28546,,,,0,3.00,2.25,2.25,490.00,0.00,490.00,490.00,N/A
28555_3,REPAIR FOOT DISLOCATION,ProFee,0989,28555,,,,0,3.00,2.25,2.25,951.00,0.00,951.00,951.00,N/A
28570_3,TREAT FOOT DISLOCATION,ProFee,0989,28570,,,,0,3.00,2.25,2.25,275.00,0.00,275.00,275.00,N/A
28575_3,TREAT FOOT DISLOCATION,ProFee,0989,28575,,,,0,3.00,2.25,2.25,475.50,0.00,475.50,475.50,N/A
28576_3,TREAT FOOT DISLOCATION,ProFee,0989,28576,,,,0,3.00,2.25,2.25,570.50,0.00,570.50,570.50,N/A
28585_3,REPAIR FOOT DISLOCATION,ProFee,0989,28585,,,,0,3.00,2.25,2.25,973.50,0.00,973.50,973.50,N/A
28600_3,TREAT FOOT DISLOCATION,ProFee,0989,28600,,,,0,3.00,2.25,2.25,267.50,0.00,267.50,267.50,N/A
28605_3,TREAT FOOT DISLOCATION,ProFee,0989,28605,,,,0,3.00,2.25,2.25,424.00,0.00,424.00,424.00,N/A
28606_3,TREAT FOOT DISLOCATION,ProFee,0989,28606,,,,0,3.00,2.25,2.25,577.50,0.00,577.50,577.50,N/A
28615_3,REPAIR FOOT DISLOCATION,ProFee,0989,28615,,,,0,3.00,2.25,2.25,1158.50,0.00,1158.50,1158.50,N/A
28630_3,TREAT TOE DISLOCATION,ProFee,0989,28630,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
28635_3,TREAT TOE DISLOCATION,ProFee,0989,28635,,,,0,3.00,2.25,2.25,191.00,0.00,191.00,191.00,N/A
28636_3,TREAT TOE DISLOCATION,ProFee,0989,28636,,,,0,3.00,2.25,2.25,303.50,0.00,303.50,303.50,N/A
28645_3,REPAIR TOE DISLOCATION,ProFee,0989,28645,,,,0,3.00,2.25,2.25,694.50,0.00,694.50,694.50,N/A
28660_3,TREAT TOE DISLOCATION,ProFee,0989,28660,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
28665_3,TREAT TOE DISLOCATION,ProFee,0989,28665,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
28666_3,TREAT TOE DISLOCATION,ProFee,0989,28666,,,,0,3.00,2.25,2.25,258.00,0.00,258.00,258.00,N/A
28675_3,REPAIR OF TOE DISLOCATION,ProFee,0989,28675,,,,0,3.00,2.25,2.25,584.50,0.00,584.50,584.50,N/A
28705_3,FUSION OF FOOT BONES,ProFee,0989,28705,,,,0,3.00,2.25,2.25,1799.00,0.00,1799.00,1799.00,N/A
28715_3,FUSION OF FOOT BONES,ProFee,0989,28715,,,,0,3.00,2.25,2.25,1352.50,0.00,1352.50,1352.50,N/A
28725_3,FUSION OF FOOT BONES,ProFee,0989,28725,,,,0,3.00,2.25,2.25,1121.50,0.00,1121.50,1121.50,N/A
28730_3,FUSION OF FOOT BONES,ProFee,0989,28730,,,,0,3.00,2.25,2.25,1059.50,0.00,1059.50,1059.50,N/A
28735_3,FUSION OF FOOT BONES,ProFee,0989,28735,,,,0,3.00,2.25,2.25,1126.50,0.00,1126.50,1126.50,N/A
28737_3,REVISION OF FOOT BONES,ProFee,0989,28737,,,,0,3.00,2.25,2.25,1001.50,0.00,1001.50,1001.50,N/A
28740_3,FUSION OF FOOT BONES,ProFee,0989,28740,,,,0,3.00,2.25,2.25,896.50,0.00,896.50,896.50,N/A
28750_3,FUSION OF BIG TOE JOINT,ProFee,0989,28750,,,,0,3.00,2.25,2.25,845.00,0.00,845.00,845.00,N/A
28755_3,FUSION OF BIG TOE JOINT,ProFee,0989,28755,,,,0,3.00,2.25,2.25,477.00,0.00,477.00,477.00,N/A
28760_3,FUSION OF BIG TOE JOINT,ProFee,0989,28760,,,,0,3.00,2.25,2.25,836.50,0.00,836.50,836.50,N/A
28800_3,AMPUTATION OF MIDFOOT,ProFee,0989,28800,,,,0,3.00,2.25,2.25,772.50,0.00,772.50,772.50,N/A
28805_3,AMPUTATION THRU METATARSAL,ProFee,0989,28805,,,,0,3.00,2.25,2.25,1050.00,0.00,1050.00,1050.00,N/A
28810_3,AMPUTATION TOE & METATARSAL,ProFee,0989,28810,,,,0,3.00,2.25,2.25,619.50,0.00,619.50,619.50,N/A
28820_3,AMPUTATION OF TOE,ProFee,0989,28820,,,,0,3.00,2.25,2.25,568.50,0.00,568.50,568.50,N/A
28825_3,PARTIAL AMPUTATION OF TOE,ProFee,0989,28825,,,,0,3.00,2.25,2.25,533.50,0.00,533.50,533.50,N/A
28890_3,"HIGH ENERGY ESWT, PLANTAR F",ProFee,0989,28890,,,,0,3.00,2.25,2.25,321.50,0.00,321.50,321.50,N/A
28899_3,FOOT/TOES SURGERY PROCEDURE,ProFee,0989,28899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
29010_3,APPLICATION OF BODY CAST,ProFee,0989,29010,,,,0,3.00,2.25,2.25,233.50,0.00,233.50,233.50,N/A
29015_3,APPLICATION OF BODY CAST,ProFee,0989,29015,,,,0,3.00,2.25,2.25,263.50,0.00,263.50,263.50,N/A
29020_3,APPLICATION OF BODY CAST,ProFee,0989,29020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
29025_3,APPLICATION OF BODY CAST,ProFee,0989,29025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
29035_3,APPLICATION OF BODY CAST,ProFee,0989,29035,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
29040_3,APPLICATION OF BODY CAST,ProFee,0989,29040,,,,0,3.00,2.25,2.25,252.00,0.00,252.00,252.00,N/A
29044_3,APPLICATION OF BODY CAST,ProFee,0989,29044,,,,0,3.00,2.25,2.25,243.50,0.00,243.50,243.50,N/A
29046_3,APPLICATION OF BODY CAST,ProFee,0989,29046,,,,0,3.00,2.25,2.25,273.50,0.00,273.50,273.50,N/A
29049_3,APPLICATION OF FIGURE EIGHT,ProFee,0989,29049,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
29055_3,APPLICATION OF SHOULDER CAST,ProFee,0989,29055,,,,0,3.00,2.25,2.25,200.50,0.00,200.50,200.50,N/A
29058_3,APPLICATION OF SHOULDER CAST,ProFee,0989,29058,,,,0,3.00,2.25,2.25,136.50,0.00,136.50,136.50,N/A
29065_2,APPLICATION OF LONG ARM CAST,Ambulatory Surgical,0521,29065,,,,0,244.00,183.00,183.00,231.80,219.60,231.80,0.00,219.60
29065_2,APPLICATION OF LONG ARM CAST,Inpatient,0521,29065,,,,0,244.00,183.00,183.00,231.80,219.60,231.80,231.80,219.60
29065_3,APPLICATION OF LONG ARM CAST,Ambulatory Surgical,0521,29065,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,0.00,216.00
29065_3,APPLICATION OF LONG ARM CAST,Inpatient,0521,29065,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,228.00,216.00
29075_2,APPLICATION OF FOREARM CAST,Ambulatory Surgical,0521,29075,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,0.00,190.80
29075_2,APPLICATION OF FOREARM CAST,Inpatient,0521,29075,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
29075_3,APPLICATION OF FOREARM CAST,Ambulatory Surgical,0521,29075,,,,0,209.00,156.75,156.75,198.55,188.10,198.55,0.00,188.10
29075_3,APPLICATION OF FOREARM CAST,Inpatient,0521,29075,,,,0,209.00,156.75,156.75,198.55,188.10,198.55,198.55,188.10
29085_2,APPLY HAND/WRIST CAST,Ambulatory Surgical,0521,29085,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,0.00,190.80
29085_2,APPLY HAND/WRIST CAST,Inpatient,0521,29085,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
29085_3,APPLY HAND/WRIST CAST,Ambulatory Surgical,0521,29085,,,,0,209.00,156.75,156.75,198.55,188.10,198.55,0.00,188.10
29085_3,APPLY HAND/WRIST CAST,Inpatient,0521,29085,,,,0,209.00,156.75,156.75,198.55,188.10,198.55,198.55,188.10
29086_3,APPLY FINGER CAST,ProFee,0989,29086,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
29105_3,APPLY LONG ARM SPLINT,ProFee,0989,29105,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
29125_2,APPLY FOREARM SPLINT,Inpatient,0521,29125,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
29125_2,APPLY FOREARM SPLINT,Outpatient,0521,29125,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,144.90
29125_3,APPLY FOREARM SPLINT,Inpatient,0521,29125,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
29125_3,APPLY FOREARM SPLINT,Outpatient,0521,29125,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
29126_3,APPLY FOREARM SPLINT,ProFee,0989,29126,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
29130_2,APPLICATION OF FINGER SPLINT,Outpatient,0521,29130,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,0.00,114.30
29130_2,APPLICATION OF FINGER SPLINT,Inpatient,0521,29130,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
29130_3,APPLICATION OF FINGER SPLINT,Inpatient,0521,29130,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
29130_3,APPLICATION OF FINGER SPLINT,Outpatient,0521,29130,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,0.00,114.30
29131_3,APPLICATION OF FINGER SPLINT,ProFee,0989,29131,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
29200_3,STRAPPING OF CHEST,ProFee,0989,29200,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
29220_3,STRAPPING OF LOW BACK,ProFee,0989,29220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
29240_3,STRAPPING OF SHOULDER,ProFee,0989,29240,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
29260_3,STRAPPING OF ELBOW OR WRIST,ProFee,0989,29260,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
29280_3,STRAPPING OF HAND OR FINGER,ProFee,0989,29280,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
29305_3,APPLICATION OF HIP CAST,ProFee,0989,29305,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
29325_3,APPLICATION OF HIP CASTS,ProFee,0989,29325,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
29345_2,APPLICATION OF LONG LEG CAST,Ambulatory Surgical,0521,29345,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,0.00,292.50
29345_2,APPLICATION OF LONG LEG CAST,Inpatient,0521,29345,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
29345_3,APPLICATION OF LONG LEG CAST,Inpatient,0521,29345,,,,0,319.00,239.25,239.25,303.05,287.10,303.05,303.05,287.10
29345_3,APPLICATION OF LONG LEG CAST,Ambulatory Surgical,0521,29345,,,,0,319.00,239.25,239.25,303.05,287.10,303.05,0.00,287.10
29355_2,APPLICATION OF LONG LEG CAST,Ambulatory Surgical,0521,29355,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,0.00,313.20
29355_2,APPLICATION OF LONG LEG CAST,Inpatient,0521,29355,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,330.60,313.20
29355_3,APPLICATION OF LONG LEG CAST,Inpatient,0521,29355,,,,0,341.00,255.75,255.75,323.95,306.90,323.95,323.95,306.90
29355_3,APPLICATION OF LONG LEG CAST,Ambulatory Surgical,0521,29355,,,,0,341.00,255.75,255.75,323.95,306.90,323.95,0.00,306.90
29358_3,APPLY LONG LEG CAST BRACE,ProFee,0989,29358,,,,0,3.00,2.25,2.25,150.50,0.00,150.50,150.50,N/A
29365_3,APPLICATION OF LONG LEG CAST,ProFee,0989,29365,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
29405_2,APPLY SHORT LEG CAST,Inpatient,0521,29405,,,,0,227.00,170.25,170.25,215.65,204.30,215.65,215.65,204.30
29405_2,APPLY SHORT LEG CAST,Ambulatory Surgical,0521,29405,,,,0,227.00,170.25,170.25,215.65,204.30,215.65,0.00,204.30
29405_3,APPLY SHORT LEG CAST,Ambulatory Surgical,0521,29405,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,0.00,201.60
29405_3,APPLY SHORT LEG CAST,Inpatient,0521,29405,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
29425_2,APPLY SHORT LEG CAST,Ambulatory Surgical,0521,29425,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,0.00,216.90
29425_2,APPLY SHORT LEG CAST,Inpatient,0521,29425,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,228.95,216.90
29425_3,APPLY SHORT LEG CAST,Ambulatory Surgical,0521,29425,,,,0,237.00,177.75,177.75,225.15,213.30,225.15,0.00,213.30
29425_3,APPLY SHORT LEG CAST,Inpatient,0521,29425,,,,0,237.00,177.75,177.75,225.15,213.30,225.15,225.15,213.30
29435_3,APPLY SHORT LEG CAST,ProFee,0989,29435,,,,0,3.00,2.25,2.25,120.50,0.00,120.50,120.50,N/A
29440_3,ADDITION OF WALKER TO CAST,ProFee,0989,29440,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
29445_3,APPLY RIGID LEG CAST,ProFee,0989,29445,,,,0,3.00,2.25,2.25,148.00,0.00,148.00,148.00,N/A
29450_3,APPLICATION OF LEG CAST,ProFee,0989,29450,,,,0,3.00,2.25,2.25,163.50,0.00,163.50,163.50,N/A
29505_2,"APPLICATION, LONG LEG SPLINT",Inpatient,0521,29505,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
29505_2,"APPLICATION, LONG LEG SPLINT",Ambulatory Surgical,0521,29505,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,0.00,165.60
29505_3,"APPLICATION, LONG LEG SPLINT",Inpatient,0521,29505,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,172.90,163.80
29505_3,"APPLICATION, LONG LEG SPLINT",Ambulatory Surgical,0521,29505,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,0.00,163.80
29515_2,APPLICATION LOWER LEG SPLINT,Ambulatory Surgical,0521,29515,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,144.90
29515_2,APPLICATION LOWER LEG SPLINT,Inpatient,0521,29515,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
29515_3,APPLICATION LOWER LEG SPLINT,Inpatient,0521,29515,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
29515_3,APPLICATION LOWER LEG SPLINT,Ambulatory Surgical,0521,29515,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
29520_3,STRAPPING OF HIP,ProFee,0989,29520,,,,0,3.00,2.25,2.25,27.50,0.00,27.50,27.50,N/A
29530_3,STRAPPING OF KNEE,ProFee,0989,29530,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
29540_2,STRAPPING OF ANKLE AND/OR FT,Inpatient,0521,29540,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
29540_2,STRAPPING OF ANKLE AND/OR FT,Ambulatory Surgical,0521,29540,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,144.90
29540_3,STRAPPING OF ANKLE AND/OR FT,Ambulatory Surgical,0521,29540,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,144.00
29540_3,STRAPPING OF ANKLE AND/OR FT,Inpatient,0521,29540,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
29550_3,STRAPPING OF TOES,ProFee,0989,29550,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
29580_3,APPLICATION OF PASTE BOOT,ProFee,0989,29580,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
29581_3,APPLY MULTLAY COMPRS LWR LEG,ProFee,0989,29581,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
29582_3,APPLY MULTLAY COMPRS UPR LEG,ProFee,0989,29581,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
29583_3,APPLY MULTLAY COMPRS UPR ARM,ProFee,0989,29584,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
29584_3,APPL MULTLAY COMPRS ARM/HAND,ProFee,0989,29584,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
29590_3,APPLICATION OF FOOT SPLINT,ProFee,0989,29590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
29700_2,REMOVAL/REVISION OF CAST,Ambulatory Surgical,0521,29700,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,0.00,92.70
29700_2,REMOVAL/REVISION OF CAST,Inpatient,0521,29700,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
29700_3,REMOVAL/REVISION OF CAST,Inpatient,0521,29700,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
29700_3,REMOVAL/REVISION OF CAST,Ambulatory Surgical,0521,29700,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,0.00,92.70
29705_2,REMOVAL/REVISION OF CAST,Ambulatory Surgical,0521,29705,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,0.00,88.20
29705_2,REMOVAL/REVISION OF CAST,Inpatient,0521,29705,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
29705_3,REMOVAL/REVISION OF CAST,Inpatient,0521,29705,,,,0,99.00,74.25,74.25,94.05,89.10,94.05,94.05,89.10
29705_3,REMOVAL/REVISION OF CAST,Ambulatory Surgical,0521,29705,,,,0,99.00,74.25,74.25,94.05,89.10,94.05,0.00,89.10
29710_3,REMOVAL/REVISION OF CAST,ProFee,0989,29710,,,,0,3.00,2.25,2.25,120.50,0.00,120.50,120.50,N/A
29715_3,REMOVAL/REVISION OF CAST,ProFee,0989,29715,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
29720_3,REPAIR OF BODY CAST,ProFee,0989,29720,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
29750_3,WEDGING OF CLUBFOOT CAST,ProFee,0989,29750,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
29799_3,CASTING/STRAPPING PROCEDURE,ProFee,0989,29799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
29800_3,JAW ARTHROSCOPY/SURGERY,ProFee,0989,29800,,,,0,3.00,2.25,2.25,761.00,0.00,761.00,761.00,N/A
29804_3,JAW ARTHROSCOPY/SURGERY,ProFee,0989,29804,,,,0,3.00,2.25,2.25,923.50,0.00,923.50,923.50,N/A
29805_3,"SHOULDER ARTHROSCOPY, DX",ProFee,0989,29805,,,,0,3.00,2.25,2.25,679.50,0.00,679.50,679.50,N/A
29806_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29806,,,,0,3.00,2.25,2.25,1529.50,0.00,1529.50,1529.50,N/A
29807_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29807,,,,0,3.00,2.25,2.25,1494.00,0.00,1494.00,1494.00,N/A
29819_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29819,,,,0,3.00,2.25,2.25,841.50,0.00,841.50,841.50,N/A
29820_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29820,,,,0,3.00,2.25,2.25,768.50,0.00,768.50,768.50,N/A
29821_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29821,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
29822_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29822,,,,0,3.00,2.25,2.25,817.00,0.00,817.00,817.00,N/A
29823_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29823,,,,0,3.00,2.25,2.25,890.00,0.00,890.00,890.00,N/A
29824_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29824,,,,0,3.00,2.25,2.25,959.50,0.00,959.50,959.50,N/A
29825_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29825,,,,0,3.00,2.25,2.25,829.50,0.00,829.50,829.50,N/A
29826_3,SHOULDER ARTHROSCOPY/SURGERY,ProFee,0989,29826,,,,0,3.00,2.25,2.25,254.50,0.00,254.50,254.50,N/A
29827_3,ARTHROSCOP ROTATOR CUFF REPR,ProFee,0989,29827,,,,0,3.00,2.25,2.25,1518.50,0.00,1518.50,1518.50,N/A
29828_3,ARTHROSCOPY BICEPS TENODESIS,ProFee,0989,29828,,,,0,3.00,2.25,2.25,1310.00,0.00,1310.00,1310.00,N/A
29830_3,ELBOW ARTHROSCOPY,ProFee,0989,29830,,,,0,3.00,2.25,2.25,657.50,0.00,657.50,657.50,N/A
29834_3,ELBOW ARTHROSCOPY/SURGERY,ProFee,0989,29834,,,,0,3.00,2.25,2.25,700.00,0.00,700.00,700.00,N/A
29835_3,ELBOW ARTHROSCOPY/SURGERY,ProFee,0989,29835,,,,0,3.00,2.25,2.25,732.50,0.00,732.50,732.50,N/A
29836_3,ELBOW ARTHROSCOPY/SURGERY,ProFee,0989,29836,,,,0,3.00,2.25,2.25,839.00,0.00,839.00,839.00,N/A
29837_3,ELBOW ARTHROSCOPY/SURGERY,ProFee,0989,29837,,,,0,3.00,2.25,2.25,754.00,0.00,754.00,754.00,N/A
29838_3,ELBOW ARTHROSCOPY/SURGERY,ProFee,0989,29838,,,,0,3.00,2.25,2.25,847.00,0.00,847.00,847.00,N/A
29840_3,WRIST ARTHROSCOPY,ProFee,0989,29840,,,,0,3.00,2.25,2.25,651.00,0.00,651.00,651.00,N/A
29843_3,WRIST ARTHROSCOPY/SURGERY,ProFee,0989,29843,,,,0,3.00,2.25,2.25,698.50,0.00,698.50,698.50,N/A
29844_3,WRIST ARTHROSCOPY/SURGERY,ProFee,0989,29844,,,,0,3.00,2.25,2.25,715.00,0.00,715.00,715.00,N/A
29845_3,WRIST ARTHROSCOPY/SURGERY,ProFee,0989,29845,,,,0,3.00,2.25,2.25,829.50,0.00,829.50,829.50,N/A
29846_3,WRIST ARTHROSCOPY/SURGERY,ProFee,0989,29846,,,,0,3.00,2.25,2.25,750.00,0.00,750.00,750.00,N/A
29847_3,WRIST ARTHROSCOPY/SURGERY,ProFee,0989,29847,,,,0,3.00,2.25,2.25,784.00,0.00,784.00,784.00,N/A
29848_3,WRIST ENDOSCOPY/SURGERY,ProFee,0989,29848,,,,0,3.00,2.25,2.25,737.00,0.00,737.00,737.00,N/A
29850_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29850,,,,0,3.00,2.25,2.25,900.00,0.00,900.00,900.00,N/A
29851_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29851,,,,0,3.00,2.25,2.25,1346.00,0.00,1346.00,1346.00,N/A
29855_3,TIBIAL ARTHROSCOPY/SURGERY,ProFee,0989,29855,,,,0,3.00,2.25,2.25,1128.00,0.00,1128.00,1128.00,N/A
29856_3,TIBIAL ARTHROSCOPY/SURGERY,ProFee,0989,29856,,,,0,3.00,2.25,2.25,1439.00,0.00,1439.00,1439.00,N/A
29860_3,"HIP ARTHROSCOPY, DX",ProFee,0989,29860,,,,0,3.00,2.25,2.25,962.50,0.00,962.50,962.50,N/A
29861_3,HIP ARTHROSCOPY/SURGERY,ProFee,0989,29861,,,,0,3.00,2.25,2.25,1040.00,0.00,1040.00,1040.00,N/A
29862_3,HIP ARTHROSCOPY/SURGERY,ProFee,0989,29862,,,,0,3.00,2.25,2.25,1160.50,0.00,1160.50,1160.50,N/A
29863_3,HIP ARTHROSCOPY/SURGERY,ProFee,0989,29863,,,,0,3.00,2.25,2.25,1159.00,0.00,1159.00,1159.00,N/A
29866_3,"AUTGRFT IMPLNT, KNEE W/SCOPE",ProFee,0989,29866,,,,0,3.00,2.25,2.25,1515.50,0.00,1515.50,1515.50,N/A
29867_3,"ALLGRFT IMPLNT, KNEE W/SCOPE",ProFee,0989,29867,,,,0,3.00,2.25,2.25,1848.50,0.00,1848.50,1848.50,N/A
29868_3,"MENISCAL TRNSPL, KNEE W/SCPE",ProFee,0989,29868,,,,0,3.00,2.25,2.25,2421.50,0.00,2421.50,2421.50,N/A
29870_3,"KNEE ARTHROSCOPY, DX",ProFee,0989,29870,,,,0,3.00,2.25,2.25,588.50,0.00,588.50,588.50,N/A
29871_3,KNEE ARTHROSCOPY/DRAINAGE,ProFee,0989,29871,,,,0,3.00,2.25,2.25,742.00,0.00,742.00,742.00,N/A
29873_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29873,,,,0,3.00,2.25,2.25,756.50,0.00,756.50,756.50,N/A
29874_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29874,,,,0,3.00,2.25,2.25,772.50,0.00,772.50,772.50,N/A
29875_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29875,,,,0,3.00,2.25,2.25,714.00,0.00,714.00,714.00,N/A
29876_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29876,,,,0,3.00,2.25,2.25,947.50,0.00,947.50,947.50,N/A
29877_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29877,,,,0,3.00,2.25,2.25,895.00,0.00,895.00,895.00,N/A
29879_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29879,,,,0,3.00,2.25,2.25,954.50,0.00,954.50,954.50,N/A
29880_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29880,,,,0,3.00,2.25,2.25,810.50,0.00,810.50,810.50,N/A
29881_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29881,,,,0,3.00,2.25,2.25,780.00,0.00,780.00,780.00,N/A
29882_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29882,,,,0,3.00,2.25,2.25,1008.00,0.00,1008.00,1008.00,N/A
29883_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29883,,,,0,3.00,2.25,2.25,1216.00,0.00,1216.00,1216.00,N/A
29884_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29884,,,,0,3.00,2.25,2.25,884.00,0.00,884.00,884.00,N/A
29885_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29885,,,,0,3.00,2.25,2.25,1087.50,0.00,1087.50,1087.50,N/A
29886_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29886,,,,0,3.00,2.25,2.25,919.50,0.00,919.50,919.50,N/A
29887_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29887,,,,0,3.00,2.25,2.25,1082.50,0.00,1082.50,1082.50,N/A
29888_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29888,,,,0,3.00,2.25,2.25,1419.00,0.00,1419.00,1419.00,N/A
29889_3,KNEE ARTHROSCOPY/SURGERY,ProFee,0989,29889,,,,0,3.00,2.25,2.25,1767.50,0.00,1767.50,1767.50,N/A
29891_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29891,,,,0,3.00,2.25,2.25,966.50,0.00,966.50,966.50,N/A
29892_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29892,,,,0,3.00,2.25,2.25,983.00,0.00,983.00,983.00,N/A
29893_3,"SCOPE, PLANTAR FASCIOTOMY",ProFee,0989,29893,,,,0,3.00,2.25,2.25,614.00,0.00,614.00,614.00,N/A
29894_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29894,,,,0,3.00,2.25,2.25,706.50,0.00,706.50,706.50,N/A
29895_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29895,,,,0,3.00,2.25,2.25,676.00,0.00,676.00,676.00,N/A
29897_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29897,,,,0,3.00,2.25,2.25,723.00,0.00,723.00,723.00,N/A
29898_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29898,,,,0,3.00,2.25,2.25,810.00,0.00,810.00,810.00,N/A
29899_3,ANKLE ARTHROSCOPY/SURGERY,ProFee,0989,29899,,,,0,3.00,2.25,2.25,1489.00,0.00,1489.00,1489.00,N/A
29900_3,"MCP JOINT ARTHROSCOPY, DX",ProFee,0989,29900,,,,0,3.00,2.25,2.25,714.00,0.00,714.00,714.00,N/A
29901_3,"MCP JOINT ARTHROSCOPY, SURG",ProFee,0989,29901,,,,0,3.00,2.25,2.25,769.50,0.00,769.50,769.50,N/A
29902_3,"MCP JOINT ARTHROSCOPY, SURG",ProFee,0989,29902,,,,0,3.00,2.25,2.25,817.50,0.00,817.50,817.50,N/A
29904_3,SUBTALAR ARTHRO W/FB RMVL,ProFee,0989,29904,,,,0,3.00,2.25,2.25,921.00,0.00,921.00,921.00,N/A
29905_3,SUBTALAR ARTHRO W/EXC,ProFee,0989,29905,,,,0,3.00,2.25,2.25,791.50,0.00,791.50,791.50,N/A
29906_3,SUBTALAR ARTHRO W/DEB,ProFee,0989,29906,,,,0,3.00,2.25,2.25,1002.00,0.00,1002.00,1002.00,N/A
29907_3,SUBTALAR ARTHRO W/FUSION,ProFee,0989,29907,,,,0,3.00,2.25,2.25,1265.50,0.00,1265.50,1265.50,N/A
29914_3,HIP ARTHRO W/FEMOROPLASTY,ProFee,0989,29914,,,,0,3.00,2.25,2.25,1414.50,0.00,1414.50,1414.50,N/A
29915_3,HIP ARTHRO ACETABULOPLASTY,ProFee,0989,29915,,,,0,3.00,2.25,2.25,1450.00,0.00,1450.00,1450.00,N/A
29916_3,HIP ARTHRO W/LABRAL REPAIR,ProFee,0989,29916,,,,0,3.00,2.25,2.25,1459.00,0.00,1459.00,1459.00,N/A
29999_3,ARTHROSCOPY OF JOINT,ProFee,0989,29999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30000_3,DRAINAGE OF NOSE LESION,ProFee,0989,30000,,,,0,3.00,2.25,2.25,167.00,0.00,167.00,167.00,N/A
3000F_3,CONTROL BP <=140/90,ProFee,0989,3000F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
30020_3,DRAINAGE OF NOSE LESION,ProFee,0989,30020,,,,0,3.00,2.25,2.25,167.00,0.00,167.00,167.00,N/A
3002F_3,CONTROL BP > 140/90,ProFee,0989,3002F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3006F_3,CXR DOC REV,ProFee,0989,3006F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3008F_3,BODY MASS INDEX DOCD,ProFee,0989,3008F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30100_3,INTRANASAL BIOPSY,ProFee,0989,30100,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
30110_3,REMOVAL OF NOSE POLYP(S),ProFee,0989,30110,,,,0,3.00,2.25,2.25,183.50,0.00,183.50,183.50,N/A
30115_3,REMOVAL OF NOSE POLYP(S),ProFee,0989,30115,,,,0,3.00,2.25,2.25,604.50,0.00,604.50,604.50,N/A
30117_3,REMOVAL OF INTRANASAL LESION,ProFee,0989,30117,,,,0,3.00,2.25,2.25,477.50,0.00,477.50,477.50,N/A
30118_3,REMOVAL OF INTRANASAL LESION,ProFee,0989,30118,,,,0,3.00,2.25,2.25,1084.50,0.00,1084.50,1084.50,N/A
3011F_3,LIPID PANEL DOC REV,ProFee,0989,3011F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30120_3,REVISION OF NOSE,ProFee,0989,30120,,,,0,3.00,2.25,2.25,623.50,0.00,623.50,623.50,N/A
30124_3,REMOVAL OF NOSE LESION,ProFee,0989,30124,,,,0,3.00,2.25,2.25,399.00,0.00,399.00,399.00,N/A
30125_3,REMOVAL OF NOSE LESION,ProFee,0989,30125,,,,0,3.00,2.25,2.25,849.50,0.00,849.50,849.50,N/A
30130_3,REMOVAL OF TURBINATE BONES,ProFee,0989,30130,,,,0,3.00,2.25,2.25,534.00,0.00,534.00,534.00,N/A
30140_3,REMOVAL OF TURBINATE BONES,ProFee,0989,30140,,,,0,3.00,2.25,2.25,256.00,0.00,256.00,256.00,N/A
3014F_3,SCREEN MAMMO DOC REV,ProFee,0989,3014F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30150_3,PARTIAL REMOVAL OF NOSE,ProFee,0989,30150,,,,0,3.00,2.25,2.25,1080.50,0.00,1080.50,1080.50,N/A
3015F_3,CERV CANCER SCREEN DOCD,ProFee,0989,3015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30160_3,REMOVAL OF NOSE,ProFee,0989,30160,,,,0,3.00,2.25,2.25,1082.50,0.00,1082.50,1082.50,N/A
3016F_3,PT SCRND UNHLTHY OH USE,ProFee,0989,3016F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3017F_3,COLORECTAL CA SCREEN DOC REV,ProFee,0989,3017F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3018F_3,PRE-PRXD RSK ET AL DOCD,ProFee,0989,3018F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3019F_3,LVEF ASSESS PLANPOST DSCHRGE,ProFee,0989,3019F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30200_3,INJECTION TREATMENT OF NOSE,ProFee,0989,30200,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
3020F_3,LVF ASSESS,ProFee,0989,3020F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30210_3,NASAL SINUS THERAPY,ProFee,0989,30210,,,,0,3.00,2.25,2.25,139.50,0.00,139.50,139.50,N/A
3021F_3,LVEF MOD/SEVER DEPRS SYST,ProFee,0989,3021F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30220_3,INSERT NASAL SEPTAL BUTTON,ProFee,0989,30220,,,,0,3.00,2.25,2.25,176.00,0.00,176.00,176.00,N/A
3022F_3,LVEF >=40% SYSTOLIC,ProFee,0989,3022F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3023F_3,SPIROM DOC REV,ProFee,0989,3023F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3025F_3,SPIROM FEV/FVC<70% W COPD,ProFee,0989,3025F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3027F_3,SPIROM FEV/FVC>=70%/W/O COPD,ProFee,0989,3027F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3028F_3,O2 SATURATION DOC REV,ProFee,0989,3028F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30300_2,REMOVE NASAL FOREIGN BODY,Outpatient,0521,30300,,,,0,358.00,268.50,268.50,340.10,322.20,340.10,0.00,322.20
30300_2,REMOVE NASAL FOREIGN BODY,Inpatient,0521,30300,,,,0,358.00,268.50,268.50,340.10,322.20,340.10,340.10,322.20
30300_3,REMOVE NASAL FOREIGN BODY,Outpatient,0521,30300,,,,0,351.00,263.25,263.25,333.45,315.90,333.45,0.00,315.90
30300_3,REMOVE NASAL FOREIGN BODY,Inpatient,0521,30300,,,,0,351.00,263.25,263.25,333.45,315.90,333.45,333.45,315.90
30310_3,REMOVE NASAL FOREIGN BODY,ProFee,0989,30310,,,,0,3.00,2.25,2.25,284.00,0.00,284.00,284.00,N/A
30320_3,REMOVE NASAL FOREIGN BODY,ProFee,0989,30320,,,,0,3.00,2.25,2.25,631.50,0.00,631.50,631.50,N/A
3035F_3,O2 SATURATION<=88% /PAO<=55,ProFee,0989,3035F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3037F_3,O2 SATURATION >88% /PAO>55,ProFee,0989,3037F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3038F_3,PULM FX W/IN 12 MON B/4 SURG,ProFee,0989,3038F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30400_3,RECONSTRUCTION OF NOSE,ProFee,0989,30400,,,,0,3.00,2.25,2.25,1493.50,0.00,1493.50,1493.50,N/A
3040F_3,FEV<40% PREDICTED VALUE,ProFee,0989,3040F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30410_3,RECONSTRUCTION OF NOSE,ProFee,0989,30410,,,,0,3.00,2.25,2.25,1760.00,0.00,1760.00,1760.00,N/A
30420_3,RECONSTRUCTION OF NOSE,ProFee,0989,30420,,,,0,3.00,2.25,2.25,1920.50,0.00,1920.50,1920.50,N/A
3042F_3,FEV>= 40% PREDICTED VALUE,ProFee,0989,3042F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30430_3,REVISION OF NOSE,ProFee,0989,30430,,,,0,3.00,2.25,2.25,1310.50,0.00,1310.50,1310.50,N/A
30435_3,REVISION OF NOSE,ProFee,0989,30435,,,,0,3.00,2.25,2.25,1645.50,0.00,1645.50,1645.50,N/A
3044F_3,HG A1C LEVEL LT 7.0%,ProFee,0989,3044F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30450_3,REVISION OF NOSE,ProFee,0989,30450,,,,0,3.00,2.25,2.25,2184.00,0.00,2184.00,2184.00,N/A
30460_3,REVISION OF NOSE,ProFee,0989,30460,,,,0,3.00,2.25,2.25,1165.50,0.00,1165.50,1165.50,N/A
30462_3,REVISION OF NOSE,ProFee,0989,30462,,,,0,3.00,2.25,2.25,2236.00,0.00,2236.00,2236.00,N/A
30465_3,REPAIR NASAL STENOSIS,ProFee,0989,30465,,,,0,3.00,2.25,2.25,1374.00,0.00,1374.00,1374.00,N/A
3046F_3,HEMOGLOBIN A1C LEVEL > 9.0%,ProFee,0989,3046F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3048F_3,LDL-C <100 MG/DL,ProFee,0989,3048F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3049F_3,LDL-C 100-129 MG/DL,ProFee,0989,3049F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3050F_3,LDL-C >= 130 MG/DL,ProFee,0989,3050F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3051F_3,HG A1C>EQUAL 7.0%<8.0%,ProFee,0989,3051F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
30520_3,REPAIR OF NASAL SEPTUM,ProFee,0989,30520,,,,0,3.00,2.25,2.25,871.50,0.00,871.50,871.50,N/A
3052F_3,HG A1C>EQUAL 8.0%<EQUAL 9.0%,ProFee,0989,3052F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
30540_3,REPAIR NASAL DEFECT,ProFee,0989,30540,,,,0,3.00,2.25,2.25,961.50,0.00,961.50,961.50,N/A
30545_3,REPAIR NASAL DEFECT,ProFee,0989,30545,,,,0,3.00,2.25,2.25,1316.50,0.00,1316.50,1316.50,N/A
3055F_3,LVEF LESS THAN/EQUAL TO 35%,ProFee,0989,3055F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30560_3,RELEASE OF NASAL ADHESIONS,ProFee,0989,30560,,,,0,3.00,2.25,2.25,192.00,0.00,192.00,192.00,N/A
3056F_3,LVEF GREATER THAN 35%,ProFee,0989,3056F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30580_3,REPAIR UPPER JAW FISTULA,ProFee,0989,30580,,,,0,3.00,2.25,2.25,726.00,0.00,726.00,726.00,N/A
30600_3,REPAIR MOUTH/NOSE FISTULA,ProFee,0989,30600,,,,0,3.00,2.25,2.25,647.50,0.00,647.50,647.50,N/A
3060F_3,POS MICROALBUMINURIA REV,ProFee,0989,3060F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3061F_3,NEG MICROALBUMINURIA REV,ProFee,0989,3061F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30620_3,INTRANASAL RECONSTRUCTION,ProFee,0989,30620,,,,0,3.00,2.25,2.25,871.50,0.00,871.50,871.50,N/A
3062F_3,POS MACROALBUMINURIA REV,ProFee,0989,3062F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30630_3,REPAIR NASAL SEPTUM DEFECT,ProFee,0989,30630,,,,0,3.00,2.25,2.25,871.00,0.00,871.00,871.00,N/A
3066F_3,NEPHROPATHY DOC TX,ProFee,0989,3066F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30713071_1,"INPATIENT, ACUTE LEVEL 1",Inpatient,0110,,,,,0,1793.00,1344.75,1344.75,1703.35,1613.70,1703.35,1703.35,1613.70
30713072_1,"INPATIENT, ACUTE LEVEL 2",Inpatient,0110,,,,,0,2030.00,1522.50,1522.50,1928.50,1827.00,1928.50,1928.50,1827.00
30713201_1,SWING BED SKILLED,Inpatient,0120,,,,,0,1282.00,961.50,961.50,1217.90,1153.80,1217.90,1217.90,1153.80
30713202_1,SWING BED PRIVATE PAY,Inpatient,0160,,,,,0,330.00,247.50,247.50,313.50,297.00,313.50,313.50,297.00
30713203_1,Swingbed Intermediate,Inpatient,0160,,,,,0,330.00,247.50,247.50,313.50,297.00,313.50,313.50,297.00
30713204_1,HOSPICE RESPITE CARE ROOM CHARGE,Inpatient,0110,,,,,0,226.00,169.50,169.50,214.70,203.40,214.70,214.70,203.40
3072F_3,LOW RISK FOR RETINOPATHY,ProFee,0989,3072F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3073F_3,PRE-SURG EYE MEASURES DOC'D,ProFee,0989,3073F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3074F_3,SYST BP LT 130 MM HG,ProFee,0989,3074F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3075F_3,SYST BP GE 130 - 139MM HG,ProFee,0989,3075F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3077F_3,SYST BP >= 140 MM HG6 IT,ProFee,0989,3077F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3078F_3,DIAST BP < 80 MM HG,ProFee,0989,3078F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3079F_3,DIAST BP 80-89 MM HG,ProFee,0989,3079F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30801_3,"CAUTERIZATION, INNER NOSE",ProFee,0989,30801,,,,0,3.00,2.25,2.25,191.50,0.00,191.50,191.50,N/A
30802_3,"CAUTERIZATION, INNER NOSE",ProFee,0989,30802,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
3080F_3,DIAST BP >= 90 MM HG,ProFee,0989,3080F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3082F_3,KT/V LT 1.2,ProFee,0989,3082F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3083F_3,KT/V GE 1.2 AND <1.7,ProFee,0989,3083F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3084F_3,KT/V GE 1.7,ProFee,0989,3084F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3085F_3,SUICIDE RISK ASSESSED,ProFee,0989,3085F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3088F_3,"MDD, MILD",ProFee,0989,3088F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3089F_3,"MDD, MODERATE",ProFee,0989,3089F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30901_2,CONTROL OF NOSEBLEED,Inpatient,0521,30901,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
30901_2,CONTROL OF NOSEBLEED,Outpatient,0521,30901,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,0.00,217.80
30901_3,CONTROL OF NOSEBLEED,Inpatient,0521,30901,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
30901_3,CONTROL OF NOSEBLEED,Outpatient,0521,30901,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,0.00,214.20
30903_2,CONTROL OF NOSEBLEED,Ambulatory Surgical,0521,30903,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,0.00,272.70
30903_2,CONTROL OF NOSEBLEED,Inpatient,0521,30903,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,287.85,272.70
30903_3,CONTROL OF NOSEBLEED,Ambulatory Surgical,0521,30903,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,0.00,268.20
30903_3,CONTROL OF NOSEBLEED,Inpatient,0521,30903,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,283.10,268.20
30905_3,CONTROL OF NOSEBLEED,ProFee,0989,30905,,,,0,3.00,2.25,2.25,150.50,0.00,150.50,150.50,N/A
30906_3,REPEAT CONTROL OF NOSEBLEED,ProFee,0989,30906,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
3090F_3,"MDD, SEVERE; W/O PSYCH",ProFee,0989,3090F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30915_3,"LIGATION, NASAL SINUS ARTERY",ProFee,0989,30915,,,,0,3.00,2.25,2.25,805.50,0.00,805.50,805.50,N/A
3091F_3,"MDD, SEVERE; W/ PSYCH",ProFee,0989,3091F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30920_3,"LIGATION, UPPER JAW ARTERY",ProFee,0989,30920,,,,0,3.00,2.25,2.25,1169.00,0.00,1169.00,1169.00,N/A
3092F_3,"MDD, IN REMISSION",ProFee,0989,3092F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30930_3,"THERAPY, FRACTURE OF NOSE",ProFee,0989,30930,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
3093F_3,DOC NEW DIAG 1ST/ADDL MDD,ProFee,0989,3093F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3095F_3,CENTRAL DEXA RESULTS DOC'D,ProFee,0989,3095F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3096F_3,CENTRAL DEXA ORDERED,ProFee,0989,3096F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
30999_3,NASAL SURGERY PROCEDURE,ProFee,0989,30999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31000_3,"IRRIGATION, MAXILLARY SINUS",ProFee,0989,31000,,,,0,3.00,2.25,2.25,149.50,0.00,149.50,149.50,N/A
31002_3,"IRRIGATION, SPHENOID SINUS",ProFee,0989,31002,,,,0,3.00,2.25,2.25,264.50,0.00,264.50,264.50,N/A
3100F_3,IMAGE TEST REF CAROT DIAM,ProFee,0989,3100F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31020_3,"EXPLORATION, MAXILLARY SINUS",ProFee,0989,31020,,,,0,3.00,2.25,2.25,504.50,0.00,504.50,504.50,N/A
31030_3,"EXPLORATION, MAXILLARY SINUS",ProFee,0989,31030,,,,0,3.00,2.25,2.25,743.50,0.00,743.50,743.50,N/A
31032_3,"EXPLORE SINUS, REMOVE POLYPS",ProFee,0989,31032,,,,0,3.00,2.25,2.25,806.50,0.00,806.50,806.50,N/A
31040_3,EXPLORATION BEHIND UPPER JAW,ProFee,0989,31040,,,,0,3.00,2.25,2.25,1072.50,0.00,1072.50,1072.50,N/A
31050_3,"EXPLORATION, SPHENOID SINUS",ProFee,0989,31050,,,,0,3.00,2.25,2.25,677.50,0.00,677.50,677.50,N/A
31051_3,SPHENOID SINUS SURGERY,ProFee,0989,31051,,,,0,3.00,2.25,2.25,901.00,0.00,901.00,901.00,N/A
31070_3,EXPLORATION OF FRONTAL SINUS,ProFee,0989,31070,,,,0,3.00,2.25,2.25,613.00,0.00,613.00,613.00,N/A
31075_3,EXPLORATION OF FRONTAL SINUS,ProFee,0989,31075,,,,0,3.00,2.25,2.25,1092.50,0.00,1092.50,1092.50,N/A
31080_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31080,,,,0,3.00,2.25,2.25,1439.50,0.00,1439.50,1439.50,N/A
31081_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31081,,,,0,3.00,2.25,2.25,1722.00,0.00,1722.00,1722.00,N/A
31084_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31084,,,,0,3.00,2.25,2.25,1612.00,0.00,1612.00,1612.00,N/A
31085_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31085,,,,0,3.00,2.25,2.25,1838.00,0.00,1838.00,1838.00,N/A
31086_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31086,,,,0,3.00,2.25,2.25,1565.50,0.00,1565.50,1565.50,N/A
31087_3,REMOVAL OF FRONTAL SINUS,ProFee,0989,31087,,,,0,3.00,2.25,2.25,1512.50,0.00,1512.50,1512.50,N/A
31090_3,EXPLORATION OF SINUSES,ProFee,0989,31090,,,,0,3.00,2.25,2.25,1438.50,0.00,1438.50,1438.50,N/A
3110F_3,PRES/ABSN HMRHG/LESION DOC'D,ProFee,0989,3110F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3111F_3,CT/MRI BRAIN DONE W/IN 24HRS,ProFee,0989,3111F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3112F_3,CT/MRI BRAIN DONE GT 24 HRS,ProFee,0989,3112F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3115F_3,QUANT RESULTS ACTIVITY +SYMP,ProFee,0989,3115F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3117F_3,HF ASSESSMENT TOOL COMPLETED,ProFee,0989,3117F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3118F_3,NY HEART ASSOC CLASS DOCD,ProFee,0989,3118F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3119F_3,NO EVAL ACTIVITY CLIN SYMP,ProFee,0989,3119F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31200_3,REMOVAL OF ETHMOID SINUS,ProFee,0989,31200,,,,0,3.00,2.25,2.25,815.00,0.00,815.00,815.00,N/A
31201_3,REMOVAL OF ETHMOID SINUS,ProFee,0989,31201,,,,0,3.00,2.25,2.25,1047.00,0.00,1047.00,1047.00,N/A
31205_3,REMOVAL OF ETHMOID SINUS,ProFee,0989,31205,,,,0,3.00,2.25,2.25,1283.00,0.00,1283.00,1283.00,N/A
3120F_3,12-LEAD ECG PERFORMED,ProFee,0989,3120F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31225_3,REMOVAL OF UPPER JAW,ProFee,0989,31225,,,,0,3.00,2.25,2.25,2644.00,0.00,2644.00,2644.00,N/A
31230_3,REMOVAL OF UPPER JAW,ProFee,0989,31230,,,,0,3.00,2.25,2.25,2912.50,0.00,2912.50,2912.50,N/A
31231_3,"NASAL ENDOSCOPY, DX",ProFee,0989,31231,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
31233_3,"NASAL/SINUS ENDOSCOPY, DX",ProFee,0989,31233,,,,0,3.00,2.25,2.25,192.50,0.00,192.50,192.50,N/A
31235_3,"NASAL/SINUS ENDOSCOPY, DX",ProFee,0989,31235,,,,0,3.00,2.25,2.25,228.50,0.00,228.50,228.50,N/A
31237_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31237,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
31238_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31238,,,,0,3.00,2.25,2.25,238.50,0.00,238.50,238.50,N/A
31239_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31239,,,,0,3.00,2.25,2.25,878.00,0.00,878.00,878.00,N/A
31240_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31240,,,,0,3.00,2.25,2.25,227.00,0.00,227.00,227.00,N/A
31241_3,NSL/SINS NDSC W/ARTERY LIG,ProFee,0989,31241,,,,0,3.00,2.25,2.25,641.50,0.00,641.50,641.50,N/A
31253_3,NSL/SINS NDSC TOTAL,ProFee,0989,31253,,,,0,3.00,2.25,2.25,719.00,0.00,719.00,719.00,N/A
31254_3,REVISION OF ETHMOID SINUS,ProFee,0989,31254,,,,0,3.00,2.25,2.25,349.50,0.00,349.50,349.50,N/A
31255_3,REMOVAL OF ETHMOID SINUS,ProFee,0989,31255,,,,0,3.00,2.25,2.25,464.50,0.00,464.50,464.50,N/A
31256_3,EXPLORATION MAXILLARY SINUS,ProFee,0989,31256,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
31257_3,NSL/SINS NDSC TOT W/SPHENDT,ProFee,0989,31257,,,,0,3.00,2.25,2.25,640.00,0.00,640.00,640.00,N/A
31259_3,NSL/SINS NDSC SPHN TISS RMVL,ProFee,0989,31259,,,,0,3.00,2.25,2.25,678.50,0.00,678.50,678.50,N/A
3125F_3,ESOPH BX RPRT W/DYSPL INFO,ProFee,0989,3125F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31267_3,"ENDOSCOPY, MAXILLARY SINUS",ProFee,0989,31267,,,,0,3.00,2.25,2.25,381.00,0.00,381.00,381.00,N/A
3126F_3,ESOPH BX RPRT W/DYSPL INFO,ProFee,0989,3126F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31276_3,"SINUS ENDOSCOPY, SURGICAL",ProFee,0989,31276,,,,0,3.00,2.25,2.25,542.50,0.00,542.50,542.50,N/A
31287_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31287,,,,0,3.00,2.25,2.25,289.00,0.00,289.00,289.00,N/A
31288_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31288,,,,0,3.00,2.25,2.25,336.00,0.00,336.00,336.00,N/A
31290_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31290,,,,0,3.00,2.25,2.25,1635.00,0.00,1635.00,1635.00,N/A
31291_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31291,,,,0,3.00,2.25,2.25,1750.50,0.00,1750.50,1750.50,N/A
31292_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31292,,,,0,3.00,2.25,2.25,1407.00,0.00,1407.00,1407.00,N/A
31293_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31293,,,,0,3.00,2.25,2.25,1526.50,0.00,1526.50,1526.50,N/A
31294_3,"NASAL/SINUS ENDOSCOPY, SURG",ProFee,0989,31294,,,,0,3.00,2.25,2.25,1748.50,0.00,1748.50,1748.50,N/A
31295_3,SINUS ENDO W/BALLOON DIL,ProFee,0989,31295,,,,0,3.00,2.25,2.25,226.00,0.00,226.00,226.00,N/A
31296_3,SINUS ENDO W/BALLOON DIL,ProFee,0989,31296,,,,0,3.00,2.25,2.25,258.00,0.00,258.00,258.00,N/A
31297_3,SINUS ENDO W/BALLOON DIL,ProFee,0989,31297,,,,0,3.00,2.25,2.25,205.50,0.00,205.50,205.50,N/A
31298_3,NSL/SINS NDSC SURG FRNT&SPHN,ProFee,0989,31298,,,,0,3.00,2.25,2.25,366.50,0.00,366.50,366.50,N/A
31299_3,SINUS SURGERY PROCEDURE,ProFee,0989,31299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31300_3,REMOVAL OF LARYNX LESION,ProFee,0989,31300,,,,0,3.00,2.25,2.25,1837.50,0.00,1837.50,1837.50,N/A
3130F_3,UPPER GI ENDOSCOPY PERFORMED,ProFee,0989,3130F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31320_3,"DIAGNOSTIC INCISION, LARYNX",ProFee,0989,31320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3132F_3,DOC REF UPPER GI ENDOSCOPY,ProFee,0989,3132F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31360_3,REMOVAL OF LARYNX,ProFee,0989,31360,,,,0,3.00,2.25,2.25,2985.00,0.00,2985.00,2985.00,N/A
31365_3,REMOVAL OF LARYNX,ProFee,0989,31365,,,,0,3.00,2.25,2.25,3678.50,0.00,3678.50,3678.50,N/A
31367_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31367,,,,0,3.00,2.25,2.25,3158.00,0.00,3158.00,3158.00,N/A
31368_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31368,,,,0,3.00,2.25,2.25,3510.50,0.00,3510.50,3510.50,N/A
31370_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31370,,,,0,3.00,2.25,2.25,2970.00,0.00,2970.00,2970.00,N/A
31375_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31375,,,,0,3.00,2.25,2.25,2816.00,0.00,2816.00,2816.00,N/A
31380_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31380,,,,0,3.00,2.25,2.25,2776.50,0.00,2776.50,2776.50,N/A
31382_3,PARTIAL REMOVAL OF LARYNX,ProFee,0989,31382,,,,0,3.00,2.25,2.25,3048.50,0.00,3048.50,3048.50,N/A
31390_3,REMOVAL OF LARYNX & PHARYNX,ProFee,0989,31390,,,,0,3.00,2.25,2.25,4095.00,0.00,4095.00,4095.00,N/A
31395_3,RECONSTRUCT LARYNX & PHARYNX,ProFee,0989,31395,,,,0,3.00,2.25,2.25,4334.50,0.00,4334.50,4334.50,N/A
31400_3,REVISION OF LARYNX,ProFee,0989,31400,,,,0,3.00,2.25,2.25,1395.50,0.00,1395.50,1395.50,N/A
3140F_3,UPPER GI ENDO SHOWS BARRTT'S,ProFee,0989,3140F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3141F_3,UPPER GI ENDO NOT BARRTT'S,ProFee,0989,3141F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31420_3,REMOVAL OF EPIGLOTTIS,ProFee,0989,31420,,,,0,3.00,2.25,2.25,1171.00,0.00,1171.00,1171.00,N/A
3142F_3,BARIUM SWALLOW TEST ORDERED,ProFee,0989,3142F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31502_3,CHANGE OF WINDPIPE AIRWAY,ProFee,0989,31502,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
3150F_3,FORCEPS ESOPH BIOPSY DONE,ProFee,0989,3150F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31510_3,LARYNGOSCOPY WITH BIOPSY,ProFee,0989,31510,,,,0,3.00,2.25,2.25,172.50,0.00,172.50,172.50,N/A
31511_3,"REMOVE FOREIGN BODY, LARYNX",ProFee,0989,31511,,,,0,3.00,2.25,2.25,186.50,0.00,186.50,186.50,N/A
31512_3,REMOVAL OF LARYNX LESION,ProFee,0989,31512,,,,0,3.00,2.25,2.25,184.00,0.00,184.00,184.00,N/A
31513_3,INJECTION INTO VOCAL CORD,ProFee,0989,31513,,,,0,3.00,2.25,2.25,187.00,0.00,187.00,187.00,N/A
31515_3,LARYNGOSCOPY FOR ASPIRATION,ProFee,0989,31515,,,,0,3.00,2.25,2.25,157.50,0.00,157.50,157.50,N/A
31520_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31520,,,,0,3.00,2.25,2.25,222.50,0.00,222.50,222.50,N/A
31525_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31525,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
31526_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31526,,,,0,3.00,2.25,2.25,223.50,0.00,223.50,223.50,N/A
31527_3,LARYNGOSCOPY FOR TREATMENT,ProFee,0989,31527,,,,0,3.00,2.25,2.25,278.50,0.00,278.50,278.50,N/A
31528_3,LARYNGOSCOPY AND DILATION,ProFee,0989,31528,,,,0,3.00,2.25,2.25,205.50,0.00,205.50,205.50,N/A
31529_3,LARYNGOSCOPY AND DILATION,ProFee,0989,31529,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
31530_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31530,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
31531_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31531,,,,0,3.00,2.25,2.25,303.00,0.00,303.00,303.00,N/A
31535_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31535,,,,0,3.00,2.25,2.25,271.00,0.00,271.00,271.00,N/A
31536_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31536,,,,0,3.00,2.25,2.25,300.50,0.00,300.50,300.50,N/A
31540_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31540,,,,0,3.00,2.25,2.25,344.50,0.00,344.50,344.50,N/A
31541_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31541,,,,0,3.00,2.25,2.25,376.00,0.00,376.00,376.00,N/A
31545_3,REMOVE VC LESION W/SCOPE,ProFee,0989,31545,,,,0,3.00,2.25,2.25,516.50,0.00,516.50,516.50,N/A
31546_3,REMOVE VC LESION SCOPE/GRAFT,ProFee,0989,31546,,,,0,3.00,2.25,2.25,785.00,0.00,785.00,785.00,N/A
31551_3,LARYNGOPLASTY LARYNGEAL STEN,ProFee,0989,31551,,,,0,3.00,2.25,2.25,2048.00,0.00,2048.00,2048.00,N/A
31552_3,LARYNGOPLASTY LARYNGEAL STEN,ProFee,0989,31552,,,,0,3.00,2.25,2.25,2054.00,0.00,2054.00,2054.00,N/A
31553_3,LARYNGOPLASTY LARYNGEAL STEN,ProFee,0989,31553,,,,0,3.00,2.25,2.25,2260.00,0.00,2260.00,2260.00,N/A
31554_3,LARYNGOPLASTY LARYNGEAL STEN,ProFee,0989,31554,,,,0,3.00,2.25,2.25,2358.00,0.00,2358.00,2358.00,N/A
3155F_3,CYTOGEN TEST MARROW B/4 TX,ProFee,0989,3155F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31560_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31560,,,,0,3.00,2.25,2.25,446.50,0.00,446.50,446.50,N/A
31561_3,OPERATIVE LARYNGOSCOPY,ProFee,0989,31561,,,,0,3.00,2.25,2.25,488.00,0.00,488.00,488.00,N/A
31570_3,LARYNGOSCOPY WITH INJECTION,ProFee,0989,31570,,,,0,3.00,2.25,2.25,327.50,0.00,327.50,327.50,N/A
31571_3,LARYNGOSCOPY WITH INJECTION,ProFee,0989,31571,,,,0,3.00,2.25,2.25,355.50,0.00,355.50,355.50,N/A
31572_3,LARGSC W/LASER DSTRJ LES,ProFee,0989,31572,,,,0,3.00,2.25,2.25,257.50,0.00,257.50,257.50,N/A
31573_3,LARGSC W/THER INJECTION,ProFee,0989,31573,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
31574_3,LARGSC W/NJX AUGMENTATION,ProFee,0989,31574,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
31575_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31575,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
31576_3,LARYNGOSCOPY WITH BIOPSY,ProFee,0989,31576,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
31577_3,"REMOVE FOREIGN BODY, LARYNX",ProFee,0989,31577,,,,0,3.00,2.25,2.25,191.00,0.00,191.00,191.00,N/A
31578_3,REMOVAL OF LARYNX LESION,ProFee,0989,31578,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
31579_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31579,,,,0,3.00,2.25,2.25,170.50,0.00,170.50,170.50,N/A
31580_3,REVISION OF LARYNX,ProFee,0989,31580,,,,0,3.00,2.25,2.25,1766.50,0.00,1766.50,1766.50,N/A
31582_3,REVISION OF LARYNX,ProFee,0989,31582,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31584_3,TREAT LARYNX FRACTURE,ProFee,0989,31584,,,,0,3.00,2.25,2.25,1956.50,0.00,1956.50,1956.50,N/A
31587_3,REVISION OF LARYNX,ProFee,0989,31587,,,,0,3.00,2.25,2.25,1634.00,0.00,1634.00,1634.00,N/A
31588_3,REVISION OF LARYNX,ProFee,0989,31599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31590_3,REINNERVATE LARYNX,ProFee,0989,31590,,,,0,3.00,2.25,2.25,1241.00,0.00,1241.00,1241.00,N/A
31591_3,LARYNGOPLASTY MEDIALIZATION,ProFee,0989,31591,,,,0,3.00,2.25,2.25,1477.50,0.00,1477.50,1477.50,N/A
31592_3,CRICOTRACHEAL RESECTION,ProFee,0989,31592,,,,0,3.00,2.25,2.25,2407.00,0.00,2407.00,2407.00,N/A
31595_3,LARYNX NERVE SURGERY,ProFee,0989,31595,,,,0,3.00,2.25,2.25,1070.00,0.00,1070.00,1070.00,N/A
31599_3,LARYNX SURGERY PROCEDURE,ProFee,0989,31599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31600_3,INCISION OF WINDPIPE,ProFee,0989,31600,,,,0,3.00,2.25,2.25,464.00,0.00,464.00,464.00,N/A
31601_3,INCISION OF WINDPIPE,ProFee,0989,31601,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
31603_3,INCISION OF WINDPIPE,ProFee,0989,31603,,,,0,3.00,2.25,2.25,463.50,0.00,463.50,463.50,N/A
31605_3,INCISION OF WINDPIPE,ProFee,0989,31605,,,,0,3.00,2.25,2.25,481.50,0.00,481.50,481.50,N/A
3160F_3,DOC FE+ STORES B/4 EPO THX,ProFee,0989,3160F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31610_3,INCISION OF WINDPIPE,ProFee,0989,31610,,,,0,3.00,2.25,2.25,1347.50,0.00,1347.50,1347.50,N/A
31611_3,SURGERY/SPEECH PROSTHESIS,ProFee,0989,31611,,,,0,3.00,2.25,2.25,757.50,0.00,757.50,757.50,N/A
31612_3,PUNCTURE/CLEAR WINDPIPE,ProFee,0989,31612,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
31613_3,REPAIR WINDPIPE OPENING,ProFee,0989,31613,,,,0,3.00,2.25,2.25,642.00,0.00,642.00,642.00,N/A
31614_3,REPAIR WINDPIPE OPENING,ProFee,0989,31614,,,,0,3.00,2.25,2.25,1062.00,0.00,1062.00,1062.00,N/A
31615_3,VISUALIZATION OF WINDPIPE,ProFee,0989,31615,,,,0,3.00,2.25,2.25,164.00,0.00,164.00,164.00,N/A
31620_3,ENDOBRONCHIAL US ADD-ON,ProFee,0989,31620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31622_3,DX BRONCHOSCOPE/WASH,ProFee,0989,31622,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
31623_3,DX BRONCHOSCOPE/BRUSH,ProFee,0989,31623,,,,0,3.00,2.25,2.25,193.00,0.00,193.00,193.00,N/A
31624_3,DX BRONCHOSCOPE/LAVAGE,ProFee,0989,31624,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
31625_3,BRONCHOSCOPY W/BIOPSY(S),ProFee,0989,31625,,,,0,3.00,2.25,2.25,225.50,0.00,225.50,225.50,N/A
31626_3,BRONCHOSCOPY W/MARKERS,ProFee,0989,31626,,,,0,3.00,2.25,2.25,288.00,0.00,288.00,288.00,N/A
31627_3,NAVIGATIONAL BRONCHOSCOPY,ProFee,0989,31627,,,,0,3.00,2.25,2.25,140.50,0.00,140.50,140.50,N/A
31628_3,"BRONCHOSCOPY/LUNG BX, EACH",ProFee,0989,31628,,,,0,3.00,2.25,2.25,254.50,0.00,254.50,254.50,N/A
31629_3,"BRONCHOSCOPY/NEEDLE BX, EACH",ProFee,0989,31629,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
31630_3,BRONCHOSCOPY DILATE/FX REPR,ProFee,0989,31630,,,,0,3.00,2.25,2.25,287.50,0.00,287.50,287.50,N/A
31631_3,"BRONCHOSCOPY, DILATE W/STENT",ProFee,0989,31631,,,,0,3.00,2.25,2.25,329.50,0.00,329.50,329.50,N/A
31632_3,"BRONCHOSCOPY/LUNG BX, ADD'L",ProFee,0989,31632,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
31633_3,BRONCHOSCOPY/NEEDLE BX ADD'L,ProFee,0989,31633,,,,0,3.00,2.25,2.25,91.50,0.00,91.50,91.50,N/A
31634_3,BRONCH W/BALLOON OCCLUSION,ProFee,0989,31634,,,,0,3.00,2.25,2.25,271.50,0.00,271.50,271.50,N/A
31635_3,BRONCHOSCOPY W/FB REMOVAL,ProFee,0989,31635,,,,0,3.00,2.25,2.25,253.00,0.00,253.00,253.00,N/A
31636_3,"BRONCHOSCOPY, BRONCH STENTS",ProFee,0989,31636,,,,0,3.00,2.25,2.25,319.00,0.00,319.00,319.00,N/A
31637_3,"BRONCHOSCOPY, STENT ADD-ON",ProFee,0989,31637,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
31638_3,"BRONCHOSCOPY, REVISE STENT",ProFee,0989,31638,,,,0,3.00,2.25,2.25,360.50,0.00,360.50,360.50,N/A
31640_3,BRONCHOSCOPY W/TUMOR EXCISE,ProFee,0989,31640,,,,0,3.00,2.25,2.25,362.50,0.00,362.50,362.50,N/A
31641_3,"BRONCHOSCOPY, TREAT BLOCKAGE",ProFee,0989,31641,,,,0,3.00,2.25,2.25,371.00,0.00,371.00,371.00,N/A
31643_3,DIAG BRONCHOSCOPE/CATHETER,ProFee,0989,31643,,,,0,3.00,2.25,2.25,255.50,0.00,255.50,255.50,N/A
31645_3,"BRONCHOSCOPY, CLEAR AIRWAYS",ProFee,0989,31645,,,,0,3.00,2.25,2.25,211.50,0.00,211.50,211.50,N/A
31646_3,"BRONCHOSCOPY, RECLEAR AIRWAY",ProFee,0989,31646,,,,0,3.00,2.25,2.25,204.50,0.00,204.50,204.50,N/A
31647_3,BRONCHIAL VALVE INIT INSERT,ProFee,0989,31647,,,,0,3.00,2.25,2.25,306.50,0.00,306.50,306.50,N/A
31648_3,BRONCHIAL VALVE REMOV INIT,ProFee,0989,31648,,,,0,3.00,2.25,2.25,281.00,0.00,281.00,281.00,N/A
31649_3,BRONCHIAL VALVE REMOV ADDL,ProFee,0989,31649,,,,0,3.00,2.25,2.25,97.50,0.00,97.50,97.50,N/A
31651_3,BRONCHIAL VALVE ADDL INSERT,ProFee,0989,31651,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
31652_3,BRONCH EBUS SAMPLNG 1/2 NODE,ProFee,0989,31652,,,,0,3.00,2.25,2.25,320.00,0.00,320.00,320.00,N/A
31653_3,BRONCH EBUS SAMPLNG 3/> NODE,ProFee,0989,31653,,,,0,3.00,2.25,2.25,355.00,0.00,355.00,355.00,N/A
31654_3,BRONCH EBUS IVNTJ PERPH LES,ProFee,0989,31654,,,,0,3.00,2.25,2.25,97.50,0.00,97.50,97.50,N/A
31656_3,"BRONCHOSCOPY, INJ FOR X-RAY",ProFee,0989,31656,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31660_3,BRONCH THERMOPLSTY 1 LOBE,ProFee,0989,31660,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
31661_3,BRONCH THERMOPLSTY 2/> LOBES,ProFee,0989,31661,,,,0,3.00,2.25,2.25,298.00,0.00,298.00,298.00,N/A
31700_3,INSERTION OF AIRWAY CATHETER,ProFee,0989,31700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31708_3,INSTILL AIRWAY CONTRAST DYE,ProFee,0989,31708,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3170F_3,FLOW CYTO DONE B/4 TX,ProFee,0989,3170F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
31710_3,INSERTION OF AIRWAY CATHETER,ProFee,0989,31710,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31715_3,INJECTION FOR BRONCHUS X-RAY,ProFee,0989,31715,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
31717_3,BRONCHIAL BRUSH BIOPSY,ProFee,0989,31717,,,,0,3.00,2.25,2.25,159.00,0.00,159.00,159.00,N/A
31720_3,CLEARANCE OF AIRWAYS,ProFee,0989,31720,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
31725_3,CLEARANCE OF AIRWAYS,ProFee,0989,31725,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
31730_3,"INTRO, WINDPIPE WIRE/TUBE",ProFee,0989,31730,,,,0,3.00,2.25,2.25,216.00,0.00,216.00,216.00,N/A
31750_3,REPAIR OF WINDPIPE,ProFee,0989,31750,,,,0,3.00,2.25,2.25,1986.50,0.00,1986.50,1986.50,N/A
31755_3,REPAIR OF WINDPIPE,ProFee,0989,31755,,,,0,3.00,2.25,2.25,2509.00,0.00,2509.00,2509.00,N/A
31760_3,REPAIR OF WINDPIPE,ProFee,0989,31760,,,,0,3.00,2.25,2.25,1980.50,0.00,1980.50,1980.50,N/A
31766_3,RECONSTRUCTION OF WINDPIPE,ProFee,0989,31766,,,,0,3.00,2.25,2.25,2570.50,0.00,2570.50,2570.50,N/A
31770_3,REPAIR/GRAFT OF BRONCHUS,ProFee,0989,31770,,,,0,3.00,2.25,2.25,1925.50,0.00,1925.50,1925.50,N/A
31775_3,RECONSTRUCT BRONCHUS,ProFee,0989,31775,,,,0,3.00,2.25,2.25,2022.00,0.00,2022.00,2022.00,N/A
31780_3,RECONSTRUCT WINDPIPE,ProFee,0989,31780,,,,0,3.00,2.25,2.25,1698.00,0.00,1698.00,1698.00,N/A
31781_3,RECONSTRUCT WINDPIPE,ProFee,0989,31781,,,,0,3.00,2.25,2.25,2002.00,0.00,2002.00,2002.00,N/A
31785_3,REMOVE WINDPIPE LESION,ProFee,0989,31785,,,,0,3.00,2.25,2.25,1520.00,0.00,1520.00,1520.00,N/A
31786_3,REMOVE WINDPIPE LESION,ProFee,0989,31786,,,,0,3.00,2.25,2.25,2085.00,0.00,2085.00,2085.00,N/A
31800_3,REPAIR OF WINDPIPE INJURY,ProFee,0989,31800,,,,0,3.00,2.25,2.25,1035.00,0.00,1035.00,1035.00,N/A
31805_3,REPAIR OF WINDPIPE INJURY,ProFee,0989,31805,,,,0,3.00,2.25,2.25,1177.00,0.00,1177.00,1177.00,N/A
31820_3,CLOSURE OF WINDPIPE LESION,ProFee,0989,31820,,,,0,3.00,2.25,2.25,463.50,0.00,463.50,463.50,N/A
31825_3,REPAIR OF WINDPIPE DEFECT,ProFee,0989,31825,,,,0,3.00,2.25,2.25,677.00,0.00,677.00,677.00,N/A
31830_3,REVISE WINDPIPE SCAR,ProFee,0989,31830,,,,0,3.00,2.25,2.25,485.50,0.00,485.50,485.50,N/A
31899_3,AIRWAYS SURGICAL PROCEDURE,ProFee,0989,31899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32002_3,TREATMENT OF COLLAPSED LUNG,ProFee,0989,32002,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32005_3,TREAT LUNG LINING CHEMICALLY,ProFee,0989,32005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3200F_3,BARIUM SWALLOW TEST NOT REQ,ProFee,0989,3200F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32019_3,INSERT PLEURAL CATHETER,ProFee,0989,32019,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32020_3,INSERTION OF CHEST TUBE,ProFee,0989,32020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32035_3,EXPLORATION OF CHEST,ProFee,0989,32035,,,,0,3.00,2.25,2.25,1048.50,0.00,1048.50,1048.50,N/A
32036_3,EXPLORATION OF CHEST,ProFee,0989,32036,,,,0,3.00,2.25,2.25,1115.50,0.00,1115.50,1115.50,N/A
32095_3,BIOPSY THROUGH CHEST WALL,ProFee,0989,32095,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32096_3,OPEN WEDGE/BX LUNG INFILTR,ProFee,0989,32096,,,,0,3.00,2.25,2.25,1161.00,0.00,1161.00,1161.00,N/A
32097_3,OPEN WEDGE/BX LUNG NODULE,ProFee,0989,32097,,,,0,3.00,2.25,2.25,1160.00,0.00,1160.00,1160.00,N/A
32098_3,OPEN BIOPSY OF LUNG PLEURA,ProFee,0989,32098,,,,0,3.00,2.25,2.25,1101.00,0.00,1101.00,1101.00,N/A
32100_3,EXPLORATION/BIOPSY OF CHEST,ProFee,0989,32100,,,,0,3.00,2.25,2.25,1168.00,0.00,1168.00,1168.00,N/A
3210F_3,GRP A STREP TEST PERFORMED,ProFee,0989,3210F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32110_3,EXPLORE/REPAIR CHEST,ProFee,0989,32110,,,,0,3.00,2.25,2.25,2116.00,0.00,2116.00,2116.00,N/A
32120_3,RE-EXPLORATION OF CHEST,ProFee,0989,32120,,,,0,3.00,2.25,2.25,1257.50,0.00,1257.50,1257.50,N/A
32124_3,EXPLORE CHEST FREE ADHESIONS,ProFee,0989,32124,,,,0,3.00,2.25,2.25,1337.00,0.00,1337.00,1337.00,N/A
32140_3,REMOVAL OF LUNG LESION(S),ProFee,0989,32140,,,,0,3.00,2.25,2.25,1433.50,0.00,1433.50,1433.50,N/A
32141_3,REMOVE/TREAT LUNG LESIONS,ProFee,0989,32141,,,,0,3.00,2.25,2.25,2200.00,0.00,2200.00,2200.00,N/A
32150_3,REMOVAL OF LUNG LESION(S),ProFee,0989,32150,,,,0,3.00,2.25,2.25,1446.50,0.00,1446.50,1446.50,N/A
32151_3,REMOVE LUNG FOREIGN BODY,ProFee,0989,32151,,,,0,3.00,2.25,2.25,1454.50,0.00,1454.50,1454.50,N/A
3215F_3,PT IMMUNITY TO HEP A DOC'D,ProFee,0989,3215F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32160_3,OPEN CHEST HEART MASSAGE,ProFee,0989,32160,,,,0,3.00,2.25,2.25,1140.50,0.00,1140.50,1140.50,N/A
3216F_3,PT IMMUNITY TO HEP B DOC'D,ProFee,0989,3216F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3218F_3,RNA TSTNG HEP C DOC'D-DONE,ProFee,0989,3218F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32200_3,"DRAIN, OPEN, LUNG LESION",ProFee,0989,32200,,,,0,3.00,2.25,2.25,1645.50,0.00,1645.50,1645.50,N/A
32201_3,"DRAIN, PERCUT, LUNG LESION",ProFee,0989,32201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3220F_3,HEP C QUANT RNA TSTNG DOC'D,ProFee,0989,3220F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32215_3,TREAT CHEST LINING,ProFee,0989,32215,,,,0,3.00,2.25,2.25,1161.50,0.00,1161.50,1161.50,N/A
32220_3,RELEASE OF LUNG,ProFee,0989,32220,,,,0,3.00,2.25,2.25,2284.50,0.00,2284.50,2284.50,N/A
32225_3,PARTIAL RELEASE OF LUNG,ProFee,0989,32225,,,,0,3.00,2.25,2.25,1434.50,0.00,1434.50,1434.50,N/A
3230F_3,NOTE HRING TST W/IN 6 MON,ProFee,0989,3230F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32310_3,REMOVAL OF CHEST LINING,ProFee,0989,32310,,,,0,3.00,2.25,2.25,1316.50,0.00,1316.50,1316.50,N/A
32320_3,FREE/REMOVE CHEST LINING,ProFee,0989,32320,,,,0,3.00,2.25,2.25,2303.00,0.00,2303.00,2303.00,N/A
32400_3,NEEDLE BIOPSY CHEST LINING,ProFee,0989,32400,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
32402_3,OPEN BIOPSY CHEST LINING,ProFee,0989,32402,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32405_3,"BIOPSY, LUNG OR MEDIASTINUM",ProFee,0989,32408,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32420_3,PUNCTURE/CLEAR LUNG,ProFee,0989,32420,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32422_3,THORACENTESIS W/TUBE INSERT,ProFee,0989,32422,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32440_3,REMOVAL OF LUNG,ProFee,0989,32440,,,,0,3.00,2.25,2.25,2257.50,0.00,2257.50,2257.50,N/A
32442_3,SLEEVE PNEUMONECTOMY,ProFee,0989,32442,,,,0,3.00,2.25,2.25,4433.00,0.00,4433.00,4433.00,N/A
32445_3,REMOVAL OF LUNG,ProFee,0989,32445,,,,0,3.00,2.25,2.25,5107.50,0.00,5107.50,5107.50,N/A
32480_3,PARTIAL REMOVAL OF LUNG,ProFee,0989,32480,,,,0,3.00,2.25,2.25,2133.00,0.00,2133.00,2133.00,N/A
32482_3,BILOBECTOMY,ProFee,0989,32482,,,,0,3.00,2.25,2.25,2282.50,0.00,2282.50,2282.50,N/A
32484_3,SEGMENTECTOMY,ProFee,0989,32484,,,,0,3.00,2.25,2.25,2071.50,0.00,2071.50,2071.50,N/A
32486_3,SLEEVE LOBECTOMY,ProFee,0989,32486,,,,0,3.00,2.25,2.25,3400.50,0.00,3400.50,3400.50,N/A
32488_3,COMPLETION PNEUMONECTOMY,ProFee,0989,32488,,,,0,3.00,2.25,2.25,3469.00,0.00,3469.00,3469.00,N/A
32491_3,LUNG VOLUME REDUCTION,ProFee,0989,32491,,,,0,3.00,2.25,2.25,2096.50,0.00,2096.50,2096.50,N/A
32500_3,PARTIAL REMOVAL OF LUNG,ProFee,0989,32500,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32501_3,REPAIR BRONCHUS ADD-ON,ProFee,0989,32501,,,,0,3.00,2.25,2.25,354.00,0.00,354.00,354.00,N/A
32503_3,RESECT APICAL LUNG TUMOR,ProFee,0989,32503,,,,0,3.00,2.25,2.25,2600.00,0.00,2600.00,2600.00,N/A
32504_3,RESECT APICAL LUNG TUM/CHEST,ProFee,0989,32504,,,,0,3.00,2.25,2.25,2962.50,0.00,2962.50,2962.50,N/A
32505_3,WEDGE RESECT OF LUNG INITIAL,ProFee,0989,32505,,,,0,3.00,2.25,2.25,1343.00,0.00,1343.00,1343.00,N/A
32506_3,WEDGE RESECT OF LUNG ADD-ON,ProFee,0989,32506,,,,0,3.00,2.25,2.25,226.50,0.00,226.50,226.50,N/A
32507_3,WEDGE RESECT OF LUNG DIAG,ProFee,0989,32507,,,,0,3.00,2.25,2.25,226.50,0.00,226.50,226.50,N/A
3250F_3,NONPRIM LOC ANAT BX SITE TUM,ProFee,0989,3250F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32540_3,REMOVAL OF LUNG LESION,ProFee,0989,32540,,,,0,3.00,2.25,2.25,2494.00,0.00,2494.00,2494.00,N/A
32550_3,INSERT PLEURAL CATH,ProFee,0989,32550,,,,0,3.00,2.25,2.25,300.50,0.00,300.50,300.50,N/A
32551_3,INSERTION OF CHEST TUBE,ProFee,0989,32551,,,,0,3.00,2.25,2.25,227.00,0.00,227.00,227.00,N/A
32552_3,REMOVE LUNG CATHETER,ProFee,0989,32552,,,,0,3.00,2.25,2.25,227.50,0.00,227.50,227.50,N/A
32553_3,INS MARK THOR FOR RT PERQ,ProFee,0989,32553,,,,0,3.00,2.25,2.25,260.00,0.00,260.00,260.00,N/A
32554_3,ASPIRATE PLEURA W/O IMAGING,ProFee,0989,32554,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
32555_3,ASPIRATE PLEURA W/ IMAGING,ProFee,0989,32555,,,,0,3.00,2.25,2.25,161.00,0.00,161.00,161.00,N/A
32556_3,INSERT CATH PLEURA W/O IMAGE,ProFee,0989,32556,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
32557_3,INSERT CATH PLEURA W/ IMAGE,ProFee,0989,32557,,,,0,3.00,2.25,2.25,219.50,0.00,219.50,219.50,N/A
32560_3,TREAT LUNG LINING CHEMICALLY,ProFee,0989,32560,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
32561_3,LYSE CHEST FIBRIN INIT DAY,ProFee,0989,32561,,,,0,3.00,2.25,2.25,98.50,0.00,98.50,98.50,N/A
32562_3,LYSE CHEST FIBRIN SUBQ DAY,ProFee,0989,32562,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
32601_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32601,,,,0,3.00,2.25,2.25,446.00,0.00,446.00,446.00,N/A
32602_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32602,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32603_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32603,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32604_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32604,,,,0,3.00,2.25,2.25,697.00,0.00,697.00,697.00,N/A
32605_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32605,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32606_3,"THORACOSCOPY, DIAGNOSTIC",ProFee,0989,32606,,,,0,3.00,2.25,2.25,668.50,0.00,668.50,668.50,N/A
32607_3,THORACOSCOPY W/BX INFILTRATE,ProFee,0989,32607,,,,0,3.00,2.25,2.25,445.50,0.00,445.50,445.50,N/A
32608_3,THORACOSCOPY W/BX NODULE,ProFee,0989,32608,,,,0,3.00,2.25,2.25,546.00,0.00,546.00,546.00,N/A
32609_3,THORACOSCOPY W/BX PLEURA,ProFee,0989,32609,,,,0,3.00,2.25,2.25,373.50,0.00,373.50,373.50,N/A
3260F_3,PT CAT/PN CAT/HIST GRD DOC'D,ProFee,0989,3260F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32650_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32650,,,,0,3.00,2.25,2.25,960.50,0.00,960.50,960.50,N/A
32651_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32651,,,,0,3.00,2.25,2.25,1580.50,0.00,1580.50,1580.50,N/A
32652_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32652,,,,0,3.00,2.25,2.25,2397.50,0.00,2397.50,2397.50,N/A
32653_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32653,,,,0,3.00,2.25,2.25,1528.50,0.00,1528.50,1528.50,N/A
32654_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32654,,,,0,3.00,2.25,2.25,1664.00,0.00,1664.00,1664.00,N/A
32655_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32655,,,,0,3.00,2.25,2.25,1379.50,0.00,1379.50,1379.50,N/A
32656_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32656,,,,0,3.00,2.25,2.25,1154.50,0.00,1154.50,1154.50,N/A
32657_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32657,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32658_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32658,,,,0,3.00,2.25,2.25,1030.50,0.00,1030.50,1030.50,N/A
32659_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32659,,,,0,3.00,2.25,2.25,1053.50,0.00,1053.50,1053.50,N/A
3265F_3,RNA TSTNG HEPC VIR ORD/DOC'D,ProFee,0989,3265F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32660_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32660,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
32661_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32661,,,,0,3.00,2.25,2.25,1154.00,0.00,1154.00,1154.00,N/A
32662_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32662,,,,0,3.00,2.25,2.25,1285.00,0.00,1285.00,1285.00,N/A
32663_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32663,,,,0,3.00,2.25,2.25,2020.50,0.00,2020.50,2020.50,N/A
32664_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32664,,,,0,3.00,2.25,2.25,1225.50,0.00,1225.50,1225.50,N/A
32665_3,"THORACOSCOPY, SURGICAL",ProFee,0989,32665,,,,0,3.00,2.25,2.25,1783.50,0.00,1783.50,1783.50,N/A
32666_3,THORACOSCOPY W/WEDGE RESECT,ProFee,0989,32666,,,,0,3.00,2.25,2.25,1256.00,0.00,1256.00,1256.00,N/A
32667_3,THORACOSCOPY W/W RESECT ADDL,ProFee,0989,32667,,,,0,3.00,2.25,2.25,227.00,0.00,227.00,227.00,N/A
32668_3,THORACOSCOPY W/W RESECT DIAG,ProFee,0989,32668,,,,0,3.00,2.25,2.25,227.00,0.00,227.00,227.00,N/A
32669_3,THORACOSCOPY REMOVE SEGMENT,ProFee,0989,32669,,,,0,3.00,2.25,2.25,1941.50,0.00,1941.50,1941.50,N/A
3266F_3,HEPC GN TSTNG DOC'D B/4TXMNT,ProFee,0989,3266F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32670_3,THORACOSCOPY BILOBECTOMY,ProFee,0989,32670,,,,0,3.00,2.25,2.25,2317.50,0.00,2317.50,2317.50,N/A
32671_3,THORACOSCOPY PNEUMONECTOMY,ProFee,0989,32671,,,,0,3.00,2.25,2.25,2573.50,0.00,2573.50,2573.50,N/A
32672_3,THORACOSCOPY FOR LVRS,ProFee,0989,32672,,,,0,3.00,2.25,2.25,2208.50,0.00,2208.50,2208.50,N/A
32673_3,THORACOSCOPY W/THYMUS RESECT,ProFee,0989,32673,,,,0,3.00,2.25,2.25,1760.00,0.00,1760.00,1760.00,N/A
32674_3,THORACOSCOPY LYMPH NODE EXC,ProFee,0989,32674,,,,0,3.00,2.25,2.25,311.50,0.00,311.50,311.50,N/A
3267F_3,PATH RPRT W/ PT PN CAT ET AL,ProFee,0989,3267F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3268F_3,PSA/T/GLSC DOC'D B/4 TXMNT,ProFee,0989,3268F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3269F_3,BONE SCN B/4 TXMNT/AFTR DX,ProFee,0989,3269F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32701_3,THORAX STEREO RAD TARGETW/TX,ProFee,0989,32701,,,,0,3.00,2.25,2.25,310.00,0.00,310.00,310.00,N/A
3270F_3,NO BONE SCN B/4 TXMNT/AFTRDX,ProFee,0989,3270F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3271F_3,"LOW RISK, PROSTATE CANCER",ProFee,0989,3271F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3272F_3,"MED. RISK, PROSTATE CANCER",ProFee,0989,3272F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3273F_3,"HIGH RISK, PROSTATE CANCER",ProFee,0989,3273F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3274F_3,PROST CNCR RSK NOT LW/MD/HGH,ProFee,0989,3274F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3278F_3,SERUM LVLS CA/IPTH/LPD ORD,ProFee,0989,3278F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3279F_3,HGB LVL >/= 13 G/DL,ProFee,0989,3279F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32800_3,REPAIR LUNG HERNIA,ProFee,0989,32800,,,,0,3.00,2.25,2.25,1362.50,0.00,1362.50,1362.50,N/A
3280F_3,HGB LVL 11-12.9 G/DL,ProFee,0989,3280F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32810_3,CLOSE CHEST AFTER DRAINAGE,ProFee,0989,32810,,,,0,3.00,2.25,2.25,1302.00,0.00,1302.00,1302.00,N/A
32815_3,CLOSE BRONCHIAL FISTULA,ProFee,0989,32815,,,,0,3.00,2.25,2.25,4026.50,0.00,4026.50,4026.50,N/A
3281F_3,HGB LVL < 11 G/DL,ProFee,0989,3281F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32820_3,RECONSTRUCT INJURED CHEST,ProFee,0989,32820,,,,0,3.00,2.25,2.25,1923.00,0.00,1923.00,1923.00,N/A
3284F_3,IOP DOWN >15% OF PRE-SVC LVL,ProFee,0989,3284F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32850_3,DONOR PNEUMONECTOMY,ProFee,0989,32850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32851_3,"LUNG TRANSPLANT, SINGLE",ProFee,0989,32851,,,,0,3.00,2.25,2.25,4754.00,0.00,4754.00,4754.00,N/A
32852_3,LUNG TRANSPLANT WITH BYPASS,ProFee,0989,32852,,,,0,3.00,2.25,2.25,5171.00,0.00,5171.00,5171.00,N/A
32853_3,"LUNG TRANSPLANT, DOUBLE",ProFee,0989,32853,,,,0,3.00,2.25,2.25,6621.00,0.00,6621.00,6621.00,N/A
32854_3,LUNG TRANSPLANT WITH BYPASS,ProFee,0989,32854,,,,0,3.00,2.25,2.25,7023.00,0.00,7023.00,7023.00,N/A
32855_3,"PREPARE DONOR LUNG, SINGLE",ProFee,0989,32855,,,,0,3.00,2.25,2.25,427.00,0.00,427.00,427.00,N/A
32856_3,"PREPARE DONOR LUNG, DOUBLE",ProFee,0989,32856,,,,0,3.00,2.25,2.25,537.00,0.00,537.00,537.00,N/A
3285F_3,IOP DOWN <15% OF PRE-SVC LVL,ProFee,0989,3285F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3288F_3,FALL RISK ASSESSMENT DOC'D,ProFee,0989,3288F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32900_3,REMOVAL OF RIB(S),ProFee,0989,32900,,,,0,3.00,2.25,2.25,2047.50,0.00,2047.50,2047.50,N/A
32905_3,REVISE & REPAIR CHEST WALL,ProFee,0989,32905,,,,0,3.00,2.25,2.25,1934.00,0.00,1934.00,1934.00,N/A
32906_3,REVISE & REPAIR CHEST WALL,ProFee,0989,32906,,,,0,3.00,2.25,2.25,2388.00,0.00,2388.00,2388.00,N/A
3290F_3,PT=D(RH)- AND UNSENSITIZED,ProFee,0989,3290F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3291F_3,PT=D(RH)+ OR SENSITIZED,ProFee,0989,3291F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3292F_3,HIV TSTNG ASKED/DOC'D/REVW'D,ProFee,0989,3292F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3293F_3,ABO RH BLOOD TYPING DOCD,ProFee,0989,3293F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32940_3,REVISION OF LUNG,ProFee,0989,32940,,,,0,3.00,2.25,2.25,1786.00,0.00,1786.00,1786.00,N/A
3294F_3,GRP B STREP SCREENING DOCD,ProFee,0989,3294F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
32960_3,THERAPEUTIC PNEUMOTHORAX,ProFee,0989,32960,,,,0,3.00,2.25,2.25,132.00,0.00,132.00,132.00,N/A
32994_3,ABLATE PULM TUMOR PERQ CRYBL,ProFee,0989,32994,,,,0,3.00,2.25,2.25,701.00,0.00,701.00,701.00,N/A
32997_3,TOTAL LUNG LAVAGE,ProFee,0989,32997,,,,0,3.00,2.25,2.25,493.00,0.00,493.00,493.00,N/A
32998_3,"PERQ RF ABLATE TX, PUL TUMOR",ProFee,0989,32998,,,,0,3.00,2.25,2.25,648.00,0.00,648.00,648.00,N/A
32999_3,CHEST SURGERY PROCEDURE,ProFee,0989,32999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3300F_3,AJCC STAGE DOC'D B/4 THXPY,ProFee,0989,3300F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33016_3,PERICARDIOCENTESIS W/IMAGING,ProFee,0989,33016,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33017_3,PRCRD DRG 6YR+ W/O CGEN CAR,ProFee,0989,33017,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33018_3,PRCRD DRG 0-5YR OR W/ANOMLY,ProFee,0989,33018,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33019_3,PERQ PRCRD DRG INSJ CATH CT,ProFee,0989,33019,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3301F_3,"CANCER STAGE DOC'D, METAST",ProFee,0989,3301F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33020_3,INCISION OF HEART SAC,ProFee,0989,33020,,,,0,3.00,2.25,2.25,1271.50,0.00,1271.50,1271.50,N/A
33025_3,INCISION OF HEART SAC,ProFee,0989,33025,,,,0,3.00,2.25,2.25,1153.00,0.00,1153.00,1153.00,N/A
3302F_3,AJCC STAGE 0 DOC'D,ProFee,0989,3302F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33030_3,PARTIAL REMOVAL OF HEART SAC,ProFee,0989,33030,,,,0,3.00,2.25,2.25,2894.50,0.00,2894.50,2894.50,N/A
33031_3,PARTIAL REMOVAL OF HEART SAC,ProFee,0989,33031,,,,0,3.00,2.25,2.25,3573.50,0.00,3573.50,3573.50,N/A
3303F_3,AJCC STAGE IA DOC'D,ProFee,0989,3303F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3304F_3,AJCC STAGE IB DOC'D,ProFee,0989,3304F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33050_3,REMOVAL OF HEART SAC LESION,ProFee,0989,33050,,,,0,3.00,2.25,2.25,1461.50,0.00,1461.50,1461.50,N/A
3305F_3,AJCC STAGE IC DOC'D,ProFee,0989,3305F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3306F_3,AJCC STAGE IIA DOC'D,ProFee,0989,3306F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3307F_3,AJCC STAGE IIB DOC'D,ProFee,0989,3307F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3308F_3,AJCC STAGE IIC DOC'D,ProFee,0989,3308F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3309F_3,AJCC STAGE IIIA DOC'D,ProFee,0989,3309F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3310F_3,AJCC STAGE IIIB DOC'D,ProFee,0989,3310F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3311F_3,AJCC STAGE IIIC DOC'D,ProFee,0989,3311F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33120_3,REMOVAL OF HEART LESION,ProFee,0989,33120,,,,0,3.00,2.25,2.25,3030.50,0.00,3030.50,3030.50,N/A
3312F_3,AJCC STAGE IVA DOC'D,ProFee,0989,3312F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33130_3,REMOVAL OF HEART LESION,ProFee,0989,33130,,,,0,3.00,2.25,2.25,1990.50,0.00,1990.50,1990.50,N/A
3313F_3,AJCC STAGE IVB DOC'D,ProFee,0989,3313F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33140_3,HEART REVASCULARIZE (TMR),ProFee,0989,33140,,,,0,3.00,2.25,2.25,2275.00,0.00,2275.00,2275.00,N/A
33141_3,HEART TMR W/OTHER PROCEDURE,ProFee,0989,33141,,,,0,3.00,2.25,2.25,190.50,0.00,190.50,190.50,N/A
3314F_3,AJCC STAGE IVC DOC'D,ProFee,0989,3314F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3315F_3,ER+ OR PR+ BREAST CANCER,ProFee,0989,3315F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3316F_3,ER_ OR PR_ BREAST CANCER,ProFee,0989,3316F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3317F_3,PATH RPT MALIG CANCER DOC'D,ProFee,0989,3317F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3318F_3,PATH RPT MALIG CANCER DOC'D,ProFee,0989,3318F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3319F_3,X-RAY/CT/ULTRSND ET AL ORD'D,ProFee,0989,3319F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33200_3,INSERTION OF HEART PACEMAKER,ProFee,0989,33200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33201_3,INSERTION OF HEART PACEMAKER,ProFee,0989,33201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33202_3,"INSERT EPICARD ELTRD, OPEN",ProFee,0989,33202,,,,0,3.00,2.25,2.25,1123.00,0.00,1123.00,1123.00,N/A
33203_3,"INSERT EPICARD ELTRD, ENDO",ProFee,0989,33203,,,,0,3.00,2.25,2.25,1171.00,0.00,1171.00,1171.00,N/A
33206_3,INSERTION OF HEART PACEMAKER,ProFee,0989,33206,,,,0,3.00,2.25,2.25,656.00,0.00,656.00,656.00,N/A
33207_3,INSERTION OF HEART PACEMAKER,ProFee,0989,33207,,,,0,3.00,2.25,2.25,698.50,0.00,698.50,698.50,N/A
33208_3,INSERTION OF HEART PACEMAKER,ProFee,0989,33208,,,,0,3.00,2.25,2.25,756.50,0.00,756.50,756.50,N/A
3320F_3,NO XRAY/CT/ ET AL ORD'D,ProFee,0989,3320F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33210_3,INSERTION OF HEART ELECTRODE,ProFee,0989,33210,,,,0,3.00,2.25,2.25,239.00,0.00,239.00,239.00,N/A
33211_3,INSERTION OF HEART ELECTRODE,ProFee,0989,33211,,,,0,3.00,2.25,2.25,246.50,0.00,246.50,246.50,N/A
33212_3,INSERTION OF PULSE GENERATOR,ProFee,0989,33212,,,,0,3.00,2.25,2.25,465.00,0.00,465.00,465.00,N/A
33213_3,INSERTION OF PULSE GENERATOR,ProFee,0989,33213,,,,0,3.00,2.25,2.25,486.50,0.00,486.50,486.50,N/A
33214_3,UPGRADE OF PACEMAKER SYSTEM,ProFee,0989,33214,,,,0,3.00,2.25,2.25,694.50,0.00,694.50,694.50,N/A
33215_3,REPOSITION PACING-DEFIB LEAD,ProFee,0989,33215,,,,0,3.00,2.25,2.25,451.00,0.00,451.00,451.00,N/A
33216_3,"INSERT LEAD PACE-DEFIB, ONE",ProFee,0989,33216,,,,0,3.00,2.25,2.25,537.50,0.00,537.50,537.50,N/A
33217_3,"INSERT LEAD PACE-DEFIB, DUAL",ProFee,0989,33217,,,,0,3.00,2.25,2.25,528.00,0.00,528.00,528.00,N/A
33218_3,"REPAIR LEAD PACE-DEFIB, ONE",ProFee,0989,33218,,,,0,3.00,2.25,2.25,563.00,0.00,563.00,563.00,N/A
3321F_3,AJCC CNCR 0/IA MELAN DOCD,ProFee,0989,3321F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33220_3,"REPAIR LEAD PACE-DEFIB, DUAL",ProFee,0989,33220,,,,0,3.00,2.25,2.25,568.00,0.00,568.00,568.00,N/A
33221_3,INSERT PULSE GEN MULT LEADS,ProFee,0989,33221,,,,0,3.00,2.25,2.25,522.50,0.00,522.50,522.50,N/A
33222_3,"REVISE POCKET, PACEMAKER",ProFee,0989,33222,,,,0,3.00,2.25,2.25,489.50,0.00,489.50,489.50,N/A
33223_3,"REVISE POCKET, PACING-DEFIB",ProFee,0989,33223,,,,0,3.00,2.25,2.25,593.00,0.00,593.00,593.00,N/A
33224_3,INSERT PACING LEAD & CONNECT,ProFee,0989,33224,,,,0,3.00,2.25,2.25,749.50,0.00,749.50,749.50,N/A
33225_3,L VENTRIC PACING LEAD ADD-ON,ProFee,0989,33225,,,,0,3.00,2.25,2.25,683.50,0.00,683.50,683.50,N/A
33226_3,REPOSITION L VENTRIC LEAD,ProFee,0989,33226,,,,0,3.00,2.25,2.25,720.50,0.00,720.50,720.50,N/A
33227_3,REMOVE&REPLACE PM GEN SINGL,ProFee,0989,33227,,,,0,3.00,2.25,2.25,490.50,0.00,490.50,490.50,N/A
33228_3,REMV&REPLC PM GEN DUAL LEAD,ProFee,0989,33228,,,,0,3.00,2.25,2.25,513.50,0.00,513.50,513.50,N/A
33229_3,REMV&REPLC PM GEN MULT LEADS,ProFee,0989,33229,,,,0,3.00,2.25,2.25,543.50,0.00,543.50,543.50,N/A
3322F_3,MELAN >AJCC STAGE 0 OR IA,ProFee,0989,3322F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33230_3,INSRT PULSE GEN W/DUAL LEADS,ProFee,0989,33230,,,,0,3.00,2.25,2.25,554.50,0.00,554.50,554.50,N/A
33231_3,INSRT PULSE GEN W/MULT LEADS,ProFee,0989,33231,,,,0,3.00,2.25,2.25,582.50,0.00,582.50,582.50,N/A
33233_3,REMOVAL OF PACEMAKER SYSTEM,ProFee,0989,33233,,,,0,3.00,2.25,2.25,333.50,0.00,333.50,333.50,N/A
33234_3,REMOVAL OF PACEMAKER SYSTEM,ProFee,0989,33234,,,,0,3.00,2.25,2.25,704.00,0.00,704.00,704.00,N/A
33235_3,REMOVAL PACEMAKER ELECTRODE,ProFee,0989,33235,,,,0,3.00,2.25,2.25,926.00,0.00,926.00,926.00,N/A
33236_3,REMOVE ELECTRODE/THORACOTOMY,ProFee,0989,33236,,,,0,3.00,2.25,2.25,1132.00,0.00,1132.00,1132.00,N/A
33237_3,REMOVE ELECTRODE/THORACOTOMY,ProFee,0989,33237,,,,0,3.00,2.25,2.25,1215.50,0.00,1215.50,1215.50,N/A
33238_3,REMOVE ELECTRODE/THORACOTOMY,ProFee,0989,33238,,,,0,3.00,2.25,2.25,1362.50,0.00,1362.50,1362.50,N/A
3323F_3,CLIN NODE STGNG DOCDB/4 SURG,ProFee,0989,3323F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33240_3,INSERT PULSE GENERATOR,ProFee,0989,33240,,,,0,3.00,2.25,2.25,530.50,0.00,530.50,530.50,N/A
33241_3,REMOVE PULSE GENERATOR,ProFee,0989,33241,,,,0,3.00,2.25,2.25,312.50,0.00,312.50,312.50,N/A
33243_3,REMOVE ELTRD/THORACOTOMY,ProFee,0989,33243,,,,0,3.00,2.25,2.25,1983.00,0.00,1983.00,1983.00,N/A
33244_3,"REMOVE ELTRD, TRANSVEN",ProFee,0989,33244,,,,0,3.00,2.25,2.25,1249.50,0.00,1249.50,1249.50,N/A
33245_3,INSERT EPIC ELTRD PACE-DEFIB,ProFee,0989,33245,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33246_3,INSERT EPIC ELTRD/GENERATOR,ProFee,0989,33246,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33249_3,ELTRD/INSERT PACE-DEFIB,ProFee,0989,33249,,,,0,3.00,2.25,2.25,1331.50,0.00,1331.50,1331.50,N/A
3324F_3,MRI CT SCAN ORD RVWD RQSTD,ProFee,0989,3324F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33250_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,33250,,,,0,3.00,2.25,2.25,2121.50,0.00,2121.50,2121.50,N/A
33251_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,33251,,,,0,3.00,2.25,2.25,2348.00,0.00,2348.00,2348.00,N/A
33253_3,RECONSTRUCT ATRIA,ProFee,0989,33253,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33254_3,"ABLATE ATRIA, LMTD",ProFee,0989,33254,,,,0,3.00,2.25,2.25,1970.50,0.00,1970.50,1970.50,N/A
33255_3,"ABLATE ATRIA W/O BYPASS, EXT",ProFee,0989,33255,,,,0,3.00,2.25,2.25,2372.00,0.00,2372.00,2372.00,N/A
33256_3,"ABLATE ATRIA W/BYPASS, EXTEN",ProFee,0989,33256,,,,0,3.00,2.25,2.25,2815.00,0.00,2815.00,2815.00,N/A
33257_3,"ABLATE ATRIA, LMTD, ADD-ON",ProFee,0989,33257,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
33258_3,"ABLATE ATRIA, X10SV, ADD-ON",ProFee,0989,33258,,,,0,3.00,2.25,2.25,951.50,0.00,951.50,951.50,N/A
33259_3,ABLATE ATRIA W/BYPASS ADD-ON,ProFee,0989,33259,,,,0,3.00,2.25,2.25,1221.50,0.00,1221.50,1221.50,N/A
3325F_3,PREOP ASSES 4 CATARACT SURG,ProFee,0989,3325F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33261_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,33261,,,,0,3.00,2.25,2.25,2348.50,0.00,2348.50,2348.50,N/A
33262_3,REMV&REPLC CVD GEN SING LEAD,ProFee,0989,33262,,,,0,3.00,2.25,2.25,540.50,0.00,540.50,540.50,N/A
33263_3,REMV&REPLC CVD GEN DUAL LEAD,ProFee,0989,33263,,,,0,3.00,2.25,2.25,564.00,0.00,564.00,564.00,N/A
33264_3,REMV&REPLC CVD GEN MULT LEAD,ProFee,0989,33264,,,,0,3.00,2.25,2.25,587.50,0.00,587.50,587.50,N/A
33265_3,"ABLATE ATRIA,  LMTD,  ENDO",ProFee,0989,33265,,,,0,3.00,2.25,2.25,1965.50,0.00,1965.50,1965.50,N/A
33266_3,"ABLATE ATRIA, X10SV, ENDO",ProFee,0989,33266,,,,0,3.00,2.25,2.25,2669.50,0.00,2669.50,2669.50,N/A
33270_3,INS/REP SUBQ DEFIBRILLATOR,ProFee,0989,33270,,,,0,3.00,2.25,2.25,825.50,0.00,825.50,825.50,N/A
33271_3,INSJ SUBQ IMPLTBL DFB ELCTRD,ProFee,0989,33271,,,,0,3.00,2.25,2.25,663.50,0.00,663.50,663.50,N/A
33272_3,RMVL OF SUBQ DEFIBRILLATOR,ProFee,0989,33272,,,,0,3.00,2.25,2.25,507.50,0.00,507.50,507.50,N/A
33273_3,REPOS PREV IMPLTBL SUBQ DFB,ProFee,0989,33273,,,,0,3.00,2.25,2.25,584.50,0.00,584.50,584.50,N/A
33274_3,TCAT INSJ/RPL PERM LDLS PM,ProFee,0989,33274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33275_3,TCAT RMVL PERM LDLS PM W/IMG,ProFee,0989,33275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33282_3,IMPLANT PAT-ACTIVE HT RECORD,ProFee,0989,33282,,,,0,3.00,2.25,2.25,327.50,0.00,327.50,327.50,N/A
33284_3,REMOVE PAT-ACTIVE HT RECORD,ProFee,0989,33284,,,,0,3.00,2.25,2.25,287.00,0.00,287.00,287.00,N/A
33285_3,INSJ SUBQ CAR RHYTHM MNTR,ProFee,0989,33285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33286_3,RMVL SUBQ CAR RHYTHM MNTR,ProFee,0989,33286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33289_3,TCAT IMPL WRLS P-ART PRS SNR,ProFee,0989,33289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3328F_3,PRFRMNC DOCD 2 WKS B/4 SURG,ProFee,0989,3328F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33300_3,REPAIR OF HEART WOUND,ProFee,0989,33300,,,,0,3.00,2.25,2.25,3544.00,0.00,3544.00,3544.00,N/A
33305_3,REPAIR OF HEART WOUND,ProFee,0989,33305,,,,0,3.00,2.25,2.25,5932.00,0.00,5932.00,5932.00,N/A
3330F_3,IMAGING STUDY ORDERED (BKP),ProFee,0989,3330F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33310_3,EXPLORATORY HEART SURGERY,ProFee,0989,33310,,,,0,3.00,2.25,2.25,1703.00,0.00,1703.00,1703.00,N/A
33315_3,EXPLORATORY HEART SURGERY,ProFee,0989,33315,,,,0,3.00,2.25,2.25,2763.00,0.00,2763.00,2763.00,N/A
3331F_3,BK IMAGING TST NOT ORDERED,ProFee,0989,3331F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33320_3,REPAIR MAJOR BLOOD VESSEL(S),ProFee,0989,33320,,,,0,3.00,2.25,2.25,1528.00,0.00,1528.00,1528.00,N/A
33321_3,REPAIR MAJOR VESSEL,ProFee,0989,33321,,,,0,3.00,2.25,2.25,1730.50,0.00,1730.50,1730.50,N/A
33322_3,REPAIR MAJOR BLOOD VESSEL(S),ProFee,0989,33322,,,,0,3.00,2.25,2.25,2008.00,0.00,2008.00,2008.00,N/A
33330_3,INSERT MAJOR VESSEL GRAFT,ProFee,0989,33330,,,,0,3.00,2.25,2.25,2076.00,0.00,2076.00,2076.00,N/A
33332_3,INSERT MAJOR VESSEL GRAFT,ProFee,0989,33332,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33335_3,INSERT MAJOR VESSEL GRAFT,ProFee,0989,33335,,,,0,3.00,2.25,2.25,2737.50,0.00,2737.50,2737.50,N/A
33340_3,PERQ CLSR TCAT L ATR APNDGE,ProFee,0989,33340,,,,0,3.00,2.25,2.25,1154.50,0.00,1154.50,1154.50,N/A
33361_3,REPLACE AORTIC VALVE PERQ,ProFee,0989,33361,,,,0,3.00,2.25,2.25,1973.00,0.00,1973.00,1973.00,N/A
33362_3,REPLACE AORTIC VALVE OPEN,ProFee,0989,33362,,,,0,3.00,2.25,2.25,2154.00,0.00,2154.00,2154.00,N/A
33363_3,REPLACE AORTIC VALVE OPEN,ProFee,0989,33363,,,,0,3.00,2.25,2.25,2234.00,0.00,2234.00,2234.00,N/A
33364_3,REPLACE AORTIC VALVE OPEN,ProFee,0989,33364,,,,0,3.00,2.25,2.25,2353.00,0.00,2353.00,2353.00,N/A
33365_3,REPLACE AORTIC VALVE OPEN,ProFee,0989,33365,,,,0,3.00,2.25,2.25,2588.00,0.00,2588.00,2588.00,N/A
33366_3,TRCATH REPLACE AORTIC VALVE,ProFee,0989,33366,,,,0,3.00,2.25,2.25,2799.00,0.00,2799.00,2799.00,N/A
33367_3,REPLACE AORTIC VALVE W/BYP,ProFee,0989,33367,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
33368_3,REPLACE AORTIC VALVE W/BYP,ProFee,0989,33368,,,,0,3.00,2.25,2.25,1085.00,0.00,1085.00,1085.00,N/A
33369_3,REPLACE AORTIC VALVE W/BYP,ProFee,0989,33369,,,,0,3.00,2.25,2.25,1432.50,0.00,1432.50,1432.50,N/A
33390_3,VALVULOPLASTY AORTIC VALVE,ProFee,0989,33390,,,,0,3.00,2.25,2.25,2747.50,0.00,2747.50,2747.50,N/A
33391_3,VALVULOPLASTY AORTIC VALVE,ProFee,0989,33391,,,,0,3.00,2.25,2.25,3259.50,0.00,3259.50,3259.50,N/A
33400_3,REPAIR OF AORTIC VALVE,ProFee,0989,33400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33401_3,"VALVULOPLASTY, OPEN",ProFee,0989,33401,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33403_3,"VALVULOPLASTY, W/CP BYPASS",ProFee,0989,33403,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33404_3,PREPARE HEART-AORTA CONDUIT,ProFee,0989,33404,,,,0,3.00,2.25,2.25,2549.50,0.00,2549.50,2549.50,N/A
33405_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33405,,,,0,3.00,2.25,2.25,3281.00,0.00,3281.00,3281.00,N/A
33406_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33406,,,,0,3.00,2.25,2.25,4152.00,0.00,4152.00,4152.00,N/A
3340F_3,BRST IMAG-RPT/DATACAT 0 DOCD,ProFee,0989,3340F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33410_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33410,,,,0,3.00,2.25,2.25,3680.00,0.00,3680.00,3680.00,N/A
33411_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33411,,,,0,3.00,2.25,2.25,4847.00,0.00,4847.00,4847.00,N/A
33412_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33412,,,,0,3.00,2.25,2.25,4597.00,0.00,4597.00,4597.00,N/A
33413_3,REPLACEMENT OF AORTIC VALVE,ProFee,0989,33413,,,,0,3.00,2.25,2.25,4702.00,0.00,4702.00,4702.00,N/A
33414_3,REPAIR OF AORTIC VALVE,ProFee,0989,33414,,,,0,3.00,2.25,2.25,3121.50,0.00,3121.50,3121.50,N/A
33415_3,"REVISION, SUBVALVULAR TISSUE",ProFee,0989,33415,,,,0,3.00,2.25,2.25,2936.50,0.00,2936.50,2936.50,N/A
33416_3,REVISE VENTRICLE MUSCLE,ProFee,0989,33416,,,,0,3.00,2.25,2.25,2932.50,0.00,2932.50,2932.50,N/A
33417_3,REPAIR OF AORTIC VALVE,ProFee,0989,33417,,,,0,3.00,2.25,2.25,2418.50,0.00,2418.50,2418.50,N/A
33418_3,REPAIR TCAT MITRAL VALVE,ProFee,0989,33418,,,,0,3.00,2.25,2.25,2616.00,0.00,2616.00,2616.00,N/A
33419_3,REPAIR TCAT MITRAL VALVE,ProFee,0989,33419,,,,0,3.00,2.25,2.25,618.00,0.00,618.00,618.00,N/A
3341F_3,BRST IMAG-RPT/DATACAT 1 DOCD,ProFee,0989,3341F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33420_3,REVISION OF MITRAL VALVE,ProFee,0989,33420,,,,0,3.00,2.25,2.25,2113.50,0.00,2113.50,2113.50,N/A
33422_3,REVISION OF MITRAL VALVE,ProFee,0989,33422,,,,0,3.00,2.25,2.25,2426.00,0.00,2426.00,2426.00,N/A
33425_3,REPAIR OF MITRAL VALVE,ProFee,0989,33425,,,,0,3.00,2.25,2.25,3955.00,0.00,3955.00,3955.00,N/A
33426_3,REPAIR OF MITRAL VALVE,ProFee,0989,33426,,,,0,3.00,2.25,2.25,3445.50,0.00,3445.50,3445.50,N/A
33427_3,REPAIR OF MITRAL VALVE,ProFee,0989,33427,,,,0,3.00,2.25,2.25,3537.00,0.00,3537.00,3537.00,N/A
3342F_3,BRST IMAG-RPT/DATACAT 2 DOCD,ProFee,0989,3342F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33430_3,REPLACEMENT OF MITRAL VALVE,ProFee,0989,33430,,,,0,3.00,2.25,2.25,4045.00,0.00,4045.00,4045.00,N/A
3343F_3,BRST IMAG-RPT/DATACAT 3 DOCD,ProFee,0989,3343F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33440_3,RPLCMT A-VALVE TLCJ AUTOL PV,ProFee,0989,33440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3344F_3,BRST IMAG-RPT/DATACAT 4 DOCD,ProFee,0989,3344F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3345F_3,BRST IMAG-RPT/DATACAT 5 DOCD,ProFee,0989,3345F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33460_3,REVISION OF TRICUSPID VALVE,ProFee,0989,33460,,,,0,3.00,2.25,2.25,3507.50,0.00,3507.50,3507.50,N/A
33463_3,"VALVULOPLASTY, TRICUSPID",ProFee,0989,33463,,,,0,3.00,2.25,2.25,4465.50,0.00,4465.50,4465.50,N/A
33464_3,"VALVULOPLASTY, TRICUSPID",ProFee,0989,33464,,,,0,3.00,2.25,2.25,3532.50,0.00,3532.50,3532.50,N/A
33465_3,REPLACE TRICUSPID VALVE,ProFee,0989,33465,,,,0,3.00,2.25,2.25,3988.00,0.00,3988.00,3988.00,N/A
33468_3,REVISION OF TRICUSPID VALVE,ProFee,0989,33468,,,,0,3.00,2.25,2.25,3559.00,0.00,3559.00,3559.00,N/A
33470_3,REVISION OF PULMONARY VALVE,ProFee,0989,33470,,,,0,3.00,2.25,2.25,1795.00,0.00,1795.00,1795.00,N/A
33471_3,"VALVOTOMY, PULMONARY VALVE",ProFee,0989,33471,,,,0,3.00,2.25,2.25,1921.50,0.00,1921.50,1921.50,N/A
33472_3,REVISION OF PULMONARY VALVE,ProFee,0989,33472,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33474_3,REVISION OF PULMONARY VALVE,ProFee,0989,33474,,,,0,3.00,2.25,2.25,3161.00,0.00,3161.00,3161.00,N/A
33475_3,"REPLACEMENT, PULMONARY VALVE",ProFee,0989,33475,,,,0,3.00,2.25,2.25,3387.50,0.00,3387.50,3387.50,N/A
33476_3,REVISION OF HEART CHAMBER,ProFee,0989,33476,,,,0,3.00,2.25,2.25,2208.50,0.00,2208.50,2208.50,N/A
33477_3,IMPLANT TCAT PULM VLV PERQ,ProFee,0989,33477,,,,0,3.00,2.25,2.25,1982.50,0.00,1982.50,1982.50,N/A
33478_3,REVISION OF HEART CHAMBER,ProFee,0989,33478,,,,0,3.00,2.25,2.25,2282.00,0.00,2282.00,2282.00,N/A
33496_3,"REPAIR, PROSTH VALVE CLOT",ProFee,0989,33496,,,,0,3.00,2.25,2.25,2426.50,0.00,2426.50,2426.50,N/A
33500_3,REPAIR HEART VESSEL FISTULA,ProFee,0989,33500,,,,0,3.00,2.25,2.25,2275.00,0.00,2275.00,2275.00,N/A
33501_3,REPAIR HEART VESSEL FISTULA,ProFee,0989,33501,,,,0,3.00,2.25,2.25,1624.50,0.00,1624.50,1624.50,N/A
33502_3,CORONARY ARTERY CORRECTION,ProFee,0989,33502,,,,0,3.00,2.25,2.25,1851.00,0.00,1851.00,1851.00,N/A
33503_3,CORONARY ARTERY GRAFT,ProFee,0989,33503,,,,0,3.00,2.25,2.25,1924.00,0.00,1924.00,1924.00,N/A
33504_3,CORONARY ARTERY GRAFT,ProFee,0989,33504,,,,0,3.00,2.25,2.25,2127.00,0.00,2127.00,2127.00,N/A
33505_3,REPAIR ARTERY W/TUNNEL,ProFee,0989,33505,,,,0,3.00,2.25,2.25,2997.00,0.00,2997.00,2997.00,N/A
33506_3,"REPAIR ARTERY, TRANSLOCATION",ProFee,0989,33506,,,,0,3.00,2.25,2.25,2984.50,0.00,2984.50,2984.50,N/A
33507_3,"REPAIR ART, INTRAMURAL",ProFee,0989,33507,,,,0,3.00,2.25,2.25,2503.50,0.00,2503.50,2503.50,N/A
33508_3,ENDOSCOPIC VEIN HARVEST,ProFee,0989,33508,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
3350F_3,MAMMO BX PROVEN MALIG DOCD,ProFee,0989,3350F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33510_3,"CABG, VEIN, SINGLE",ProFee,0989,33510,,,,0,3.00,2.25,2.25,2794.50,0.00,2794.50,2794.50,N/A
33511_3,"CABG, VEIN, TWO",ProFee,0989,33511,,,,0,3.00,2.25,2.25,3071.00,0.00,3071.00,3071.00,N/A
33512_3,"CABG, VEIN, THREE",ProFee,0989,33512,,,,0,3.00,2.25,2.25,3492.00,0.00,3492.00,3492.00,N/A
33513_3,"CABG, VEIN, FOUR",ProFee,0989,33513,,,,0,3.00,2.25,2.25,3592.50,0.00,3592.50,3592.50,N/A
33514_3,"CABG, VEIN, FIVE",ProFee,0989,33514,,,,0,3.00,2.25,2.25,3809.00,0.00,3809.00,3809.00,N/A
33516_3,"CABG, VEIN, SIX OR MORE",ProFee,0989,33516,,,,0,3.00,2.25,2.25,3944.00,0.00,3944.00,3944.00,N/A
33517_3,"CABG, ARTERY-VEIN, SINGLE",ProFee,0989,33517,,,,0,3.00,2.25,2.25,271.50,0.00,271.50,271.50,N/A
33518_3,"CABG, ARTERY-VEIN, TWO",ProFee,0989,33518,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
33519_3,"CABG, ARTERY-VEIN, THREE",ProFee,0989,33519,,,,0,3.00,2.25,2.25,788.50,0.00,788.50,788.50,N/A
3351F_3,NEG SCRN DEP SYMP BY DEPTOOL,ProFee,0989,3351F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33521_3,"CABG, ARTERY-VEIN, FOUR",ProFee,0989,33521,,,,0,3.00,2.25,2.25,945.00,0.00,945.00,945.00,N/A
33522_3,"CABG, ARTERY-VEIN, FIVE",ProFee,0989,33522,,,,0,3.00,2.25,2.25,1062.00,0.00,1062.00,1062.00,N/A
33523_3,"CABG, ART-VEIN, SIX OR MORE",ProFee,0989,33523,,,,0,3.00,2.25,2.25,1211.50,0.00,1211.50,1211.50,N/A
3352F_3,NO SIG DEP SYMP BY DEP TOOL,ProFee,0989,3352F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33530_3,"CORONARY ARTERY, BYPASS/REOP",ProFee,0989,33530,,,,0,3.00,2.25,2.25,762.00,0.00,762.00,762.00,N/A
33533_3,"CABG, ARTERIAL, SINGLE",ProFee,0989,33533,,,,0,3.00,2.25,2.25,2703.00,0.00,2703.00,2703.00,N/A
33534_3,"CABG, ARTERIAL, TWO",ProFee,0989,33534,,,,0,3.00,2.25,2.25,3180.00,0.00,3180.00,3180.00,N/A
33535_3,"CABG, ARTERIAL, THREE",ProFee,0989,33535,,,,0,3.00,2.25,2.25,3543.00,0.00,3543.00,3543.00,N/A
33536_3,"CABG, ARTERIAL, FOUR OR MORE",ProFee,0989,33536,,,,0,3.00,2.25,2.25,3805.50,0.00,3805.50,3805.50,N/A
3353F_3,MILD-MOD DEP SYMP BY DEPTOOL,ProFee,0989,3353F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33542_3,REMOVAL OF HEART LESION,ProFee,0989,33542,,,,0,3.00,2.25,2.25,3792.50,0.00,3792.50,3792.50,N/A
33545_3,REPAIR OF HEART DAMAGE,ProFee,0989,33545,,,,0,3.00,2.25,2.25,4475.50,0.00,4475.50,4475.50,N/A
33548_3,"RESTORE/REMODEL, VENTRICLE",ProFee,0989,33548,,,,0,3.00,2.25,2.25,4306.50,0.00,4306.50,4306.50,N/A
3354F_3,CLIN SIG DEP SYM BY DEP TOOL,ProFee,0989,3354F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33572_3,OPEN CORONARY ENDARTERECTOMY,ProFee,0989,33572,,,,0,3.00,2.25,2.25,333.50,0.00,333.50,333.50,N/A
33600_3,CLOSURE OF VALVE,ProFee,0989,33600,,,,0,3.00,2.25,2.25,2494.00,0.00,2494.00,2494.00,N/A
33602_3,CLOSURE OF VALVE,ProFee,0989,33602,,,,0,3.00,2.25,2.25,2420.00,0.00,2420.00,2420.00,N/A
33606_3,ANASTOMOSIS/ARTERY-AORTA,ProFee,0989,33606,,,,0,3.00,2.25,2.25,2580.00,0.00,2580.00,2580.00,N/A
33608_3,REPAIR ANOMALY W/CONDUIT,ProFee,0989,33608,,,,0,3.00,2.25,2.25,2612.50,0.00,2612.50,2612.50,N/A
33610_3,REPAIR BY ENLARGEMENT,ProFee,0989,33610,,,,0,3.00,2.25,2.25,2576.00,0.00,2576.00,2576.00,N/A
33611_3,REPAIR DOUBLE VENTRICLE,ProFee,0989,33611,,,,0,3.00,2.25,2.25,2835.50,0.00,2835.50,2835.50,N/A
33612_3,REPAIR DOUBLE VENTRICLE,ProFee,0989,33612,,,,0,3.00,2.25,2.25,2910.00,0.00,2910.00,2910.00,N/A
33615_3,"REPAIR, MODIFIED FONTAN",ProFee,0989,33615,,,,0,3.00,2.25,2.25,2898.00,0.00,2898.00,2898.00,N/A
33617_3,REPAIR SINGLE VENTRICLE,ProFee,0989,33617,,,,0,3.00,2.25,2.25,3139.00,0.00,3139.00,3139.00,N/A
33619_3,REPAIR SINGLE VENTRICLE,ProFee,0989,33619,,,,0,3.00,2.25,2.25,3955.00,0.00,3955.00,3955.00,N/A
33620_3,APPLY R&L PULM ART BANDS,ProFee,0989,33620,,,,0,3.00,2.25,2.25,2397.00,0.00,2397.00,2397.00,N/A
33621_3,TRANSTHOR CATH FOR STENT,ProFee,0989,33621,,,,0,3.00,2.25,2.25,1351.50,0.00,1351.50,1351.50,N/A
33622_3,REDO COMPL CARDIAC ANOMALY,ProFee,0989,33622,,,,0,3.00,2.25,2.25,4980.50,0.00,4980.50,4980.50,N/A
33641_3,REPAIR HEART SEPTUM DEFECT,ProFee,0989,33641,,,,0,3.00,2.25,2.25,2381.00,0.00,2381.00,2381.00,N/A
33645_3,REVISION OF HEART VEINS,ProFee,0989,33645,,,,0,3.00,2.25,2.25,2514.00,0.00,2514.00,2514.00,N/A
33647_3,REPAIR HEART SEPTUM DEFECTS,ProFee,0989,33647,,,,0,3.00,2.25,2.25,2640.00,0.00,2640.00,2640.00,N/A
33660_3,REPAIR OF HEART DEFECTS,ProFee,0989,33660,,,,0,3.00,2.25,2.25,2551.50,0.00,2551.50,2551.50,N/A
33665_3,REPAIR OF HEART DEFECTS,ProFee,0989,33665,,,,0,3.00,2.25,2.25,2780.50,0.00,2780.50,2780.50,N/A
33670_3,REPAIR OF HEART CHAMBERS,ProFee,0989,33670,,,,0,3.00,2.25,2.25,2866.00,0.00,2866.00,2866.00,N/A
33675_3,CLOSE MULT VSD,ProFee,0989,33675,,,,0,3.00,2.25,2.25,2865.00,0.00,2865.00,2865.00,N/A
33676_3,CLOSE MULT VSD W/RESECTION,ProFee,0989,33676,,,,0,3.00,2.25,2.25,2941.00,0.00,2941.00,2941.00,N/A
33677_3,CL MULT VSD W/REM PUL BAND,ProFee,0989,33677,,,,0,3.00,2.25,2.25,3054.50,0.00,3054.50,3054.50,N/A
33681_3,REPAIR HEART SEPTUM DEFECT,ProFee,0989,33681,,,,0,3.00,2.25,2.25,2669.00,0.00,2669.00,2669.00,N/A
33684_3,REPAIR HEART SEPTUM DEFECT,ProFee,0989,33684,,,,0,3.00,2.25,2.25,2744.00,0.00,2744.00,2744.00,N/A
33688_3,REPAIR HEART SEPTUM DEFECT,ProFee,0989,33688,,,,0,3.00,2.25,2.25,2738.50,0.00,2738.50,2738.50,N/A
33690_3,REINFORCE PULMONARY ARTERY,ProFee,0989,33690,,,,0,3.00,2.25,2.25,1741.00,0.00,1741.00,1741.00,N/A
33692_3,REPAIR OF HEART DEFECTS,ProFee,0989,33692,,,,0,3.00,2.25,2.25,2843.00,0.00,2843.00,2843.00,N/A
33694_3,REPAIR OF HEART DEFECTS,ProFee,0989,33694,,,,0,3.00,2.25,2.25,2835.50,0.00,2835.50,2835.50,N/A
33697_3,REPAIR OF HEART DEFECTS,ProFee,0989,33697,,,,0,3.00,2.25,2.25,2987.00,0.00,2987.00,2987.00,N/A
33702_3,REPAIR OF HEART DEFECTS,ProFee,0989,33702,,,,0,3.00,2.25,2.25,2244.00,0.00,2244.00,2244.00,N/A
3370F_3,AJCC BRST CNCR STAGE 0 DOCD,ProFee,0989,3370F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33710_3,REPAIR OF HEART DEFECTS,ProFee,0989,33710,,,,0,3.00,2.25,2.25,2981.50,0.00,2981.50,2981.50,N/A
33720_3,REPAIR OF HEART DEFECT,ProFee,0989,33720,,,,0,3.00,2.25,2.25,2246.00,0.00,2246.00,2246.00,N/A
33722_3,REPAIR OF HEART DEFECT,ProFee,0989,33722,,,,0,3.00,2.25,2.25,2360.00,0.00,2360.00,2360.00,N/A
33724_3,REPAIR VENOUS ANOMALY,ProFee,0989,33724,,,,0,3.00,2.25,2.25,2236.00,0.00,2236.00,2236.00,N/A
33726_3,REPAIR PUL VENOUS STENOSIS,ProFee,0989,33726,,,,0,3.00,2.25,2.25,2954.50,0.00,2954.50,2954.50,N/A
3372F_3,AJCC BRST CNCR STAGE 1+DOCD,ProFee,0989,3372F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33730_3,REPAIR HEART-VEIN DEFECT(S),ProFee,0989,33730,,,,0,3.00,2.25,2.25,2910.50,0.00,2910.50,2910.50,N/A
33732_3,REPAIR HEART-VEIN DEFECT,ProFee,0989,33732,,,,0,3.00,2.25,2.25,2390.50,0.00,2390.50,2390.50,N/A
33735_3,REVISION OF HEART CHAMBER,ProFee,0989,33735,,,,0,3.00,2.25,2.25,1880.00,0.00,1880.00,1880.00,N/A
33736_3,REVISION OF HEART CHAMBER,ProFee,0989,33736,,,,0,3.00,2.25,2.25,2039.50,0.00,2039.50,2039.50,N/A
33737_3,REVISION OF HEART CHAMBER,ProFee,0989,33737,,,,0,3.00,2.25,2.25,1883.00,0.00,1883.00,1883.00,N/A
3374F_3,AJCC BRST CNCR STAGE 1+DOCD,ProFee,0989,3374F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33750_3,MAJOR VESSEL SHUNT,ProFee,0989,33750,,,,0,3.00,2.25,2.25,1831.50,0.00,1831.50,1831.50,N/A
33755_3,MAJOR VESSEL SHUNT,ProFee,0989,33755,,,,0,3.00,2.25,2.25,1911.00,0.00,1911.00,1911.00,N/A
33762_3,MAJOR VESSEL SHUNT,ProFee,0989,33762,,,,0,3.00,2.25,2.25,1861.00,0.00,1861.00,1861.00,N/A
33764_3,MAJOR VESSEL SHUNT & GRAFT,ProFee,0989,33764,,,,0,3.00,2.25,2.25,1911.00,0.00,1911.00,1911.00,N/A
33766_3,MAJOR VESSEL SHUNT,ProFee,0989,33766,,,,0,3.00,2.25,2.25,1933.00,0.00,1933.00,1933.00,N/A
33767_3,MAJOR VESSEL SHUNT,ProFee,0989,33767,,,,0,3.00,2.25,2.25,2065.50,0.00,2065.50,2065.50,N/A
33768_3,CAVOPULMONARY SHUNTING,ProFee,0989,33768,,,,0,3.00,2.25,2.25,605.00,0.00,605.00,605.00,N/A
3376F_3,AJCC BRSTCNCR STAGE 2 DOCD,ProFee,0989,3376F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33770_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33770,,,,0,3.00,2.25,2.25,3075.00,0.00,3075.00,3075.00,N/A
33771_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33771,,,,0,3.00,2.25,2.25,3165.00,0.00,3165.00,3165.00,N/A
33774_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33774,,,,0,3.00,2.25,2.25,2611.00,0.00,2611.00,2611.00,N/A
33775_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33775,,,,0,3.00,2.25,2.25,2690.50,0.00,2690.50,2690.50,N/A
33776_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33776,,,,0,3.00,2.25,2.25,2844.50,0.00,2844.50,2844.50,N/A
33777_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33777,,,,0,3.00,2.25,2.25,2746.00,0.00,2746.00,2746.00,N/A
33778_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33778,,,,0,3.00,2.25,2.25,3410.50,0.00,3410.50,3410.50,N/A
33779_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33779,,,,0,3.00,2.25,2.25,3378.00,0.00,3378.00,3378.00,N/A
33780_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33780,,,,0,3.00,2.25,2.25,3441.00,0.00,3441.00,3441.00,N/A
33781_3,REPAIR GREAT VESSELS DEFECT,ProFee,0989,33781,,,,0,3.00,2.25,2.25,3359.00,0.00,3359.00,3359.00,N/A
33782_3,NIKAIDOH PROC,ProFee,0989,33782,,,,0,3.00,2.25,2.25,4686.50,0.00,4686.50,4686.50,N/A
33783_3,NIKAIDOH PROC W/OSTIA IMPLT,ProFee,0989,33783,,,,0,3.00,2.25,2.25,5062.00,0.00,5062.00,5062.00,N/A
33786_3,REPAIR ARTERIAL TRUNK,ProFee,0989,33786,,,,0,3.00,2.25,2.25,3305.50,0.00,3305.50,3305.50,N/A
33788_3,REVISION OF PULMONARY ARTERY,ProFee,0989,33788,,,,0,3.00,2.25,2.25,2225.50,0.00,2225.50,2225.50,N/A
3378F_3,AJCC BRSTCNCR STAGE 3 DOCD,ProFee,0989,3378F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33800_3,AORTIC SUSPENSION,ProFee,0989,33800,,,,0,3.00,2.25,2.25,1433.00,0.00,1433.00,1433.00,N/A
33802_3,REPAIR VESSEL DEFECT,ProFee,0989,33802,,,,0,3.00,2.25,2.25,1573.50,0.00,1573.50,1573.50,N/A
33803_3,REPAIR VESSEL DEFECT,ProFee,0989,33803,,,,0,3.00,2.25,2.25,1670.50,0.00,1670.50,1670.50,N/A
3380F_3,AJCC BRSTCNCR STAGE 4 DOCD,ProFee,0989,3380F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33813_3,REPAIR SEPTAL DEFECT,ProFee,0989,33813,,,,0,3.00,2.25,2.25,1798.50,0.00,1798.50,1798.50,N/A
33814_3,REPAIR SEPTAL DEFECT,ProFee,0989,33814,,,,0,3.00,2.25,2.25,2211.00,0.00,2211.00,2211.00,N/A
33820_3,REVISE MAJOR VESSEL,ProFee,0989,33820,,,,0,3.00,2.25,2.25,1406.00,0.00,1406.00,1406.00,N/A
33822_3,REVISE MAJOR VESSEL,ProFee,0989,33822,,,,0,3.00,2.25,2.25,1483.50,0.00,1483.50,1483.50,N/A
33824_3,REVISE MAJOR VESSEL,ProFee,0989,33824,,,,0,3.00,2.25,2.25,1711.50,0.00,1711.50,1711.50,N/A
3382F_3,AJCC CLN CNCR STAGE 0 DOCD,ProFee,0989,3382F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33840_3,REMOVE AORTA CONSTRICTION,ProFee,0989,33840,,,,0,3.00,2.25,2.25,1797.50,0.00,1797.50,1797.50,N/A
33845_3,REMOVE AORTA CONSTRICTION,ProFee,0989,33845,,,,0,3.00,2.25,2.25,1936.50,0.00,1936.50,1936.50,N/A
3384F_3,AJCC CLN CNCR STAGE 1 DOCD,ProFee,0989,3384F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33851_3,REMOVE AORTA CONSTRICTION,ProFee,0989,33851,,,,0,3.00,2.25,2.25,1846.00,0.00,1846.00,1846.00,N/A
33852_3,REPAIR SEPTAL DEFECT,ProFee,0989,33852,,,,0,3.00,2.25,2.25,2029.50,0.00,2029.50,2029.50,N/A
33853_3,REPAIR SEPTAL DEFECT,ProFee,0989,33853,,,,0,3.00,2.25,2.25,2660.50,0.00,2660.50,2660.50,N/A
33858_3,AS-AORT GRF F/AORTIC DSJ,ProFee,0989,33858,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33859_3,AS-AORT GRF F/DS OTH/THN DSJ,ProFee,0989,33859,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33861_3,ASCENDING AORTIC GRAFT,ProFee,0989,33861,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33863_3,ASCENDING AORTIC GRAFT,ProFee,0989,33863,,,,0,3.00,2.25,2.25,4559.00,0.00,4559.00,4559.00,N/A
33864_3,ASCENDING AORTIC GRAFT,ProFee,0989,33864,,,,0,3.00,2.25,2.25,4669.00,0.00,4669.00,4669.00,N/A
33866_3,AORTIC HEMIARCH GRAFT,ProFee,0989,33866,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3386F_3,AJCC CLN CNCR STAGE 2 DOCD,ProFee,0989,3386F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33871_3,TRANSVRS A-ARCH GRF HYPTHRM,ProFee,0989,33871,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33875_3,THORACIC AORTIC GRAFT,ProFee,0989,33875,,,,0,3.00,2.25,2.25,3976.50,0.00,3976.50,3976.50,N/A
33877_3,THORACOABDOMINAL GRAFT,ProFee,0989,33877,,,,0,3.00,2.25,2.25,5248.00,0.00,5248.00,5248.00,N/A
33880_3,ENDOVASC TAA REPR INCL SUBCL,ProFee,0989,33880,,,,0,3.00,2.25,2.25,2608.50,0.00,2608.50,2608.50,N/A
33881_3,ENDOVASC TAA REPR W/O SUBCL,ProFee,0989,33881,,,,0,3.00,2.25,2.25,2240.50,0.00,2240.50,2240.50,N/A
33883_3,"INSERT ENDOVASC PROSTH, TAA",ProFee,0989,33883,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
33884_3,"ENDOVASC PROSTH, TAA, ADD-ON",ProFee,0989,33884,,,,0,3.00,2.25,2.25,604.00,0.00,604.00,604.00,N/A
33886_3,"ENDOVASC PROSTH, DELAYED",ProFee,0989,33886,,,,0,3.00,2.25,2.25,1410.50,0.00,1410.50,1410.50,N/A
33889_3,ARTERY TRANSPOSE/ENDOVAS TAA,ProFee,0989,33889,,,,0,3.00,2.25,2.25,1153.00,0.00,1153.00,1153.00,N/A
3388F_3,AJCC CLN CNCR STAGE 3 DOCD,ProFee,0989,3388F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33891_3,CAR-CAR BP GRFT/ENDOVAS TAA,ProFee,0989,33891,,,,0,3.00,2.25,2.25,1402.00,0.00,1402.00,1402.00,N/A
3390F_3,AJCC CLN CNCR STAGE 4 DOCD,ProFee,0989,3390F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33910_3,REMOVE LUNG ARTERY EMBOLI,ProFee,0989,33910,,,,0,3.00,2.25,2.25,3814.00,0.00,3814.00,3814.00,N/A
33915_3,REMOVE LUNG ARTERY EMBOLI,ProFee,0989,33915,,,,0,3.00,2.25,2.25,2007.50,0.00,2007.50,2007.50,N/A
33916_3,SURGERY OF GREAT VESSEL,ProFee,0989,33916,,,,0,3.00,2.25,2.25,6122.00,0.00,6122.00,6122.00,N/A
33917_3,REPAIR PULMONARY ARTERY,ProFee,0989,33917,,,,0,3.00,2.25,2.25,2115.00,0.00,2115.00,2115.00,N/A
33920_3,REPAIR PULMONARY ATRESIA,ProFee,0989,33920,,,,0,3.00,2.25,2.25,2627.50,0.00,2627.50,2627.50,N/A
33922_3,TRANSECT PULMONARY ARTERY,ProFee,0989,33922,,,,0,3.00,2.25,2.25,2015.50,0.00,2015.50,2015.50,N/A
33924_3,REMOVE PULMONARY SHUNT,ProFee,0989,33924,,,,0,3.00,2.25,2.25,416.50,0.00,416.50,416.50,N/A
33925_3,RPR PUL ART UNIFOCAL W/O CPB,ProFee,0989,33925,,,,0,3.00,2.25,2.25,2496.00,0.00,2496.00,2496.00,N/A
33926_3,"REPR PUL ART, UNIFOCAL W/CPB",ProFee,0989,33926,,,,0,3.00,2.25,2.25,3510.50,0.00,3510.50,3510.50,N/A
33927_3,IMPLTJ TOT RPLCMT HRT SYS,ProFee,0989,33927,,,,0,3.00,2.25,2.25,3691.50,0.00,3691.50,3691.50,N/A
33928_3,RMVL & RPLCMT TOT HRT SYS,ProFee,0989,33928,,,,0,3.00,2.25,2.25,5187.50,0.00,5187.50,5187.50,N/A
33929_3,RMVL RPLCMT HRT SYS F/TRNSPL,ProFee,0989,33929,,,,0,3.00,2.25,2.25,1941.50,0.00,1941.50,1941.50,N/A
33930_3,REMOVAL OF DONOR HEART/LUNG,ProFee,0989,33930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33933_3,PREPARE DONOR HEART/LUNG,ProFee,0989,33933,,,,0,3.00,2.25,2.25,600.00,0.00,600.00,600.00,N/A
33935_3,"TRANSPLANTATION, HEART/LUNG",ProFee,0989,33935,,,,0,3.00,2.25,2.25,7127.00,0.00,7127.00,7127.00,N/A
33940_3,REMOVAL OF DONOR HEART,ProFee,0989,33940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33944_3,PREPARE DONOR HEART,ProFee,0989,33944,,,,0,3.00,2.25,2.25,529.50,0.00,529.50,529.50,N/A
33945_3,TRANSPLANTATION OF HEART,ProFee,0989,33945,,,,0,3.00,2.25,2.25,7009.00,0.00,7009.00,7009.00,N/A
33946_3,ECMO/ECLS INITIATION VENOUS,ProFee,0989,33946,,,,0,3.00,2.25,2.25,448.00,0.00,448.00,448.00,N/A
33947_3,ECMO/ECLS INITIATION ARTERY,ProFee,0989,33947,,,,0,3.00,2.25,2.25,499.50,0.00,499.50,499.50,N/A
33948_3,ECMO/ECLS DAILY MGMT-VENOUS,ProFee,0989,33948,,,,0,3.00,2.25,2.25,347.00,0.00,347.00,347.00,N/A
33949_3,ECMO/ECLS DAILY MGMT ARTERY,ProFee,0989,33949,,,,0,3.00,2.25,2.25,336.50,0.00,336.50,336.50,N/A
3394F_3,QUANT HER2 IHC EVAL BRST CX,ProFee,0989,3394F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33951_3,ECMO/ECLS INSJ PRPH CANNULA,ProFee,0989,33951,,,,0,3.00,2.25,2.25,619.00,0.00,619.00,619.00,N/A
33952_3,ECMO/ECLS INSJ PRPH CANNULA,ProFee,0989,33952,,,,0,3.00,2.25,2.25,621.50,0.00,621.50,621.50,N/A
33953_3,ECMO/ECLS INSJ PRPH CANNULA,ProFee,0989,33953,,,,0,3.00,2.25,2.25,692.00,0.00,692.00,692.00,N/A
33954_3,ECMO/ECLS INSJ PRPH CANNULA,ProFee,0989,33954,,,,0,3.00,2.25,2.25,694.50,0.00,694.50,694.50,N/A
33955_3,ECMO/ECLS INSJ CTR CANNULA,ProFee,0989,33955,,,,0,3.00,2.25,2.25,1212.50,0.00,1212.50,1212.50,N/A
33956_3,ECMO/ECLS INSJ CTR CANNULA,ProFee,0989,33956,,,,0,3.00,2.25,2.25,1210.00,0.00,1210.00,1210.00,N/A
33957_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33957,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
33958_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33958,,,,0,3.00,2.25,2.25,270.00,0.00,270.00,270.00,N/A
33959_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33959,,,,0,3.00,2.25,2.25,342.00,0.00,342.00,342.00,N/A
3395F_3,QUANT NONHER2 IHC BRST CX,ProFee,0989,3395F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
33960_3,EXTERNAL CIRCULATION ASSIST,ProFee,0989,33960,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33961_3,EXTERNAL CIRCULATION ASSIST,ProFee,0989,33961,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
33962_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33962,,,,0,3.00,2.25,2.25,343.00,0.00,343.00,343.00,N/A
33963_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33963,,,,0,3.00,2.25,2.25,683.50,0.00,683.50,683.50,N/A
33964_3,ECMO/ECLS REPOS PERPH CNULA,ProFee,0989,33964,,,,0,3.00,2.25,2.25,721.50,0.00,721.50,721.50,N/A
33965_3,ECMO/ECLS RMVL PERPH CANNULA,ProFee,0989,33965,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
33966_3,ECMO/ECLS RMVL PRPH CANNULA,ProFee,0989,33966,,,,0,3.00,2.25,2.25,344.50,0.00,344.50,344.50,N/A
33967_3,INSERT IA PERCUT DEVICE,ProFee,0989,33967,,,,0,3.00,2.25,2.25,377.50,0.00,377.50,377.50,N/A
33968_3,REMOVE AORTIC ASSIST DEVICE,ProFee,0989,33968,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
33969_3,ECMO/ECLS RMVL PERPH CANNULA,ProFee,0989,33969,,,,0,3.00,2.25,2.25,399.00,0.00,399.00,399.00,N/A
33970_3,AORTIC CIRCULATION ASSIST,ProFee,0989,33970,,,,0,3.00,2.25,2.25,515.50,0.00,515.50,515.50,N/A
33971_3,AORTIC CIRCULATION ASSIST,ProFee,0989,33971,,,,0,3.00,2.25,2.25,1026.50,0.00,1026.50,1026.50,N/A
33973_3,INSERT BALLOON DEVICE,ProFee,0989,33973,,,,0,3.00,2.25,2.25,752.00,0.00,752.00,752.00,N/A
33974_3,REMOVE INTRA-AORTIC BALLOON,ProFee,0989,33974,,,,0,3.00,2.25,2.25,1290.50,0.00,1290.50,1290.50,N/A
33975_3,IMPLANT VENTRICULAR DEVICE,ProFee,0989,33975,,,,0,3.00,2.25,2.25,1898.00,0.00,1898.00,1898.00,N/A
33976_3,IMPLANT VENTRICULAR DEVICE,ProFee,0989,33976,,,,0,3.00,2.25,2.25,2319.00,0.00,2319.00,2319.00,N/A
33977_3,REMOVE VENTRICULAR DEVICE,ProFee,0989,33977,,,,0,3.00,2.25,2.25,1630.50,0.00,1630.50,1630.50,N/A
33978_3,REMOVE VENTRICULAR DEVICE,ProFee,0989,33978,,,,0,3.00,2.25,2.25,1945.50,0.00,1945.50,1945.50,N/A
33979_3,INSERT INTRACORPOREAL DEVICE,ProFee,0989,33979,,,,0,3.00,2.25,2.25,2831.50,0.00,2831.50,2831.50,N/A
33980_3,REMOVE INTRACORPOREAL DEVICE,ProFee,0989,33980,,,,0,3.00,2.25,2.25,2589.50,0.00,2589.50,2589.50,N/A
33981_3,REPLACE VAD PUMP EXT,ProFee,0989,33981,,,,0,3.00,2.25,2.25,1215.00,0.00,1215.00,1215.00,N/A
33982_3,REPLACE VAD INTRA W/O BP,ProFee,0989,33982,,,,0,3.00,2.25,2.25,2854.50,0.00,2854.50,2854.50,N/A
33983_3,REPLACE VAD INTRA W/BP,ProFee,0989,33983,,,,0,3.00,2.25,2.25,3354.50,0.00,3354.50,3354.50,N/A
33984_3,ECMO/ECLS RMVL PRPH CANNULA,ProFee,0989,33984,,,,0,3.00,2.25,2.25,414.00,0.00,414.00,414.00,N/A
33985_3,ECMO/ECLS RMVL CTR CANNULA,ProFee,0989,33985,,,,0,3.00,2.25,2.25,751.00,0.00,751.00,751.00,N/A
33986_3,ECMO/ECLS RMVL CTR CANNULA,ProFee,0989,33986,,,,0,3.00,2.25,2.25,758.50,0.00,758.50,758.50,N/A
33987_3,ARTERY EXPOS/GRAFT ARTERY,ProFee,0989,33987,,,,0,3.00,2.25,2.25,304.50,0.00,304.50,304.50,N/A
33988_3,INSERTION OF LEFT HEART VENT,ProFee,0989,33988,,,,0,3.00,2.25,2.25,1135.50,0.00,1135.50,1135.50,N/A
33989_3,REMOVAL OF LEFT HEART VENT,ProFee,0989,33989,,,,0,3.00,2.25,2.25,721.50,0.00,721.50,721.50,N/A
33990_3,INSERT VAD ARTERY ACCESS,ProFee,0989,33990,,,,0,3.00,2.25,2.25,619.50,0.00,619.50,619.50,N/A
33991_3,INSERT VAD ART&VEIN ACCESS,ProFee,0989,33991,,,,0,3.00,2.25,2.25,913.50,0.00,913.50,913.50,N/A
33992_3,REMOVE VAD DIFFERENT SESSION,ProFee,0989,33992,,,,0,3.00,2.25,2.25,291.00,0.00,291.00,291.00,N/A
33993_3,REPOSITION VAD DIFF SESSION,ProFee,0989,33993,,,,0,3.00,2.25,2.25,254.50,0.00,254.50,254.50,N/A
33999_3,CARDIAC SURGERY PROCEDURE,ProFee,0989,33999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34001_3,REMOVAL OF ARTERY CLOT,ProFee,0989,34001,,,,0,3.00,2.25,2.25,1328.50,0.00,1328.50,1328.50,N/A
34051_3,REMOVAL OF ARTERY CLOT,ProFee,0989,34051,,,,0,3.00,2.25,2.25,1439.00,0.00,1439.00,1439.00,N/A
34101_3,REMOVAL OF ARTERY CLOT,ProFee,0989,34101,,,,0,3.00,2.25,2.25,871.50,0.00,871.50,871.50,N/A
34111_3,REMOVAL OF ARM ARTERY CLOT,ProFee,0989,34111,,,,0,3.00,2.25,2.25,871.00,0.00,871.00,871.00,N/A
34151_3,REMOVAL OF ARTERY CLOT,ProFee,0989,34151,,,,0,3.00,2.25,2.25,2030.50,0.00,2030.50,2030.50,N/A
34201_3,REMOVAL OF ARTERY CLOT,ProFee,0989,34201,,,,0,3.00,2.25,2.25,1498.00,0.00,1498.00,1498.00,N/A
34203_3,REMOVAL OF LEG ARTERY CLOT,ProFee,0989,34203,,,,0,3.00,2.25,2.25,1387.00,0.00,1387.00,1387.00,N/A
34401_3,REMOVAL OF VEIN CLOT,ProFee,0989,34401,,,,0,3.00,2.25,2.25,2141.00,0.00,2141.00,2141.00,N/A
34421_3,REMOVAL OF VEIN CLOT,ProFee,0989,34421,,,,0,3.00,2.25,2.25,1069.00,0.00,1069.00,1069.00,N/A
34451_3,REMOVAL OF VEIN CLOT,ProFee,0989,34451,,,,0,3.00,2.25,2.25,2083.50,0.00,2083.50,2083.50,N/A
34471_3,REMOVAL OF VEIN CLOT,ProFee,0989,34471,,,,0,3.00,2.25,2.25,1565.00,0.00,1565.00,1565.00,N/A
34490_3,REMOVAL OF VEIN CLOT,ProFee,0989,34490,,,,0,3.00,2.25,2.25,898.00,0.00,898.00,898.00,N/A
34501_3,"REPAIR VALVE, FEMORAL VEIN",ProFee,0989,34501,,,,0,3.00,2.25,2.25,1294.50,0.00,1294.50,1294.50,N/A
34502_3,RECONSTRUCT VENA CAVA,ProFee,0989,34502,,,,0,3.00,2.25,2.25,2243.00,0.00,2243.00,2243.00,N/A
3450F_3,"DYSPNEA SCRND, NO-MILD DYSP",ProFee,0989,3450F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34510_3,TRANSPOSITION OF VEIN VALVE,ProFee,0989,34510,,,,0,3.00,2.25,2.25,1480.00,0.00,1480.00,1480.00,N/A
3451F_3,DYSPNEA SCRND MOD-HIGH DYSP,ProFee,0989,3451F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34520_3,CROSS-OVER VEIN GRAFT,ProFee,0989,34520,,,,0,3.00,2.25,2.25,1434.50,0.00,1434.50,1434.50,N/A
3452F_3,DYSPNEA NOT SCREENED,ProFee,0989,3452F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34530_3,LEG VEIN FUSION,ProFee,0989,34530,,,,0,3.00,2.25,2.25,1360.50,0.00,1360.50,1360.50,N/A
3455F_3,TB SCRNG DONE-INTERPD 6MON,ProFee,0989,3455F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34701_3,EVASC RPR A-AO NDGFT,ProFee,0989,34701,,,,0,3.00,2.25,2.25,1786.00,0.00,1786.00,1786.00,N/A
34702_3,EVASC RPR A-AO NDGFT RPT,ProFee,0989,34702,,,,0,3.00,2.25,2.25,2668.00,0.00,2668.00,2668.00,N/A
34703_3,EVASC RPR A-UNILAC NDGFT,ProFee,0989,34703,,,,0,3.00,2.25,2.25,2012.50,0.00,2012.50,2012.50,N/A
34704_3,EVASC RPR A-UNILAC NDGFT RPT,ProFee,0989,34704,,,,0,3.00,2.25,2.25,3347.50,0.00,3347.50,3347.50,N/A
34705_3,EVAC RPR A-BIILIAC NDGFT,ProFee,0989,34705,,,,0,3.00,2.25,2.25,2217.00,0.00,2217.00,2217.00,N/A
34706_3,EVASC RPR A-BIILIAC RPT,ProFee,0989,34706,,,,0,3.00,2.25,2.25,3337.00,0.00,3337.00,3337.00,N/A
34707_3,EVASC RPR ILIO-ILIAC NDGFT,ProFee,0989,34707,,,,0,3.00,2.25,2.25,1665.50,0.00,1665.50,1665.50,N/A
34708_3,EVASC RPR ILIO-ILIAC RPT,ProFee,0989,34708,,,,0,3.00,2.25,2.25,2680.50,0.00,2680.50,2680.50,N/A
34709_3,PLMT XTN PROSTH EVASC RPR,ProFee,0989,34709,,,,0,3.00,2.25,2.25,469.00,0.00,469.00,469.00,N/A
3470F_3,"RA DISEASE ACTIVITY, LOW",ProFee,0989,3470F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34710_3,DLYD PLMT XTN PROSTH 1ST VSL,ProFee,0989,34710,,,,0,3.00,2.25,2.25,1162.50,0.00,1162.50,1162.50,N/A
34711_3,DLYD PLMT XTN PROSTH EA ADDL,ProFee,0989,34711,,,,0,3.00,2.25,2.25,433.00,0.00,433.00,433.00,N/A
34712_3,TCAT DLVR ENHNCD FIXJ DEV,ProFee,0989,34712,,,,0,3.00,2.25,2.25,993.50,0.00,993.50,993.50,N/A
34713_3,PERQ ACCESS & CLSR FEM ART,ProFee,0989,34713,,,,0,3.00,2.25,2.25,187.00,0.00,187.00,187.00,N/A
34714_3,OPN FEM ART EXPOS CNDT CRTJ,ProFee,0989,34714,,,,0,3.00,2.25,2.25,392.50,0.00,392.50,392.50,N/A
34715_3,OPN AX/SUBCLA ART EXPOS,ProFee,0989,34715,,,,0,3.00,2.25,2.25,438.50,0.00,438.50,438.50,N/A
34716_3,OPN AX/SUBCLA ART EXPOS CNDT,ProFee,0989,34716,,,,0,3.00,2.25,2.25,544.50,0.00,544.50,544.50,N/A
34717_3,EVASC RPR A-ILIAC NDGFT,ProFee,0989,34717,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34718_3,EVASC RPR N/A A-ILIAC NDGFT,ProFee,0989,34718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3471F_3,"RA DISEASE ACTIVITY, MOD",ProFee,0989,3471F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3472F_3,"RA DISEASE ACTIVITY, HIGH",ProFee,0989,3472F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3475F_3,DISEASE PROGN RA POOR DOCD,ProFee,0989,3475F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3476F_3,DISEASE PROGN RA GOOD DOCD,ProFee,0989,3476F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34800_3,ENDOVAS AAA REPR W/SM TUBE,ProFee,0989,34800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34802_3,ENDOVAS AAA REPR W/2-P PART,ProFee,0989,34802,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34803_3,ENDOVAS AAA REPR W/3-P PART,ProFee,0989,34803,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34804_3,ENDOVAS AAA REPR W/1-P PART,ProFee,0989,34804,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34805_3,ENDOVAS AAA REPR W/LONG TUBE,ProFee,0989,34805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34806_3,ANEURYSM PRESS SENSOR ADD-ON,ProFee,0989,34806,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34808_3,ENDOVAS ILIAC A DEVICE ADDON,ProFee,0989,34808,,,,0,3.00,2.25,2.25,303.00,0.00,303.00,303.00,N/A
34812_3,"XPOSE FOR ENDOPROSTH, FEMORL",ProFee,0989,34812,,,,0,3.00,2.25,2.25,301.00,0.00,301.00,301.00,N/A
34813_3,FEMORAL ENDOVAS GRAFT ADD-ON,ProFee,0989,34813,,,,0,3.00,2.25,2.25,344.00,0.00,344.00,344.00,N/A
34820_3,"XPOSE FOR ENDOPROSTH, ILIAC",ProFee,0989,34820,,,,0,3.00,2.25,2.25,513.50,0.00,513.50,513.50,N/A
34825_3,"ENDOVASC EXTEND PROSTH, INIT",ProFee,0989,34825,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34826_3,"ENDOVASC EXTEN PROSTH, ADD'L",ProFee,0989,34826,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
34830_3,OPEN AORTIC TUBE PROSTH REPR,ProFee,0989,34830,,,,0,3.00,2.25,2.25,2558.00,0.00,2558.00,2558.00,N/A
34831_3,OPEN AORTOILIAC PROSTH REPR,ProFee,0989,34831,,,,0,3.00,2.25,2.25,2806.50,0.00,2806.50,2806.50,N/A
34832_3,OPEN AORTOFEMOR PROSTH REPR,ProFee,0989,34832,,,,0,3.00,2.25,2.25,2751.00,0.00,2751.00,2751.00,N/A
34833_3,"XPOSE FOR ENDOPROSTH, ILIAC",ProFee,0989,34833,,,,0,3.00,2.25,2.25,589.00,0.00,589.00,589.00,N/A
34834_3,"XPOSE, ENDOPROSTH, BRACHIAL",ProFee,0989,34834,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
34839_3,PLNNING PT SPEC FENEST GRAFT,ProFee,0989,34839,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
34841_3,ENDOVASC VISC AORTA 1 GRAFT,ProFee,0989,34841,,,,0,3.00,2.25,2.25,2292.00,0.00,2292.00,2292.00,N/A
34842_3,ENDOVASC VISC AORTA 2 GRAFT,ProFee,0989,34842,,,,0,3.00,2.25,2.25,2658.00,0.00,2658.00,2658.00,N/A
34843_3,ENDOVASC VISC AORTA 3 GRAFT,ProFee,0989,34843,,,,0,3.00,2.25,2.25,2966.00,0.00,2966.00,2966.00,N/A
34844_3,ENDOVASC VISC AORTA 4 GRAFT,ProFee,0989,34844,,,,0,3.00,2.25,2.25,3285.50,0.00,3285.50,3285.50,N/A
34845_3,VISC & INFRAREN ABD 1 PROSTH,ProFee,0989,34845,,,,0,3.00,2.25,2.25,2869.50,0.00,2869.50,2869.50,N/A
34846_3,VISC & INFRAREN ABD 2 PROSTH,ProFee,0989,34846,,,,0,3.00,2.25,2.25,3217.50,0.00,3217.50,3217.50,N/A
34847_3,VISC & INFRAREN ABD 3 PROSTH,ProFee,0989,34847,,,,0,3.00,2.25,2.25,3543.00,0.00,3543.00,3543.00,N/A
34848_3,VISC & INFRAREN ABD 4+ PROST,ProFee,0989,34848,,,,0,3.00,2.25,2.25,3862.50,0.00,3862.50,3862.50,N/A
34900_3,ENDOVASC ILIAC REPR W/GRAFT,ProFee,0989,34900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3490F_3,HISTORY - AIDS-DEFINING COND,ProFee,0989,3490F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3491F_3,HIV UNSURE BABY OF HIV+MOMS,ProFee,0989,3491F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3492F_3,HISTORY CD4+ CELL COUNT <350,ProFee,0989,3492F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3493F_3,NO HIST CD4+CELL CNT<350,ProFee,0989,3493F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3494F_3,CD4+CELL COUNT <200CELLS/MM3,ProFee,0989,3494F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3495F_3,CD4+CELL CNT 200-499 CELLS,ProFee,0989,3495F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3496F_3,CD4+ CELL COUNT >=500 CELLS,ProFee,0989,3496F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3497F_3,CD4+ CELL PERCENTAGE <15%,ProFee,0989,3497F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3498F_3,CD4+ CELL PERCENTAGE >=15%,ProFee,0989,3498F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35001_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35001,,,,0,3.00,2.25,2.25,1631.00,0.00,1631.00,1631.00,N/A
35002_3,"REPAIR ARTERY RUPTURE, NECK",ProFee,0989,35002,,,,0,3.00,2.25,2.25,1646.50,0.00,1646.50,1646.50,N/A
35005_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35005,,,,0,3.00,2.25,2.25,1440.50,0.00,1440.50,1440.50,N/A
3500F_3,CD4+CELL CNT/% DOCD AS DONE,ProFee,0989,3500F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35011_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35011,,,,0,3.00,2.25,2.25,1462.00,0.00,1462.00,1462.00,N/A
35013_3,"REPAIR ARTERY RUPTURE, ARM",ProFee,0989,35013,,,,0,3.00,2.25,2.25,1828.00,0.00,1828.00,1828.00,N/A
35021_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35021,,,,0,3.00,2.25,2.25,1830.00,0.00,1830.00,1830.00,N/A
35022_3,"REPAIR ARTERY RUPTURE, CHEST",ProFee,0989,35022,,,,0,3.00,2.25,2.25,2096.50,0.00,2096.50,2096.50,N/A
3502F_3,HIV RNA VRL LD <LMTS QUANTIF,ProFee,0989,3502F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3503F_3,HIV RNA VRL LDNOT<LMTS QUNTF,ProFee,0989,3503F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35045_3,REPAIR DEFECT OF ARM ARTERY,ProFee,0989,35045,,,,0,3.00,2.25,2.25,1433.00,0.00,1433.00,1433.00,N/A
35081_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35081,,,,0,3.00,2.25,2.25,2531.00,0.00,2531.00,2531.00,N/A
35082_3,"REPAIR ARTERY RUPTURE, AORTA",ProFee,0989,35082,,,,0,3.00,2.25,2.25,3188.50,0.00,3188.50,3188.50,N/A
35091_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35091,,,,0,3.00,2.25,2.25,2602.00,0.00,2602.00,2602.00,N/A
35092_3,"REPAIR ARTERY RUPTURE, AORTA",ProFee,0989,35092,,,,0,3.00,2.25,2.25,3779.00,0.00,3779.00,3779.00,N/A
35102_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35102,,,,0,3.00,2.25,2.25,2738.00,0.00,2738.00,2738.00,N/A
35103_3,"REPAIR ARTERY RUPTURE, GROIN",ProFee,0989,35103,,,,0,3.00,2.25,2.25,3260.00,0.00,3260.00,3260.00,N/A
3510F_3,DOC TB SCRNG-RSLTS INTERPD,ProFee,0989,3510F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35111_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35111,,,,0,3.00,2.25,2.25,1927.50,0.00,1927.50,1927.50,N/A
35112_3,"REPAIR ARTERY RUPTURE,SPLEEN",ProFee,0989,35112,,,,0,3.00,2.25,2.25,2372.00,0.00,2372.00,2372.00,N/A
3511F_3,CHLMYD/GONRH TSTS DOCD DONE,ProFee,0989,3511F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35121_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35121,,,,0,3.00,2.25,2.25,2402.50,0.00,2402.50,2402.50,N/A
35122_3,"REPAIR ARTERY RUPTURE, BELLY",ProFee,0989,35122,,,,0,3.00,2.25,2.25,2744.00,0.00,2744.00,2744.00,N/A
3512F_3,SYPH SCRNG DOCD AS DONE,ProFee,0989,3512F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35131_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35131,,,,0,3.00,2.25,2.25,2026.00,0.00,2026.00,2026.00,N/A
35132_3,"REPAIR ARTERY RUPTURE, GROIN",ProFee,0989,35132,,,,0,3.00,2.25,2.25,2372.00,0.00,2372.00,2372.00,N/A
3513F_3,HEP B SCRNG DOCD AS DONE,ProFee,0989,3513F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35141_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35141,,,,0,3.00,2.25,2.25,1609.00,0.00,1609.00,1609.00,N/A
35142_3,"REPAIR ARTERY RUPTURE, THIGH",ProFee,0989,35142,,,,0,3.00,2.25,2.25,1931.50,0.00,1931.50,1931.50,N/A
3514F_3,HEP C SCRNG DOCD AS DONE,ProFee,0989,3514F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35151_3,REPAIR DEFECT OF ARTERY,ProFee,0989,35151,,,,0,3.00,2.25,2.25,1808.00,0.00,1808.00,1808.00,N/A
35152_3,"REPAIR ARTERY RUPTURE, KNEE",ProFee,0989,35152,,,,0,3.00,2.25,2.25,2028.00,0.00,2028.00,2028.00,N/A
3515F_3,PT HAS DOCD IMMUN TO HEP C,ProFee,0989,3515F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3517F_3,HBV ASSESS&RESULTS INTRP 1YR,ProFee,0989,3517F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35180_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35180,,,,0,3.00,2.25,2.25,1268.50,0.00,1268.50,1268.50,N/A
35182_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35182,,,,0,3.00,2.25,2.25,2592.00,0.00,2592.00,2592.00,N/A
35184_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35184,,,,0,3.00,2.25,2.25,1399.00,0.00,1399.00,1399.00,N/A
35188_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35188,,,,0,3.00,2.25,2.25,1884.50,0.00,1884.50,1884.50,N/A
35189_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35189,,,,0,3.00,2.25,2.25,2189.50,0.00,2189.50,2189.50,N/A
35190_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35190,,,,0,3.00,2.25,2.25,1109.50,0.00,1109.50,1109.50,N/A
35201_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35201,,,,0,3.00,2.25,2.25,1363.50,0.00,1363.50,1363.50,N/A
35206_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35206,,,,0,3.00,2.25,2.25,1135.50,0.00,1135.50,1135.50,N/A
35207_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35207,,,,0,3.00,2.25,2.25,1091.00,0.00,1091.00,1091.00,N/A
3520F_3,CDIFFICILE TESTING PERFORMED,ProFee,0989,3520F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35211_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35211,,,,0,3.00,2.25,2.25,2001.50,0.00,2001.50,2001.50,N/A
35216_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35216,,,,0,3.00,2.25,2.25,2979.00,0.00,2979.00,2979.00,N/A
35221_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35221,,,,0,3.00,2.25,2.25,2122.50,0.00,2122.50,2122.50,N/A
35226_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35226,,,,0,3.00,2.25,2.25,1213.00,0.00,1213.00,1213.00,N/A
35231_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35231,,,,0,3.00,2.25,2.25,1799.00,0.00,1799.00,1799.00,N/A
35236_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35236,,,,0,3.00,2.25,2.25,1448.50,0.00,1448.50,1448.50,N/A
35241_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35241,,,,0,3.00,2.25,2.25,2104.00,0.00,2104.00,2104.00,N/A
35246_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35246,,,,0,3.00,2.25,2.25,2279.50,0.00,2279.50,2279.50,N/A
35251_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35251,,,,0,3.00,2.25,2.25,2533.50,0.00,2533.50,2533.50,N/A
35256_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35256,,,,0,3.00,2.25,2.25,1488.50,0.00,1488.50,1488.50,N/A
35261_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35261,,,,0,3.00,2.25,2.25,1533.00,0.00,1533.00,1533.00,N/A
35266_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35266,,,,0,3.00,2.25,2.25,1258.00,0.00,1258.00,1258.00,N/A
35271_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35271,,,,0,3.00,2.25,2.25,2004.00,0.00,2004.00,2004.00,N/A
35276_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35276,,,,0,3.00,2.25,2.25,2120.00,0.00,2120.00,2120.00,N/A
35281_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35281,,,,0,3.00,2.25,2.25,2343.50,0.00,2343.50,2343.50,N/A
35286_3,REPAIR BLOOD VESSEL LESION,ProFee,0989,35286,,,,0,3.00,2.25,2.25,1355.00,0.00,1355.00,1355.00,N/A
35301_3,RECHANNELING OF ARTERY,ProFee,0989,35301,,,,0,3.00,2.25,2.25,1648.50,0.00,1648.50,1648.50,N/A
35302_3,RECHANNELING OF ARTERY,ProFee,0989,35302,,,,0,3.00,2.25,2.25,1635.00,0.00,1635.00,1635.00,N/A
35303_3,RECHANNELING OF ARTERY,ProFee,0989,35303,,,,0,3.00,2.25,2.25,1807.50,0.00,1807.50,1807.50,N/A
35304_3,RECHANNELING OF ARTERY,ProFee,0989,35304,,,,0,3.00,2.25,2.25,1868.50,0.00,1868.50,1868.50,N/A
35305_3,RECHANNELING OF ARTERY,ProFee,0989,35305,,,,0,3.00,2.25,2.25,1796.50,0.00,1796.50,1796.50,N/A
35306_3,RECHANNELING OF ARTERY,ProFee,0989,35306,,,,0,3.00,2.25,2.25,648.50,0.00,648.50,648.50,N/A
35311_3,RECHANNELING OF ARTERY,ProFee,0989,35311,,,,0,3.00,2.25,2.25,2269.50,0.00,2269.50,2269.50,N/A
35321_3,RECHANNELING OF ARTERY,ProFee,0989,35321,,,,0,3.00,2.25,2.25,1296.50,0.00,1296.50,1296.50,N/A
35331_3,RECHANNELING OF ARTERY,ProFee,0989,35331,,,,0,3.00,2.25,2.25,2115.00,0.00,2115.00,2115.00,N/A
35341_3,RECHANNELING OF ARTERY,ProFee,0989,35341,,,,0,3.00,2.25,2.25,2002.00,0.00,2002.00,2002.00,N/A
35351_3,RECHANNELING OF ARTERY,ProFee,0989,35351,,,,0,3.00,2.25,2.25,1866.50,0.00,1866.50,1866.50,N/A
35355_3,RECHANNELING OF ARTERY,ProFee,0989,35355,,,,0,3.00,2.25,2.25,1503.00,0.00,1503.00,1503.00,N/A
35361_3,RECHANNELING OF ARTERY,ProFee,0989,35361,,,,0,3.00,2.25,2.25,2208.00,0.00,2208.00,2208.00,N/A
35363_3,RECHANNELING OF ARTERY,ProFee,0989,35363,,,,0,3.00,2.25,2.25,2562.00,0.00,2562.00,2562.00,N/A
35371_3,RECHANNELING OF ARTERY,ProFee,0989,35371,,,,0,3.00,2.25,2.25,1191.00,0.00,1191.00,1191.00,N/A
35372_3,RECHANNELING OF ARTERY,ProFee,0989,35372,,,,0,3.00,2.25,2.25,1430.00,0.00,1430.00,1430.00,N/A
35381_3,RECHANNELING OF ARTERY,ProFee,0989,35381,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35390_3,"REOPERATION, CAROTID ADD-ON",ProFee,0989,35390,,,,0,3.00,2.25,2.25,232.00,0.00,232.00,232.00,N/A
35400_3,ANGIOSCOPY,ProFee,0989,35400,,,,0,3.00,2.25,2.25,217.50,0.00,217.50,217.50,N/A
35450_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35450,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35452_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35452,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35454_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35454,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35456_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35456,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35458_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35458,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35459_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35459,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35460_3,REPAIR VENOUS BLOCKAGE,ProFee,0989,35460,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35470_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35471_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35471,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35472_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35472,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35473_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35473,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35474_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35474,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35475_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,35475,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35476_3,REPAIR VENOUS BLOCKAGE,ProFee,0989,35476,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35480_3,"ATHERECTOMY, OPEN",ProFee,0989,35480,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35481_3,"ATHERECTOMY, OPEN",ProFee,0989,35481,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35482_3,"ATHERECTOMY, OPEN",ProFee,0989,35482,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35483_3,"ATHERECTOMY, OPEN",ProFee,0989,35483,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35484_3,"ATHERECTOMY, OPEN",ProFee,0989,35484,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35485_3,"ATHERECTOMY, OPEN",ProFee,0989,35485,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35490_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35490,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35491_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35491,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35492_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35492,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35493_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35493,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35494_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35494,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35495_3,"ATHERECTOMY, PERCUTANEOUS",ProFee,0989,35495,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35500_3,HARVEST VEIN FOR BYPASS,ProFee,0989,35500,,,,0,3.00,2.25,2.25,466.00,0.00,466.00,466.00,N/A
35501_3,ARTERY BYPASS GRAFT,ProFee,0989,35501,,,,0,3.00,2.25,2.25,2120.50,0.00,2120.50,2120.50,N/A
35506_3,ARTERY BYPASS GRAFT,ProFee,0989,35506,,,,0,3.00,2.25,2.25,1850.50,0.00,1850.50,1850.50,N/A
35507_3,ARTERY BYPASS GRAFT,ProFee,0989,35507,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35508_3,ARTERY BYPASS GRAFT,ProFee,0989,35508,,,,0,3.00,2.25,2.25,1928.50,0.00,1928.50,1928.50,N/A
35509_3,ARTERY BYPASS GRAFT,ProFee,0989,35509,,,,0,3.00,2.25,2.25,2053.50,0.00,2053.50,2053.50,N/A
3550F_3,LOW RSK THROMBOEMBOLISM,ProFee,0989,3550F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35510_3,ARTERY BYPASS GRAFT,ProFee,0989,35510,,,,0,3.00,2.25,2.25,1786.50,0.00,1786.50,1786.50,N/A
35511_3,ARTERY BYPASS GRAFT,ProFee,0989,35511,,,,0,3.00,2.25,2.25,1627.00,0.00,1627.00,1627.00,N/A
35512_3,ARTERY BYPASS GRAFT,ProFee,0989,35512,,,,0,3.00,2.25,2.25,1751.50,0.00,1751.50,1751.50,N/A
35515_3,ARTERY BYPASS GRAFT,ProFee,0989,35515,,,,0,3.00,2.25,2.25,1928.50,0.00,1928.50,1928.50,N/A
35516_3,ARTERY BYPASS GRAFT,ProFee,0989,35516,,,,0,3.00,2.25,2.25,1771.50,0.00,1771.50,1771.50,N/A
35518_3,ARTERY BYPASS GRAFT,ProFee,0989,35518,,,,0,3.00,2.25,2.25,1658.50,0.00,1658.50,1658.50,N/A
3551F_3,INTRMED RSK THROMBOEMBOLISM,ProFee,0989,3551F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35521_3,ARTERY BYPASS GRAFT,ProFee,0989,35521,,,,0,3.00,2.25,2.25,1780.50,0.00,1780.50,1780.50,N/A
35522_3,ARTERY BYPASS GRAFT,ProFee,0989,35522,,,,0,3.00,2.25,2.25,1762.00,0.00,1762.00,1762.00,N/A
35523_3,ARTERY BYPASS GRAFT,ProFee,0989,35523,,,,0,3.00,2.25,2.25,1855.00,0.00,1855.00,1855.00,N/A
35525_3,ARTERY BYPASS GRAFT,ProFee,0989,35525,,,,0,3.00,2.25,2.25,1660.50,0.00,1660.50,1660.50,N/A
35526_3,ARTERY BYPASS GRAFT,ProFee,0989,35526,,,,0,3.00,2.25,2.25,2524.00,0.00,2524.00,2524.00,N/A
3552F_3,HGH RISK FOR THROMBOEMBOLISM,ProFee,0989,3552F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35531_3,ARTERY BYPASS GRAFT,ProFee,0989,35531,,,,0,3.00,2.25,2.25,2963.00,0.00,2963.00,2963.00,N/A
35533_3,ARTERY BYPASS GRAFT,ProFee,0989,35533,,,,0,3.00,2.25,2.25,2185.50,0.00,2185.50,2185.50,N/A
35535_3,ARTERY BYPASS GRAFT,ProFee,0989,35535,,,,0,3.00,2.25,2.25,2763.50,0.00,2763.50,2763.50,N/A
35536_3,ARTERY BYPASS GRAFT,ProFee,0989,35536,,,,0,3.00,2.25,2.25,2453.50,0.00,2453.50,2453.50,N/A
35537_3,ARTERY BYPASS GRAFT,ProFee,0989,35537,,,,0,3.00,2.25,2.25,3026.50,0.00,3026.50,3026.50,N/A
35538_3,ARTERY BYPASS GRAFT,ProFee,0989,35538,,,,0,3.00,2.25,2.25,3387.50,0.00,3387.50,3387.50,N/A
35539_3,ARTERY BYPASS GRAFT,ProFee,0989,35539,,,,0,3.00,2.25,2.25,3183.00,0.00,3183.00,3183.00,N/A
35540_3,ARTERY BYPASS GRAFT,ProFee,0989,35540,,,,0,3.00,2.25,2.25,3547.50,0.00,3547.50,3547.50,N/A
35541_3,ARTERY BYPASS GRAFT,ProFee,0989,35541,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35546_3,ARTERY BYPASS GRAFT,ProFee,0989,35546,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35548_3,ARTERY BYPASS GRAFT,ProFee,0989,35548,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35549_3,ARTERY BYPASS GRAFT,ProFee,0989,35549,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35551_3,ARTERY BYPASS GRAFT,ProFee,0989,35551,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35556_3,ARTERY BYPASS GRAFT,ProFee,0989,35556,,,,0,3.00,2.25,2.25,2039.00,0.00,2039.00,2039.00,N/A
35558_3,ARTERY BYPASS GRAFT,ProFee,0989,35558,,,,0,3.00,2.25,2.25,1793.00,0.00,1793.00,1793.00,N/A
3555F_3,PT INR MEASUREMENT PERFORMED,ProFee,0989,3555F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35560_3,ARTERY BYPASS GRAFT,ProFee,0989,35560,,,,0,3.00,2.25,2.25,2474.50,0.00,2474.50,2474.50,N/A
35563_3,ARTERY BYPASS GRAFT,ProFee,0989,35563,,,,0,3.00,2.25,2.25,1920.00,0.00,1920.00,1920.00,N/A
35565_3,ARTERY BYPASS GRAFT,ProFee,0989,35565,,,,0,3.00,2.25,2.25,1926.50,0.00,1926.50,1926.50,N/A
35566_3,ARTERY BYPASS GRAFT,ProFee,0989,35566,,,,0,3.00,2.25,2.25,2433.50,0.00,2433.50,2433.50,N/A
35570_3,ARTERY BYPASS GRAFT,ProFee,0989,35570,,,,0,3.00,2.25,2.25,2211.50,0.00,2211.50,2211.50,N/A
35571_3,ARTERY BYPASS GRAFT,ProFee,0989,35571,,,,0,3.00,2.25,2.25,1931.50,0.00,1931.50,1931.50,N/A
35572_3,HARVEST FEMOROPOPLITEAL VEIN,ProFee,0989,35572,,,,0,3.00,2.25,2.25,505.00,0.00,505.00,505.00,N/A
35583_3,VEIN BYPASS GRAFT,ProFee,0989,35583,,,,0,3.00,2.25,2.25,2106.50,0.00,2106.50,2106.50,N/A
35585_3,VEIN BYPASS GRAFT,ProFee,0989,35585,,,,0,3.00,2.25,2.25,2439.50,0.00,2439.50,2439.50,N/A
35587_3,VEIN BYPASS GRAFT,ProFee,0989,35587,,,,0,3.00,2.25,2.25,1993.00,0.00,1993.00,1993.00,N/A
35600_3,HARVEST ARTERY FOR CABG,ProFee,0989,35600,,,,0,3.00,2.25,2.25,370.00,0.00,370.00,370.00,N/A
35601_3,ARTERY BYPASS GRAFT,ProFee,0989,35601,,,,0,3.00,2.25,2.25,2032.00,0.00,2032.00,2032.00,N/A
35606_3,ARTERY BYPASS GRAFT,ProFee,0989,35606,,,,0,3.00,2.25,2.25,1709.00,0.00,1709.00,1709.00,N/A
35612_3,ARTERY BYPASS GRAFT,ProFee,0989,35612,,,,0,3.00,2.25,2.25,1515.00,0.00,1515.00,1515.00,N/A
35616_3,ARTERY BYPASS GRAFT,ProFee,0989,35616,,,,0,3.00,2.25,2.25,1600.50,0.00,1600.50,1600.50,N/A
35621_3,ARTERY BYPASS GRAFT,ProFee,0989,35621,,,,0,3.00,2.25,2.25,1600.50,0.00,1600.50,1600.50,N/A
35623_3,"BYPASS GRAFT, NOT VEIN",ProFee,0989,35623,,,,0,3.00,2.25,2.25,1906.50,0.00,1906.50,1906.50,N/A
35626_3,ARTERY BYPASS GRAFT,ProFee,0989,35626,,,,0,3.00,2.25,2.25,2301.00,0.00,2301.00,2301.00,N/A
35631_3,ARTERY BYPASS GRAFT,ProFee,0989,35631,,,,0,3.00,2.25,2.25,2696.00,0.00,2696.00,2696.00,N/A
35632_3,ARTERY BYPASS GRAFT,ProFee,0989,35632,,,,0,3.00,2.25,2.25,2623.50,0.00,2623.50,2623.50,N/A
35633_3,ARTERY BYPASS GRAFT,ProFee,0989,35633,,,,0,3.00,2.25,2.25,2910.00,0.00,2910.00,2910.00,N/A
35634_3,ARTERY BYPASS GRAFT,ProFee,0989,35634,,,,0,3.00,2.25,2.25,2567.00,0.00,2567.00,2567.00,N/A
35636_3,ARTERY BYPASS GRAFT,ProFee,0989,35636,,,,0,3.00,2.25,2.25,2314.50,0.00,2314.50,2314.50,N/A
35637_3,ARTERY BYPASS GRAFT,ProFee,0989,35637,,,,0,3.00,2.25,2.25,2507.00,0.00,2507.00,2507.00,N/A
35638_3,ARTERY BYPASS GRAFT,ProFee,0989,35638,,,,0,3.00,2.25,2.25,2559.50,0.00,2559.50,2559.50,N/A
35641_3,ARTERY BYPASS GRAFT,ProFee,0989,35641,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35642_3,ARTERY BYPASS GRAFT,ProFee,0989,35642,,,,0,3.00,2.25,2.25,1431.00,0.00,1431.00,1431.00,N/A
35645_3,ARTERY BYPASS GRAFT,ProFee,0989,35645,,,,0,3.00,2.25,2.25,1373.00,0.00,1373.00,1373.00,N/A
35646_3,ARTERY BYPASS GRAFT,ProFee,0989,35646,,,,0,3.00,2.25,2.25,2500.00,0.00,2500.00,2500.00,N/A
35647_3,ARTERY BYPASS GRAFT,ProFee,0989,35647,,,,0,3.00,2.25,2.25,2261.50,0.00,2261.50,2261.50,N/A
35650_3,ARTERY BYPASS GRAFT,ProFee,0989,35650,,,,0,3.00,2.25,2.25,1580.50,0.00,1580.50,1580.50,N/A
35651_3,ARTERY BYPASS GRAFT,ProFee,0989,35651,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35654_3,ARTERY BYPASS GRAFT,ProFee,0989,35654,,,,0,3.00,2.25,2.25,1994.50,0.00,1994.50,1994.50,N/A
35656_3,ARTERY BYPASS GRAFT,ProFee,0989,35656,,,,0,3.00,2.25,2.25,1577.50,0.00,1577.50,1577.50,N/A
35661_3,ARTERY BYPASS GRAFT,ProFee,0989,35661,,,,0,3.00,2.25,2.25,1580.00,0.00,1580.00,1580.00,N/A
35663_3,ARTERY BYPASS GRAFT,ProFee,0989,35663,,,,0,3.00,2.25,2.25,1766.50,0.00,1766.50,1766.50,N/A
35665_3,ARTERY BYPASS GRAFT,ProFee,0989,35665,,,,0,3.00,2.25,2.25,1709.00,0.00,1709.00,1709.00,N/A
35666_3,ARTERY BYPASS GRAFT,ProFee,0989,35666,,,,0,3.00,2.25,2.25,1843.00,0.00,1843.00,1843.00,N/A
35671_3,ARTERY BYPASS GRAFT,ProFee,0989,35671,,,,0,3.00,2.25,2.25,1625.50,0.00,1625.50,1625.50,N/A
35681_3,COMPOSITE BYPASS GRAFT,ProFee,0989,35681,,,,0,3.00,2.25,2.25,117.00,0.00,117.00,117.00,N/A
35682_3,COMPOSITE BYPASS GRAFT,ProFee,0989,35682,,,,0,3.00,2.25,2.25,514.50,0.00,514.50,514.50,N/A
35683_3,COMPOSITE BYPASS GRAFT,ProFee,0989,35683,,,,0,3.00,2.25,2.25,594.50,0.00,594.50,594.50,N/A
35685_3,BYPASS GRAFT PATENCY/PATCH,ProFee,0989,35685,,,,0,3.00,2.25,2.25,289.00,0.00,289.00,289.00,N/A
35686_3,BYPASS GRAFT/AV FIST PATENCY,ProFee,0989,35686,,,,0,3.00,2.25,2.25,234.50,0.00,234.50,234.50,N/A
35691_3,ARTERIAL TRANSPOSITION,ProFee,0989,35691,,,,0,3.00,2.25,2.25,1372.00,0.00,1372.00,1372.00,N/A
35693_3,ARTERIAL TRANSPOSITION,ProFee,0989,35693,,,,0,3.00,2.25,2.25,1209.50,0.00,1209.50,1209.50,N/A
35694_3,ARTERIAL TRANSPOSITION,ProFee,0989,35694,,,,0,3.00,2.25,2.25,1431.50,0.00,1431.50,1431.50,N/A
35695_3,ARTERIAL TRANSPOSITION,ProFee,0989,35695,,,,0,3.00,2.25,2.25,1487.00,0.00,1487.00,1487.00,N/A
35697_3,REIMPLANT ARTERY EACH,ProFee,0989,35697,,,,0,3.00,2.25,2.25,216.00,0.00,216.00,216.00,N/A
35700_3,"REOPERATION, BYPASS GRAFT",ProFee,0989,35700,,,,0,3.00,2.25,2.25,222.50,0.00,222.50,222.50,N/A
35701_3,"EXPLORATION, CAROTID ARTERY",ProFee,0989,35701,,,,0,3.00,2.25,2.25,816.50,0.00,816.50,816.50,N/A
35702_3,EXPL N/FLWD SURG UXTR ART,ProFee,0989,35702,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
35703_3,EXPL N/FLWD SURG LXTR ART,ProFee,0989,35703,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3570F_3,RPRT BONE SCINT X-REF W/ X-RAY,ProFee,0989,3570F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3572F_3,PT CONSID POSS RISK FX,ProFee,0989,3572F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3573F_3,PT NOT CONSID POSS RISK FX,ProFee,0989,3573F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
35800_3,EXPLORE NECK VESSELS,ProFee,0989,35800,,,,0,3.00,2.25,2.25,1039.50,0.00,1039.50,1039.50,N/A
35820_3,EXPLORE CHEST VESSELS,ProFee,0989,35820,,,,0,3.00,2.25,2.25,2916.50,0.00,2916.50,2916.50,N/A
35840_3,EXPLORE ABDOMINAL VESSELS,ProFee,0989,35840,,,,0,3.00,2.25,2.25,1735.50,0.00,1735.50,1735.50,N/A
35860_3,EXPLORE LIMB VESSELS,ProFee,0989,35860,,,,0,3.00,2.25,2.25,1220.50,0.00,1220.50,1220.50,N/A
35870_3,REPAIR VESSEL GRAFT DEFECT,ProFee,0989,35870,,,,0,3.00,2.25,2.25,1805.50,0.00,1805.50,1805.50,N/A
35875_3,REMOVAL OF CLOT IN GRAFT,ProFee,0989,35875,,,,0,3.00,2.25,2.25,868.50,0.00,868.50,868.50,N/A
35876_3,REMOVAL OF CLOT IN GRAFT,ProFee,0989,35876,,,,0,3.00,2.25,2.25,1382.50,0.00,1382.50,1382.50,N/A
35879_3,REVISE GRAFT W/VEIN,ProFee,0989,35879,,,,0,3.00,2.25,2.25,1349.50,0.00,1349.50,1349.50,N/A
35881_3,REVISE GRAFT W/VEIN,ProFee,0989,35881,,,,0,3.00,2.25,2.25,1484.00,0.00,1484.00,1484.00,N/A
35883_3,REVISE GRAFT W/NONAUTO GRAFT,ProFee,0989,35883,,,,0,3.00,2.25,2.25,1755.00,0.00,1755.00,1755.00,N/A
35884_3,REVISE GRAFT W/VEIN,ProFee,0989,35884,,,,0,3.00,2.25,2.25,1801.50,0.00,1801.50,1801.50,N/A
35901_3,"EXCISION, GRAFT, NECK",ProFee,0989,35901,,,,0,3.00,2.25,2.25,682.00,0.00,682.00,682.00,N/A
35903_3,"EXCISION, GRAFT, EXTREMITY",ProFee,0989,35903,,,,0,3.00,2.25,2.25,819.50,0.00,819.50,819.50,N/A
35905_3,"EXCISION, GRAFT, THORAX",ProFee,0989,35905,,,,0,3.00,2.25,2.25,2438.50,0.00,2438.50,2438.50,N/A
35907_3,"EXCISION, GRAFT, ABDOMEN",ProFee,0989,35907,,,,0,3.00,2.25,2.25,2785.50,0.00,2785.50,2785.50,N/A
36000_3,PLACE NEEDLE IN VEIN,ProFee,0989,36000,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
36002_3,PSEUDOANEURYSM INJECTION TRT,ProFee,0989,36002,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
36005_3,INJECTION EXT VENOGRAPHY,ProFee,0989,36005,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
36010_3,PLACE CATHETER IN VEIN,ProFee,0989,36010,,,,0,3.00,2.25,2.25,159.00,0.00,159.00,159.00,N/A
36011_3,PLACE CATHETER IN VEIN,ProFee,0989,36011,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
36012_3,PLACE CATHETER IN VEIN,ProFee,0989,36012,,,,0,3.00,2.25,2.25,252.00,0.00,252.00,252.00,N/A
36013_3,PLACE CATHETER IN ARTERY,ProFee,0989,36013,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
36014_3,PLACE CATHETER IN ARTERY,ProFee,0989,36014,,,,0,3.00,2.25,2.25,218.50,0.00,218.50,218.50,N/A
36015_3,PLACE CATHETER IN ARTERY,ProFee,0989,36015,,,,0,3.00,2.25,2.25,249.00,0.00,249.00,249.00,N/A
36100_3,ESTABLISH ACCESS TO ARTERY,ProFee,0989,36100,,,,0,3.00,2.25,2.25,225.00,0.00,225.00,225.00,N/A
36120_3,ESTABLISH ACCESS TO ARTERY,ProFee,0989,36120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36140_3,ESTABLISH ACCESS TO ARTERY,ProFee,0989,36140,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
36145_3,ARTERY TO VEIN SHUNT,ProFee,0989,36145,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36147_3,ACCESS AV DIAL GRFT FOR EVAL,ProFee,0989,36147,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36148_3,ACCESS AV DIAL GRFT FOR PROC,ProFee,0989,36148,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36160_3,ESTABLISH ACCESS TO AORTA,ProFee,0989,36160,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
36200_3,PLACE CATHETER IN AORTA,ProFee,0989,36200,,,,0,3.00,2.25,2.25,203.00,0.00,203.00,203.00,N/A
36215_3,PLACE CATHETER IN ARTERY,ProFee,0989,36215,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
36216_3,PLACE CATHETER IN ARTERY,ProFee,0989,36216,,,,0,3.00,2.25,2.25,397.50,0.00,397.50,397.50,N/A
36217_3,PLACE CATHETER IN ARTERY,ProFee,0989,36217,,,,0,3.00,2.25,2.25,474.50,0.00,474.50,474.50,N/A
36218_3,PLACE CATHETER IN ARTERY,ProFee,0989,36218,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
36221_3,PLACE CATH THORACIC AORTA,ProFee,0989,36221,,,,0,3.00,2.25,2.25,292.00,0.00,292.00,292.00,N/A
36222_3,PLACE CATH CAROTID/INOM ART,ProFee,0989,36222,,,,0,3.00,2.25,2.25,410.50,0.00,410.50,410.50,N/A
36223_3,PLACE CATH CAROTID/INOM ART,ProFee,0989,36223,,,,0,3.00,2.25,2.25,457.00,0.00,457.00,457.00,N/A
36224_3,PLACE CATH CAROTD ART,ProFee,0989,36224,,,,0,3.00,2.25,2.25,518.50,0.00,518.50,518.50,N/A
36225_3,PLACE CATH SUBCLAVIAN ART,ProFee,0989,36225,,,,0,3.00,2.25,2.25,455.50,0.00,455.50,455.50,N/A
36226_3,PLACE CATH VERTEBRAL ART,ProFee,0989,36226,,,,0,3.00,2.25,2.25,514.00,0.00,514.00,514.00,N/A
36227_3,PLACE CATH XTRNL CAROTID,ProFee,0989,36227,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
36228_3,PLACE CATH INTRACRANIAL ART,ProFee,0989,36228,,,,0,3.00,2.25,2.25,349.50,0.00,349.50,349.50,N/A
36245_3,PLACE CATHETER IN ARTERY,ProFee,0989,36245,,,,0,3.00,2.25,2.25,346.50,0.00,346.50,346.50,N/A
36246_3,PLACE CATHETER IN ARTERY,ProFee,0989,36246,,,,0,3.00,2.25,2.25,370.50,0.00,370.50,370.50,N/A
36247_3,PLACE CATHETER IN ARTERY,ProFee,0989,36247,,,,0,3.00,2.25,2.25,440.50,0.00,440.50,440.50,N/A
36248_3,PLACE CATHETER IN ARTERY,ProFee,0989,36248,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
36251_3,INS CATH REN ART 1ST UNILAT,ProFee,0989,36251,,,,0,3.00,2.25,2.25,378.50,0.00,378.50,378.50,N/A
36252_3,INS CATH REN ART 1ST BILAT,ProFee,0989,36252,,,,0,3.00,2.25,2.25,525.50,0.00,525.50,525.50,N/A
36253_3,INS CATH REN ART 2ND+ UNILAT,ProFee,0989,36253,,,,0,3.00,2.25,2.25,521.50,0.00,521.50,521.50,N/A
36254_3,INS CATH REN ART 2ND+ BILAT,ProFee,0989,36254,,,,0,3.00,2.25,2.25,613.50,0.00,613.50,613.50,N/A
36260_3,INSERTION OF INFUSION PUMP,ProFee,0989,36260,,,,0,3.00,2.25,2.25,936.50,0.00,936.50,936.50,N/A
36261_3,REVISION OF INFUSION PUMP,ProFee,0989,36261,,,,0,3.00,2.25,2.25,579.50,0.00,579.50,579.50,N/A
36262_3,REMOVAL OF INFUSION PUMP,ProFee,0989,36262,,,,0,3.00,2.25,2.25,440.00,0.00,440.00,440.00,N/A
36299_3,VESSEL INJECTION PROCEDURE,ProFee,0989,36299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
36400_3,BL DRAW < 3 YRS FEM/JUGULAR,ProFee,0989,36400,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
36405_3,BL DRAW < 3 YRS SCALP VEIN,ProFee,0989,36405,,,,0,3.00,2.25,2.25,22.00,0.00,22.00,22.00,N/A
36406_3,BL DRAW < 3 YRS OTHER VEIN,ProFee,0989,36406,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
36410_3,NON-ROUTINE BL DRAW > 3 YRS,ProFee,0989,36410,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
36415_3,ROUTINE VENIPUNCTURE,ProFee,0989,36415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
36416_3,CAPILLARY BLOOD DRAW,ProFee,0989,36416,,,,0,3.00,2.25,2.25,4.00,0.00,4.00,4.00,N/A
36420_3,VEIN ACCESS CUTDOWN < 1 YR,ProFee,0989,36420,,,,0,3.00,2.25,2.25,67.50,0.00,67.50,67.50,N/A
36425_3,VEIN ACCESS CUTDOWN > 1 YR,ProFee,0989,36425,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
36430_3,BLOOD TRANSFUSION SERVICE,ProFee,0989,36430,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
36440_3,"BL PUSH TRANSFUSE, 2 YR OR <",ProFee,0989,36440,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
36450_3,"BL EXCHANGE/TRANSFUSE, NB",ProFee,0989,36450,,,,0,3.00,2.25,2.25,247.00,0.00,247.00,247.00,N/A
36455_3,BL EXCHANGE/TRANSFUSE NON-NB,ProFee,0989,36455,,,,0,3.00,2.25,2.25,184.00,0.00,184.00,184.00,N/A
36456_3,PRTL EXCHANGE TRANSFUSE NB,ProFee,0989,36456,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
36460_3,"TRANSFUSION SERVICE, FETAL",ProFee,0989,36460,,,,0,3.00,2.25,2.25,494.50,0.00,494.50,494.50,N/A
36465_3,NJX NONCMPND SCLRSNT 1 VEIN,ProFee,0989,36465,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
36466_3,NJX NONCMPND SCLRSNT MLT VN,ProFee,0989,36466,,,,0,3.00,2.25,2.25,220.00,0.00,220.00,220.00,N/A
36468_3,"INJECTION(S), SPIDER VEINS",ProFee,0989,36468,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
36469_3,"INJECTION(S), SPIDER VEINS",ProFee,0989,36469,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36470_3,INJECTION THERAPY OF VEIN,ProFee,0989,36470,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
36471_3,INJECTION THERAPY OF VEINS,ProFee,0989,36471,,,,0,3.00,2.25,2.25,110.50,0.00,110.50,110.50,N/A
36473_3,ENDOVENOUS MCHNCHEM 1ST VEIN,ProFee,0989,36473,,,,0,3.00,2.25,2.25,256.50,0.00,256.50,256.50,N/A
36474_3,ENDOVENOUS MCHNCHEM ADD-ON,ProFee,0989,36474,,,,0,3.00,2.25,2.25,128.50,0.00,128.50,128.50,N/A
36475_3,"ENDOVENOUS RF, 1ST VEIN",ProFee,0989,36475,,,,0,3.00,2.25,2.25,407.00,0.00,407.00,407.00,N/A
36476_3,"ENDOVENOUS RF, VEIN ADD-ON",ProFee,0989,36476,,,,0,3.00,2.25,2.25,197.50,0.00,197.50,197.50,N/A
36478_3,"ENDOVENOUS LASER, 1ST VEIN",ProFee,0989,36478,,,,0,3.00,2.25,2.25,404.00,0.00,404.00,404.00,N/A
36479_3,ENDOVENOUS LASER VEIN ADDON,ProFee,0989,36479,,,,0,3.00,2.25,2.25,198.00,0.00,198.00,198.00,N/A
36481_3,"INSERTION OF CATHETER, VEIN",ProFee,0989,36481,,,,0,3.00,2.25,2.25,487.00,0.00,487.00,487.00,N/A
36482_3,ENDOVEN THER CHEM ADHES 1ST,ProFee,0989,36482,,,,0,3.00,2.25,2.25,256.50,0.00,256.50,256.50,N/A
36483_3,ENDOVEN THER CHEM ADHES SBSQ,ProFee,0989,36483,,,,0,3.00,2.25,2.25,128.00,0.00,128.00,128.00,N/A
36500_3,"INSERTION OF CATHETER, VEIN",ProFee,0989,36500,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
3650F_3,EEG ORDERED RVWD REQSTD,ProFee,0989,3650F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
36510_3,"INSERTION OF CATHETER, VEIN",ProFee,0989,36510,,,,0,3.00,2.25,2.25,77.00,0.00,77.00,77.00,N/A
36511_3,APHERESIS WBC,ProFee,0989,36511,,,,0,3.00,2.25,2.25,156.00,0.00,156.00,156.00,N/A
36512_3,APHERESIS RBC,ProFee,0989,36512,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
36513_3,APHERESIS PLATELETS,ProFee,0989,36513,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
36514_3,APHERESIS PLASMA,ProFee,0989,36514,,,,0,3.00,2.25,2.25,139.50,0.00,139.50,139.50,N/A
36515_3,"APHERESIS, ADSORP/REINFUSE",ProFee,0989,36516,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
36516_3,"APHERESIS, SELECTIVE",ProFee,0989,36516,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
36522_3,PHOTOPHERESIS,ProFee,0989,36522,,,,0,3.00,2.25,2.25,140.50,0.00,140.50,140.50,N/A
36540_3,COLLECT BLOOD VENOUS DEVICE,ProFee,0989,36540,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36550_3,DECLOT VASCULAR DEVICE,ProFee,0989,36550,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36555_3,INSERT NON-TUNNEL CV CATH,ProFee,0989,36555,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
36556_3,INSERT NON-TUNNEL CV CATH,ProFee,0989,36556,,,,0,3.00,2.25,2.25,141.00,0.00,141.00,141.00,N/A
36557_3,INSERT TUNNELED CV CATH,ProFee,0989,36557,,,,0,3.00,2.25,2.25,459.00,0.00,459.00,459.00,N/A
36558_3,INSERT TUNNELED CV CATH,ProFee,0989,36558,,,,0,3.00,2.25,2.25,379.00,0.00,379.00,379.00,N/A
36560_3,INSERT TUNNELED CV CATH,ProFee,0989,36560,,,,0,3.00,2.25,2.25,551.50,0.00,551.50,551.50,N/A
36561_3,INSERT TUNNELED CV CATH,ProFee,0989,36561,,,,0,3.00,2.25,2.25,489.50,0.00,489.50,489.50,N/A
36563_3,INSERT TUNNELED CV CATH,ProFee,0989,36563,,,,0,3.00,2.25,2.25,533.50,0.00,533.50,533.50,N/A
36565_3,INSERT TUNNELED CV CATH,ProFee,0989,36565,,,,0,3.00,2.25,2.25,484.00,0.00,484.00,484.00,N/A
36566_3,INSERT TUNNELED CV CATH,ProFee,0989,36566,,,,0,3.00,2.25,2.25,532.50,0.00,532.50,532.50,N/A
36568_3,INSERT PICC CATH,ProFee,0989,36568,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
36569_3,INSERT PICC CATH,ProFee,0989,36569,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
36570_3,INSERT PICVAD CATH,ProFee,0989,36570,,,,0,3.00,2.25,2.25,477.50,0.00,477.50,477.50,N/A
36571_3,INSERT PICVAD CATH,ProFee,0989,36571,,,,0,3.00,2.25,2.25,449.00,0.00,449.00,449.00,N/A
36572_3,INSJ PICC RS&I <5 YR,ProFee,0989,36572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
36573_3,INSJ PICC RS&I 5 YR+,ProFee,0989,36573,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
36575_3,REPAIR TUNNELED CV CATH,ProFee,0989,36575,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
36576_3,REPAIR TUNNELED CV CATH,ProFee,0989,36576,,,,0,3.00,2.25,2.25,266.00,0.00,266.00,266.00,N/A
36578_3,REPLACE TUNNELED CV CATH,ProFee,0989,36578,,,,0,3.00,2.25,2.25,293.50,0.00,293.50,293.50,N/A
36580_3,REPLACE CVAD CATH,ProFee,0989,36580,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
36581_3,REPLACE TUNNELED CV CATH,ProFee,0989,36581,,,,0,3.00,2.25,2.25,265.00,0.00,265.00,265.00,N/A
36582_3,REPLACE TUNNELED CV CATH,ProFee,0989,36582,,,,0,3.00,2.25,2.25,419.50,0.00,419.50,419.50,N/A
36583_3,REPLACE TUNNELED CV CATH,ProFee,0989,36583,,,,0,3.00,2.25,2.25,472.00,0.00,472.00,472.00,N/A
36584_3,REPLACE PICC CATH,ProFee,0989,36584,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
36585_3,REPLACE PICVAD CATH,ProFee,0989,36585,,,,0,3.00,2.25,2.25,392.50,0.00,392.50,392.50,N/A
36589_3,REMOVAL TUNNELED CV CATH,ProFee,0989,36589,,,,0,3.00,2.25,2.25,197.50,0.00,197.50,197.50,N/A
36590_3,REMOVAL TUNNELED CV CATH,ProFee,0989,36590,,,,0,3.00,2.25,2.25,275.50,0.00,275.50,275.50,N/A
36591_3,DRAW BLOOD OFF VENOUS DEVICE,ProFee,0989,36591,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
36592_3,COLLECT BLOOD FROM PICC,ProFee,0989,36592,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
36593_3,DECLOT VASCULAR DEVICE,ProFee,0989,36593,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
36595_3,MECH REMOV TUNNELED CV CATH,ProFee,0989,36595,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
36596_3,MECH REMOV TUNNELED CV CATH,ProFee,0989,36596,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
36597_3,REPOSITION VENOUS CATHETER,ProFee,0989,36597,,,,0,3.00,2.25,2.25,88.00,0.00,88.00,88.00,N/A
36598_3,"INJ W/FLUOR, EVAL CV DEVICE",ProFee,0989,36598,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
36600_3,WITHDRAWAL OF ARTERIAL BLOOD,ProFee,0989,36600,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
36620_3,"INSERTION CATHETER, ARTERY",ProFee,0989,36620,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
36625_3,"INSERTION CATHETER, ARTERY",ProFee,0989,36625,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
36640_3,"INSERTION CATHETER, ARTERY",ProFee,0989,36640,,,,0,3.00,2.25,2.25,165.00,0.00,165.00,165.00,N/A
36660_3,"INSERTION CATHETER, ARTERY",ProFee,0989,36660,,,,0,3.00,2.25,2.25,99.00,0.00,99.00,99.00,N/A
36800_3,INSERTION OF CANNULA,ProFee,0989,36800,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
36810_3,INSERTION OF CANNULA,ProFee,0989,36810,,,,0,3.00,2.25,2.25,307.00,0.00,307.00,307.00,N/A
36815_3,INSERTION OF CANNULA,ProFee,0989,36815,,,,0,3.00,2.25,2.25,197.00,0.00,197.00,197.00,N/A
36818_3,"AV FUSE, UPPR ARM, CEPHALIC",ProFee,0989,36818,,,,0,3.00,2.25,2.25,1010.50,0.00,1010.50,1010.50,N/A
36819_3,"AV FUSE, UPPR ARM, BASILIC",ProFee,0989,36819,,,,0,3.00,2.25,2.25,1064.50,0.00,1064.50,1064.50,N/A
36820_3,AV FUSION/FOREARM VEIN,ProFee,0989,36820,,,,0,3.00,2.25,2.25,1068.50,0.00,1068.50,1068.50,N/A
36821_3,AV FUSION DIRECT ANY SITE,ProFee,0989,36821,,,,0,3.00,2.25,2.25,966.50,0.00,966.50,966.50,N/A
36822_3,INSERTION OF CANNULA(S),ProFee,0989,36822,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36823_3,INSERTION OF CANNULA(S),ProFee,0989,36823,,,,0,3.00,2.25,2.25,2018.50,0.00,2018.50,2018.50,N/A
36825_3,ARTERY-VEIN AUTOGRAFT,ProFee,0989,36825,,,,0,3.00,2.25,2.25,1161.00,0.00,1161.00,1161.00,N/A
36830_3,ARTERY-VEIN NONAUTOGRAFT,ProFee,0989,36830,,,,0,3.00,2.25,2.25,970.00,0.00,970.00,970.00,N/A
36831_3,OPEN THROMBECT AV FISTULA,ProFee,0989,36831,,,,0,3.00,2.25,2.25,898.00,0.00,898.00,898.00,N/A
36832_3,"AV FISTULA REVISION, OPEN",ProFee,0989,36832,,,,0,3.00,2.25,2.25,1101.50,0.00,1101.50,1101.50,N/A
36833_3,AV FISTULA REVISION,ProFee,0989,36833,,,,0,3.00,2.25,2.25,1182.50,0.00,1182.50,1182.50,N/A
36834_3,REPAIR A-V ANEURYSM,ProFee,0989,36834,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36835_3,ARTERY TO VEIN SHUNT,ProFee,0989,36835,,,,0,3.00,2.25,2.25,690.00,0.00,690.00,690.00,N/A
36838_3,"DIST REVAS LIGATION, HEMO",ProFee,0989,36838,,,,0,3.00,2.25,2.25,1668.50,0.00,1668.50,1668.50,N/A
36860_3,EXTERNAL CANNULA DECLOTTING,ProFee,0989,36860,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
36861_3,CANNULA DECLOTTING,ProFee,0989,36861,,,,0,3.00,2.25,2.25,201.00,0.00,201.00,201.00,N/A
36870_3,PERCUT THROMBECT AV FISTULA,ProFee,0989,36870,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
36901_3,INTRO CATH DIALYSIS CIRCUIT,ProFee,0989,36901,,,,0,3.00,2.25,2.25,245.00,0.00,245.00,245.00,N/A
36902_3,INTRO CATH DIALYSIS CIRCUIT,ProFee,0989,36902,,,,0,3.00,2.25,2.25,349.00,0.00,349.00,349.00,N/A
36903_3,INTRO CATH DIALYSIS CIRCUIT,ProFee,0989,36903,,,,0,3.00,2.25,2.25,462.00,0.00,462.00,462.00,N/A
36904_3,THRMBC/NFS DIALYSIS CIRCUIT,ProFee,0989,36904,,,,0,3.00,2.25,2.25,539.00,0.00,539.00,539.00,N/A
36905_3,THRMBC/NFS DIALYSIS CIRCUIT,ProFee,0989,36905,,,,0,3.00,2.25,2.25,647.00,0.00,647.00,647.00,N/A
36906_3,THRMBC/NFS DIALYSIS CIRCUIT,ProFee,0989,36906,,,,0,3.00,2.25,2.25,747.50,0.00,747.50,747.50,N/A
36907_3,BALO ANGIOP CTR DIALYSIS SEG,ProFee,0989,36907,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
36908_3,STENT PLMT CTR DIALYSIS SEG,ProFee,0989,36908,,,,0,3.00,2.25,2.25,305.00,0.00,305.00,305.00,N/A
36909_3,DIALYSIS CIRCUIT EMBOLJ,ProFee,0989,36909,,,,0,3.00,2.25,2.25,302.00,0.00,302.00,302.00,N/A
3700F_3,PSYCH DISORDERS ASSESSED,ProFee,0989,3700F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37140_3,REVISION OF CIRCULATION,ProFee,0989,37140,,,,0,3.00,2.25,2.25,3359.50,0.00,3359.50,3359.50,N/A
37145_3,REVISION OF CIRCULATION,ProFee,0989,37145,,,,0,3.00,2.25,2.25,3117.00,0.00,3117.00,3117.00,N/A
37160_3,REVISION OF CIRCULATION,ProFee,0989,37160,,,,0,3.00,2.25,2.25,3200.50,0.00,3200.50,3200.50,N/A
37180_3,REVISION OF CIRCULATION,ProFee,0989,37180,,,,0,3.00,2.25,2.25,3080.00,0.00,3080.00,3080.00,N/A
37181_3,SPLICE SPLEEN/KIDNEY VEINS,ProFee,0989,37181,,,,0,3.00,2.25,2.25,3359.50,0.00,3359.50,3359.50,N/A
37182_3,INSERT HEPATIC SHUNT (TIPS),ProFee,0989,37182,,,,0,3.00,2.25,2.25,1195.00,0.00,1195.00,1195.00,N/A
37183_3,REMOVE HEPATIC SHUNT (TIPS),ProFee,0989,37183,,,,0,3.00,2.25,2.25,545.00,0.00,545.00,545.00,N/A
37184_3,PRIM ART MECH THROMBECTOMY,ProFee,0989,37184,,,,0,3.00,2.25,2.25,654.50,0.00,654.50,654.50,N/A
37185_3,PRIM ART M-THROMBECT ADD-ON,ProFee,0989,37185,,,,0,3.00,2.25,2.25,245.00,0.00,245.00,245.00,N/A
37186_3,SEC ART M-THROMBECT ADD-ON,ProFee,0989,37186,,,,0,3.00,2.25,2.25,357.00,0.00,357.00,357.00,N/A
37187_3,VENOUS MECH THROMBECTOMY,ProFee,0989,37187,,,,0,3.00,2.25,2.25,571.00,0.00,571.00,571.00,N/A
37188_3,VENOUS M-THROMBECTOMY ADD-ON,ProFee,0989,37188,,,,0,3.00,2.25,2.25,406.50,0.00,406.50,406.50,N/A
37191_3,INS ENDOVAS VENA CAVA FILTR,ProFee,0989,37191,,,,0,3.00,2.25,2.25,326.50,0.00,326.50,326.50,N/A
37192_3,REDO ENDOVAS VENA CAVA FILTR,ProFee,0989,37192,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
37193_3,REM ENDOVAS VENA CAVA FILTER,ProFee,0989,37193,,,,0,3.00,2.25,2.25,509.50,0.00,509.50,509.50,N/A
37195_3,"THROMBOLYTIC THERAPY, STROKE",ProFee,0989,37195,,,,0,3.00,2.25,2.25,1357.50,0.00,1357.50,1357.50,N/A
37197_3,REMOVE INTRVAS FOREIGN BODY,ProFee,0989,37197,,,,0,3.00,2.25,2.25,438.50,0.00,438.50,438.50,N/A
37200_3,TRANSCATHETER BIOPSY,ProFee,0989,37200,,,,0,3.00,2.25,2.25,315.50,0.00,315.50,315.50,N/A
37201_3,TRANSCATHETER THERAPY INFUSE,ProFee,0989,37201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37202_3,TRANSCATHETER THERAPY INFUSE,ProFee,0989,37202,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37203_3,TRANSCATHETER RETRIEVAL,ProFee,0989,37203,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37204_3,TRANSCATHETER OCCLUSION,ProFee,0989,37204,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37205_3,"TRANSCATH IV STENT, PERCUT",ProFee,0989,37205,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37206_3,TRANSCATH IV STENT/PERC ADDL,ProFee,0989,37206,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37207_3,"TRANSCATH IV STENT, OPEN",ProFee,0989,37207,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37208_3,TRANSCATH IV STENT/OPEN ADDL,ProFee,0989,37208,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37209_3,EXCHANGE ARTERIAL CATHETER,ProFee,0989,37209,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3720F_3,COGNIT IMPAIRMENT ASSESSED,ProFee,0989,3720F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37210_3,EMBOLIZATION UTERINE FIBROID,ProFee,0989,37210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37211_3,THROMBOLYTIC ART THERAPY,ProFee,0989,37211,,,,0,3.00,2.25,2.25,560.50,0.00,560.50,560.50,N/A
37212_3,THROMBOLYTIC VENOUS THERAPY,ProFee,0989,37212,,,,0,3.00,2.25,2.25,491.00,0.00,491.00,491.00,N/A
37213_3,THROMBLYTIC ART/VEN THERAPY,ProFee,0989,37213,,,,0,3.00,2.25,2.25,339.50,0.00,339.50,339.50,N/A
37214_3,CESSJ THERAPY CATH REMOVAL,ProFee,0989,37214,,,,0,3.00,2.25,2.25,178.00,0.00,178.00,178.00,N/A
37215_3,"TRANSCATH STENT, CCA W/EPS",ProFee,0989,37215,,,,0,3.00,2.25,2.25,1459.00,0.00,1459.00,1459.00,N/A
37216_3,"TRANSCATH STENT, CCA W/O EPS",ProFee,0989,37216,,,,0,3.00,2.25,2.25,1465.50,0.00,1465.50,1465.50,N/A
37217_3,STENT PLACEMT RETRO CAROTID,ProFee,0989,37217,,,,0,3.00,2.25,2.25,1576.50,0.00,1576.50,1576.50,N/A
37218_3,STENT PLACEMT ANTE CAROTID,ProFee,0989,37218,,,,0,3.00,2.25,2.25,1181.50,0.00,1181.50,1181.50,N/A
37220_3,ILIAC REVASC,ProFee,0989,37220,,,,0,3.00,2.25,2.25,586.00,0.00,586.00,586.00,N/A
37221_3,ILIAC REVASC W/STENT,ProFee,0989,37221,,,,0,3.00,2.25,2.25,723.00,0.00,723.00,723.00,N/A
37222_3,ILIAC REVASC ADD-ON,ProFee,0989,37222,,,,0,3.00,2.25,2.25,272.50,0.00,272.50,272.50,N/A
37223_3,ILIAC REVASC W/STENT ADD-ON,ProFee,0989,37223,,,,0,3.00,2.25,2.25,311.50,0.00,311.50,311.50,N/A
37224_3,FEM/POPL REVAS W/TLA,ProFee,0989,37224,,,,0,3.00,2.25,2.25,648.50,0.00,648.50,648.50,N/A
37225_3,FEM/POPL REVAS W/ATHER,ProFee,0989,37225,,,,0,3.00,2.25,2.25,884.50,0.00,884.50,884.50,N/A
37226_3,FEM/POPL REVASC W/STENT,ProFee,0989,37226,,,,0,3.00,2.25,2.25,762.50,0.00,762.50,762.50,N/A
37227_3,FEM/POPL REVASC STNT & ATHER,ProFee,0989,37227,,,,0,3.00,2.25,2.25,1063.00,0.00,1063.00,1063.00,N/A
37228_3,TIB/PER REVASC W/TLA,ProFee,0989,37228,,,,0,3.00,2.25,2.25,794.00,0.00,794.00,794.00,N/A
37229_3,TIB/PER REVASC W/ATHER,ProFee,0989,37229,,,,0,3.00,2.25,2.25,1031.00,0.00,1031.00,1031.00,N/A
37230_3,TIB/PER REVASC W/STENT,ProFee,0989,37230,,,,0,3.00,2.25,2.25,1020.50,0.00,1020.50,1020.50,N/A
37231_3,TIB/PER REVASC STENT & ATHER,ProFee,0989,37231,,,,0,3.00,2.25,2.25,1108.50,0.00,1108.50,1108.50,N/A
37232_3,TIB/PER REVASC ADD-ON,ProFee,0989,37232,,,,0,3.00,2.25,2.25,294.50,0.00,294.50,294.50,N/A
37233_3,TIBPER REVASC W/ATHER ADD-ON,ProFee,0989,37233,,,,0,3.00,2.25,2.25,480.00,0.00,480.00,480.00,N/A
37234_3,REVSC OPN/PRQ TIB/PERO STENT,ProFee,0989,37234,,,,0,3.00,2.25,2.25,416.50,0.00,416.50,416.50,N/A
37235_3,TIB/PER REVASC STNT & ATHER,ProFee,0989,37235,,,,0,3.00,2.25,2.25,584.00,0.00,584.00,584.00,N/A
37236_3,OPEN/PERQ PLACE STENT 1ST,ProFee,0989,37236,,,,0,3.00,2.25,2.25,650.00,0.00,650.00,650.00,N/A
37237_3,OPEN/PERQ PLACE STENT EA ADD,ProFee,0989,37237,,,,0,3.00,2.25,2.25,311.00,0.00,311.00,311.00,N/A
37238_3,OPEN/PERQ PLACE STENT SAME,ProFee,0989,37238,,,,0,3.00,2.25,2.25,436.50,0.00,436.50,436.50,N/A
37239_3,OPEN/PERQ PLACE STENT EA ADD,ProFee,0989,37239,,,,0,3.00,2.25,2.25,221.50,0.00,221.50,221.50,N/A
37241_3,VASC EMBOLIZE/OCCLUDE VENOUS,ProFee,0989,37241,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
37242_3,VASC EMBOLIZE/OCCLUDE ARTERY,ProFee,0989,37242,,,,0,3.00,2.25,2.25,697.50,0.00,697.50,697.50,N/A
37243_3,VASC EMBOLIZE/OCCLUDE ORGAN,ProFee,0989,37243,,,,0,3.00,2.25,2.25,819.00,0.00,819.00,819.00,N/A
37244_3,VASC EMBOLIZE/OCCLUDE BLEED,ProFee,0989,37244,,,,0,3.00,2.25,2.25,968.50,0.00,968.50,968.50,N/A
37246_3,TRLUML BALO ANGIOP 1ST ART,ProFee,0989,37246,,,,0,3.00,2.25,2.25,507.00,0.00,507.00,507.00,N/A
37247_3,TRLUML BALO ANGIOP ADDL ART,ProFee,0989,37247,,,,0,3.00,2.25,2.25,249.00,0.00,249.00,249.00,N/A
37248_3,TRLUML BALO ANGIOP 1ST VEIN,ProFee,0989,37248,,,,0,3.00,2.25,2.25,434.00,0.00,434.00,434.00,N/A
37249_3,TRLUML BALO ANGIOP ADDL VEIN,ProFee,0989,37249,,,,0,3.00,2.25,2.25,211.00,0.00,211.00,211.00,N/A
37250_3,IV US FIRST VESSEL ADD-ON,ProFee,0989,37250,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37251_3,IV US EACH ADD VESSEL ADD-ON,ProFee,0989,37251,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
37252_3,INTRVASC US NONCORONARY 1ST,ProFee,0989,37252,,,,0,3.00,2.25,2.25,133.00,0.00,133.00,133.00,N/A
37253_3,INTRVASC US NONCORONARY ADDL,ProFee,0989,37253,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
3725F_3,SCREEN DEPRESSION PERFORMED,ProFee,0989,3725F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37500_3,ENDOSCOPY LIGATE PERF VEINS,ProFee,0989,37500,,,,0,3.00,2.25,2.25,923.00,0.00,923.00,923.00,N/A
37501_3,VASCULAR ENDOSCOPY PROCEDURE,ProFee,0989,37501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3750F_3,PTNOTRCVNGSTEROID>/=10MG/DAY,ProFee,0989,3750F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3751F_3,ELECTRODIAG POLYNEURO 6 MN,ProFee,0989,3751F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3752F_3,NO ELECTRODIAG POLYNEURO 6MN,ProFee,0989,3752F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3753F_3,PT HAS SYMP&SIGNS NEUROPATHY,ProFee,0989,3753F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3754F_3,SCREENING TESTS DM DONE,ProFee,0989,3754F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3755F_3,COG&BEHAV IMPRMNT SCRNG DONE,ProFee,0989,3755F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37565_3,LIGATION OF NECK VEIN,ProFee,0989,37565,,,,0,3.00,2.25,2.25,1048.50,0.00,1048.50,1048.50,N/A
3756F_3,PT W/PSEUDOBULB AFFECT/ALS,ProFee,0989,3756F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3757F_3,PT W/O PSEUDOBULBAFFECT/ALS,ProFee,0989,3757F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3758F_3,PT REF PULM FX TEST/PEAKFLOW,ProFee,0989,3758F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3759F_3,PT SCRN DYSPHAG/WT LOSS/NUTR,ProFee,0989,3759F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37600_3,LIGATION OF NECK ARTERY,ProFee,0989,37600,,,,0,3.00,2.25,2.25,1041.50,0.00,1041.50,1041.50,N/A
37605_3,LIGATION OF NECK ARTERY,ProFee,0989,37605,,,,0,3.00,2.25,2.25,1072.00,0.00,1072.00,1072.00,N/A
37606_3,LIGATION OF NECK ARTERY,ProFee,0989,37606,,,,0,3.00,2.25,2.25,1043.50,0.00,1043.50,1043.50,N/A
37607_3,LIGATION OF A-V FISTULA,ProFee,0989,37607,,,,0,3.00,2.25,2.25,545.00,0.00,545.00,545.00,N/A
37609_3,TEMPORAL ARTERY PROCEDURE,ProFee,0989,37609,,,,0,3.00,2.25,2.25,298.50,0.00,298.50,298.50,N/A
3760F_3,PT W/DYSPHAG/WT LOSS/NUTR,ProFee,0989,3760F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37615_3,LIGATION OF NECK ARTERY,ProFee,0989,37615,,,,0,3.00,2.25,2.25,756.50,0.00,756.50,756.50,N/A
37616_3,LIGATION OF CHEST ARTERY,ProFee,0989,37616,,,,0,3.00,2.25,2.25,1613.00,0.00,1613.00,1613.00,N/A
37617_3,LIGATION OF ABDOMEN ARTERY,ProFee,0989,37617,,,,0,3.00,2.25,2.25,1941.50,0.00,1941.50,1941.50,N/A
37618_3,LIGATION OF EXTREMITY ARTERY,ProFee,0989,37618,,,,0,3.00,2.25,2.25,555.00,0.00,555.00,555.00,N/A
37619_3,LIGATION OF INF VENA CAVA,ProFee,0989,37619,,,,0,3.00,2.25,2.25,2500.00,0.00,2500.00,2500.00,N/A
3761F_3,PT W/O DYSPHAG/WT LOSS/NUTR,ProFee,0989,3761F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37620_3,REVISION OF MAJOR VEIN,ProFee,0989,37620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
3762F_3,PATIENT IS DYSARTHRIC,ProFee,0989,3762F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
3763F_3,PATIENT IS NOT DYSARTHRIC,ProFee,0989,3763F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37650_3,REVISION OF MAJOR VEIN,ProFee,0989,37650,,,,0,3.00,2.25,2.25,665.50,0.00,665.50,665.50,N/A
37660_3,REVISION OF MAJOR VEIN,ProFee,0989,37660,,,,0,3.00,2.25,2.25,1907.00,0.00,1907.00,1907.00,N/A
37700_3,REVISE LEG VEIN,ProFee,0989,37700,,,,0,3.00,2.25,2.25,358.00,0.00,358.00,358.00,N/A
37718_3,LIGATE/STRIP SHORT LEG VEIN,ProFee,0989,37718,,,,0,3.00,2.25,2.25,626.50,0.00,626.50,626.50,N/A
37722_3,LIGATE/STRIP LONG LEG VEIN,ProFee,0989,37722,,,,0,3.00,2.25,2.25,688.00,0.00,688.00,688.00,N/A
37735_3,REMOVAL OF LEG VEINS/LESION,ProFee,0989,37735,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
3775F_3,ADENOMA DETECTED SCREENING,ProFee,0989,3775F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37760_3,"LIGATION, LEG VEINS, OPEN",ProFee,0989,37760,,,,0,3.00,2.25,2.25,896.00,0.00,896.00,896.00,N/A
37761_3,LIGATE LEG VEINS OPEN,ProFee,0989,37761,,,,0,3.00,2.25,2.25,789.00,0.00,789.00,789.00,N/A
37765_3,PHLEB VEINS - EXTREM - to 20,ProFee,0989,37765,,,,0,3.00,2.25,2.25,650.00,0.00,650.00,650.00,N/A
37766_3,PHLEB VEINS - EXTREM 20+,ProFee,0989,37766,,,,0,3.00,2.25,2.25,795.00,0.00,795.00,795.00,N/A
3776F_3,ADENOMA NOT DETECT SCREENING,ProFee,0989,3776F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
37780_3,REVISION OF LEG VEIN,ProFee,0989,37780,,,,0,3.00,2.25,2.25,339.50,0.00,339.50,339.50,N/A
37785_3,LIGATE/DIVIDE/EXCISE VEIN,ProFee,0989,37785,,,,0,3.00,2.25,2.25,377.00,0.00,377.00,377.00,N/A
37788_3,"REVASCULARIZATION, PENIS",ProFee,0989,37788,,,,0,3.00,2.25,2.25,1831.50,0.00,1831.50,1831.50,N/A
37790_3,PENILE VENOUS OCCLUSION,ProFee,0989,37790,,,,0,3.00,2.25,2.25,706.50,0.00,706.50,706.50,N/A
37799_3,VASCULAR SURGERY PROCEDURE,ProFee,0989,37799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
38100_3,"REMOVAL OF SPLEEN, TOTAL",ProFee,0989,38100,,,,0,3.00,2.25,2.25,1670.00,0.00,1670.00,1670.00,N/A
38101_3,"REMOVAL OF SPLEEN, PARTIAL",ProFee,0989,38101,,,,0,3.00,2.25,2.25,1688.50,0.00,1688.50,1688.50,N/A
38102_3,"REMOVAL OF SPLEEN, TOTAL",ProFee,0989,38102,,,,0,3.00,2.25,2.25,382.50,0.00,382.50,382.50,N/A
38115_3,REPAIR OF RUPTURED SPLEEN,ProFee,0989,38115,,,,0,3.00,2.25,2.25,1848.50,0.00,1848.50,1848.50,N/A
38120_3,"LAPAROSCOPY, SPLENECTOMY",ProFee,0989,38120,,,,0,3.00,2.25,2.25,1522.50,0.00,1522.50,1522.50,N/A
38129_3,"LAPAROSCOPE PROC, SPLEEN",ProFee,0989,38129,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
38200_3,INJECTION FOR SPLEEN X-RAY,ProFee,0989,38200,,,,0,3.00,2.25,2.25,192.00,0.00,192.00,192.00,N/A
38204_3,BL DONOR SEARCH MANAGEMENT,ProFee,0989,38204,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
38205_3,HARVEST ALLOGENIC STEM CELLS,ProFee,0989,38205,,,,0,3.00,2.25,2.25,120.50,0.00,120.50,120.50,N/A
38206_3,HARVEST AUTO STEM CELLS,ProFee,0989,38206,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
38207_3,CRYOPRESERVE STEM CELLS,ProFee,0989,38207,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
38208_3,THAW PRESERVED STEM CELLS,ProFee,0989,38208,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
38209_3,WASH HARVEST STEM CELLS,ProFee,0989,38209,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
38210_3,T-CELL DEPLETION OF HARVEST,ProFee,0989,38210,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
38211_3,TUMOR CELL DEPLETE OF HARVST,ProFee,0989,38211,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
38212_3,RBC DEPLETION OF HARVEST,ProFee,0989,38212,,,,0,3.00,2.25,2.25,72.00,0.00,72.00,72.00,N/A
38213_3,PLATELET DEPLETE OF HARVEST,ProFee,0989,38213,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
38214_3,VOLUME DEPLETE OF HARVEST,ProFee,0989,38214,,,,0,3.00,2.25,2.25,62.00,0.00,62.00,62.00,N/A
38215_3,HARVEST STEM CELL CONCENTRTE,ProFee,0989,38215,,,,0,3.00,2.25,2.25,72.00,0.00,72.00,72.00,N/A
38220_3,BONE MARROW ASPIRATION,ProFee,0989,38220,,,,0,3.00,2.25,2.25,100.00,0.00,100.00,100.00,N/A
38221_3,BONE MARROW BIOPSY,ProFee,0989,38221,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
38222_3,DX BONE MARROW BX & ASPIR,ProFee,0989,38222,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
38230_3,BONE MARROW COLLECTION,ProFee,0989,38230,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
38232_3,BONE MARROW HARVEST AUTOLOG,ProFee,0989,38232,,,,0,3.00,2.25,2.25,288.00,0.00,288.00,288.00,N/A
38240_3,BONE MARROW/STEM TRANSPLANT,ProFee,0989,38240,,,,0,3.00,2.25,2.25,326.00,0.00,326.00,326.00,N/A
38241_3,BONE MARROW/STEM TRANSPLANT,ProFee,0989,38241,,,,0,3.00,2.25,2.25,244.00,0.00,244.00,244.00,N/A
38242_3,LYMPHOCYTE INFUSE TRANSPLANT,ProFee,0989,38242,,,,0,3.00,2.25,2.25,172.00,0.00,172.00,172.00,N/A
38243_3,TRANSPLJ HEMATOPOIETIC BOOST,ProFee,0989,38243,,,,0,3.00,2.25,2.25,155.50,0.00,155.50,155.50,N/A
38300_3,"DRAINAGE, LYMPH NODE LESION",ProFee,0989,38300,,,,0,3.00,2.25,2.25,291.50,0.00,291.50,291.50,N/A
38305_3,"DRAINAGE, LYMPH NODE LESION",ProFee,0989,38305,,,,0,3.00,2.25,2.25,697.50,0.00,697.50,697.50,N/A
38308_3,INCISION OF LYMPH CHANNELS,ProFee,0989,38308,,,,0,3.00,2.25,2.25,643.50,0.00,643.50,643.50,N/A
38380_3,THORACIC DUCT PROCEDURE,ProFee,0989,38380,,,,0,3.00,2.25,2.25,806.50,0.00,806.50,806.50,N/A
38381_3,THORACIC DUCT PROCEDURE,ProFee,0989,38381,,,,0,3.00,2.25,2.25,1159.00,0.00,1159.00,1159.00,N/A
38382_3,THORACIC DUCT PROCEDURE,ProFee,0989,38382,,,,0,3.00,2.25,2.25,971.50,0.00,971.50,971.50,N/A
38500_3,"BIOPSY/REMOVAL, LYMPH NODES",ProFee,0989,38500,,,,0,3.00,2.25,2.25,367.00,0.00,367.00,367.00,N/A
38505_3,"NEEDLE BIOPSY, LYMPH NODES",ProFee,0989,38505,,,,0,3.00,2.25,2.25,102.00,0.00,102.00,102.00,N/A
38510_3,"BIOPSY/REMOVAL, LYMPH NODES",ProFee,0989,38510,,,,0,3.00,2.25,2.25,602.50,0.00,602.50,602.50,N/A
38520_3,"BIOPSY/REMOVAL, LYMPH NODES",ProFee,0989,38520,,,,0,3.00,2.25,2.25,668.00,0.00,668.00,668.00,N/A
38525_3,"BIOPSY/REMOVAL, LYMPH NODES",ProFee,0989,38525,,,,0,3.00,2.25,2.25,631.00,0.00,631.00,631.00,N/A
38530_3,"BIOPSY/REMOVAL, LYMPH NODES",ProFee,0989,38530,,,,0,3.00,2.25,2.25,806.00,0.00,806.00,806.00,N/A
38531_3,OPEN BX/EXC INGUINOFEM NODES,ProFee,0989,38531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
38542_3,"EXPLORE DEEP NODE(S), NECK",ProFee,0989,38542,,,,0,3.00,2.25,2.25,740.50,0.00,740.50,740.50,N/A
38550_3,"REMOVAL, NECK/ARMPIT LESION",ProFee,0989,38550,,,,0,3.00,2.25,2.25,734.00,0.00,734.00,734.00,N/A
38555_3,"REMOVAL, NECK/ARMPIT LESION",ProFee,0989,38555,,,,0,3.00,2.25,2.25,1456.00,0.00,1456.00,1456.00,N/A
38562_3,"REMOVAL, PELVIC LYMPH NODES",ProFee,0989,38562,,,,0,3.00,2.25,2.25,1019.50,0.00,1019.50,1019.50,N/A
38564_3,"REMOVAL, ABDOMEN LYMPH NODES",ProFee,0989,38564,,,,0,3.00,2.25,2.25,1016.00,0.00,1016.00,1016.00,N/A
38570_3,"LAPAROSCOPY, LYMPH NODE BIOP",ProFee,0989,38570,,,,0,3.00,2.25,2.25,733.00,0.00,733.00,733.00,N/A
38571_3,"LAPAROSCOPY, LYMPHADENECTOMY",ProFee,0989,38571,,,,0,3.00,2.25,2.25,961.50,0.00,961.50,961.50,N/A
38572_3,"LAPAROSCOPY, LYMPHADENECTOMY",ProFee,0989,38572,,,,0,3.00,2.25,2.25,1337.50,0.00,1337.50,1337.50,N/A
38573_3,LAPS PELVIC LYMPHADEC,ProFee,0989,38573,,,,0,3.00,2.25,2.25,1679.50,0.00,1679.50,1679.50,N/A
38589_3,"LAPAROSCOPE PROC, LYMPHATIC",ProFee,0989,38589,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
38700_3,"REMOVAL OF LYMPH NODES, NECK",ProFee,0989,38700,,,,0,3.00,2.25,2.25,1146.50,0.00,1146.50,1146.50,N/A
38720_3,"REMOVAL OF LYMPH NODES, NECK",ProFee,0989,38720,,,,0,3.00,2.25,2.25,1919.00,0.00,1919.00,1919.00,N/A
38724_3,"REMOVAL OF LYMPH NODES, NECK",ProFee,0989,38724,,,,0,3.00,2.25,2.25,2069.00,0.00,2069.00,2069.00,N/A
38740_3,REMOVE ARMPIT LYMPH NODES,ProFee,0989,38740,,,,0,3.00,2.25,2.25,1003.50,0.00,1003.50,1003.50,N/A
38745_3,REMOVE ARMPIT LYMPH NODES,ProFee,0989,38745,,,,0,3.00,2.25,2.25,1267.50,0.00,1267.50,1267.50,N/A
38746_3,REMOVE THORACIC LYMPH NODES,ProFee,0989,38746,,,,0,3.00,2.25,2.25,311.50,0.00,311.50,311.50,N/A
38747_3,REMOVE ABDOMINAL LYMPH NODES,ProFee,0989,38747,,,,0,3.00,2.25,2.25,387.50,0.00,387.50,387.50,N/A
38760_3,REMOVE GROIN LYMPH NODES,ProFee,0989,38760,,,,0,3.00,2.25,2.25,1217.00,0.00,1217.00,1217.00,N/A
38765_3,REMOVE GROIN LYMPH NODES,ProFee,0989,38765,,,,0,3.00,2.25,2.25,1872.00,0.00,1872.00,1872.00,N/A
38770_3,REMOVE PELVIS LYMPH NODES,ProFee,0989,38770,,,,0,3.00,2.25,2.25,1170.00,0.00,1170.00,1170.00,N/A
38780_3,REMOVE ABDOMEN LYMPH NODES,ProFee,0989,38780,,,,0,3.00,2.25,2.25,1484.00,0.00,1484.00,1484.00,N/A
38790_3,INJECT FOR LYMPHATIC X-RAY,ProFee,0989,38790,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
38792_3,IDENTIFY SENTINEL NODE,ProFee,0989,38792,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
38794_3,ACCESS THORACIC LYMPH DUCT,ProFee,0989,38794,,,,0,3.00,2.25,2.25,431.00,0.00,431.00,431.00,N/A
38900_3,IO MAP OF SENT LYMPH NODE,ProFee,0989,38900,,,,0,3.00,2.25,2.25,199.50,0.00,199.50,199.50,N/A
38999_3,BLOOD/LYMPH SYSTEM PROCEDURE,ProFee,0989,38999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
39000_3,EXPLORATION OF CHEST,ProFee,0989,39000,,,,0,3.00,2.25,2.25,716.50,0.00,716.50,716.50,N/A
39010_3,EXPLORATION OF CHEST,ProFee,0989,39010,,,,0,3.00,2.25,2.25,1136.00,0.00,1136.00,1136.00,N/A
39200_3,REMOVAL CHEST LESION,ProFee,0989,39200,,,,0,3.00,2.25,2.25,1265.00,0.00,1265.00,1265.00,N/A
39220_3,REMOVAL CHEST LESION,ProFee,0989,39220,,,,0,3.00,2.25,2.25,1643.50,0.00,1643.50,1643.50,N/A
39400_3,VISUALIZATION OF CHEST,ProFee,0989,39400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
39401_3,MEDIASTINOSCPY W/MEDSTNL BX,ProFee,0989,39401,,,,0,3.00,2.25,2.25,450.00,0.00,450.00,450.00,N/A
39402_3,MEDIASTINOSCPY W/LMPH NOD BX,ProFee,0989,39402,,,,0,3.00,2.25,2.25,587.50,0.00,587.50,587.50,N/A
39499_3,CHEST PROCEDURE,ProFee,0989,39499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
39501_3,REPAIR DIAPHRAGM LACERATION,ProFee,0989,39501,,,,0,3.00,2.25,2.25,1228.00,0.00,1228.00,1228.00,N/A
39502_3,REPAIR PARAESOPHAGEAL HERNIA,ProFee,0989,39502,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
39503_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39503,,,,0,3.00,2.25,2.25,8380.50,0.00,8380.50,8380.50,N/A
39520_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
39530_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
39531_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39531,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
39540_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39540,,,,0,3.00,2.25,2.25,1255.00,0.00,1255.00,1255.00,N/A
39541_3,REPAIR OF DIAPHRAGM HERNIA,ProFee,0989,39541,,,,0,3.00,2.25,2.25,1355.00,0.00,1355.00,1355.00,N/A
39545_3,REVISION OF DIAPHRAGM,ProFee,0989,39545,,,,0,3.00,2.25,2.25,1287.50,0.00,1287.50,1287.50,N/A
39560_3,"RESECT DIAPHRAGM, SIMPLE",ProFee,0989,39560,,,,0,3.00,2.25,2.25,1156.00,0.00,1156.00,1156.00,N/A
39561_3,"RESECT DIAPHRAGM, COMPLEX",ProFee,0989,39561,,,,0,3.00,2.25,2.25,1795.50,0.00,1795.50,1795.50,N/A
39599_3,DIAPHRAGM SURGERY PROCEDURE,ProFee,0989,39599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4000F_3,TOBACCO USE TXMNT COUNSELING,ProFee,0989,4000F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4001F_3,"TOBACCO USE TXMNT, PHARMACOL",ProFee,0989,4001F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4002F_3,"STATIN THERAPY, RX",ProFee,0989,4002F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4003F_3,PATIENT EDUCATION,ProFee,0989,4003F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4004F_3,PT TOBACCO USE DONE RCVD TLK,ProFee,0989,4004F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4005F_3,PHARM THX FOR OP RX'D,ProFee,0989,4005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4006F_3,"BETA-BLOCKER THERAPY, RX",ProFee,0989,4006F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4008F_3,BETA-BLOCKER THERAPY RXD/TKN,ProFee,0989,4008F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4009F_3,"ACE INHIBITOR THERAPY, RX",ProFee,0989,4009F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4010F_3,ACE/ARB THERAPY RXD/TAKEN,ProFee,0989,4010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4011F_3,"ORAL ANTIPLATELET TX, RX",ProFee,0989,4011F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4012F_3,WARFARIN THERAPY,ProFee,0989,4012F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4013F_3,STATIN THERAPY/CURRENTLY TKN,ProFee,0989,4013F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4014F_3,HEART FAIL DISCHRGE INSTRUCT,ProFee,0989,4014F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4015F_3,ASTHMA PHARMACOLOGIC THERAPY,ProFee,0989,4015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4016F_3,ANTI-INFLAM/ANALGES THERAPY,ProFee,0989,4016F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4017F_3,GASTROINTESTINAL PROPHYLAXIS,ProFee,0989,4017F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4018F_3,THERAPEUTIC EXERCISE KNEE,ProFee,0989,4018F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4019F_3,DOC RECPT COUNSL VIT D/CALC+,ProFee,0989,4019F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4025F_3,INHALED BRONCHODILATOR RX,ProFee,0989,4025F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4030F_3,OXYGEN THERAPY RX,ProFee,0989,4030F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4033F_3,PULMONARY REHAB REC,ProFee,0989,4033F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4035F_3,INFLUENZA IMM REC,ProFee,0989,4035F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4037F_3,INFLUENZA IMM ORDER/ADMIN,ProFee,0989,4037F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4040F_3,PNEUMOC VAC/ADMIN/RCV'D,ProFee,0989,4040F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4041F_3,DOC ORDER CEFAZOLIN/CEFUROX,ProFee,0989,4041F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4042F_3,DOC ANTIBIO NOT GIVEN,ProFee,0989,4042F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4043F_3,DOC ORDER GIVEN STOP ANTIBIO,ProFee,0989,4043F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4044F_3,DOC ORDER GIVEN VTE PROPHYLX,ProFee,0989,4044F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4045F_3,EMPIRIC ANTIBIOTIC RX,ProFee,0989,4045F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4046F_3,DOC ANTIBIO GIVEN B/4 SURG,ProFee,0989,4046F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4047F_3,DOC ANTIBIO GIVEN B/4 SURG,ProFee,0989,4047F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4048F_3,DOC ANTIBIO GIVEN B/4 SURG,ProFee,0989,4048F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40490_3,BIOPSY OF LIP,ProFee,0989,40490,,,,0,3.00,2.25,2.25,105.50,0.00,105.50,105.50,N/A
4049F_3,DOC ORDER GIVEN STOP ANTIBIO,ProFee,0989,4049F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40500_3,PARTIAL EXCISION OF LIP,ProFee,0989,40500,,,,0,3.00,2.25,2.25,522.50,0.00,522.50,522.50,N/A
4050F_3,HT CARE PLAN DOC,ProFee,0989,4050F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40510_3,PARTIAL EXCISION OF LIP,ProFee,0989,40510,,,,0,3.00,2.25,2.25,510.00,0.00,510.00,510.00,N/A
4051F_3,REFERRED FOR AN AV FISTULA,ProFee,0989,4051F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40520_3,PARTIAL EXCISION OF LIP,ProFee,0989,40520,,,,0,3.00,2.25,2.25,514.50,0.00,514.50,514.50,N/A
40525_3,RECONSTRUCT LIP WITH FLAP,ProFee,0989,40525,,,,0,3.00,2.25,2.25,792.00,0.00,792.00,792.00,N/A
40527_3,RECONSTRUCT LIP WITH FLAP,ProFee,0989,40527,,,,0,3.00,2.25,2.25,877.00,0.00,877.00,877.00,N/A
4052F_3,HEMODIALYSIS VIA AV FISTULA,ProFee,0989,4052F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40530_3,PARTIAL REMOVAL OF LIP,ProFee,0989,40530,,,,0,3.00,2.25,2.25,574.00,0.00,574.00,574.00,N/A
4053F_3,HEMODIALYSIS VIA AV GRAFT,ProFee,0989,4053F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4054F_3,HEMODIALYSIS VIA CATHETER,ProFee,0989,4054F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4055F_3,PT RCVNG PERITON DIALYSIS,ProFee,0989,4055F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4056F_3,APPROP ORAL REHYD RECOMM'D,ProFee,0989,4056F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4058F_3,"PED GASTRO ED GIVEN, CAREGVR",ProFee,0989,4058F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40600240_1,"IV or SubQ Casirivimab/Imdevimab, initial or repeat",Inpatient,0260,M0240,,,,0,500.00,375.00,375.00,475.00,450.00,475.00,475.00,450.00
40600240_1,"IV or SubQ Casirivimab/Imdevimab, initial or repeat",Outpatient,0260,M0240,,,,0,500.00,375.00,375.00,475.00,450.00,475.00,475.00,450.00
40602673_1,NORMAL SALINE IRRIGATION 500 CC,Inpatient,0272,A4217,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40602673_1,NORMAL SALINE IRRIGATION 500 CC,Outpatient,0272,A4217,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40602698_1,STERIL WATER 500 ML,Outpatient,0272,A4217,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40602698_1,STERIL WATER 500 ML,Inpatient,0272,A4217,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40607030_1,INFUSION NORMAL SALINE 1000CC,Inpatient,0258,J7030,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607030_1,INFUSION NORMAL SALINE 1000CC,Outpatient,0258,J7030,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607042_1,5% DEXTROSENORMAL SALINE 5001000,Outpatient,0258,J7042,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607042_1,5% DEXTROSENORMAL SALINE 5001000,Inpatient,0258,J7042,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607050_1,INFUSION NORMAL SALINE 250CC,Inpatient,0258,J7050,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607050_1,INFUSION NORMAL SALINE 250CC,Outpatient,0258,J7050,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607070_1,INFUSION D5W 1000CC,Outpatient,0258,J7070,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607070_1,INFUSION D5W 1000CC,Inpatient,0258,J7070,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607120_1,LR 100ML1000ML,Inpatient,0258,J7120,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
40607120_1,LR 100ML1000ML,Outpatient,0258,J7120,,,,0,66.00,49.50,49.50,62.70,59.40,62.70,62.70,59.40
4060F_3,PSYCH SVCS PROVIDED,ProFee,0989,4060F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4062F_3,PT REFERRAL PSYCH DOC'D,ProFee,0989,4062F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4063F_3,ANTIDEPRES RXTHXPY NOT RXD,ProFee,0989,4063F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4064F_3,ANTIDEPRESSANT RX,ProFee,0989,4064F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40650_3,REPAIR LIP,ProFee,0989,40650,,,,0,3.00,2.25,2.25,431.00,0.00,431.00,431.00,N/A
40652_3,REPAIR LIP,ProFee,0989,40652,,,,0,3.00,2.25,2.25,509.00,0.00,509.00,509.00,N/A
40654_3,REPAIR LIP,ProFee,0989,40654,,,,0,3.00,2.25,2.25,614.00,0.00,614.00,614.00,N/A
4065F_3,ANTIPSYCHOTIC RX,ProFee,0989,4065F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4066F_3,ECT PROVIDED,ProFee,0989,4066F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4067F_3,PT REFERRAL FOR ECT DOC'D,ProFee,0989,4067F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4069F_3,VTE PROPHYLAXIS RCVD,ProFee,0989,4069F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40700_3,REPAIR CLEFT LIP/NASAL,ProFee,0989,40700,,,,0,3.00,2.25,2.25,1458.00,0.00,1458.00,1458.00,N/A
40700020_1,Contract: Drug Screening,Outpatient,0300,,,,,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
40700020_1,Contract: Drug Screening,Inpatient,0300,,,,,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
40700030_1,Contract: Breath Alcohol Test (EBT) confirmation,Outpatient,0300,,,,,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
40700030_1,Contract: Breath Alcohol Test (EBT) confirmation,Inpatient,0300,,,,,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
40700034_1,Iodine,Inpatient,0300,83789,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40700034_1,Iodine,Outpatient,0300,83789,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40700040_1,CONTRACT: Rapid Drug Test (Clinic's Kit),Inpatient,0300,,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40700040_1,CONTRACT: Rapid Drug Test (Clinic's Kit),Outpatient,0300,,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40700048_1,BASIC METABOLIC PANEL,Inpatient,0300,80048,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40700048_1,BASIC METABOLIC PANEL,Outpatient,0300,80048,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40700050_1,Contract: Breath Alcohol Test (EBT),Outpatient,0300,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40700050_1,Contract: Breath Alcohol Test (EBT),Inpatient,0300,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40700051_1,ELECTROLYTE PANEL,Inpatient,0300,80051,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40700051_1,ELECTROLYTE PANEL,Outpatient,0300,80051,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40700053_1,COMPREHENSIVE METABOLIC PANEL,Outpatient,0300,80053,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40700053_1,COMPREHENSIVE METABOLIC PANEL,Inpatient,0300,80053,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40700055_1,OBSTERIC PANEL,Outpatient,0300,80055,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
40700055_1,OBSTERIC PANEL,Inpatient,0300,80055,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
40700060_1,CONTRACT:  Drugs of Abuse,Outpatient,0300,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
40700060_1,CONTRACT:  Drugs of Abuse,Inpatient,0300,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
40700061_1,LIPID PROFILE,Outpatient,0300,80061,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700061_1,LIPID PROFILE,Inpatient,0300,80061,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700069_1,RENAL PANAL,Inpatient,0300,80069,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40700069_1,RENAL PANAL,Outpatient,0300,80069,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40700074_1,HEPATITIS PANEL ACUTE,Outpatient,0300,80074,,,,0,332.00,249.00,249.00,315.40,298.80,315.40,315.40,298.80
40700074_1,HEPATITIS PANEL ACUTE,Inpatient,0300,80074,,,,0,332.00,249.00,249.00,315.40,298.80,315.40,315.40,298.80
40700076_1,HEPATIC FUNCTION TEST,Inpatient,0300,80076,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40700076_1,HEPATIC FUNCTION TEST,Outpatient,0300,80076,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40700101_1,Urine Drug Screen,Outpatient,0300,80305,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
40700101_1,Urine Drug Screen,Inpatient,0300,80305,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
40700103_1,PSA SCREENING MEDICARE,Inpatient,0300,G0103,,,,0,110.00,82.50,82.50,104.50,99.00,104.50,104.50,99.00
40700103_1,PSA SCREENING MEDICARE,Outpatient,0300,G0103,,,,0,110.00,82.50,82.50,104.50,99.00,104.50,104.50,99.00
40700156_1,TEGRETOL LEVEL (CARBAMAZEPINE),Inpatient,0300,80156,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40700156_1,TEGRETOL LEVEL (CARBAMAZEPINE),Outpatient,0300,80156,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40700158_1,CYCLOSPORINE ASSAYS,Outpatient,0300,80158,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40700158_1,CYCLOSPORINE ASSAYS,Inpatient,0300,80158,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40700162_1,DIGOXINLANOXIN LEVEL,Outpatient,0300,80162,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40700162_1,DIGOXINLANOXIN LEVEL,Inpatient,0300,80162,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40700164_1,DEPAKOTE LEVEL,Inpatient,0300,80164,,,,0,128.00,96.00,96.00,121.60,115.20,121.60,121.60,115.20
40700164_1,DEPAKOTE LEVEL,Outpatient,0300,80164,,,,0,128.00,96.00,96.00,121.60,115.20,121.60,121.60,115.20
40700177_1,Keppra (Levetiracetam),Inpatient,0300,80177,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40700177_1,Keppra (Levetiracetam),Outpatient,0300,80177,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40700178_1,Lithium,Inpatient,0300,80178,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40700178_1,Lithium,Outpatient,0300,80178,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40700185_1,DILANTIN,Outpatient,0300,80185,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40700185_1,DILANTIN,Inpatient,0300,80185,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40700196_1,SALICYLATE LEVEL,Outpatient,0300,80179,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40700196_1,SALICYLATE LEVEL,Inpatient,0300,80179,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40700197_1,Tacrolimus,Inpatient,0300,80197,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
40700197_1,Tacrolimus,Outpatient,0300,80197,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
40700198_1,Theophylline Level,Inpatient,0300,80198,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700198_1,Theophylline Level,Outpatient,0300,80198,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700202_1,VANCOMYCIN TROUGH,Outpatient,0300,80202,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40700202_1,VANCOMYCIN TROUGH,Inpatient,0300,80202,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40700299_1,LAMICTALGABAPEATIN,Outpatient,0300,80299,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700299_1,LAMICTALGABAPEATIN,Inpatient,0300,80299,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40700306_1,Drugs Of Abuse Urine Medtox,Inpatient,0300,80306,,,,0,235.00,176.25,176.25,223.25,211.50,223.25,223.25,211.50
40700306_1,Drugs Of Abuse Urine Medtox,Outpatient,0300,80306,,,,0,235.00,176.25,176.25,223.25,211.50,223.25,223.25,211.50
40700324_1,Amphetamines Confirmation,Outpatient,0300,80324,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
40700324_1,Amphetamines Confirmation,Inpatient,0300,80324,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
40700349_1,THC Confirmation,Inpatient,0300,80349,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
40700349_1,THC Confirmation,Outpatient,0300,80349,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
40700354_1,Fentanyl,Outpatient,0300,80354,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40700354_1,Fentanyl,Inpatient,0300,80354,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40700400_1,Cortisol Stimulation (3 Spec),Inpatient,0300,80400,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
40700400_1,Cortisol Stimulation (3 Spec),Outpatient,0300,80400,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
40701_3,REPAIR CLEFT LIP/NASAL,ProFee,0989,40701,,,,0,3.00,2.25,2.25,1727.00,0.00,1727.00,1727.00,N/A
40701000_1,URINALYSIS,Inpatient,0300,81005,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40701000_1,URINALYSIS,Outpatient,0300,81005,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40701001_1,URINALYSISURINALYSIS WITH MICRO,Outpatient,0300,81001,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
40701001_1,URINALYSISURINALYSIS WITH MICRO,Inpatient,0300,81001,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
40701003_1,URINALYSIS DIPSTICK  DPS,Inpatient,0300,81003,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40701003_1,URINALYSIS DIPSTICK  DPS,Outpatient,0300,81003,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40701015_1,URINALYSIS MICROSCOPIC ONLY,Inpatient,0300,81015,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40701015_1,URINALYSIS MICROSCOPIC ONLY,Outpatient,0300,81015,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40701050_1,24 HOUR URINE VOLUME,Outpatient,0300,81050,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40701050_1,24 HOUR URINE VOLUME,Inpatient,0300,81050,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40701225_1,Clopidogrel,Outpatient,0310,81225,,,,0,582.00,436.50,436.50,552.90,523.80,552.90,552.90,523.80
40701225_1,Clopidogrel,Inpatient,0310,81225,,,,0,582.00,436.50,436.50,552.90,523.80,552.90,552.90,523.80
40701332_1,"SERPINA1, GENE ANALYSIS",Outpatient,0310,81332,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,314.45,297.90
40701332_1,"SERPINA1, GENE ANALYSIS",Inpatient,0310,81332,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,314.45,297.90
40701456_1,T3 UPTAKE,Inpatient,0300,84479,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40701456_1,T3 UPTAKE,Outpatient,0300,84479,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40701596_1,Hep C Fibrosis,Inpatient,0310,81596,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
40701596_1,Hep C Fibrosis,Outpatient,0310,81596,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
40702_3,REPAIR CLEFT LIP/NASAL,ProFee,0989,40702,,,,0,3.00,2.25,2.25,1449.50,0.00,1449.50,1449.50,N/A
40702003_1,ACETAMINOPHEN LEVEL,Outpatient,0300,G0480,,,,0,282.00,211.50,211.50,267.90,253.80,267.90,267.90,253.80
40702003_1,ACETAMINOPHEN LEVEL,Inpatient,0300,G0480,,,,0,282.00,211.50,211.50,267.90,253.80,267.90,267.90,253.80
40702009_1,KETONE BODIES SERUM QUAL,Inpatient,0300,82009,,,,0,53.00,39.75,39.75,50.35,47.70,50.35,50.35,47.70
40702009_1,KETONE BODIES SERUM QUAL,Outpatient,0300,82009,,,,0,53.00,39.75,39.75,50.35,47.70,50.35,50.35,47.70
40702010_1,Beta Hydroxybutyric Acid,Inpatient,0300,82010,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40702010_1,Beta Hydroxybutyric Acid,Outpatient,0300,82010,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40702024_1,ACTH Assay,Outpatient,0300,82024,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
40702024_1,ACTH Assay,Inpatient,0300,82024,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
40702040_1,ALBUMIN,Outpatient,0300,82040,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40702040_1,ALBUMIN,Inpatient,0300,82040,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40702043_1,MICROALBUMIN QUANTITATIVE,Outpatient,0300,82043,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40702043_1,MICROALBUMIN QUANTITATIVE,Inpatient,0300,82043,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40702055_1,ALCOHOL  BLOOD,Outpatient,0300,H0001,,,,0,82.00,61.50,61.50,77.90,73.80,77.90,77.90,73.80
40702055_1,ALCOHOL  BLOOD,Inpatient,0300,H0001,,,,0,82.00,61.50,61.50,77.90,73.80,77.90,77.90,73.80
40702075_1,Breath Alcohol test,Inpatient,0300,82075,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40702075_1,Breath Alcohol test,Outpatient,0300,82075,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40702085_1,"Aldolase, Serum",Outpatient,0300,82085,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40702085_1,"Aldolase, Serum",Inpatient,0300,82085,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40702088_1,Aldosterone (Serum),Inpatient,0300,82088,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40702088_1,Aldosterone (Serum),Outpatient,0300,82088,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40702103_1,Alpha 1 Antitrypsin,Inpatient,0300,82103,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
40702103_1,Alpha 1 Antitrypsin,Outpatient,0300,82103,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
40702105_1,ALPHA FETOPROTEIN,Inpatient,0300,82105,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40702105_1,ALPHA FETOPROTEIN,Outpatient,0300,82105,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40702140_1,AMMONIA,Inpatient,0300,82140,,,,0,157.00,117.75,117.75,149.15,141.30,149.15,149.15,141.30
40702140_1,AMMONIA,Outpatient,0300,82140,,,,0,157.00,117.75,117.75,149.15,141.30,149.15,149.15,141.30
40702150_1,AMYLASE,Inpatient,0300,82150,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40702150_1,AMYLASE,Outpatient,0300,82150,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40702164_1,ACE (ANGIOTENSIN I),Outpatient,0300,82164,,,,0,166.00,124.50,124.50,157.70,149.40,157.70,157.70,149.40
40702164_1,ACE (ANGIOTENSIN I),Inpatient,0300,82164,,,,0,166.00,124.50,124.50,157.70,149.40,157.70,157.70,149.40
40702172_1,APOLIPOPROTEIN B,Outpatient,0300,82172,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
40702172_1,APOLIPOPROTEIN B,Inpatient,0300,82172,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
40702239_1,Bile Acids,Inpatient,0300,82239,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40702239_1,Bile Acids,Outpatient,0300,82239,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40702247_1,BILIRUBIN TOTAL,Outpatient,0300,82247,,,,0,80.00,60.00,60.00,76.00,72.00,76.00,76.00,72.00
40702247_1,BILIRUBIN TOTAL,Inpatient,0300,82247,,,,0,80.00,60.00,60.00,76.00,72.00,76.00,76.00,72.00
40702248_1,BILIRUBIN  DIRECT,Inpatient,0300,82248,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40702248_1,BILIRUBIN  DIRECT,Outpatient,0300,82248,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40702270_1,BLOOD OCCULT; FECES SCREENING 1,Inpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
40702270_1,BLOOD OCCULT; FECES SCREENING 1,Outpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
40702271_1,BLOOD OCCULT OTHER SOURCES,Outpatient,0300,82271,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
40702271_1,BLOOD OCCULT OTHER SOURCES,Inpatient,0300,82271,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
40702272_1,BLOOD OCCULT FECES 13,Inpatient,0300,82272,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40702272_1,BLOOD OCCULT FECES 13,Outpatient,0300,82272,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40702306_1,VITAMIN D 25HYDROXY,Inpatient,0300,82306,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40702306_1,VITAMIN D 25HYDROXY,Outpatient,0300,82306,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40702310_1,CALCIUM,Inpatient,0300,82310,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40702310_1,CALCIUM,Outpatient,0300,82310,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40702330_1,CALCIUM IONIZED,Inpatient,0300,82330,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40702330_1,CALCIUM IONIZED,Outpatient,0300,82330,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40702340_1,URINE (QUANTITATIVE) 24 HOUR,Inpatient,0300,81050,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40702340_1,URINE (QUANTITATIVE) 24 HOUR,Outpatient,0300,81050,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40702365_1,STONE ANALYSIS SPECTROSCOPY,Inpatient,0300,82365,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
40702365_1,STONE ANALYSIS SPECTROSCOPY,Outpatient,0300,82365,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
40702374_1,CARBON DIOXIDE,Inpatient,0300,82374,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40702374_1,CARBON DIOXIDE,Outpatient,0300,82374,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40702375_1,CARBOXYHEMOGLOBIN QUANTITATIVE,Outpatient,0300,82375,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40702375_1,CARBOXYHEMOGLOBIN QUANTITATIVE,Inpatient,0300,82375,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40702378_1,CARCINOEMBRYONIC ANTIGEN (CEA),Outpatient,0300,82378,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702378_1,CARCINOEMBRYONIC ANTIGEN (CEA),Inpatient,0300,82378,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702380_1,Carotene,Inpatient,0300,82380,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
40702380_1,Carotene,Outpatient,0300,82380,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
40702384_1,CATECHOLAMINES  FRACTIONATED,Inpatient,0300,82384,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40702384_1,CATECHOLAMINES  FRACTIONATED,Outpatient,0300,82384,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40702390_1,Ceruloplasmin,Outpatient,0300,82390,,,,0,117.00,87.75,87.75,111.15,105.30,111.15,111.15,105.30
40702390_1,Ceruloplasmin,Inpatient,0300,82390,,,,0,117.00,87.75,87.75,111.15,105.30,111.15,111.15,105.30
40702435_1,CHLORIDE BLOOD,Inpatient,0300,82435,,,,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
40702435_1,CHLORIDE BLOOD,Outpatient,0300,82435,,,,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
40702465_1,CHOLESTEROL,Inpatient,0300,82465,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
40702465_1,CHOLESTEROL,Outpatient,0300,82465,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
40702525_1,Copper,Outpatient,0300,82525,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40702525_1,Copper,Inpatient,0300,82525,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40702530_1,CORTISOL FREE (URINE),Inpatient,0300,82530,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702530_1,CORTISOL FREE (URINE),Outpatient,0300,82530,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702533_1,CORTISOL AM,Outpatient,0300,82533,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
40702533_1,CORTISOL AM,Inpatient,0300,82533,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
40702540_1,CARBAMAZEPINE,Inpatient,0300,80156,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40702540_1,CARBAMAZEPINE,Outpatient,0300,80156,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40702550_1,CK CPK CREATINE KINASE TOTAL,Outpatient,0300,82550,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40702550_1,CK CPK CREATINE KINASE TOTAL,Inpatient,0300,82550,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40702552_1,CK ISOENZYMES,Outpatient,0300,82552,,,,0,141.00,105.75,105.75,133.95,126.90,133.95,133.95,126.90
40702552_1,CK ISOENZYMES,Inpatient,0300,82552,,,,0,141.00,105.75,105.75,133.95,126.90,133.95,133.95,126.90
40702553_1,CK MB,Outpatient,0300,82553,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40702553_1,CK MB,Inpatient,0300,82553,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40702565_1,CREATININE BLOOD,Outpatient,0300,82565,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40702565_1,CREATININE BLOOD,Inpatient,0300,82565,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40702570_1,CREATININE URINE,Outpatient,0300,82570,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
40702570_1,CREATININE URINE,Inpatient,0300,82570,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
40702575_1,CREATININE CLEARANCE,Outpatient,0300,82575,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702575_1,CREATININE CLEARANCE,Inpatient,0300,82575,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702607_1,VITAMIN B12,Inpatient,0300,82607,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40702607_1,VITAMIN B12,Outpatient,0300,82607,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40702610_1,CYSTATIN C,Inpatient,0300,82610,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,139.65,132.30
40702610_1,CYSTATIN C,Outpatient,0300,82610,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,139.65,132.30
40702627_1,DHEAS,Outpatient,0300,82627,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702627_1,DHEAS,Inpatient,0300,82627,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702642_1,DIHYDROTESTOSTERONE,Inpatient,0300,82642,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40702642_1,DIHYDROTESTOSTERONE,Outpatient,0300,82642,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40702652_1,VITAMIN D (1 25DIHYDROXY),Outpatient,0300,82652,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40702652_1,VITAMIN D (1 25DIHYDROXY),Inpatient,0300,82652,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40702656_1,"Pancreatic Elastase, Fecal",Outpatient,0300,82656,,,,0,307.00,230.25,230.25,291.65,276.30,291.65,291.65,276.30
40702656_1,"Pancreatic Elastase, Fecal",Inpatient,0300,82656,,,,0,307.00,230.25,230.25,291.65,276.30,291.65,291.65,276.30
40702668_1,ERYTHROPOIETIN,Outpatient,0300,82668,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
40702668_1,ERYTHROPOIETIN,Inpatient,0300,82668,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
40702670_1,ESTRADIOL,Inpatient,0300,82670,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40702670_1,ESTRADIOL,Outpatient,0300,82670,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40702671_1,ESTROGENS FRACTIONATED,Outpatient,0300,82671,,,,0,269.00,201.75,201.75,255.55,242.10,255.55,255.55,242.10
40702671_1,ESTROGENS FRACTIONATED,Inpatient,0300,82671,,,,0,269.00,201.75,201.75,255.55,242.10,255.55,255.55,242.10
40702672_1,ESTROGEN TOTAL,Outpatient,0300,82672,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702672_1,ESTROGEN TOTAL,Inpatient,0300,82672,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40702677_1,ESTRIOL,Outpatient,0300,82677,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40702677_1,ESTRIOL,Inpatient,0300,82677,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40702679_1,ESTRONE,Outpatient,0300,82679,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,200.45,189.90
40702679_1,ESTRONE,Inpatient,0300,82679,,,,0,211.00,158.25,158.25,200.45,189.90,200.45,200.45,189.90
40702705_1,FATS OR LIPIDS FECES; QUALITATIVE,Outpatient,0300,82705,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40702705_1,FATS OR LIPIDS FECES; QUALITATIVE,Inpatient,0300,82705,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40702710_1,FATS OR LIPIDS FECES; QUANTITATIV,Inpatient,0300,82710,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
40702710_1,FATS OR LIPIDS FECES; QUANTITATIV,Outpatient,0300,82710,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
40702728_1,FERRITIN,Inpatient,0300,82728,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40702728_1,FERRITIN,Outpatient,0300,82728,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40702746_1,FOLATESERUM,Inpatient,0300,82746,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40702746_1,FOLATESERUM,Outpatient,0300,82746,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40702747_1,FOLATERBC,Outpatient,0300,82747,,,,0,181.00,135.75,135.75,171.95,162.90,171.95,171.95,162.90
40702747_1,FOLATERBC,Inpatient,0300,82747,,,,0,181.00,135.75,135.75,171.95,162.90,171.95,171.95,162.90
40702784_1,GAMMAGLOBULIN IGA IGD IGG IGM EA,Inpatient,0300,82784,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40702784_1,GAMMAGLOBULIN IGA IGD IGG IGM EA,Outpatient,0300,82784,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40702785_1,Immunoglobuline Total,Outpatient,0300,82785,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702785_1,Immunoglobuline Total,Inpatient,0300,82785,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40702787_1,Immunoglobulin G Subclasses,Inpatient,0300,82787,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40702787_1,Immunoglobulin G Subclasses,Outpatient,0300,82787,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40702803_1,ARTERIAL BLOOD GASES,Outpatient,0300,82803,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40702803_1,ARTERIAL BLOOD GASES,Inpatient,0300,82803,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40702945_1,GLUCOSE OTHER THAN BLOOD,Outpatient,0300,82945,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40702945_1,GLUCOSE OTHER THAN BLOOD,Inpatient,0300,82945,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40702947_1,GLUCOSE BLOOD,Outpatient,0300,82947,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40702947_1,GLUCOSE BLOOD,Inpatient,0300,82947,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40702950_1,GLUCOSEPOST DOSE 1 HOUR,Inpatient,0300,82950,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40702950_1,GLUCOSEPOST DOSE 1 HOUR,Outpatient,0300,82950,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40702951_1,GLUCOSE TOLERANCE TEST 3 SPEC,Outpatient,0300,82951,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
40702951_1,GLUCOSE TOLERANCE TEST 3 SPEC,Inpatient,0300,82951,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
40702952_1,GLUCOSE TOL TEST EA. ADD'L HOUR,Outpatient,0300,82952,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
40702952_1,GLUCOSE TOL TEST EA. ADD'L HOUR,Inpatient,0300,82952,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
40702962_1,GLUCOSE ONE TOUCH,Inpatient,0300,82962,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
40702962_1,GLUCOSE ONE TOUCH,Outpatient,0300,82962,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
40702977_1,GGT,Outpatient,0300,82977,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
40702977_1,GGT,Inpatient,0300,82977,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
40703001_1,FOLLICLE STIM HORMONE (FSH),Outpatient,0300,83001,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40703001_1,FOLLICLE STIM HORMONE (FSH),Inpatient,0300,83001,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40703002_1,LUTEINIZING HORMONE,Outpatient,0300,83002,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40703002_1,LUTEINIZING HORMONE,Inpatient,0300,83002,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40703003_1,GROWTH HORMONE (SOMATROTROPIN),Inpatient,0300,83003,,,,0,173.00,129.75,129.75,164.35,155.70,164.35,164.35,155.70
40703003_1,GROWTH HORMONE (SOMATROTROPIN),Outpatient,0300,83003,,,,0,173.00,129.75,129.75,164.35,155.70,164.35,164.35,155.70
40703010_1,HAPTOGLOBIN,Outpatient,0300,83010,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40703010_1,HAPTOGLOBIN,Inpatient,0300,83010,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40703013_1,H PYLORI BREATH,Outpatient,0300,83013,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
40703013_1,H PYLORI BREATH,Inpatient,0300,83013,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
40703018_1,HEAVY METALS QUANTITATIVE EACH,Outpatient,0300,83018,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40703018_1,HEAVY METALS QUANTITATIVE EACH,Inpatient,0300,83018,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40703020_1,HEMOGLOBIN A2,Inpatient,0300,83020,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40703020_1,HEMOGLOBIN A2,Outpatient,0300,83020,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40703021_1,Hemoglobin Fractionation And Quantitation,Outpatient,0300,83021,,,,0,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
40703021_1,Hemoglobin Fractionation And Quantitation,Inpatient,0300,83021,,,,0,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
40703036_1,GLYCO HGB (HGA1C),Inpatient,0300,83036,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40703036_1,GLYCO HGB (HGA1C),Outpatient,0300,83036,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40703090_1,HOMOCYSTINE,Inpatient,0300,83090,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40703090_1,HOMOCYSTINE,Outpatient,0300,83090,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40703497_1,5 HIAA URINE QUANTITATIVE,Outpatient,0300,83497,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40703497_1,5 HIAA URINE QUANTITATIVE,Inpatient,0300,83497,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40703498_1,HYDROXPROGESTERONE 17D,Outpatient,0300,83498,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
40703498_1,HYDROXPROGESTERONE 17D,Inpatient,0300,83498,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
40703516_1,CENTROMERE B AUTOANTIBODY IGG (CENTMP),Inpatient,0300,83516,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40703516_1,CENTROMERE B AUTOANTIBODY IGG (CENTMP),Outpatient,0300,83516,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40703519_1,PTH Related Protein,Inpatient,0300,83519,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40703519_1,PTH Related Protein,Outpatient,0300,83519,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40703520_1,"Immunoassay, not otherwise specified",Inpatient,0300,83520,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40703520_1,"Immunoassay, not otherwise specified",Outpatient,0300,83520,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40703525_1,INSULIN TOTAL,Inpatient,0300,83525,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40703525_1,INSULIN TOTAL,Outpatient,0300,83525,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40703540_1,IRON,Outpatient,0300,83540,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
40703540_1,IRON,Inpatient,0300,83540,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
40703550_1,IRON BINDING CAPACITY,Outpatient,0300,83550,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
40703550_1,IRON BINDING CAPACITY,Inpatient,0300,83550,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
40703586_1,17KETOSTEROIDS URINE,Outpatient,0300,83586,,,,0,134.00,100.50,100.50,127.30,120.60,127.30,127.30,120.60
40703586_1,17KETOSTEROIDS URINE,Inpatient,0300,83586,,,,0,134.00,100.50,100.50,127.30,120.60,127.30,127.30,120.60
40703605_1,LACTATE ACID VENOUS,Inpatient,0300,83605,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40703605_1,LACTATE ACID VENOUS,Outpatient,0300,83605,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40703615_1,LDH,Inpatient,0300,83615,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
40703615_1,LDH,Outpatient,0300,83615,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
40703625_1,LD ISOENZYMES,Outpatient,0300,83625,,,,0,134.00,100.50,100.50,127.30,120.60,127.30,127.30,120.60
40703625_1,LD ISOENZYMES,Inpatient,0300,83625,,,,0,134.00,100.50,100.50,127.30,120.60,127.30,127.30,120.60
40703630_1,"Lactoferrin, Qualitative Stool",Outpatient,0300,83630,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40703630_1,"Lactoferrin, Qualitative Stool",Inpatient,0300,83630,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40703655_1,LEAD,Outpatient,0300,83655,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40703655_1,LEAD,Inpatient,0300,83655,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40703690_1,LIPASE,Inpatient,0300,83690,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40703690_1,LIPASE,Outpatient,0300,83690,,,,0,120.00,90.00,90.00,114.00,108.00,114.00,114.00,108.00
40703695_1,Lipoprotein A,Outpatient,0300,83695,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
40703695_1,Lipoprotein A,Inpatient,0300,83695,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
40703718_1,H D L,Outpatient,0300,83718,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
40703718_1,H D L,Inpatient,0300,83718,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
40703721_1,LDL CHOLESTEROL DIRECT (DLDL),Outpatient,0300,83721,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40703721_1,LDL CHOLESTEROL DIRECT (DLDL),Inpatient,0300,83721,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40703735_1,MAGNESIUM,Outpatient,0300,83735,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40703735_1,MAGNESIUM,Inpatient,0300,83735,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40703789_1,TIAGABINE LEVEL (GABITRIL),Inpatient,0300,83789,,,,0,484.00,363.00,363.00,459.80,435.60,459.80,459.80,435.60
40703789_1,TIAGABINE LEVEL (GABITRIL),Outpatient,0300,83789,,,,0,484.00,363.00,363.00,459.80,435.60,459.80,459.80,435.60
40703825_1,MERCURY QUANTITAVE,Inpatient,0300,83825,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
40703825_1,MERCURY QUANTITAVE,Outpatient,0300,83825,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
40703835_1,METANEPHRINES,Inpatient,0300,83835,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40703835_1,METANEPHRINES,Outpatient,0300,83835,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40703874_1,MYOGLOBIN BLOOD OR URINE,Inpatient,0300,83874,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40703874_1,MYOGLOBIN BLOOD OR URINE,Outpatient,0300,83874,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40703880_1,BTNP  NATRIURETIC PRPTIDE,Outpatient,0300,83880,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
40703880_1,BTNP  NATRIURETIC PRPTIDE,Inpatient,0300,83880,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
40703883_1,KAPPALAMBDA FREE LIGHT CHAINSER,Outpatient,0300,83883,,,,0,131.00,98.25,98.25,124.45,117.90,124.45,124.45,117.90
40703883_1,KAPPALAMBDA FREE LIGHT CHAINSER,Inpatient,0300,83883,,,,0,131.00,98.25,98.25,124.45,117.90,124.45,124.45,117.90
40703891_1,MOLECULE ISOLATE NUCLEIC,Inpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703891_1,MOLECULE ISOLATE NUCLEIC,Outpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703896_1,MOLECULAR DIAGNOSTICS,Outpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703896_1,MOLECULAR DIAGNOSTICS,Inpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703898_1,POLYMERASE CHAIN REACTION (PCR),Outpatient,0300,81200,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40703898_1,POLYMERASE CHAIN REACTION (PCR),Inpatient,0300,81200,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40703901_1,HEREDITARY HEMOCHROMOTOSIS,Inpatient,0300,81200,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40703901_1,HEREDITARY HEMOCHROMOTOSIS,Outpatient,0300,81200,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40703903_1,MOLECULE MUTATION SCAN,Inpatient,0300,81200,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,165.30,156.60
40703903_1,MOLECULE MUTATION SCAN,Outpatient,0300,81200,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,165.30,156.60
40703912_1,GENETIC EXAMINATION,Outpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703912_1,GENETIC EXAMINATION,Inpatient,0300,81200,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40703915_1,NUCLEOTIDASE SERUM 5,Inpatient,0300,83915,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40703915_1,NUCLEOTIDASE SERUM 5,Outpatient,0300,83915,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40703921_1,METHYLMALONIC ACID (MMA) URINE,Outpatient,0300,83921,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40703921_1,METHYLMALONIC ACID (MMA) URINE,Inpatient,0300,83921,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40703925_1,URINE RANDOM FOR DRUG SCREEN,Outpatient,0300,80361,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
40703925_1,URINE RANDOM FOR DRUG SCREEN,Inpatient,0300,80361,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
40703930_1,OSOMOLALITY SERUM,Inpatient,0300,83930,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40703930_1,OSOMOLALITY SERUM,Outpatient,0300,83930,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40703935_1,OSMOLALITY URINE,Outpatient,0300,83935,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
40703935_1,OSMOLALITY URINE,Inpatient,0300,83935,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
40703945_1,OXALATE,Inpatient,0300,83945,,,,0,196.00,147.00,147.00,186.20,176.40,186.20,186.20,176.40
40703945_1,OXALATE,Outpatient,0300,83945,,,,0,196.00,147.00,147.00,186.20,176.40,186.20,186.20,176.40
40703970_1,PARATHYROID HORMONE (INTACT PTH),Outpatient,0300,83970,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,230.85,218.70
40703970_1,PARATHYROID HORMONE (INTACT PTH),Inpatient,0300,83970,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,230.85,218.70
40703987_1,THYROID PANEL,Inpatient,0300,84445,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
40703987_1,THYROID PANEL,Outpatient,0300,84445,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
40703993_1,CALPROTECTIN FECAL,Inpatient,0300,83993,,,,0,304.00,228.00,228.00,288.80,273.60,288.80,288.80,273.60
40703993_1,CALPROTECTIN FECAL,Outpatient,0300,83993,,,,0,304.00,228.00,228.00,288.80,273.60,288.80,288.80,273.60
40704030_1,PKU,Inpatient,0300,84030,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40704030_1,PKU,Outpatient,0300,84030,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40704060_1,ACID PHOS  TOTAL,Inpatient,0300,84060,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40704060_1,ACID PHOS  TOTAL,Outpatient,0300,84060,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40704066_1,ACID PHOS PROSTATIC FRACTION,Inpatient,0300,84066,,,,0,123.00,92.25,92.25,116.85,110.70,116.85,116.85,110.70
40704066_1,ACID PHOS PROSTATIC FRACTION,Outpatient,0300,84066,,,,0,123.00,92.25,92.25,116.85,110.70,116.85,116.85,110.70
40704075_1,ALKALINE PHOSPHATES,Inpatient,0300,84075,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
40704075_1,ALKALINE PHOSPHATES,Outpatient,0300,84075,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
40704080_1,ALKALINE PHOSPHATES ISOENZYMES,Outpatient,0300,84080,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40704080_1,ALKALINE PHOSPHATES ISOENZYMES,Inpatient,0300,84080,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40704100_1,PHOSPHORUS,Inpatient,0300,84100,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
40704100_1,PHOSPHORUS,Outpatient,0300,84100,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
40704105_1,"Phosphorus, Urine Random",Outpatient,0300,84105,,,,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
40704105_1,"Phosphorus, Urine Random",Inpatient,0300,84105,,,,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
40704110_1,PORPHYRINS URINE,Inpatient,0300,84110,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40704110_1,PORPHYRINS URINE,Outpatient,0300,84110,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40704120_1,PORPHYRINS URINE; QUANTITATION,Inpatient,0300,84120,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,167.20,158.40
40704120_1,PORPHYRINS URINE; QUANTITATION,Outpatient,0300,84120,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,167.20,158.40
40704132_1,POTASSIUM,Inpatient,0300,84132,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40704132_1,POTASSIUM,Outpatient,0300,84132,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40704133_1,POTASSIUM URINE,Inpatient,0300,84133,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40704133_1,POTASSIUM URINE,Outpatient,0300,84133,,,,0,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
40704134_1,PREALBUMIN,Inpatient,0300,84134,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40704134_1,PREALBUMIN,Outpatient,0300,84134,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40704144_1,PROGESTERONE,Inpatient,0300,84144,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40704144_1,PROGESTERONE,Outpatient,0300,84144,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40704146_1,PROLACTIN,Inpatient,0300,84146,,,,0,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
40704146_1,PROLACTIN,Outpatient,0300,84146,,,,0,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
40704153_1,PSATOTAL,Outpatient,0300,84153,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40704153_1,PSATOTAL,Inpatient,0300,84153,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40704154_1,PSAFREE,Inpatient,0300,84154,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704154_1,PSAFREE,Outpatient,0300,84154,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704155_1,PROTEIN SERUM,Inpatient,0300,84155,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
40704155_1,PROTEIN SERUM,Outpatient,0300,84155,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
40704156_1,PROTEIN URINE 24 HR,Outpatient,0300,84156,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40704156_1,PROTEIN URINE 24 HR,Inpatient,0300,84156,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40704157_1,PROTEINFLUID,Inpatient,0300,84157,,,,0,72.00,54.00,54.00,68.40,64.80,68.40,68.40,64.80
40704157_1,PROTEINFLUID,Outpatient,0300,84157,,,,0,72.00,54.00,54.00,68.40,64.80,68.40,68.40,64.80
40704165_1,ELECTROPHORESIS PROTEIN (REFLEXI,Inpatient,0300,84165,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40704165_1,ELECTROPHORESIS PROTEIN (REFLEXI,Outpatient,0300,84165,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40704166_1,IMMUNIOFIXATION URINESERUM RAND,Outpatient,0300,84166,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
40704166_1,IMMUNIOFIXATION URINESERUM RAND,Inpatient,0300,84166,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
40704202_1,PROTOPORPHYRIN RBC; QUANTITATIVE,Outpatient,0300,84202,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40704202_1,PROTOPORPHYRIN RBC; QUANTITATIVE,Inpatient,0300,84202,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40704238_1,SOLUBLE TRANSFERRIN RECEPTOR,Outpatient,0300,84238,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,287.85,272.70
40704238_1,SOLUBLE TRANSFERRIN RECEPTOR,Inpatient,0300,84238,,,,0,303.00,227.25,227.25,287.85,272.70,287.85,287.85,272.70
40704244_1,RENIN (PLASMA),Inpatient,0300,84244,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40704244_1,RENIN (PLASMA),Outpatient,0300,84244,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40704255_1,"Selenium, Whole Blood",Inpatient,0300,84255,,,,0,288.00,216.00,216.00,273.60,259.20,273.60,273.60,259.20
40704255_1,"Selenium, Whole Blood",Outpatient,0300,84255,,,,0,288.00,216.00,216.00,273.60,259.20,273.60,273.60,259.20
40704270_1,SEX HORMONE BINDING GLOBULIN,Outpatient,0300,84270,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40704270_1,SEX HORMONE BINDING GLOBULIN,Inpatient,0300,84270,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40704295_1,SODIUM,Inpatient,0300,84295,,,,0,51.00,38.25,38.25,48.45,45.90,48.45,48.45,45.90
40704295_1,SODIUM,Outpatient,0300,84295,,,,0,51.00,38.25,38.25,48.45,45.90,48.45,48.45,45.90
40704300_1,SODIUM URINE,Inpatient,0300,84300,,,,0,68.00,51.00,51.00,64.60,61.20,64.60,64.60,61.20
40704300_1,SODIUM URINE,Outpatient,0300,84300,,,,0,68.00,51.00,51.00,64.60,61.20,64.60,64.60,61.20
40704305_1,SOMATOMEDINIGF1,Outpatient,0300,84305,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
40704305_1,SOMATOMEDINIGF1,Inpatient,0300,84305,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
40704311_1,SPECTROPHOTOMETRY ANALYTE NES,Inpatient,0300,84311,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40704311_1,SPECTROPHOTOMETRY ANALYTE NES,Outpatient,0300,84311,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40704315_1,SPECIFIC GRAVITY NONURINE,Outpatient,0300,84315,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40704315_1,SPECIFIC GRAVITY NONURINE,Inpatient,0300,84315,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40704402_1,TESTOSTERONE FREE,Inpatient,0300,84402,,,,0,108.00,81.00,81.00,102.60,97.20,102.60,102.60,97.20
40704402_1,TESTOSTERONE FREE,Outpatient,0300,84402,,,,0,108.00,81.00,81.00,102.60,97.20,102.60,102.60,97.20
40704403_1,TESTOSTERONE TOTAL,Outpatient,0300,84403,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40704403_1,TESTOSTERONE TOTAL,Inpatient,0300,84403,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40704425_1,THIAMINE,Outpatient,0300,84425,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40704425_1,THIAMINE,Inpatient,0300,84425,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40704432_1,THYROGLOBULIN,Inpatient,0300,84432,,,,0,167.00,125.25,125.25,158.65,150.30,158.65,158.65,150.30
40704432_1,THYROGLOBULIN,Outpatient,0300,84432,,,,0,167.00,125.25,125.25,158.65,150.30,158.65,158.65,150.30
40704436_1,T4 TOTAL,Inpatient,0300,84436,,,,0,68.00,51.00,51.00,64.60,61.20,64.60,64.60,61.20
40704436_1,T4 TOTAL,Outpatient,0300,84436,,,,0,68.00,51.00,51.00,64.60,61.20,64.60,64.60,61.20
40704439_1,T4 FREE,Inpatient,0300,84439,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
40704439_1,T4 FREE,Outpatient,0300,84439,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
40704443_1,TSH REFLEXIVE,Outpatient,0300,84443,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40704443_1,TSH REFLEXIVE,Inpatient,0300,84443,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40704446_1,VITAMIN E,Inpatient,0300,84446,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40704446_1,VITAMIN E,Outpatient,0300,84446,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40704450_1,AST,Outpatient,0300,84450,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40704450_1,AST,Inpatient,0300,84450,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40704460_1,ALT (SGPT),Inpatient,0300,84460,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40704460_1,ALT (SGPT),Outpatient,0300,84460,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40704466_1,TRANSFERRIN,Inpatient,0300,84466,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704466_1,TRANSFERRIN,Outpatient,0300,84466,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704478_1,TRIGLYCERIDES,Inpatient,0300,84478,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
40704478_1,TRIGLYCERIDES,Outpatient,0300,84478,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
40704479_1,T3 UPTAKE,Outpatient,0300,84479,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40704479_1,T3 UPTAKE,Inpatient,0300,84479,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40704480_1,T3TOTAL,Inpatient,0300,84480,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
40704480_1,T3TOTAL,Outpatient,0300,84480,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
40704481_1,T3 FREE,Inpatient,0300,84481,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40704481_1,T3 FREE,Outpatient,0300,84481,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40704482_1,T3 REVERSE,Outpatient,0300,84482,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704482_1,T3 REVERSE,Inpatient,0300,84482,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40704484_1,TROPONIN QUANTITATIVE,Outpatient,0300,84484,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40704484_1,TROPONIN QUANTITATIVE,Inpatient,0300,84484,,,,0,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
40704512_1,TRIPONIN QUALITATIVE,Outpatient,0300,84512,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40704512_1,TRIPONIN QUALITATIVE,Inpatient,0300,84512,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40704520_1,BUN,Inpatient,0300,84520,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40704520_1,BUN,Outpatient,0300,84520,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40704550_1,URIC ACID,Inpatient,0300,84550,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
40704550_1,URIC ACID,Outpatient,0300,84550,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
40704560_1,URIC ACID; URINE,Inpatient,0300,84560,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
40704560_1,URIC ACID; URINE,Outpatient,0300,84560,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
40704578_1,UROBILINOGEN URINE QUAL,Outpatient,0300,84578,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40704578_1,UROBILINOGEN URINE QUAL,Inpatient,0300,84578,,,,0,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
40704585_1,VANILLYLMANDELIC ACID (VMA) URINE,Outpatient,0300,84585,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40704585_1,VANILLYLMANDELIC ACID (VMA) URINE,Inpatient,0300,84585,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40704586_1,VIP,Outpatient,0300,84586,,,,0,291.00,218.25,218.25,276.45,261.90,276.45,276.45,261.90
40704586_1,VIP,Inpatient,0300,84586,,,,0,291.00,218.25,218.25,276.45,261.90,276.45,276.45,261.90
40704588_1,ARGININE VASOPRESSIN HORMONE,Inpatient,0300,84588,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
40704588_1,ARGININE VASOPRESSIN HORMONE,Outpatient,0300,84588,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
40704591_1,"Vitamin level, not otherwise specified",Outpatient,0300,84591,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40704591_1,"Vitamin level, not otherwise specified",Inpatient,0300,84591,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40704597_1,Vitamin K1,Outpatient,0300,84597,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40704597_1,Vitamin K1,Inpatient,0300,84597,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40704630_1,ZINC,Outpatient,0300,84630,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40704630_1,ZINC,Inpatient,0300,84630,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40704681_1,CPEPTIDE,Outpatient,0300,84681,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40704681_1,CPEPTIDE,Inpatient,0300,84681,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40704702_1,PREGNANCYHCG QUANT,Outpatient,0300,84702,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
40704702_1,PREGNANCYHCG QUANT,Inpatient,0300,84702,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
40704703_1,PREGNANCYHCG QUAL,Inpatient,0300,84703,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,95.95,90.90
40704703_1,PREGNANCYHCG QUAL,Outpatient,0300,84703,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,95.95,90.90
40704999_1,UNLISTED CHEMISTRY PROCEDURE LAB,Inpatient,0300,84999,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40704999_1,UNLISTED CHEMISTRY PROCEDURE LAB,Outpatient,0300,84999,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40705007_1,DIFFERENTIAL MANUAL,Inpatient,0300,85007,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
40705007_1,DIFFERENTIAL MANUAL,Outpatient,0300,85007,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
40705014_1,HEMATOCRIT,Inpatient,0300,85014,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
40705014_1,HEMATOCRIT,Outpatient,0300,85014,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
40705018_1,HEMOGLOBIN,Inpatient,0300,85018,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
40705018_1,HEMOGLOBIN,Outpatient,0300,85018,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
40705025_1,CBC WAUTOMATED DIFFERENTIAL,Inpatient,0300,85025,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40705025_1,CBC WAUTOMATED DIFFERENTIAL,Outpatient,0300,85025,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
40705027_1,HEMOGRAM WITH PLATELET AUTOMATED CBC WO,Inpatient,0300,85027,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40705027_1,HEMOGRAM WITH PLATELET AUTOMATED CBC WO,Outpatient,0300,85027,,,,0,78.00,58.50,58.50,74.10,70.20,74.10,74.10,70.20
40705032_1,MANUAL CELL COUNT (EACH),Outpatient,0300,85032,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
40705032_1,MANUAL CELL COUNT (EACH),Inpatient,0300,85032,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
40705041_1,RED BLOOD COUNT (RBC),Outpatient,0300,85041,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
40705041_1,RED BLOOD COUNT (RBC),Inpatient,0300,85041,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
40705046_1,RETICULOCYTE COUNT AUTOMATED,Outpatient,0300,85046,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40705046_1,RETICULOCYTE COUNT AUTOMATED,Inpatient,0300,85046,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40705049_1,PLATELET COUNT,Inpatient,0300,85049,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40705049_1,PLATELET COUNT,Outpatient,0300,85049,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40705060_1,Peripheral Flow Cytometry,Inpatient,0300,85060,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40705060_1,Peripheral Flow Cytometry,Outpatient,0300,85060,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40705170_1,CLOT RETRACTION QUANT,Outpatient,0300,85170,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40705170_1,CLOT RETRACTION QUANT,Inpatient,0300,85170,,,,0,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
40705220_1,FACTOR V (BLOOD CLOT),Inpatient,0300,85220,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
40705220_1,FACTOR V (BLOOD CLOT),Outpatient,0300,85220,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
40705230_1,"Clotting; Factor vii (proconvertin, stable factor)",Outpatient,0300,85230,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,180.50,171.00
40705230_1,"Clotting; Factor vii (proconvertin, stable factor)",Inpatient,0300,85230,,,,0,190.00,142.50,142.50,180.50,171.00,180.50,180.50,171.00
40705260_1,FACTOR X (STUARTPROWER),Outpatient,0300,85260,,,,0,186.00,139.50,139.50,176.70,167.40,176.70,176.70,167.40
40705260_1,FACTOR X (STUARTPROWER),Inpatient,0300,85260,,,,0,186.00,139.50,139.50,176.70,167.40,176.70,176.70,167.40
40705300_1,ANTITHROMBIN III ACTIVITY,Outpatient,0300,85300,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40705300_1,ANTITHROMBIN III ACTIVITY,Inpatient,0300,85300,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40705301_1,ANTITHROMBIN III ANTIGEN ASSAY,Outpatient,0300,85301,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40705301_1,ANTITHROMBIN III ANTIGEN ASSAY,Inpatient,0300,85301,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40705302_1,PROTEIN C ANTIGEN,Inpatient,0300,85302,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40705302_1,PROTEIN C ANTIGEN,Outpatient,0300,85302,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40705303_1,PROTEIN C ACTIVITY,Outpatient,0300,85303,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,139.65,132.30
40705303_1,PROTEIN C ACTIVITY,Inpatient,0300,85303,,,,0,147.00,110.25,110.25,139.65,132.30,139.65,139.65,132.30
40705305_1,PROTEIN S TOTAL,Outpatient,0300,85305,,,,0,123.00,92.25,92.25,116.85,110.70,116.85,116.85,110.70
40705305_1,PROTEIN S TOTAL,Inpatient,0300,85305,,,,0,123.00,92.25,92.25,116.85,110.70,116.85,116.85,110.70
40705306_1,PROTEIN S ACTIVITY,Outpatient,0300,85306,,,,0,194.00,145.50,145.50,184.30,174.60,184.30,184.30,174.60
40705306_1,PROTEIN S ACTIVITY,Inpatient,0300,85306,,,,0,194.00,145.50,145.50,184.30,174.60,184.30,184.30,174.60
40705307_1,ACTIVATED PROTEIN C RESISTANCE,Outpatient,0300,85307,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40705307_1,ACTIVATED PROTEIN C RESISTANCE,Inpatient,0300,85307,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40705362_1,FIBRIN DEGRAD PRODUCTS (FDP),Inpatient,0300,85362,,,,0,87.00,65.25,65.25,82.65,78.30,82.65,82.65,78.30
40705362_1,FIBRIN DEGRAD PRODUCTS (FDP),Outpatient,0300,85362,,,,0,87.00,65.25,65.25,82.65,78.30,82.65,82.65,78.30
40705379_1,DDIMER QUANTITATIVE,Outpatient,0300,85379,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40705379_1,DDIMER QUANTITATIVE,Inpatient,0300,85379,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40705384_1,FIBRINOGEN ACTIVITY,Inpatient,0300,85384,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40705384_1,FIBRINOGEN ACTIVITY,Outpatient,0300,85384,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40705385_1,FIBRINOGEN ANTIGEN,Inpatient,0300,85385,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40705385_1,FIBRINOGEN ANTIGEN,Outpatient,0300,85385,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40705520_1,HEPARIN LOW MOLECULAR WEIGHT,Inpatient,0300,85520,,,,0,251.00,188.25,188.25,238.45,225.90,238.45,238.45,225.90
40705520_1,HEPARIN LOW MOLECULAR WEIGHT,Outpatient,0300,85520,,,,0,251.00,188.25,188.25,238.45,225.90,238.45,238.45,225.90
40705540_1,LEUKOCYTE ALKALINE PHOSPHATASE,Outpatient,0300,85540,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40705540_1,LEUKOCYTE ALKALINE PHOSPHATASE,Inpatient,0300,85540,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40705549_1,LYSOZYME SERUM,Outpatient,0300,85549,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40705549_1,LYSOZYME SERUM,Inpatient,0300,85549,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40705610_1,PROTIME,Inpatient,0300,85610,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40705610_1,PROTIME,Outpatient,0300,85610,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
40705613_1,DILUTE RUSSEL VIPER VENOM,Outpatient,0300,85613,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
40705613_1,DILUTE RUSSEL VIPER VENOM,Inpatient,0300,85613,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
40705651_1,E SED RATE,Outpatient,0300,85651,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40705651_1,E SED RATE,Inpatient,0300,85651,,,,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
40705660_1,"SICKLE CELL SCREEN, REFLEX HEMOGLOBINOPATHY EVALUATION",Outpatient,0300,85660,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40705660_1,"SICKLE CELL SCREEN, REFLEX HEMOGLOBINOPATHY EVALUATION",Inpatient,0300,85660,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40705670_1,THROMBIN TIME,Inpatient,0300,85670,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
40705670_1,THROMBIN TIME,Outpatient,0300,85670,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
40705730_1,APTT,Inpatient,0300,85730,,,,0,105.00,78.75,78.75,99.75,94.50,99.75,99.75,94.50
40705730_1,APTT,Outpatient,0300,85730,,,,0,105.00,78.75,78.75,99.75,94.50,99.75,99.75,94.50
40705810_1,SERUM VISCOSITY,Outpatient,0300,85810,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40705810_1,SERUM VISCOSITY,Inpatient,0300,85810,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40706000_1,FEBRILE AGGLUTININS PROFILE,Outpatient,0300,86000,,,,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
40706000_1,FEBRILE AGGLUTININS PROFILE,Inpatient,0300,86000,,,,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
40706003_1,ALLERGEN ACREMONIUM KILIENSE IG,Inpatient,0300,86003,,,,0,140.00,105.00,105.00,133.00,126.00,133.00,133.00,126.00
40706003_1,ALLERGEN ACREMONIUM KILIENSE IG,Outpatient,0300,86003,,,,0,140.00,105.00,105.00,133.00,126.00,133.00,133.00,126.00
40706038_1,ANA SCREEN (ANTINUCLEAR ANTIBODI,Outpatient,0300,86038,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40706038_1,ANA SCREEN (ANTINUCLEAR ANTIBODI,Inpatient,0300,86038,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40706039_1,ANA TITER (ANTINUCLEAR ANTIBODIES),Inpatient,0300,86039,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40706039_1,ANA TITER (ANTINUCLEAR ANTIBODIES),Outpatient,0300,86039,,,,0,119.00,89.25,89.25,113.05,107.10,113.05,113.05,107.10
40706060_1,ASO TITRE,Inpatient,0300,86060,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40706060_1,ASO TITRE,Outpatient,0300,86060,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40706063_1,STREPTOZYME TITER,Inpatient,0300,86063,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40706063_1,STREPTOZYME TITER,Outpatient,0300,86063,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40706140_1,CREACTIVE PROTEIN,Inpatient,0300,86140,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40706140_1,CREACTIVE PROTEIN,Outpatient,0300,86140,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40706141_1,CREACTIVE PROTEIN HS,Inpatient,0300,86141,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40706141_1,CREACTIVE PROTEIN HS,Outpatient,0300,86141,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40706146_1,GLYCOPROTEIN,Outpatient,0300,86146,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40706146_1,GLYCOPROTEIN,Inpatient,0300,86146,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
40706147_1,ANTICARDIOLIPIN ANTIBODY PANEL,Outpatient,0300,86147,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706147_1,ANTICARDIOLIPIN ANTIBODY PANEL,Inpatient,0300,86147,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706148_1,PHOSPHATIDYLSERINE IGM IGG IGA,Inpatient,0300,86148,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
40706148_1,PHOSPHATIDYLSERINE IGM IGG IGA,Outpatient,0300,86148,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
40706157_1,COLD AGGLUTININS TITER,Inpatient,0300,86157,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,95.95,90.90
40706157_1,COLD AGGLUTININS TITER,Outpatient,0300,86157,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,95.95,90.90
40706160_1,C3 OR C4,Inpatient,0300,86160,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40706160_1,C3 OR C4,Outpatient,0300,86160,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40706161_1,C1,Outpatient,0300,86161,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40706161_1,C1,Inpatient,0300,86161,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40706162_1,CH 50,Inpatient,0300,86162,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706162_1,CH 50,Outpatient,0300,86162,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706200_1,CYCLIC CITRULLINATED PEPTIDE ANTI,Outpatient,0300,86200,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706200_1,CYCLIC CITRULLINATED PEPTIDE ANTI,Inpatient,0300,86200,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706225_1,DNA ANTIBODYDOUBLE STRAND,Outpatient,0300,86225,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40706225_1,DNA ANTIBODYDOUBLE STRAND,Inpatient,0300,86225,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40706235_1,SMITH AUTOANTIBODY IGG (SMMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706235_1,SMITH AUTOANTIBODY IGG (SMMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706255_1,ANTIMITOCHONDRIAL ANTIBODY,Inpatient,0300,86255,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40706255_1,ANTIMITOCHONDRIAL ANTIBODY,Outpatient,0300,86255,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40706300_1,CA 2729CA 153,Inpatient,0300,86300,,,,0,233.00,174.75,174.75,221.35,209.70,221.35,221.35,209.70
40706300_1,CA 2729CA 153,Outpatient,0300,86300,,,,0,233.00,174.75,174.75,221.35,209.70,221.35,221.35,209.70
40706301_1,CA199,Inpatient,0300,86301,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
40706301_1,CA199,Outpatient,0300,86301,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
40706304_1,CA125,Inpatient,0300,86304,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
40706304_1,CA125,Outpatient,0300,86304,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
40706305_1,Human Epididymis Protein 4,Inpatient,0300,86305,,,,0,335.00,251.25,251.25,318.25,301.50,318.25,318.25,301.50
40706305_1,Human Epididymis Protein 4,Outpatient,0300,86305,,,,0,335.00,251.25,251.25,318.25,301.50,318.25,318.25,301.50
40706308_1,MONO TEST,Inpatient,0300,86308,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40706308_1,MONO TEST,Outpatient,0300,86308,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40706316_1,IMMUNOASSAY FOR TUMOR ANTIGEN EACH,Outpatient,0300,86316,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40706316_1,IMMUNOASSAY FOR TUMOR ANTIGEN EACH,Inpatient,0300,86316,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40706318_1,H. PYLORI G 11 TEST,Outpatient,0300,86677,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
40706318_1,H. PYLORI G 11 TEST,Inpatient,0300,86677,,,,0,192.00,144.00,144.00,182.40,172.80,182.40,182.40,172.80
40706332_1,IMMUNE COMPLEX ASSAY,Inpatient,0300,86332,,,,0,203.00,152.25,152.25,192.85,182.70,192.85,192.85,182.70
40706332_1,IMMUNE COMPLEX ASSAY,Outpatient,0300,86332,,,,0,203.00,152.25,152.25,192.85,182.70,192.85,192.85,182.70
40706334_1,IMMUNOFIXATION ELECTROPHORESIS,Outpatient,0300,86334,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
40706334_1,IMMUNOFIXATION ELECTROPHORESIS,Inpatient,0300,86334,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
40706335_1,IMMUNIOFIXATION URINESERUM RQ,Outpatient,0300,86335,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40706335_1,IMMUNIOFIXATION URINESERUM RQ,Inpatient,0300,86335,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40706336_1,INHIBIN A,Outpatient,0300,86336,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40706336_1,INHIBIN A,Inpatient,0300,86336,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40706337_1,INSULIN ANTIBODIES,Inpatient,0300,86337,,,,0,222.00,166.50,166.50,210.90,199.80,210.90,210.90,199.80
40706337_1,INSULIN ANTIBODIES,Outpatient,0300,86337,,,,0,222.00,166.50,166.50,210.90,199.80,210.90,210.90,199.80
40706340_1,INTRINSIC FACTOR BLOCKING ANTIBODY,Inpatient,0300,86340,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706340_1,INTRINSIC FACTOR BLOCKING ANTIBODY,Outpatient,0300,86340,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706360_1,Helper Suppressor (CD4/CD8),Inpatient,0300,86360,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40706360_1,Helper Suppressor (CD4/CD8),Outpatient,0300,86360,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40706371_1,HEPATITIS B SURFACE ANTIBODY QUANT,Inpatient,0300,86317,,,,0,154.00,115.50,115.50,146.30,138.60,146.30,146.30,138.60
40706371_1,HEPATITIS B SURFACE ANTIBODY QUANT,Outpatient,0300,86317,,,,0,154.00,115.50,115.50,146.30,138.60,146.30,146.30,138.60
40706376_1,MICROSMAL ANTIBODIES LIVERKIDNEY Thyroid,Inpatient,0300,86376,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706376_1,MICROSMAL ANTIBODIES LIVERKIDNEY Thyroid,Outpatient,0300,86376,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706403_1,CRYPTOCOCCUS ANTIGEN CSF,Inpatient,0300,86403,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40706403_1,CRYPTOCOCCUS ANTIGEN CSF,Outpatient,0300,86403,,,,0,129.00,96.75,96.75,122.55,116.10,122.55,122.55,116.10
40706415_1,VENOUS DRAW,Inpatient,0300,36415,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
40706415_1,VENOUS DRAW,Outpatient,0300,36415,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
40706416_1,CAPILLARY DRAW,Inpatient,0300,36416,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
40706416_1,CAPILLARY DRAW,Outpatient,0300,36416,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
40706430_1,RHEUMATOID FACTOR QUAL,Outpatient,0300,86430,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40706430_1,RHEUMATOID FACTOR QUAL,Inpatient,0300,86430,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
40706431_1,RA TITER,Outpatient,0300,86431,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40706431_1,RA TITER,Inpatient,0300,86431,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40706480_1,Quantiferon Gold TB,Outpatient,0300,86480,,,,0,253.00,189.75,189.75,240.35,227.70,240.35,240.35,227.70
40706480_1,Quantiferon Gold TB,Inpatient,0300,86480,,,,0,253.00,189.75,189.75,240.35,227.70,240.35,240.35,227.70
40706592_1,RPR,Inpatient,0300,86592,,,,0,80.00,60.00,60.00,76.00,72.00,76.00,76.00,72.00
40706592_1,RPR,Outpatient,0300,86592,,,,0,80.00,60.00,60.00,76.00,72.00,76.00,76.00,72.00
40706600_1,ABG BLOOD DRAW,Outpatient,0300,36600,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,235.60,223.20
40706600_1,ABG BLOOD DRAW,Inpatient,0300,36600,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,235.60,223.20
40706606_1,"ASPERGILLUS ANTIBODIES, QUANTITATIVE",Outpatient,0300,86606,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40706606_1,"ASPERGILLUS ANTIBODIES, QUANTITATIVE",Inpatient,0300,86606,,,,0,63.00,47.25,47.25,59.85,56.70,59.85,59.85,56.70
40706617_1,LYME DISEASE CONFIRMATORY TEST,Outpatient,0300,86617,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40706617_1,LYME DISEASE CONFIRMATORY TEST,Inpatient,0300,86617,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
40706618_1,LYMES DISEASE ANTIBODY,Outpatient,0300,86618,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706618_1,LYMES DISEASE ANTIBODY,Inpatient,0300,86618,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706628_1,CANDIDA ANTIBODY & ANTISEN PANEL,Outpatient,0300,86628,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40706628_1,CANDIDA ANTIBODY & ANTISEN PANEL,Inpatient,0300,86628,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40706631_1,CHLAMYDIA ANTIBODIES,Inpatient,0300,86631,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706631_1,CHLAMYDIA ANTIBODIES,Outpatient,0300,86631,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706635_1,COCCIDIOIDES,Inpatient,0300,86635,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40706635_1,COCCIDIOIDES,Outpatient,0300,86635,,,,0,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
40706644_1,CYTOMEGALO VIRUS IGG (CMV),Inpatient,0300,86644,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40706644_1,CYTOMEGALO VIRUS IGG (CMV),Outpatient,0300,86644,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40706645_1,CYTOMEGALIC VIRUS ANTIBODY IGM (CM,Inpatient,0300,86645,,,,0,180.00,135.00,135.00,171.00,162.00,171.00,171.00,162.00
40706645_1,CYTOMEGALIC VIRUS ANTIBODY IGM (CM,Outpatient,0300,86645,,,,0,180.00,135.00,135.00,171.00,162.00,171.00,171.00,162.00
40706663_1,EPSTEINBARR VIRUS DIFFUSE IGG,Outpatient,0300,86663,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40706663_1,EPSTEINBARR VIRUS DIFFUSE IGG,Inpatient,0300,86663,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
40706664_1,EPSTEINBARR VIRUS IGG,Inpatient,0300,86664,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706664_1,EPSTEINBARR VIRUS IGG,Outpatient,0300,86664,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
40706665_1,EPSTEINBARR VIRUS VIRAL IGGIGM,Outpatient,0300,86665,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40706665_1,EPSTEINBARR VIRUS VIRAL IGGIGM,Inpatient,0300,86665,,,,0,148.00,111.00,111.00,140.60,133.20,140.60,140.60,133.20
40706674_1,GIARDIA LAMBLIA ANTIBDY IGG IGA IG,Inpatient,0300,86674,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,242.25,229.50
40706674_1,GIARDIA LAMBLIA ANTIBDY IGG IGA IG,Outpatient,0300,86674,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,242.25,229.50
40706677_1,H PYLORI ANTIBODY IGG & IGM,Outpatient,0300,86677,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40706677_1,H PYLORI ANTIBODY IGG & IGM,Inpatient,0300,86677,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40706682_1,ECHINOCOCCUS ANTIBODY IGG,Outpatient,0300,86682,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40706682_1,ECHINOCOCCUS ANTIBODY IGG,Inpatient,0300,86682,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
40706687_1,HIV 12 ANTIBODY,Inpatient,0300,86687,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40706687_1,HIV 12 ANTIBODY,Outpatient,0300,86687,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40706694_1,HERPES SIMPLEX VIRUS IGM ANTIBODY,Inpatient,0300,86694,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,228.00,216.00
40706694_1,HERPES SIMPLEX VIRUS IGM ANTIBODY,Outpatient,0300,86694,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,228.00,216.00
40706695_1,HERPES SIMPLEX VIRUS I,Inpatient,0300,86695,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40706695_1,HERPES SIMPLEX VIRUS I,Outpatient,0300,86695,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40706696_1,HERPES SIMPLEX VIRUS II,Outpatient,0300,86696,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40706696_1,HERPES SIMPLEX VIRUS II,Inpatient,0300,86696,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
40706701_1,HIV,Inpatient,0300,86701,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40706701_1,HIV,Outpatient,0300,86701,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40706703_1,HIV1 AND HIV2 SINGLE ASSAY,Inpatient,0300,86703,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40706703_1,HIV1 AND HIV2 SINGLE ASSAY,Outpatient,0300,86703,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40706704_1,HEPATITIS B CORE ANTIBODY,Outpatient,0300,86704,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40706704_1,HEPATITIS B CORE ANTIBODY,Inpatient,0300,86704,,,,0,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
40706705_1,HEP B IGM ANTIBODY,Inpatient,0300,86705,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
40706705_1,HEP B IGM ANTIBODY,Outpatient,0300,86705,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
40706706_1,HEPATITIS B SURFACE ANTIBODY,Inpatient,0300,86706,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40706706_1,HEPATITIS B SURFACE ANTIBODY,Outpatient,0300,86706,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40706707_1,HEPATITIS B E ANTIBODY,Inpatient,0300,86707,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706707_1,HEPATITIS B E ANTIBODY,Outpatient,0300,86707,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40706708_1,HEPATITIS A ANTIBODY,Outpatient,0300,86708,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40706708_1,HEPATITIS A ANTIBODY,Inpatient,0300,86708,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
40706709_1,HEPATITIS A VIRUS AB IGM,Outpatient,0300,86709,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
40706709_1,HEPATITIS A VIRUS AB IGM,Inpatient,0300,86709,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
40706710_1,INFLUENZA ANTIBODIES,Outpatient,0300,86710,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40706710_1,INFLUENZA ANTIBODIES,Inpatient,0300,86710,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40706713_1,LEGIONELLA ANTIBODY,Inpatient,0300,86713,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40706713_1,LEGIONELLA ANTIBODY,Outpatient,0300,86713,,,,0,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
40706720_1,LEPTOSPIRA ANTIBODY,Outpatient,0300,86720,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40706720_1,LEPTOSPIRA ANTIBODY,Inpatient,0300,86720,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40706723_1,LISTERIA MONOCYTOGENES ANTIBODY,Inpatient,0300,86723,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40706723_1,LISTERIA MONOCYTOGENES ANTIBODY,Outpatient,0300,86723,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
40706735_1,MUMPS VIRUS ANTIBODY IGG & IGM,Inpatient,0300,86735,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
40706735_1,MUMPS VIRUS ANTIBODY IGG & IGM,Outpatient,0300,86735,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
40706738_1,MYCOPLASMA PNEUMONIA ANTI IGGIGM,Inpatient,0300,86738,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706738_1,MYCOPLASMA PNEUMONIA ANTI IGGIGM,Outpatient,0300,86738,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
40706747_1,PARVOVIRUS B19 ANTIBODY IGM OR IGA,Outpatient,0300,86747,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706747_1,PARVOVIRUS B19 ANTIBODY IGM OR IGA,Inpatient,0300,86747,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706753_1,Entalnoeba,Inpatient,0300,86753,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40706753_1,Entalnoeba,Outpatient,0300,86753,,,,0,145.00,108.75,108.75,137.75,130.50,137.75,137.75,130.50
40706762_1,RUBELLA,Outpatient,0300,86762,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40706762_1,RUBELLA,Inpatient,0300,86762,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
40706765_1,RUBEOLA,Inpatient,0300,86765,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40706765_1,RUBEOLA,Outpatient,0300,86765,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40706769_1,COVID-19 Antibody,Inpatient,0300,86769,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40706769_1,COVID-19 Antibody,Outpatient,0300,86769,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40706777_1,TOXOPLASMA,Inpatient,0300,86777,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40706777_1,TOXOPLASMA,Outpatient,0300,86777,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
40706778_1,TOXOPLASMA AB IGM,Outpatient,0300,86778,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40706778_1,TOXOPLASMA AB IGM,Inpatient,0300,86778,,,,0,149.00,111.75,111.75,141.55,134.10,141.55,141.55,134.10
40706780_1,TREPONEMA PALLIDUM ANTIBODY BY EIA,Inpatient,0300,86780,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40706780_1,TREPONEMA PALLIDUM ANTIBODY BY EIA,Outpatient,0300,86780,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40706781_1,FTA,Outpatient,0300,86780,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40706781_1,FTA,Inpatient,0300,86780,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40706787_1,VARICELLA ZOSTER ANITBODY,Outpatient,0300,86787,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40706787_1,VARICELLA ZOSTER ANITBODY,Inpatient,0300,86787,,,,0,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
40706790_1,HANTAVIRIS IGG & IGM ANTIBODIES R,Outpatient,0300,86790,,,,0,307.00,230.25,230.25,291.65,276.30,291.65,291.65,276.30
40706790_1,HANTAVIRIS IGG & IGM ANTIBODIES R,Inpatient,0300,86790,,,,0,307.00,230.25,230.25,291.65,276.30,291.65,291.65,276.30
40706800_1,THYROGLOBULIN ANTIBODY,Outpatient,0300,86800,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40706800_1,THYROGLOBULIN ANTIBODY,Inpatient,0300,86800,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
40706803_1,HEPATITIS C ANTIBODY,Inpatient,0300,86803,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40706803_1,HEPATITIS C ANTIBODY,Outpatient,0300,86803,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
40706804_1,HEPATITIS C CONFIRMATION,Inpatient,0300,86804,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40706804_1,HEPATITIS C CONFIRMATION,Outpatient,0300,86804,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
40706812_1,HLA B27 (REFLEXIVE),Inpatient,0300,86812,,,,0,219.00,164.25,164.25,208.05,197.10,208.05,208.05,197.10
40706812_1,HLA B27 (REFLEXIVE),Outpatient,0300,86812,,,,0,219.00,164.25,164.25,208.05,197.10,208.05,208.05,197.10
40706813_1,HLA TYPING MULTIPLE A B OR C,Inpatient,0300,86813,,,,0,479.00,359.25,359.25,455.05,431.10,455.05,455.05,431.10
40706813_1,HLA TYPING MULTIPLE A B OR C,Outpatient,0300,86813,,,,0,479.00,359.25,359.25,455.05,431.10,455.05,455.05,431.10
40706850_1,ANTIBODY SCREEN RBC,Inpatient,0300,86850,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40706850_1,ANTIBODY SCREEN RBC,Outpatient,0300,86850,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40706870_1,ANTIBODY I.D. RBC,Inpatient,0300,86870,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
40706870_1,ANTIBODY I.D. RBC,Outpatient,0300,86870,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
40706880_1,COOMBS TEST,Inpatient,0300,86880,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40706880_1,COOMBS TEST,Outpatient,0300,86880,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
40706885_1,COOMBS TEST  INDIRECT,Outpatient,0300,86885,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40706885_1,COOMBS TEST  INDIRECT,Inpatient,0300,86885,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40706886_1,ISOHEMAGGLOTININ TITERS ANTI A,Inpatient,0300,86886,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40706886_1,ISOHEMAGGLOTININ TITERS ANTI A,Outpatient,0300,86886,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
40706900_1,BLOOD TYPE ABO,Inpatient,0300,86900,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40706900_1,BLOOD TYPE ABO,Outpatient,0300,86900,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40706901_1,BLOOD TYPE RH (D),Inpatient,0300,86901,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
40706901_1,BLOOD TYPE RH (D),Outpatient,0300,86901,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
40706903_1,ANTIGEN TYPING II,Outpatient,0300,86902,,,,0,315.00,236.25,236.25,299.25,283.50,299.25,299.25,283.50
40706903_1,ANTIGEN TYPING II,Inpatient,0300,86902,,,,0,315.00,236.25,236.25,299.25,283.50,299.25,299.25,283.50
40706920_1,CROSSMATCH PER UNIT,Outpatient,0300,86920,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40706920_1,CROSSMATCH PER UNIT,Inpatient,0300,86920,,,,0,155.00,116.25,116.25,147.25,139.50,147.25,147.25,139.50
40707015_1,CULTURE AFB (NO SMEAR) (REFLEXIVE,Inpatient,0300,87015,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
40707015_1,CULTURE AFB (NO SMEAR) (REFLEXIVE,Outpatient,0300,87015,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
40707040_1,CULTURE BLOOD,Inpatient,0300,87040,,,,2,194.00,145.50,145.50,184.30,174.60,184.30,184.30,174.60
40707040_1,CULTURE BLOOD,Outpatient,0300,87040,,,,2,194.00,145.50,145.50,184.30,174.60,184.30,184.30,174.60
40707045_1,CULTURE STOOL NS,Inpatient,0300,87045,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40707045_1,CULTURE STOOL NS,Outpatient,0300,87045,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40707046_1,CULTURE FECES W YERSINIA&SHIGA,Outpatient,0300,87046,,,,0,39.00,29.25,29.25,37.05,35.10,37.05,37.05,35.10
40707046_1,CULTURE FECES W YERSINIA&SHIGA,Inpatient,0300,87046,,,,0,39.00,29.25,29.25,37.05,35.10,37.05,37.05,35.10
40707070_1,CULTURE BACTERIA,Outpatient,0300,87070,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40707070_1,CULTURE BACTERIA,Inpatient,0300,87070,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40707073_1,CULTURE ANAERABIC,Inpatient,0300,87073,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40707073_1,CULTURE ANAERABIC,Outpatient,0300,87073,,,,0,100.00,75.00,75.00,95.00,90.00,95.00,95.00,90.00
40707075_1,CULTURE ANAERABIC (METPATH),Inpatient,0300,87075,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40707075_1,CULTURE ANAERABIC (METPATH),Outpatient,0300,87075,,,,0,89.00,66.75,66.75,84.55,80.10,84.55,84.55,80.10
40707077_1,CULTURE ORGANISM IDENTIFICATION,Inpatient,0300,87077,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,85.50,81.00
40707077_1,CULTURE ORGANISM IDENTIFICATION,Outpatient,0300,87077,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,85.50,81.00
40707081_1,CULTURE MRSA SCREEN,Outpatient,0300,87081,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40707081_1,CULTURE MRSA SCREEN,Inpatient,0300,87081,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40707086_1,CULTURE UA,Outpatient,0300,87086,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40707086_1,CULTURE UA,Inpatient,0300,87086,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40707088_1,CULTUREURINE IDENTIFICATION,Inpatient,0300,87088,,,,0,73.00,54.75,54.75,69.35,65.70,69.35,69.35,65.70
40707088_1,CULTUREURINE IDENTIFICATION,Outpatient,0300,87088,,,,0,73.00,54.75,54.75,69.35,65.70,69.35,69.35,65.70
40707101_1,CULTURE FUNG (SKIN HAIR NAILS) REF,Inpatient,0300,87101,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40707101_1,CULTURE FUNG (SKIN HAIR NAILS) REF,Outpatient,0300,87101,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
40707102_1,CULTURE FUNGUS  OTHER,Inpatient,0300,87102,,,,0,122.00,91.50,91.50,115.90,109.80,115.90,115.90,109.80
40707102_1,CULTURE FUNGUS  OTHER,Outpatient,0300,87102,,,,0,122.00,91.50,91.50,115.90,109.80,115.90,115.90,109.80
40707106_1,Yeast Sensitivity,Outpatient,0300,87106,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40707106_1,Yeast Sensitivity,Inpatient,0300,87106,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
40707110_1,CHLAMYDIA CULTURE,Outpatient,0300,87110,,,,0,204.00,153.00,153.00,193.80,183.60,193.80,193.80,183.60
40707110_1,CHLAMYDIA CULTURE,Inpatient,0300,87110,,,,0,204.00,153.00,153.00,193.80,183.60,193.80,193.80,183.60
40707116_1,CULTURE AFB NO SMEAR REFLEXIVE,Outpatient,0300,87116,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40707116_1,CULTURE AFB NO SMEAR REFLEXIVE,Inpatient,0300,87116,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40707172_1,PIN WORM EXAMINATION,Inpatient,0300,87172,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40707172_1,PIN WORM EXAMINATION,Outpatient,0300,87172,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40707177_1,OVA & PARASITES STOOL S&P,Inpatient,0300,87177,,,,0,83.00,62.25,62.25,78.85,74.70,78.85,78.85,74.70
40707177_1,OVA & PARASITES STOOL S&P,Outpatient,0300,87177,,,,0,83.00,62.25,62.25,78.85,74.70,78.85,78.85,74.70
40707184_1,ANTIBIOTIC SENSITIVITY,Inpatient,0300,87184,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
40707184_1,ANTIBIOTIC SENSITIVITY,Outpatient,0300,87184,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
40707186_1,Urine Culture-Colony Count RF/X,Outpatient,0300,87186,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
40707186_1,Urine Culture-Colony Count RF/X,Inpatient,0300,87186,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
40707205_1,GRAM STAIN,Inpatient,0300,87205,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40707205_1,GRAM STAIN,Outpatient,0300,87205,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40707206_1,VIRUS FLUORESCENT STAIN,Outpatient,0300,87206,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40707206_1,VIRUS FLUORESCENT STAIN,Inpatient,0300,87206,,,,0,77.00,57.75,57.75,73.15,69.30,73.15,73.15,69.30
40707207_1,MALARIA SMEAR,Outpatient,0300,87207,,,,0,79.00,59.25,59.25,75.05,71.10,75.05,75.05,71.10
40707207_1,MALARIA SMEAR,Inpatient,0300,87207,,,,0,79.00,59.25,59.25,75.05,71.10,75.05,75.05,71.10
40707209_1,PARASITES TRICHROME STAIN S&P,Inpatient,0300,87209,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
40707209_1,PARASITES TRICHROME STAIN S&P,Outpatient,0300,87209,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
40707210_1,WET MOUNT SALINE OR KOH,Outpatient,0300,87210,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40707210_1,WET MOUNT SALINE OR KOH,Inpatient,0300,87210,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
40707220_1,KOH SKIN HAIR NAILS,Inpatient,0300,87220,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40707220_1,KOH SKIN HAIR NAILS,Outpatient,0300,87220,,,,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
40707230_1,CDIFF TOXIN OR ANTITOXIN ASSAY,Outpatient,0300,87230,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40707230_1,CDIFF TOXIN OR ANTITOXIN ASSAY,Inpatient,0300,87230,,,,0,130.00,97.50,97.50,123.50,117.00,123.50,123.50,117.00
40707252_1,VIRAL CULTURE (REFLEXIVE),Outpatient,0300,87252,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40707252_1,VIRAL CULTURE (REFLEXIVE),Inpatient,0300,87252,,,,0,156.00,117.00,117.00,148.20,140.40,148.20,148.20,140.40
40707253_1,Tissue Culture; Virus Isolation,Inpatient,0300,87253,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40707253_1,Tissue Culture; Virus Isolation,Outpatient,0300,87253,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
40707254_1,CULTURE VIRAL (REFLEXIVE),Inpatient,0300,87254,,,,0,262.00,196.50,196.50,248.90,235.80,248.90,248.90,235.80
40707254_1,CULTURE VIRAL (REFLEXIVE),Outpatient,0300,87254,,,,0,262.00,196.50,196.50,248.90,235.80,248.90,248.90,235.80
40707255_1,HSV CULTURE,Inpatient,0300,87255,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
40707255_1,HSV CULTURE,Outpatient,0300,87255,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
40707328_1,CRYTOSPORIDIUM ANTIGEN,Inpatient,0300,87328,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
40707328_1,CRYTOSPORIDIUM ANTIGEN,Outpatient,0300,87328,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
40707329_1,GIARDIA ANTIGEN,Outpatient,0300,87329,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
40707329_1,GIARDIA ANTIGEN,Inpatient,0300,87329,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
40707338_1,H. PYLORI; HELICOBACTER,Outpatient,0300,87338,,,,0,179.00,134.25,134.25,170.05,161.10,170.05,170.05,161.10
40707338_1,H. PYLORI; HELICOBACTER,Inpatient,0300,87338,,,,0,179.00,134.25,134.25,170.05,161.10,170.05,170.05,161.10
40707340_1,HEPATITIS B SURFACE ANTIGEN,Inpatient,0300,87340,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,85.50,81.00
40707340_1,HEPATITIS B SURFACE ANTIGEN,Outpatient,0300,87340,,,,0,90.00,67.50,67.50,85.50,81.00,85.50,85.50,81.00
40707350_1,HEPATITIS B E ANTIGEN,Inpatient,0300,87350,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40707350_1,HEPATITIS B E ANTIGEN,Outpatient,0300,87350,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
40707389_1,Human Immunodeficiency Virus Antigen/Antibody; HIV AG AB; HIV Screen,Outpatient,0300,87389,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40707389_1,Human Immunodeficiency Virus Antigen/Antibody; HIV AG AB; HIV Screen,Inpatient,0300,87389,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40707400_1,INFLUENZA A OR B  A&B X 2,Inpatient,0300,87400,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40707400_1,INFLUENZA A OR B  A&B X 2,Outpatient,0300,87400,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
40707425_1,ROTOVIRUS ANTIGEN,Inpatient,0300,87425,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40707425_1,ROTOVIRUS ANTIGEN,Outpatient,0300,87425,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40707430_1,RAPID STREP,Inpatient,0300,87880,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40707430_1,RAPID STREP,Outpatient,0300,87880,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
40707449_1,LEGIONELLA PNEUMOPHILA ANTIGEN UR,Inpatient,0300,87449,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40707449_1,LEGIONELLA PNEUMOPHILA ANTIGEN UR,Outpatient,0300,87449,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
40707491_1,CHLYMIDIA TRACHOMATIS BY AMPLIBIE,Outpatient,0300,87491,,,,0,173.00,129.75,129.75,164.35,155.70,164.35,164.35,155.70
40707491_1,CHLYMIDIA TRACHOMATIS BY AMPLIBIE,Inpatient,0300,87491,,,,0,173.00,129.75,129.75,164.35,155.70,164.35,164.35,155.70
40707502_1,I Influenza A&B Test,Inpatient,0300,87502,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,172.90,163.80
40707502_1,I Influenza A&B Test,Outpatient,0300,87502,,,,0,182.00,136.50,136.50,172.90,163.80,172.90,172.90,163.80
40707517_1,HEPATITUS B VIRAL DNA QUANTITATIVE,Outpatient,0300,87517,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,383.80,363.60
40707517_1,HEPATITUS B VIRAL DNA QUANTITATIVE,Inpatient,0300,87517,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,383.80,363.60
40707521_1,HEPATITIS C RNA AMPLIFIED PROBE,Outpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707521_1,HEPATITIS C RNA AMPLIFIED PROBE,Inpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707522_1,HEP C VIRAL RNA QUAN BY PCR REFL,Inpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707522_1,HEP C VIRAL RNA QUAN BY PCR REFL,Outpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707591_1,GONORRHEAE BY AMPLIFIED DETECTION,Inpatient,0300,87591,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
40707591_1,GONORRHEAE BY AMPLIFIED DETECTION,Outpatient,0300,87591,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
40707641_1,MRSA NASAL SCREEN BY PCR,Inpatient,0300,87641,,,,0,237.00,177.75,177.75,225.15,213.30,225.15,225.15,213.30
40707641_1,MRSA NASAL SCREEN BY PCR,Outpatient,0300,87641,,,,0,237.00,177.75,177.75,225.15,213.30,225.15,225.15,213.30
40707798_1,POLYMERASE CHAIN REACTIONNOROVIRU,Inpatient,0300,87798,,,,0,293.00,219.75,219.75,278.35,263.70,278.35,278.35,263.70
40707798_1,POLYMERASE CHAIN REACTIONNOROVIRU,Outpatient,0300,87798,,,,0,293.00,219.75,219.75,278.35,263.70,278.35,278.35,263.70
40707799_1,"Infectious Agent by DNA or RNA, not otherwise specified",Inpatient,0300,87799,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
40707799_1,"Infectious Agent by DNA or RNA, not otherwise specified",Outpatient,0300,87799,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
40707801_1,BORDETELLA PERTUSSISPARAERTUSSIS,Outpatient,0300,87801,,,,0,299.00,224.25,224.25,284.05,269.10,284.05,284.05,269.10
40707801_1,BORDETELLA PERTUSSISPARAERTUSSIS,Inpatient,0300,87801,,,,0,299.00,224.25,224.25,284.05,269.10,284.05,284.05,269.10
40707899_1,CANDIDA ANTIGEN,Inpatient,0300,87899,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40707899_1,CANDIDA ANTIGEN,Outpatient,0300,87899,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40707900_1,HCV RNA Quant by PCR Reflex,Inpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707900_1,HCV RNA Quant by PCR Reflex,Outpatient,0300,87522,,,,0,452.00,339.00,339.00,429.40,406.80,429.40,429.40,406.80
40707901_1,HIV 1 GENOTYPE PLUS,Outpatient,0300,87901,,,,0,4219.00,3164.25,3164.25,4008.05,3797.10,4008.05,4008.05,3797.10
40707901_1,HIV 1 GENOTYPE PLUS,Inpatient,0300,87901,,,,0,4219.00,3164.25,3164.25,4008.05,3797.10,4008.05,4008.05,3797.10
40707902_1,HCV Genotyping,Inpatient,0300,87902,,,,0,510.00,382.50,382.50,484.50,459.00,484.50,484.50,459.00
40707902_1,HCV Genotyping,Outpatient,0300,87902,,,,0,510.00,382.50,382.50,484.50,459.00,484.50,484.50,459.00
40708029_1,NUERONTIN LEVEL (GABAPENTIN),Outpatient,0300,80171,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
40708029_1,NUERONTIN LEVEL (GABAPENTIN),Inpatient,0300,80171,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
40708182_1,FLOW CYTOMETRY,Inpatient,0300,88182,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40708182_1,FLOW CYTOMETRY,Outpatient,0300,88182,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40708184_1,IMMUNOPHENOTYPING ONE ANTIBODY,Outpatient,0300,88184,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40708184_1,IMMUNOPHENOTYPING ONE ANTIBODY,Inpatient,0300,88184,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
40708185_1,IMMUNOPHENOTYPING TWO ANTIBODIES,Inpatient,0300,88185,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40708185_1,IMMUNOPHENOTYPING TWO ANTIBODIES,Outpatient,0300,88185,,,,0,98.00,73.50,73.50,93.10,88.20,93.10,93.10,88.20
40708189_1,IMMUNOPHENOTYPING ACUTE LEUKEMIA,Outpatient,0300,88189,,,,0,380.00,285.00,285.00,361.00,342.00,361.00,361.00,342.00
40708189_1,IMMUNOPHENOTYPING ACUTE LEUKEMIA,Inpatient,0300,88189,,,,0,380.00,285.00,285.00,361.00,342.00,361.00,361.00,342.00
40708261_1,CHROMOSOME ANALYSIS 5 CELLS,Inpatient,0300,88261,,,,0,1452.00,1089.00,1089.00,1379.40,1306.80,1379.40,1379.40,1306.80
40708261_1,CHROMOSOME ANALYSIS 5 CELLS,Outpatient,0300,88261,,,,0,1452.00,1089.00,1089.00,1379.40,1306.80,1379.40,1379.40,1306.80
40708262_1,CHROMOSOME ANALYSIS 1520 CELLS,Inpatient,0300,88262,,,,0,1025.00,768.75,768.75,973.75,922.50,973.75,973.75,922.50
40708262_1,CHROMOSOME ANALYSIS 1520 CELLS,Outpatient,0300,88262,,,,0,1025.00,768.75,768.75,973.75,922.50,973.75,973.75,922.50
40708271_1,CYTOG MOLECULAR CYTO DNA PROBE EA,Outpatient,0300,88271,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40708271_1,CYTOG MOLECULAR CYTO DNA PROBE EA,Inpatient,0300,88271,,,,0,94.00,70.50,70.50,89.30,84.60,89.30,89.30,84.60
40708275_1,CYTOG INTERPHASE 100300 CELLS,Inpatient,0300,88275,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40708275_1,CYTOG INTERPHASE 100300 CELLS,Outpatient,0300,88275,,,,0,135.00,101.25,101.25,128.25,121.50,128.25,128.25,121.50
40708283_1,CYTOG ADDITIONAL BANDING,Inpatient,0300,88283,,,,0,830.00,622.50,622.50,788.50,747.00,788.50,788.50,747.00
40708283_1,CYTOG ADDITIONAL BANDING,Outpatient,0300,88283,,,,0,830.00,622.50,622.50,788.50,747.00,788.50,788.50,747.00
40708300_1,CA 153,Inpatient,0300,86300,,,,0,233.00,174.75,174.75,221.35,209.70,221.35,221.35,209.70
40708300_1,CA 153,Outpatient,0300,86300,,,,0,233.00,174.75,174.75,221.35,209.70,221.35,221.35,209.70
40708305_1,PRODUCT OF CONCEPTION,Inpatient,0312,88305,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,241.30,228.60
40708305_1,PRODUCT OF CONCEPTION,Outpatient,0312,88305,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,241.30,228.60
40708351_1,Antismooth Muscle Antibody,Inpatient,0300,83516,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40708351_1,Antismooth Muscle Antibody,Outpatient,0300,83516,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
40708725_1,COVID-19,Inpatient,0310,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40708725_1,COVID-19,Outpatient,0310,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
40709002_1,CULTURE SPUTUM,Inpatient,0300,87070,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40709002_1,CULTURE SPUTUM,Outpatient,0300,87070,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40709003_1,CULTURE MISC,Inpatient,0300,87070,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40709003_1,CULTURE MISC,Outpatient,0300,87070,,,,0,124.00,93.00,93.00,117.80,111.60,117.80,117.80,111.60
40709010_1,Benzodiazepine Confirmation,Inpatient,0300,80346,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40709010_1,Benzodiazepine Confirmation,Outpatient,0300,80346,,,,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
40709011_1,NON SPECIFIED DRUG LEVEL,Inpatient,0300,80299,,,,0,166.00,124.50,124.50,157.70,149.40,157.70,157.70,149.40
40709011_1,NON SPECIFIED DRUG LEVEL,Outpatient,0300,80299,,,,0,166.00,124.50,124.50,157.70,149.40,157.70,157.70,149.40
40709012_1,COMPLEMENT C1 ESTERASE INHIBITORT,Outpatient,0300,86160,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40709012_1,COMPLEMENT C1 ESTERASE INHIBITORT,Inpatient,0300,86160,,,,0,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
40709051_1,CELL COUNT BODY FLUID WDIFFERENT,Inpatient,0300,89051,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
40709051_1,CELL COUNT BODY FLUID WDIFFERENT,Outpatient,0300,89051,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
40709055_1,FECAL LEUKOCYTE STAIN,Outpatient,0300,89055,,,,0,70.00,52.50,52.50,66.50,63.00,66.50,66.50,63.00
40709055_1,FECAL LEUKOCYTE STAIN,Inpatient,0300,89055,,,,0,70.00,52.50,52.50,66.50,63.00,66.50,66.50,63.00
40709060_1,CRYSTAL ID SYNOVIAL FLUID,Inpatient,0300,89060,,,,0,82.00,61.50,61.50,77.90,73.80,77.90,77.90,73.80
40709060_1,CRYSTAL ID SYNOVIAL FLUID,Outpatient,0300,89060,,,,0,82.00,61.50,61.50,77.90,73.80,77.90,77.90,73.80
40709125_1,FAT STAIN FECES URINE OR SPUTUM,Inpatient,0300,89125,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40709125_1,FAT STAIN FECES URINE OR SPUTUM,Outpatient,0300,89125,,,,0,61.00,45.75,45.75,57.95,54.90,57.95,57.95,54.90
40709310_1,SPERM COUNT,Inpatient,0300,89310,,,,0,83.00,62.25,62.25,78.85,74.70,78.85,78.85,74.70
40709310_1,SPERM COUNT,Outpatient,0300,89310,,,,0,83.00,62.25,62.25,78.85,74.70,78.85,78.85,74.70
40709320_1,SEMEN ANALYSIS COMPLETE,Outpatient,0300,89320,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40709320_1,SEMEN ANALYSIS COMPLETE,Inpatient,0300,89320,,,,0,127.00,95.25,95.25,120.65,114.30,120.65,120.65,114.30
40709803_1,HOSPITAL OUTPATIENT CLINIC VISIT SPECIMEN COLLECTION FOR SEVERE ACUTE,Outpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
40709803_1,HOSPITAL OUTPATIENT CLINIC VISIT SPECIMEN COLLECTION FOR SEVERE ACUTE,Inpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
40709921_1,RIBOSOMAL P AUTOANTIBODY IGG (RIBPMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709921_1,RIBOSOMAL P AUTOANTIBODY IGG (RIBPMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709922_1,CHROMATIN AUTOANTIBODY IGG (CHROMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709922_1,CHROMATIN AUTOANTIBODY IGG (CHROMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709923_1,RNP AUTOANTIBODY IGG (RNPMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709923_1,RNP AUTOANTIBODY IGG (RNPMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709924_1,SMRNP AUTOANTIBODY IGG (SMRNMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709924_1,SMRNP AUTOANTIBODY IGG (SMRNMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709925_1,SCL-70 AUTOANTIBODY IGG (SCLMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709925_1,SCL-70 AUTOANTIBODY IGG (SCLMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709926_1,SSA (RO) AUTOANTIBODY IGG (SSAMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709926_1,SSA (RO) AUTOANTIBODY IGG (SSAMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709927_1,SSB (LA)AUTOANTIBODY IGG (SSBMP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709927_1,SSB (LA)AUTOANTIBODY IGG (SSBMP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709928_1,JO-1 AUTOANTIBODY IGG (JO1MP),Inpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709928_1,JO-1 AUTOANTIBODY IGG (JO1MP),Outpatient,0300,86235,,,,0,126.00,94.50,94.50,119.70,113.40,119.70,119.70,113.40
40709990_1,CHAIN OF CUSTODY,Inpatient,0300,99001,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
40709990_1,CHAIN OF CUSTODY,Outpatient,0300,99001,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
4070F_3,DVT PROPHYLX RECV'D DAY 2,ProFee,0989,4070F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40720_3,REPAIR CLEFT LIP/NASAL,ProFee,0989,40720,,,,0,3.00,2.25,2.25,1489.50,0.00,1489.50,1489.50,N/A
4073F_3,ORAL ANTIPLAT THX RX DISCHRG,ProFee,0989,4073F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4075F_3,ANTICOAG THX RX AT DISCHRG,ProFee,0989,4075F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40761_3,REPAIR CLEFT LIP/NASAL,ProFee,0989,40761,,,,0,3.00,2.25,2.25,1571.00,0.00,1571.00,1571.00,N/A
4077F_3,DOC T-PA ADMIN CONSIDERED,ProFee,0989,4077F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40799_3,LIP SURGERY PROCEDURE,ProFee,0989,40799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4079F_3,DOC REHAB SVCS CONSIDERED,ProFee,0989,4079F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40800_3,DRAINAGE OF MOUTH LESION,ProFee,0989,40800,,,,0,3.00,2.25,2.25,190.50,0.00,190.50,190.50,N/A
40801_3,DRAINAGE OF MOUTH LESION,ProFee,0989,40801,,,,0,3.00,2.25,2.25,321.50,0.00,321.50,321.50,N/A
40804_3,"REMOVAL, FOREIGN BODY, MOUTH",ProFee,0989,40804,,,,0,3.00,2.25,2.25,165.00,0.00,165.00,165.00,N/A
40805_3,"REMOVAL, FOREIGN BODY, MOUTH",ProFee,0989,40805,,,,0,3.00,2.25,2.25,334.50,0.00,334.50,334.50,N/A
40806_3,INCISION OF LIP FOLD,ProFee,0989,40806,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
40808_3,BIOPSY OF MOUTH LESION,ProFee,0989,40808,,,,0,3.00,2.25,2.25,156.00,0.00,156.00,156.00,N/A
40810_3,EXCISION OF MOUTH LESION,ProFee,0989,40810,,,,0,3.00,2.25,2.25,184.00,0.00,184.00,184.00,N/A
40812_3,EXCISE/REPAIR MOUTH LESION,ProFee,0989,40812,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
40814_3,EXCISE/REPAIR MOUTH LESION,ProFee,0989,40814,,,,0,3.00,2.25,2.25,441.00,0.00,441.00,441.00,N/A
40816_3,EXCISION OF MOUTH LESION,ProFee,0989,40816,,,,0,3.00,2.25,2.25,456.50,0.00,456.50,456.50,N/A
40818_3,EXCISE ORAL MUCOSA FOR GRAFT,ProFee,0989,40818,,,,0,3.00,2.25,2.25,397.00,0.00,397.00,397.00,N/A
40819_3,EXCISE LIP OR CHEEK FOLD,ProFee,0989,40819,,,,0,3.00,2.25,2.25,348.00,0.00,348.00,348.00,N/A
40820_3,TREATMENT OF MOUTH LESION,ProFee,0989,40820,,,,0,3.00,2.25,2.25,248.50,0.00,248.50,248.50,N/A
40830_3,REPAIR MOUTH LACERATION,ProFee,0989,40830,,,,0,3.00,2.25,2.25,242.00,0.00,242.00,242.00,N/A
40831_3,REPAIR MOUTH LACERATION,ProFee,0989,40831,,,,0,3.00,2.25,2.25,327.50,0.00,327.50,327.50,N/A
40840_3,RECONSTRUCTION OF MOUTH,ProFee,0989,40840,,,,0,3.00,2.25,2.25,902.50,0.00,902.50,902.50,N/A
40842_3,RECONSTRUCTION OF MOUTH,ProFee,0989,40842,,,,0,3.00,2.25,2.25,888.00,0.00,888.00,888.00,N/A
40843_3,RECONSTRUCTION OF MOUTH,ProFee,0989,40843,,,,0,3.00,2.25,2.25,1213.00,0.00,1213.00,1213.00,N/A
40844_3,RECONSTRUCTION OF MOUTH,ProFee,0989,40844,,,,0,3.00,2.25,2.25,1569.50,0.00,1569.50,1569.50,N/A
40845_3,RECONSTRUCTION OF MOUTH,ProFee,0989,40845,,,,0,3.00,2.25,2.25,1755.50,0.00,1755.50,1755.50,N/A
4084F_3,ASPIRIN RECV'D W/IN 24 HRS,ProFee,0989,4084F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4086F_3,ASPIRIN/CLOPIDOGREL RXD,ProFee,0989,4086F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
40899_3,MOUTH SURGERY PROCEDURE,ProFee,0989,40899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4090F_3,PT RCVNG EPO THXPY,ProFee,0989,4090F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4095F_3,PT NOT RCVNG EPO THXPY,ProFee,0989,4095F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41000_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41000,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
41005_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41005,,,,0,3.00,2.25,2.25,185.00,0.00,185.00,185.00,N/A
41006_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41006,,,,0,3.00,2.25,2.25,381.50,0.00,381.50,381.50,N/A
41006430_1,BLOOD TRANSFUSION,Inpatient,0391,36430,,,,0,1865.00,1398.75,1398.75,1771.75,1678.50,1771.75,1771.75,1678.50
41006430_1,BLOOD TRANSFUSION,Outpatient,0391,36430,,,,0,1865.00,1398.75,1398.75,1771.75,1678.50,1771.75,1771.75,1678.50
41007_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41007,,,,0,3.00,2.25,2.25,369.50,0.00,369.50,369.50,N/A
41008_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41008,,,,0,3.00,2.25,2.25,391.00,0.00,391.00,391.00,N/A
41009_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41009,,,,0,3.00,2.25,2.25,426.00,0.00,426.00,426.00,N/A
41009040_1,PACKED RED CELLS,Inpatient,0390,P9040,,,,0,574.00,430.50,430.50,545.30,516.60,545.30,545.30,516.60
41009040_1,PACKED RED CELLS,Outpatient,0390,P9040,,,,0,574.00,430.50,430.50,545.30,516.60,545.30,545.30,516.60
4100F_3,BIPHOS THXPY VEIN ORD/REC'VD,ProFee,0989,4100F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41015_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41015,,,,0,3.00,2.25,2.25,494.00,0.00,494.00,494.00,N/A
41016_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41016,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
41017_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41017,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
41018_3,DRAINAGE OF MOUTH LESION,ProFee,0989,41018,,,,0,3.00,2.25,2.25,600.50,0.00,600.50,600.50,N/A
41019_3,PLACE NEEDLES H&N FOR RT,ProFee,0989,41019,,,,0,3.00,2.25,2.25,683.00,0.00,683.00,683.00,N/A
41100_3,BIOPSY OF TONGUE,ProFee,0989,41100,,,,0,3.00,2.25,2.25,154.50,0.00,154.50,154.50,N/A
41100003_1,MEDICARE INITIAL EKG,Inpatient,0730,G0404,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
41100003_1,MEDICARE INITIAL EKG,Outpatient,0730,G0404,,,,0,139.00,104.25,104.25,132.05,125.10,132.05,132.05,125.10
41103005_1,EKG TC,Inpatient,0730,93005,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
41103005_1,EKG TC,Outpatient,0730,93005,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
41103010_1,EKG PC,ProFee,0985,93010,,,,0,94.00,70.50,12.00,70.50,0.00,12.00,12.00,N/A
41105_3,BIOPSY OF TONGUE,ProFee,0989,41105,,,,0,3.00,2.25,2.25,161.00,0.00,161.00,161.00,N/A
41108_3,BIOPSY OF FLOOR OF MOUTH,ProFee,0989,41108,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
4110F_3,INT MAM ART USED FOR CABG,ProFee,0989,4110F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41112_3,EXCISION OF TONGUE LESION,ProFee,0989,41112,,,,0,3.00,2.25,2.25,365.50,0.00,365.50,365.50,N/A
41113_3,EXCISION OF TONGUE LESION,ProFee,0989,41113,,,,0,3.00,2.25,2.25,405.00,0.00,405.00,405.00,N/A
41114_3,EXCISION OF TONGUE LESION,ProFee,0989,41114,,,,0,3.00,2.25,2.25,912.00,0.00,912.00,912.00,N/A
41115_3,EXCISION OF TONGUE FOLD,ProFee,0989,41115,,,,0,3.00,2.25,2.25,208.00,0.00,208.00,208.00,N/A
41116_3,EXCISION OF MOUTH LESION,ProFee,0989,41116,,,,0,3.00,2.25,2.25,317.00,0.00,317.00,317.00,N/A
41120_3,PARTIAL REMOVAL OF TONGUE,ProFee,0989,41120,,,,0,3.00,2.25,2.25,1550.50,0.00,1550.50,1550.50,N/A
41130_3,PARTIAL REMOVAL OF TONGUE,ProFee,0989,41130,,,,0,3.00,2.25,2.25,1909.00,0.00,1909.00,1909.00,N/A
41135_3,TONGUE AND NECK SURGERY,ProFee,0989,41135,,,,0,3.00,2.25,2.25,3137.00,0.00,3137.00,3137.00,N/A
41140_3,REMOVAL OF TONGUE,ProFee,0989,41140,,,,0,3.00,2.25,2.25,3150.00,0.00,3150.00,3150.00,N/A
41145_3,"TONGUE REMOVAL, NECK SURGERY",ProFee,0989,41145,,,,0,3.00,2.25,2.25,3991.50,0.00,3991.50,3991.50,N/A
41150_3,"TONGUE, MOUTH, JAW SURGERY",ProFee,0989,41150,,,,0,3.00,2.25,2.25,3171.50,0.00,3171.50,3171.50,N/A
41153_3,"TONGUE, MOUTH, NECK SURGERY",ProFee,0989,41153,,,,0,3.00,2.25,2.25,3437.50,0.00,3437.50,3437.50,N/A
41155_3,"TONGUE, JAW, & NECK SURGERY",ProFee,0989,41155,,,,0,3.00,2.25,2.25,4356.00,0.00,4356.00,4356.00,N/A
4115F_3,BETA BLCKR ADMIN W/IN 24 HRS,ProFee,0989,4115F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41200540_1,MRI ORBITSFACE WO,Outpatient,0610,70540,,,,0,2472.00,1854.00,1854.00,2348.40,2224.80,2348.40,2348.40,2224.80
41200540_1,MRI ORBITSFACE WO,Inpatient,0610,70540,,,,0,2472.00,1854.00,1854.00,2348.40,2224.80,2348.40,2348.40,2224.80
41200543_1,MRI ORBITS FACE NECK WWO,Inpatient,0610,70543,,,,0,3526.00,2644.50,2644.50,3349.70,3173.40,3349.70,3349.70,3173.40
41200543_1,MRI ORBITS FACE NECK WWO,Outpatient,0610,70543,,,,0,3526.00,2644.50,2644.50,3349.70,3173.40,3349.70,3349.70,3173.40
41200544_1,MRI BRAIN ANGIO,Outpatient,0610,70554,,,,0,2672.00,2004.00,2004.00,2538.40,2404.80,2538.40,2538.40,2404.80
41200544_1,MRI BRAIN ANGIO,Inpatient,0610,70554,,,,0,2672.00,2004.00,2004.00,2538.40,2404.80,2538.40,2538.40,2404.80
41200546_1,MRA Head W/O,Outpatient,0610,70546,,,,0,3803.00,2852.25,2852.25,3612.85,3422.70,3612.85,3612.85,3422.70
41200546_1,MRA Head W/O,Inpatient,0610,70546,,,,0,3803.00,2852.25,2852.25,3612.85,3422.70,3612.85,3612.85,3422.70
41200549_1,MRA Neck WW/O,Outpatient,0610,70549,,,,0,3589.00,2691.75,2691.75,3409.55,3230.10,3409.55,3409.55,3230.10
41200549_1,MRA Neck WW/O,Inpatient,0610,70549,,,,0,3589.00,2691.75,2691.75,3409.55,3230.10,3409.55,3409.55,3230.10
41200551_1,MRI BRAIN WITHOUT CONTRAST,Outpatient,0610,70551,,,,0,2335.00,1751.25,1751.25,2218.25,2101.50,2218.25,2218.25,2101.50
41200551_1,MRI BRAIN WITHOUT CONTRAST,Inpatient,0610,70551,,,,0,2335.00,1751.25,1751.25,2218.25,2101.50,2218.25,2218.25,2101.50
41200553_1,BRAIN WWO MRI,Outpatient,0610,70553,,,,0,3728.00,2796.00,2796.00,3541.60,3355.20,3541.60,3541.60,3355.20
41200553_1,BRAIN WWO MRI,Inpatient,0610,70553,,,,0,3728.00,2796.00,2796.00,3541.60,3355.20,3541.60,3541.60,3355.20
41201550_1,MRI Chest WO Cont,Outpatient,0610,71550,,,,0,2030.00,1522.50,1522.50,1928.50,1827.00,1928.50,1928.50,1827.00
41201550_1,MRI Chest WO Cont,Inpatient,0610,71550,,,,0,2030.00,1522.50,1522.50,1928.50,1827.00,1928.50,1928.50,1827.00
41201551_1,MRI Chest W Cont,Inpatient,0610,71551,,,,0,2240.00,1680.00,1680.00,2128.00,2016.00,2128.00,2128.00,2016.00
41201551_1,MRI Chest W Cont,Outpatient,0610,71551,,,,0,2240.00,1680.00,1680.00,2128.00,2016.00,2128.00,2128.00,2016.00
41202141_1,MRI CERVICAL SPINE WO,Inpatient,0610,72141,,,,0,2315.00,1736.25,1736.25,2199.25,2083.50,2199.25,2199.25,2083.50
41202141_1,MRI CERVICAL SPINE WO,Outpatient,0610,72141,,,,0,2315.00,1736.25,1736.25,2199.25,2083.50,2199.25,2199.25,2083.50
41202146_1,SPINE THORACIC MRI,Inpatient,0610,72146,,,,0,2583.00,1937.25,1937.25,2453.85,2324.70,2453.85,2453.85,2324.70
41202146_1,SPINE THORACIC MRI,Outpatient,0610,72146,,,,0,2583.00,1937.25,1937.25,2453.85,2324.70,2453.85,2453.85,2324.70
41202148_1,MRI SPINE LUMBAR WITHOUT CONTRAST,Outpatient,0610,72148,,,,0,2441.00,1830.75,1830.75,2318.95,2196.90,2318.95,2318.95,2196.90
41202148_1,MRI SPINE LUMBAR WITHOUT CONTRAST,Inpatient,0610,72148,,,,0,2441.00,1830.75,1830.75,2318.95,2196.90,2318.95,2318.95,2196.90
41202158_1,MRI LUMBAR SPINE WWO,Inpatient,0610,72158,,,,0,3684.00,2763.00,2763.00,3499.80,3315.60,3499.80,3499.80,3315.60
41202158_1,MRI LUMBAR SPINE WWO,Outpatient,0610,72158,,,,0,3684.00,2763.00,2763.00,3499.80,3315.60,3499.80,3499.80,3315.60
41202195_1,MRI PELVIS WO,Inpatient,0610,72195,,,,0,2730.00,2047.50,2047.50,2593.50,2457.00,2593.50,2593.50,2457.00
41202195_1,MRI PELVIS WO,Outpatient,0610,72195,,,,0,2730.00,2047.50,2047.50,2593.50,2457.00,2593.50,2593.50,2457.00
41202196_1,MRI PELVIS W CONTRAST,Inpatient,0610,72196,,,,0,3006.00,2254.50,2254.50,2855.70,2705.40,2855.70,2855.70,2705.40
41202196_1,MRI PELVIS W CONTRAST,Outpatient,0610,72196,,,,0,3006.00,2254.50,2254.50,2855.70,2705.40,2855.70,2855.70,2705.40
41202197_1,MRI ABD W & WO CONTRAST,Inpatient,0610,72197,,,,0,3664.00,2748.00,2748.00,3480.80,3297.60,3480.80,3480.80,3297.60
41202197_1,MRI ABD W & WO CONTRAST,Outpatient,0610,72197,,,,0,3664.00,2748.00,2748.00,3480.80,3297.60,3480.80,3480.80,3297.60
41203218_1,MRI Upper Extremity WO Contrast,Outpatient,0610,73218,,,,0,2095.00,1571.25,1571.25,1990.25,1885.50,1990.25,1990.25,1885.50
41203218_1,MRI Upper Extremity WO Contrast,Inpatient,0610,73218,,,,0,2095.00,1571.25,1571.25,1990.25,1885.50,1990.25,1990.25,1885.50
41203220_1,MRI UPPER EXTREMITY W/WO CONTRAST,Inpatient,0610,73220,,,,0,2800.00,2100.00,2100.00,2660.00,2520.00,2660.00,2660.00,2520.00
41203220_1,MRI UPPER EXTREMITY W/WO CONTRAST,Outpatient,0610,73220,,,,0,2800.00,2100.00,2100.00,2660.00,2520.00,2660.00,2660.00,2520.00
41203221_1,MRI SHOULDER ELBOW WRIST,Inpatient,0610,73221,,,,0,2251.00,1688.25,1688.25,2138.45,2025.90,2138.45,2138.45,2025.90
41203221_1,MRI SHOULDER ELBOW WRIST,Outpatient,0610,73221,,,,0,2251.00,1688.25,1688.25,2138.45,2025.90,2138.45,2138.45,2025.90
41203718_1,MRI NON JOINT THIGH CALF FOOT,Inpatient,0610,73718,,,,0,2484.00,1863.00,1863.00,2359.80,2235.60,2359.80,2359.80,2235.60
41203718_1,MRI NON JOINT THIGH CALF FOOT,Outpatient,0610,73718,,,,0,2484.00,1863.00,1863.00,2359.80,2235.60,2359.80,2359.80,2235.60
41203721_1,MRI JOINT HIP KNEE ANKLE,Inpatient,0610,73721,,,,0,2266.00,1699.50,1699.50,2152.70,2039.40,2152.70,2152.70,2039.40
41203721_1,MRI JOINT HIP KNEE ANKLE,Outpatient,0610,73721,,,,0,2266.00,1699.50,1699.50,2152.70,2039.40,2152.70,2152.70,2039.40
41204181_1,MRI ABD WO CONTRAST,Inpatient,0610,74181,,,,0,2193.00,1644.75,1644.75,2083.35,1973.70,2083.35,2083.35,1973.70
41204181_1,MRI ABD WO CONTRAST,Outpatient,0610,74181,,,,0,2193.00,1644.75,1644.75,2083.35,1973.70,2083.35,2083.35,1973.70
41204183_1,MRI Abdomen With & Without Contrast,Inpatient,0610,74183,,,,0,3819.00,2864.25,2864.25,3628.05,3437.10,3628.05,3628.05,3437.10
41204183_1,MRI Abdomen With & Without Contrast,Outpatient,0610,74183,,,,0,3819.00,2864.25,2864.25,3628.05,3437.10,3628.05,3628.05,3437.10
41207182_1,MRI ABD W CONTRAST,Inpatient,0610,74182,,,,0,2787.00,2090.25,2090.25,2647.65,2508.30,2647.65,2647.65,2508.30
41207182_1,MRI ABD W CONTRAST,Outpatient,0610,74182,,,,0,2787.00,2090.25,2090.25,2647.65,2508.30,2647.65,2647.65,2508.30
4120F_3,ANTIBIOT RX'D/GIVEN,ProFee,0989,4120F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4124F_3,ANTIBIOT NOT RX'D/GIVEN,ProFee,0989,4124F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41250_3,REPAIR TONGUE LACERATION,ProFee,0989,41250,,,,0,3.00,2.25,2.25,223.00,0.00,223.00,223.00,N/A
41251_3,REPAIR TONGUE LACERATION,ProFee,0989,41251,,,,0,3.00,2.25,2.25,268.50,0.00,268.50,268.50,N/A
41252_3,REPAIR TONGUE LACERATION,ProFee,0989,41252,,,,0,3.00,2.25,2.25,305.00,0.00,305.00,305.00,N/A
41300297_1,CT Chest- Low Dose,Outpatient,0350,71271,,,,0,1071.00,803.25,803.25,1017.45,963.90,1017.45,1017.45,963.90
41300297_1,CT Chest- Low Dose,Inpatient,0350,71271,,,,0,1071.00,803.25,803.25,1017.45,963.90,1017.45,1017.45,963.90
41300450_1,CT HEAD WO CONTRAST,Outpatient,0351,70450,,,,0,1499.00,1124.25,1124.25,1424.05,1349.10,1424.05,1424.05,1349.10
41300450_1,CT HEAD WO CONTRAST,Inpatient,0351,70450,,,,0,1499.00,1124.25,1124.25,1424.05,1349.10,1424.05,1424.05,1349.10
41300460_1,CT HEAD WCONTRAST,Inpatient,0350,70460,,,,0,1833.00,1374.75,1374.75,1741.35,1649.70,1741.35,1741.35,1649.70
41300460_1,CT HEAD WCONTRAST,Outpatient,0350,70460,,,,0,1833.00,1374.75,1374.75,1741.35,1649.70,1741.35,1741.35,1649.70
41300470_1,CT HEAD COMBINED,Inpatient,0350,70470,,,,0,3028.00,2271.00,2271.00,2876.60,2725.20,2876.60,2876.60,2725.20
41300470_1,CT HEAD COMBINED,Outpatient,0350,70470,,,,0,3028.00,2271.00,2271.00,2876.60,2725.20,2876.60,2876.60,2725.20
41300480_1,CT ORBIT SELLA POST FOSS WO CONTR,Inpatient,0350,70480,,,,0,1468.00,1101.00,1101.00,1394.60,1321.20,1394.60,1394.60,1321.20
41300480_1,CT ORBIT SELLA POST FOSS WO CONTR,Outpatient,0350,70480,,,,0,1468.00,1101.00,1101.00,1394.60,1321.20,1394.60,1394.60,1321.20
41300481_1,CT ORBIT SELLA PSOT FOSS WCONTRAS,Inpatient,0350,70481,,,,0,2050.00,1537.50,1537.50,1947.50,1845.00,1947.50,1947.50,1845.00
41300481_1,CT ORBIT SELLA PSOT FOSS WCONTRAS,Outpatient,0350,70481,,,,0,2050.00,1537.50,1537.50,1947.50,1845.00,1947.50,1947.50,1845.00
41300482_1,CT ORBIT SELLA POST FOSS COMBIN,Outpatient,0350,70482,,,,0,3128.00,2346.00,2346.00,2971.60,2815.20,2971.60,2971.60,2815.20
41300482_1,CT ORBIT SELLA POST FOSS COMBIN,Inpatient,0350,70482,,,,0,3128.00,2346.00,2346.00,2971.60,2815.20,2971.60,2971.60,2815.20
41300486_1,CT MAXILLOFACIAL AREA WO CONTRAS,Outpatient,0350,70486,,,,0,1389.00,1041.75,1041.75,1319.55,1250.10,1319.55,1319.55,1250.10
41300486_1,CT MAXILLOFACIAL AREA WO CONTRAS,Inpatient,0350,70486,,,,0,1389.00,1041.75,1041.75,1319.55,1250.10,1319.55,1319.55,1250.10
41300487_1,CT MAXILLOFACIAL AREA WCONTRAST,Inpatient,0350,70487,,,,0,1916.00,1437.00,1437.00,1820.20,1724.40,1820.20,1820.20,1724.40
41300487_1,CT MAXILLOFACIAL AREA WCONTRAST,Outpatient,0350,70487,,,,0,1916.00,1437.00,1437.00,1820.20,1724.40,1820.20,1820.20,1724.40
41300488_1,CT MAXILLOFACIAL AREA COMBINED,Inpatient,0350,70488,,,,0,2420.00,1815.00,1815.00,2299.00,2178.00,2299.00,2299.00,2178.00
41300488_1,CT MAXILLOFACIAL AREA COMBINED,Outpatient,0350,70488,,,,0,2420.00,1815.00,1815.00,2299.00,2178.00,2299.00,2299.00,2178.00
41300491_1,CT SOFT TISSUE NECK WCONTRAST,Inpatient,0350,70491,,,,0,1980.00,1485.00,1485.00,1881.00,1782.00,1881.00,1881.00,1782.00
41300491_1,CT SOFT TISSUE NECK WCONTRAST,Outpatient,0350,70491,,,,0,1980.00,1485.00,1485.00,1881.00,1782.00,1881.00,1881.00,1782.00
41300492_1,CT SOFT TISSUE NECK COMBINED,Outpatient,0350,70492,,,,0,2250.00,1687.50,1687.50,2137.50,2025.00,2137.50,2137.50,2025.00
41300492_1,CT SOFT TISSUE NECK COMBINED,Inpatient,0350,70492,,,,0,2250.00,1687.50,1687.50,2137.50,2025.00,2137.50,2137.50,2025.00
41300496_1,CT ANGIOGRAPHY HEAD,Inpatient,0350,70496,,,,0,2346.00,1759.50,1759.50,2228.70,2111.40,2228.70,2228.70,2111.40
41300496_1,CT ANGIOGRAPHY HEAD,Outpatient,0350,70496,,,,0,2346.00,1759.50,1759.50,2228.70,2111.40,2228.70,2228.70,2111.40
41300498_1,CT Angiography Neck,Inpatient,0350,70498,,,,0,2545.00,1908.75,1908.75,2417.75,2290.50,2417.75,2417.75,2290.50
41300498_1,CT Angiography Neck,Outpatient,0350,70498,,,,0,2545.00,1908.75,1908.75,2417.75,2290.50,2417.75,2417.75,2290.50
41301250_1,CT CHEST WO CONTRAST,Outpatient,0350,71250,,,,0,1583.00,1187.25,1187.25,1503.85,1424.70,1503.85,1503.85,1424.70
41301250_1,CT CHEST WO CONTRAST,Inpatient,0350,71250,,,,0,1583.00,1187.25,1187.25,1503.85,1424.70,1503.85,1503.85,1424.70
41301260_1,CT CHEST WCONTRAST,Inpatient,0350,71260,,,,0,2277.00,1707.75,1707.75,2163.15,2049.30,2163.15,2163.15,2049.30
41301260_1,CT CHEST WCONTRAST,Outpatient,0350,71260,,,,0,2277.00,1707.75,1707.75,2163.15,2049.30,2163.15,2163.15,2049.30
41301270_1,CT CHEST COMBINED,Inpatient,0350,71270,,,,0,2647.00,1985.25,1985.25,2514.65,2382.30,2514.65,2514.65,2382.30
41301270_1,CT CHEST COMBINED,Outpatient,0350,71270,,,,0,2647.00,1985.25,1985.25,2514.65,2382.30,2514.65,2514.65,2382.30
41301275_1,CT CHEST ANGIOGRAPHY,Outpatient,0350,71275,,,,0,3200.00,2400.00,2400.00,3040.00,2880.00,3040.00,3040.00,2880.00
41301275_1,CT CHEST ANGIOGRAPHY,Inpatient,0350,71275,,,,0,3200.00,2400.00,2400.00,3040.00,2880.00,3040.00,3040.00,2880.00
41301490_1,CT SOFT TISSUE NECK WO CONTRAST,Inpatient,0350,70490,,,,0,1390.00,1042.50,1042.50,1320.50,1251.00,1320.50,1320.50,1251.00
41301490_1,CT SOFT TISSUE NECK WO CONTRAST,Outpatient,0350,70490,,,,0,1390.00,1042.50,1042.50,1320.50,1251.00,1320.50,1320.50,1251.00
41302125_1,CT CSPINE WO CONTRAST (3DISC),Inpatient,0350,72125,,,,0,1631.00,1223.25,1223.25,1549.45,1467.90,1549.45,1549.45,1467.90
41302125_1,CT CSPINE WO CONTRAST (3DISC),Outpatient,0350,72125,,,,0,1631.00,1223.25,1223.25,1549.45,1467.90,1549.45,1549.45,1467.90
41302126_1,CT CSPINE WITH CONTRAST,Inpatient,0350,72126,,,,0,2143.00,1607.25,1607.25,2035.85,1928.70,2035.85,2035.85,1928.70
41302126_1,CT CSPINE WITH CONTRAST,Outpatient,0350,72126,,,,0,2143.00,1607.25,1607.25,2035.85,1928.70,2035.85,2035.85,1928.70
41302128_1,CT TSPINE WO CONTRAST (3 DISC),Outpatient,0350,72128,,,,0,1582.00,1186.50,1186.50,1502.90,1423.80,1502.90,1502.90,1423.80
41302128_1,CT TSPINE WO CONTRAST (3 DISC),Inpatient,0350,72128,,,,0,1582.00,1186.50,1186.50,1502.90,1423.80,1502.90,1502.90,1423.80
41302131_1,CT LSPINE WO CONTRAST (15030 SL,Outpatient,0350,72131,,,,0,1810.00,1357.50,1357.50,1719.50,1629.00,1719.50,1719.50,1629.00
41302131_1,CT LSPINE WO CONTRAST (15030 SL,Inpatient,0350,72131,,,,0,1810.00,1357.50,1357.50,1719.50,1629.00,1719.50,1719.50,1629.00
41302192_1,CT PELVIS,Outpatient,0350,72192,,,,0,1602.00,1201.50,1201.50,1521.90,1441.80,1521.90,1521.90,1441.80
41302192_1,CT PELVIS,Inpatient,0350,72192,,,,0,1602.00,1201.50,1201.50,1521.90,1441.80,1521.90,1521.90,1441.80
41302193_1,CT PELVIS WCONTRAST,Outpatient,0350,72193,,,,0,2273.00,1704.75,1704.75,2159.35,2045.70,2159.35,2159.35,2045.70
41302193_1,CT PELVIS WCONTRAST,Inpatient,0350,72193,,,,0,2273.00,1704.75,1704.75,2159.35,2045.70,2159.35,2159.35,2045.70
41302194_1,CT PELVIS COMBINED,Inpatient,0350,72194,,,,0,3002.00,2251.50,2251.50,2851.90,2701.80,2851.90,2851.90,2701.80
41302194_1,CT PELVIS COMBINED,Outpatient,0350,72194,,,,0,3002.00,2251.50,2251.50,2851.90,2701.80,2851.90,2851.90,2701.80
41303200_1,CT UPPER EXTREMITY WO CONTRAST,Outpatient,0350,73200,,,,0,1599.00,1199.25,1199.25,1519.05,1439.10,1519.05,1519.05,1439.10
41303200_1,CT UPPER EXTREMITY WO CONTRAST,Inpatient,0350,73200,,,,0,1599.00,1199.25,1199.25,1519.05,1439.10,1519.05,1519.05,1439.10
41303201_1,CT UPPER EXTREMITY WCONTRAST,Outpatient,0350,73201,,,,0,1924.00,1443.00,1443.00,1827.80,1731.60,1827.80,1827.80,1731.60
41303201_1,CT UPPER EXTREMITY WCONTRAST,Inpatient,0350,73201,,,,0,1924.00,1443.00,1443.00,1827.80,1731.60,1827.80,1827.80,1731.60
41303202_1,CT UPPER EXTREMITY COMBINED,Inpatient,0350,73202,,,,0,2436.00,1827.00,1827.00,2314.20,2192.40,2314.20,2314.20,2192.40
41303202_1,CT UPPER EXTREMITY COMBINED,Outpatient,0350,73202,,,,0,2436.00,1827.00,1827.00,2314.20,2192.40,2314.20,2314.20,2192.40
41303700_1,CT LOWER EXTREMITY WO CONTRAST,Outpatient,0350,73700,,,,0,1472.00,1104.00,1104.00,1398.40,1324.80,1398.40,1398.40,1324.80
41303700_1,CT LOWER EXTREMITY WO CONTRAST,Inpatient,0350,73700,,,,0,1472.00,1104.00,1104.00,1398.40,1324.80,1398.40,1398.40,1324.80
41303701_1,CT LOWER EXTREMITY WCONTRAST,Inpatient,0350,73701,,,,0,1923.00,1442.25,1442.25,1826.85,1730.70,1826.85,1826.85,1730.70
41303701_1,CT LOWER EXTREMITY WCONTRAST,Outpatient,0350,73701,,,,0,1923.00,1442.25,1442.25,1826.85,1730.70,1826.85,1826.85,1730.70
41303702_1,CT LOWER EXTREMITY COMBINED,Inpatient,0350,73702,,,,0,2359.00,1769.25,1769.25,2241.05,2123.10,2241.05,2241.05,2123.10
41303702_1,CT LOWER EXTREMITY COMBINED,Outpatient,0350,73702,,,,0,2359.00,1769.25,1769.25,2241.05,2123.10,2241.05,2241.05,2123.10
41304150_1,CT ABDOMEN WO CONTRAST,Outpatient,0350,74150,,,,0,1605.00,1203.75,1203.75,1524.75,1444.50,1524.75,1524.75,1444.50
41304150_1,CT ABDOMEN WO CONTRAST,Inpatient,0350,74150,,,,0,1605.00,1203.75,1203.75,1524.75,1444.50,1524.75,1524.75,1444.50
41304160_1,CT ABDOMEN WCONTRAST,Outpatient,0350,74160,,,,0,2312.00,1734.00,1734.00,2196.40,2080.80,2196.40,2196.40,2080.80
41304160_1,CT ABDOMEN WCONTRAST,Inpatient,0350,74160,,,,0,2312.00,1734.00,1734.00,2196.40,2080.80,2196.40,2196.40,2080.80
41304170_1,CT ABDOMEN COMBINED,Outpatient,0350,74170,,,,0,2645.00,1983.75,1983.75,2512.75,2380.50,2512.75,2512.75,2380.50
41304170_1,CT ABDOMEN COMBINED,Inpatient,0350,74170,,,,0,2645.00,1983.75,1983.75,2512.75,2380.50,2512.75,2512.75,2380.50
41304176_1,CT ABDOMENPELVIS,Outpatient,0350,74176,,,,0,2052.00,1539.00,1539.00,1949.40,1846.80,1949.40,1949.40,1846.80
41304176_1,CT ABDOMENPELVIS,Inpatient,0350,74176,,,,0,2052.00,1539.00,1539.00,1949.40,1846.80,1949.40,1949.40,1846.80
41304177_1,CT ABDOMENPELVIS WITH CONTRAST,Inpatient,0350,74177,,,,0,2734.00,2050.50,2050.50,2597.30,2460.60,2597.30,2597.30,2460.60
41304177_1,CT ABDOMENPELVIS WITH CONTRAST,Outpatient,0350,74177,,,,0,2734.00,2050.50,2050.50,2597.30,2460.60,2597.30,2597.30,2460.60
41304178_1,CT ABDOMENPELVIS W & WO CONTRAST,Outpatient,0350,74178,,,,0,3305.00,2478.75,2478.75,3139.75,2974.50,3139.75,3139.75,2974.50
41304178_1,CT ABDOMENPELVIS W & WO CONTRAST,Inpatient,0350,74178,,,,0,3305.00,2478.75,2478.75,3139.75,2974.50,3139.75,3139.75,2974.50
41309967_1,Omnipaque 300 Contrast 10 ml vial,Inpatient,0636,Q9967,,,00407-1413-10,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41309967_1,Omnipaque 300 Contrast 10 ml vial,Outpatient,0636,Q9967,,,00407-1413-10,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
4130F_3,"TOPICAL PREP RX, AOE",ProFee,0989,4130F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4131F_3,SYST ANTIMICROBIAL THX RX,ProFee,0989,4131F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4132F_3,NO SYST ANTIMICROBIAL THX RX,ProFee,0989,4132F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4133F_3,ANTIHIST/DECONG RX/RECOM,ProFee,0989,4133F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4134F_3,NO ANTIHIST/DECONG RX/RECOM,ProFee,0989,4134F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4135F_3,SYSTEMIC CORTICOSTEROIDS RX,ProFee,0989,4135F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4136F_3,SYST CORTICOSTEROIDS NOT RX,ProFee,0989,4136F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41400011_1,MANDIBLE LIMITED,Inpatient,0320,70100,,,,0,423.00,317.25,317.25,401.85,380.70,401.85,401.85,380.70
41400011_1,MANDIBLE LIMITED,Outpatient,0320,70100,,,,0,423.00,317.25,317.25,401.85,380.70,401.85,401.85,380.70
41400029_1,MANDIBLE COMPLETE,Inpatient,0320,70110,,,,0,675.00,506.25,506.25,641.25,607.50,641.25,641.25,607.50
41400029_1,MANDIBLE COMPLETE,Outpatient,0320,70110,,,,0,675.00,506.25,506.25,641.25,607.50,641.25,641.25,607.50
41400037_1,MASTIODS LIMITED,Inpatient,0320,70120,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
41400037_1,MASTIODS LIMITED,Outpatient,0320,70120,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
41400078_1,FACIAL BONES COMPLETE,Inpatient,0320,70150,,,,0,554.00,415.50,415.50,526.30,498.60,526.30,526.30,498.60
41400078_1,FACIAL BONES COMPLETE,Outpatient,0320,70150,,,,0,554.00,415.50,415.50,526.30,498.60,526.30,526.30,498.60
41400086_1,NASAL BONES,Outpatient,0320,70160,,,,0,387.00,290.25,290.25,367.65,348.30,367.65,367.65,348.30
41400086_1,NASAL BONES,Inpatient,0320,70160,,,,0,387.00,290.25,290.25,367.65,348.30,367.65,367.65,348.30
41400102_1,PHARANASAL SINUS COMPLETE,Outpatient,0320,70200,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
41400102_1,PHARANASAL SINUS COMPLETE,Inpatient,0320,70200,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
41400110_1,MANDIBLE COMPLETE,Inpatient,0320,70110,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
41400110_1,MANDIBLE COMPLETE,Outpatient,0320,70110,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
41400123_1,ORBITS COMPLETE,Outpatient,0320,70200,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
41400123_1,ORBITS COMPLETE,Inpatient,0320,70200,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
41400128_1,SKULL LIMITED,Outpatient,0320,70250,,,,0,405.00,303.75,303.75,384.75,364.50,384.75,384.75,364.50
41400128_1,SKULL LIMITED,Inpatient,0320,70250,,,,0,405.00,303.75,303.75,384.75,364.50,384.75,384.75,364.50
41400136_1,SKULL COMPLETE,Inpatient,0320,70260,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
41400136_1,SKULL COMPLETE,Outpatient,0320,70260,,,,0,478.00,358.50,358.50,454.10,430.20,454.10,454.10,430.20
41400140_1,FACIAL BONES (LESS THAN 3 VIEWS),Inpatient,0320,70140,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,479.75,454.50
41400140_1,FACIAL BONES (LESS THAN 3 VIEWS),Outpatient,0320,70140,,,,0,505.00,378.75,378.75,479.75,454.50,479.75,479.75,454.50
41400144_1,TM JOINTS,Outpatient,0320,70330,,,,0,417.00,312.75,312.75,396.15,375.30,396.15,396.15,375.30
41400144_1,TM JOINTS,Inpatient,0320,70330,,,,0,417.00,312.75,312.75,396.15,375.30,396.15,396.15,375.30
41400151_1,NECK FOR SOFT TISSUE,Inpatient,0320,70360,,,,0,295.00,221.25,221.25,280.25,265.50,280.25,280.25,265.50
41400151_1,NECK FOR SOFT TISSUE,Outpatient,0320,70360,,,,0,295.00,221.25,221.25,280.25,265.50,280.25,280.25,265.50
41400169_1,CHEST SINGLE VIEW,Inpatient,0324,71045,,,,0,234.00,175.50,175.50,222.30,210.60,222.30,222.30,210.60
41400169_1,CHEST SINGLE VIEW,Outpatient,0324,71045,,,,0,234.00,175.50,175.50,222.30,210.60,222.30,222.30,210.60
41400177_1,CHEST TWO VIEWS,Inpatient,0324,71046,,,,0,311.00,233.25,233.25,295.45,279.90,295.45,295.45,279.90
41400177_1,CHEST TWO VIEWS,Outpatient,0324,71046,,,,0,311.00,233.25,233.25,295.45,279.90,295.45,295.45,279.90
41400193_1,STERUM,Inpatient,0320,71120,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,330.60,313.20
41400193_1,STERUM,Outpatient,0320,71120,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,330.60,313.20
41400201_1,RIB UNILATERAL,Inpatient,0320,71100,,,,0,343.00,257.25,257.25,325.85,308.70,325.85,325.85,308.70
41400201_1,RIB UNILATERAL,Outpatient,0320,71100,,,,0,343.00,257.25,257.25,325.85,308.70,325.85,325.85,308.70
41400219_1,RIB BILATERAL,Outpatient,0320,71110,,,,0,498.00,373.50,373.50,473.10,448.20,473.10,473.10,448.20
41400219_1,RIB BILATERAL,Inpatient,0320,71110,,,,0,498.00,373.50,373.50,473.10,448.20,473.10,473.10,448.20
41400220_1,SINUSES COMPLETE,Outpatient,0320,70220,,,,0,423.00,317.25,317.25,401.85,380.70,401.85,401.85,380.70
41400220_1,SINUSES COMPLETE,Inpatient,0320,70220,,,,0,423.00,317.25,317.25,401.85,380.70,401.85,401.85,380.70
41400227_1,CERVICAL AP,Inpatient,0320,72020,,,,0,321.00,240.75,240.75,304.95,288.90,304.95,304.95,288.90
41400227_1,CERVICAL AP,Outpatient,0320,72020,,,,0,321.00,240.75,240.75,304.95,288.90,304.95,304.95,288.90
41400235_1,SPINE ENTIRE AP & LAT,Outpatient,0320,72082,,,,0,384.00,288.00,288.00,364.80,345.60,364.80,364.80,345.60
41400235_1,SPINE ENTIRE AP & LAT,Inpatient,0320,72082,,,,0,384.00,288.00,288.00,364.80,345.60,364.80,364.80,345.60
41400243_1,CERVICAL SPINE AP & LAT,Outpatient,0320,72040,,,,0,367.00,275.25,275.25,348.65,330.30,348.65,348.65,330.30
41400243_1,CERVICAL SPINE AP & LAT,Inpatient,0320,72040,,,,0,367.00,275.25,275.25,348.65,330.30,348.65,348.65,330.30
41400250_1,CERVICAL SPINE 4-5 Views,Outpatient,0320,72050,,,,0,504.00,378.00,378.00,478.80,453.60,478.80,478.80,453.60
41400250_1,CERVICAL SPINE 4-5 Views,Inpatient,0320,72050,,,,0,504.00,378.00,378.00,478.80,453.60,478.80,478.80,453.60
41400268_1,THORACIC MIN 3 VIEWS,Inpatient,0320,72072,,,,0,420.00,315.00,315.00,399.00,378.00,399.00,399.00,378.00
41400268_1,THORACIC MIN 3 VIEWS,Outpatient,0320,72072,,,,0,420.00,315.00,315.00,399.00,378.00,399.00,399.00,378.00
41400276_1,LUMBAR SPINE AP & LAT,Outpatient,0320,72100,,,,0,398.00,298.50,298.50,378.10,358.20,378.10,378.10,358.20
41400276_1,LUMBAR SPINE AP & LAT,Inpatient,0320,72100,,,,0,398.00,298.50,298.50,378.10,358.20,378.10,378.10,358.20
41400284_1,Lumbar Spine Complete 5 View,Inpatient,0320,72110,,,,0,476.00,357.00,357.00,452.20,428.40,452.20,452.20,428.40
41400284_1,Lumbar Spine Complete 5 View,Outpatient,0320,72110,,,,0,476.00,357.00,357.00,452.20,428.40,452.20,452.20,428.40
41400292_1,CERVICAL SPINE COMPLETE,Outpatient,0320,72052,,,,0,640.00,480.00,480.00,608.00,576.00,608.00,608.00,576.00
41400292_1,CERVICAL SPINE COMPLETE,Inpatient,0320,72052,,,,0,640.00,480.00,480.00,608.00,576.00,608.00,608.00,576.00
41400300_1,THORACIC MIN 2 VIEWWS,Inpatient,0320,72070,,,,0,380.00,285.00,285.00,361.00,342.00,361.00,361.00,342.00
41400300_1,THORACIC MIN 2 VIEWWS,Outpatient,0320,72070,,,,0,380.00,285.00,285.00,361.00,342.00,361.00,361.00,342.00
41400318_1,THORACOLUMBAR 2 VIEWS,Inpatient,0320,72080,,,,0,450.00,337.50,337.50,427.50,405.00,427.50,427.50,405.00
41400318_1,THORACOLUMBAR 2 VIEWS,Outpatient,0320,72080,,,,0,450.00,337.50,337.50,427.50,405.00,427.50,427.50,405.00
41400334_1,PELVIS AP,Inpatient,0320,72170,,,,0,268.00,201.00,201.00,254.60,241.20,254.60,254.60,241.20
41400334_1,PELVIS AP,Outpatient,0320,72170,,,,0,268.00,201.00,201.00,254.60,241.20,254.60,254.60,241.20
41400342_1,PELVIS COMPLETE,Inpatient,0320,72190,,,,0,370.00,277.50,277.50,351.50,333.00,351.50,351.50,333.00
41400342_1,PELVIS COMPLETE,Outpatient,0320,72190,,,,0,370.00,277.50,277.50,351.50,333.00,351.50,351.50,333.00
41400359_1,SACROILIAC COMPLETE,Inpatient,0320,72202,,,,0,349.00,261.75,261.75,331.55,314.10,331.55,331.55,314.10
41400359_1,SACROILIAC COMPLETE,Outpatient,0320,72202,,,,0,349.00,261.75,261.75,331.55,314.10,331.55,331.55,314.10
41400367_1,SACRUMCOCCYX,Inpatient,0320,72220,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400367_1,SACRUMCOCCYX,Outpatient,0320,72220,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400368_1,COCCYX OR SACRUM ONLY,Inpatient,0320,72220,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400368_1,COCCYX OR SACRUM ONLY,Outpatient,0320,72220,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400375_1,CLAVICLE,Inpatient,0320,73000,,,,0,286.00,214.50,214.50,271.70,257.40,271.70,271.70,257.40
41400375_1,CLAVICLE,Outpatient,0320,73000,,,,0,286.00,214.50,214.50,271.70,257.40,271.70,271.70,257.40
41400383_1,SCAPULA,Inpatient,0320,73010,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,283.10,268.20
41400383_1,SCAPULA,Outpatient,0320,73010,,,,0,298.00,223.50,223.50,283.10,268.20,283.10,283.10,268.20
41400391_1,SHOULDER 1 VIEW,Inpatient,0320,73020,,,,0,239.00,179.25,179.25,227.05,215.10,227.05,227.05,215.10
41400391_1,SHOULDER 1 VIEW,Outpatient,0320,73020,,,,0,239.00,179.25,179.25,227.05,215.10,227.05,227.05,215.10
41400409_1,SHOULDER COMPLETE,Outpatient,0320,73030,,,,0,329.00,246.75,246.75,312.55,296.10,312.55,312.55,296.10
41400409_1,SHOULDER COMPLETE,Inpatient,0320,73030,,,,0,329.00,246.75,246.75,312.55,296.10,312.55,312.55,296.10
41400425_1,HUMERUS,Inpatient,0320,73060,,,,0,306.00,229.50,229.50,290.70,275.40,290.70,290.70,275.40
41400425_1,HUMERUS,Outpatient,0320,73060,,,,0,306.00,229.50,229.50,290.70,275.40,290.70,290.70,275.40
41400441_1,ELBOW COMPLETE,Outpatient,0320,73080,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
41400441_1,ELBOW COMPLETE,Inpatient,0320,73080,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
41400458_1,FOREARM,Outpatient,0320,73090,,,,0,329.00,246.75,246.75,312.55,296.10,312.55,312.55,296.10
41400458_1,FOREARM,Inpatient,0320,73090,,,,0,329.00,246.75,246.75,312.55,296.10,312.55,312.55,296.10
41400466_1,WRIST AP & LAT,Inpatient,0320,73100,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41400466_1,WRIST AP & LAT,Outpatient,0320,73100,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41400474_1,WRIST COMPLETE,Inpatient,0320,73110,,,,0,333.00,249.75,249.75,316.35,299.70,316.35,316.35,299.70
41400474_1,WRIST COMPLETE,Outpatient,0320,73110,,,,0,333.00,249.75,249.75,316.35,299.70,316.35,316.35,299.70
41400475_1,Bilateral Wrists,Outpatient,0320,73110,,,,0,446.00,334.50,334.50,423.70,401.40,423.70,423.70,401.40
41400475_1,Bilateral Wrists,Inpatient,0320,73110,,,,0,446.00,334.50,334.50,423.70,401.40,423.70,423.70,401.40
41400476_1,Bilateral Forearm,Inpatient,0320,73090,,,,0,494.00,370.50,370.50,469.30,444.60,469.30,469.30,444.60
41400476_1,Bilateral Forearm,Outpatient,0320,73090,,,,0,494.00,370.50,370.50,469.30,444.60,469.30,469.30,444.60
41400489_1,ABDOMEN COMPLETE AP & UPRIGHT,Outpatient,0320,74021,,,,0,412.00,309.00,309.00,391.40,370.80,391.40,391.40,370.80
41400489_1,ABDOMEN COMPLETE AP & UPRIGHT,Inpatient,0320,74021,,,,0,412.00,309.00,309.00,391.40,370.80,391.40,391.40,370.80
41400490_1,HAND COMPLETE,Inpatient,0320,73130,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
41400490_1,HAND COMPLETE,Outpatient,0320,73130,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
41400516_1,HIP 1 VIEW,Inpatient,0320,73501,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
41400516_1,HIP 1 VIEW,Outpatient,0320,73501,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
41400522_1,BILATERAL HIP 3-4 VIEWS,Outpatient,0320,73522,,,,0,316.00,237.00,237.00,300.20,284.40,300.20,300.20,284.40
41400522_1,BILATERAL HIP 3-4 VIEWS,Inpatient,0320,73522,,,,0,316.00,237.00,237.00,300.20,284.40,300.20,300.20,284.40
41400524_1,HIP COMPLETE,Inpatient,0320,73503,,,,0,402.00,301.50,301.50,381.90,361.80,381.90,381.90,361.80
41400524_1,HIP COMPLETE,Outpatient,0320,73503,,,,0,402.00,301.50,301.50,381.90,361.80,381.90,381.90,361.80
41400532_1,HIP 2 VIEW,Outpatient,0320,73502,,,,0,279.00,209.25,209.25,265.05,251.10,265.05,265.05,251.10
41400532_1,HIP 2 VIEW,Inpatient,0320,73502,,,,0,279.00,209.25,209.25,265.05,251.10,265.05,265.05,251.10
41400557_1,KNEE COMPLETE 4 VIEWS,Outpatient,0320,73564,,,,0,408.00,306.00,306.00,387.60,367.20,387.60,387.60,367.20
41400557_1,KNEE COMPLETE 4 VIEWS,Inpatient,0320,73564,,,,0,408.00,306.00,306.00,387.60,367.20,387.60,387.60,367.20
41400565_1,FEMURTHIGH,Inpatient,0320,73551,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
41400565_1,FEMURTHIGH,Outpatient,0320,73551,,,,0,143.00,107.25,107.25,135.85,128.70,135.85,135.85,128.70
41400566_1,FINGERS,Inpatient,0320,73140,,,,0,258.00,193.50,193.50,245.10,232.20,245.10,245.10,232.20
41400566_1,FINGERS,Outpatient,0320,73140,,,,0,258.00,193.50,193.50,245.10,232.20,245.10,245.10,232.20
41400573_1,KNEE 2 VIEWS,Outpatient,0320,73560,,,,0,284.00,213.00,213.00,269.80,255.60,269.80,269.80,255.60
41400573_1,KNEE 2 VIEWS,Inpatient,0320,73560,,,,0,284.00,213.00,213.00,269.80,255.60,269.80,269.80,255.60
41400581_1,KNEE COMPLETE 3 VIEWS,Inpatient,0320,73562,,,,0,438.00,328.50,328.50,416.10,394.20,416.10,416.10,394.20
41400581_1,KNEE COMPLETE 3 VIEWS,Outpatient,0320,73562,,,,0,438.00,328.50,328.50,416.10,394.20,416.10,416.10,394.20
41400599_1,ANKLE 2 VIEWS,Inpatient,0320,73600,,,,0,272.00,204.00,204.00,258.40,244.80,258.40,258.40,244.80
41400599_1,ANKLE 2 VIEWS,Outpatient,0320,73600,,,,0,272.00,204.00,204.00,258.40,244.80,258.40,258.40,244.80
41400607_1,ANKLE COMPLETE,Inpatient,0320,73610,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400607_1,ANKLE COMPLETE,Outpatient,0320,73610,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
41400615_1,FOOT 2 VIEWS,Outpatient,0320,73620,,,,0,256.00,192.00,192.00,243.20,230.40,243.20,243.20,230.40
41400615_1,FOOT 2 VIEWS,Inpatient,0320,73620,,,,0,256.00,192.00,192.00,243.20,230.40,243.20,243.20,230.40
41400623_1,FOOT COMPLETE,Outpatient,0320,73630,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
41400623_1,FOOT COMPLETE,Inpatient,0320,73630,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
41400625_1,CALCANEUS (HEEL),Inpatient,0320,73650,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,235.60,223.20
41400625_1,CALCANEUS (HEEL),Outpatient,0320,73650,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,235.60,223.20
41400656_1,TOES,Inpatient,0320,73660,,,,0,414.00,310.50,310.50,393.30,372.60,393.30,393.30,372.60
41400656_1,TOES,Outpatient,0320,73660,,,,0,414.00,310.50,310.50,393.30,372.60,393.30,393.30,372.60
41400664_1,LEG TIBIA FIBULA,Outpatient,0320,73590,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
41400664_1,LEG TIBIA FIBULA,Inpatient,0320,73590,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
41400672_1,ABDOMEN AP,Outpatient,0320,74018,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,266.95,252.90
41400672_1,ABDOMEN AP,Inpatient,0320,74018,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,266.95,252.90
41400698_1,ABDOMEN 2 VIEWS,Outpatient,0320,74019,,,,0,401.00,300.75,300.75,380.95,360.90,380.95,380.95,360.90
41400698_1,ABDOMEN 2 VIEWS,Inpatient,0320,74019,,,,0,401.00,300.75,300.75,380.95,360.90,380.95,380.95,360.90
41401464_1,EYE FOREIGN BODY,Outpatient,0320,70030,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,228.95,216.90
41401464_1,EYE FOREIGN BODY,Inpatient,0320,70030,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,228.95,216.90
41402090_1,SCOLIOSIS STUDY THORACOLUMBAR,Outpatient,0320,72081,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
41402090_1,SCOLIOSIS STUDY THORACOLUMBAR,Inpatient,0320,72081,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
41403030_1,BILATERAL SHOULDERS,Outpatient,0320,73030,,,,0,494.00,370.50,370.50,469.30,444.60,469.30,469.30,444.60
41403030_1,BILATERAL SHOULDERS,Inpatient,0320,73030,,,,0,494.00,370.50,370.50,469.30,444.60,469.30,469.30,444.60
41403050_1,X-ray Shoulder AC joints,Outpatient,0320,73050,,,,0,463.00,347.25,347.25,439.85,416.70,439.85,439.85,416.70
41403050_1,X-ray Shoulder AC joints,Inpatient,0320,73050,,,,0,463.00,347.25,347.25,439.85,416.70,439.85,439.85,416.70
41403092_1,INFANT UPPER EXTRIMITY,Inpatient,0320,73092,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,317.30,300.60
41403092_1,INFANT UPPER EXTRIMITY,Outpatient,0320,73092,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,317.30,300.60
41403120_1,HAND 2 VIEW,Inpatient,0320,73120,,,,0,314.00,235.50,235.50,298.30,282.60,298.30,298.30,282.60
41403120_1,HAND 2 VIEW,Outpatient,0320,73120,,,,0,314.00,235.50,235.50,298.30,282.60,298.30,298.30,282.60
41403130_1,BILATERAL HANDS,Outpatient,0320,73130,,,,0,536.00,402.00,402.00,509.20,482.40,509.20,509.20,482.40
41403130_1,BILATERAL HANDS,Inpatient,0320,73130,,,,0,536.00,402.00,402.00,509.20,482.40,509.20,509.20,482.40
41403521_1,BILATERAL HIP 2 VIEWS,Inpatient,0320,73521,,,,0,217.00,162.75,162.75,206.15,195.30,206.15,206.15,195.30
41403521_1,BILATERAL HIP 2 VIEWS,Outpatient,0320,73521,,,,0,217.00,162.75,162.75,206.15,195.30,206.15,206.15,195.30
41403523_1,BILATERAL HIPS COMPLETE,Outpatient,0320,73523,,,,0,481.00,360.75,360.75,456.95,432.90,456.95,456.95,432.90
41403523_1,BILATERAL HIPS COMPLETE,Inpatient,0320,73523,,,,0,481.00,360.75,360.75,456.95,432.90,456.95,456.95,432.90
41403565_1,BILATERAL KNEE STANDING,Inpatient,0320,73565,,,,0,700.00,525.00,525.00,665.00,630.00,665.00,665.00,630.00
41403565_1,BILATERAL KNEE STANDING,Outpatient,0320,73565,,,,0,700.00,525.00,525.00,665.00,630.00,665.00,665.00,630.00
41403592_1,INFANT LOWER EXTREMITY,Inpatient,0320,73592,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,317.30,300.60
41403592_1,INFANT LOWER EXTREMITY,Outpatient,0320,73592,,,,0,334.00,250.50,250.50,317.30,300.60,317.30,317.30,300.60
41403630_1,BILATERAL FEET,Outpatient,0320,73630,,,,0,477.00,357.75,357.75,453.15,429.30,453.15,453.15,429.30
41403630_1,BILATERAL FEET,Inpatient,0320,73630,,,,0,477.00,357.75,357.75,453.15,429.30,453.15,453.15,429.30
41404022_1,ACUTE ABDOMEN WITH PA CHEST,Inpatient,0320,74022,,,,0,476.00,357.00,357.00,452.20,428.40,452.20,452.20,428.40
41404022_1,ACUTE ABDOMEN WITH PA CHEST,Outpatient,0320,74022,,,,0,476.00,357.00,357.00,452.20,428.40,452.20,452.20,428.40
41407075_1,Skeletal Complete Survey,Inpatient,0320,77075,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
41407075_1,Skeletal Complete Survey,Outpatient,0320,77075,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
4140F_3,INHALED CORTICOSTEROIDS RXD,ProFee,0989,4140F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4142F_3,CORTICOSTER SPARNG TXMNT RXD,ProFee,0989,4142F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4144F_3,ALT LONG-TERM CNTRL MED RXD,ProFee,0989,4144F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4145F_3,2+ ANTI-HYPRTNSV AGENTS TKN,ProFee,0989,4145F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4148F_3,HEP A VAC INJXN ADMIN/RECVD,ProFee,0989,4148F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4149F_3,HEP B VAC INJXN ADMIN/RECVD,ProFee,0989,4149F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41500_3,FIXATION OF TONGUE,ProFee,0989,41500,,,,0,3.00,2.25,2.25,676.00,0.00,676.00,676.00,N/A
41503880_1,US BI-CAROTID DOP-EXTRACRANIAL ARTERY,Inpatient,0402,93880,,,,0,1426.00,1069.50,1069.50,1354.70,1283.40,1354.70,1354.70,1283.40
41503880_1,US BI-CAROTID DOP-EXTRACRANIAL ARTERY,Outpatient,0402,93880,,,,0,1426.00,1069.50,1069.50,1354.70,1283.40,1354.70,1354.70,1283.40
41503923_1,US Complete Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Arteries,Outpatient,0402,93923,,,,0,628.00,471.00,471.00,596.60,565.20,596.60,596.60,565.20
41503923_1,US Complete Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Arteries,Inpatient,0402,93923,,,,0,628.00,471.00,471.00,596.60,565.20,596.60,596.60,565.20
41503925_1,US Lower Extermity Artial Doppler Bilaterial,Inpatient,0402,93925,,,,0,1138.00,853.50,853.50,1081.10,1024.20,1081.10,1081.10,1024.20
41503925_1,US Lower Extermity Artial Doppler Bilaterial,Outpatient,0402,93925,,,,0,1138.00,853.50,853.50,1081.10,1024.20,1081.10,1081.10,1024.20
41503931_1,US EXTREMITY VEINS UNILATERAL (UE),Outpatient,0402,93931,,,,0,1301.00,975.75,975.75,1235.95,1170.90,1235.95,1235.95,1170.90
41503931_1,US EXTREMITY VEINS UNILATERAL (UE),Inpatient,0402,93931,,,,0,1301.00,975.75,975.75,1235.95,1170.90,1235.95,1235.95,1170.90
41503970_1,US EXTREMITY VEINS BILATERAL (LE),Inpatient,0402,93970,,,,0,1997.00,1497.75,1497.75,1897.15,1797.30,1897.15,1897.15,1797.30
41503970_1,US EXTREMITY VEINS BILATERAL (LE),Outpatient,0402,93970,,,,0,1997.00,1497.75,1497.75,1897.15,1797.30,1897.15,1897.15,1797.30
41503971_1,US EXTREMITY VEINS UNILATERAL (LE),Inpatient,0402,93971,,,,0,1415.00,1061.25,1061.25,1344.25,1273.50,1344.25,1344.25,1273.50
41503971_1,US EXTREMITY VEINS UNILATERAL (LE),Outpatient,0402,93971,,,,0,1415.00,1061.25,1061.25,1344.25,1273.50,1344.25,1344.25,1273.50
41503975_1,"US DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY",Outpatient,0402,93975,,,,0,1414.00,1060.50,1060.50,1343.30,1272.60,1343.30,1343.30,1272.60
41503975_1,"US DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY",Inpatient,0402,93975,,,,0,1414.00,1060.50,1060.50,1343.30,1272.60,1343.30,1343.30,1272.60
41503976_1,"US DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY",Outpatient,0402,93976,,,,0,856.00,642.00,642.00,813.20,770.40,813.20,813.20,770.40
41503976_1,"US DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY",Inpatient,0402,93976,,,,0,856.00,642.00,642.00,813.20,770.40,813.20,813.20,770.40
41506536_1,US NECK THYROID/PARATHYROID,Inpatient,0402,76536,,,,0,750.00,562.50,562.50,712.50,675.00,712.50,712.50,675.00
41506536_1,US NECK THYROID/PARATHYROID,Outpatient,0402,76536,,,,0,750.00,562.50,562.50,712.50,675.00,712.50,712.50,675.00
41506700_1,US ABDOMEN COMPLETE,Inpatient,0402,76700,,,,0,916.00,687.00,687.00,870.20,824.40,870.20,870.20,824.40
41506700_1,US ABDOMEN COMPLETE,Outpatient,0402,76700,,,,0,916.00,687.00,687.00,870.20,824.40,870.20,870.20,824.40
41506705_1,US ABDOMEM LTD.,Inpatient,0402,76705,,,,0,788.00,591.00,591.00,748.60,709.20,748.60,748.60,709.20
41506705_1,US ABDOMEM LTD.,Outpatient,0402,76705,,,,0,788.00,591.00,591.00,748.60,709.20,748.60,748.60,709.20
41506706_1,US AAA Medicare Screening,Inpatient,0402,76706,,,,0,676.00,507.00,507.00,642.20,608.40,642.20,642.20,608.40
41506706_1,US AAA Medicare Screening,Outpatient,0402,76706,,,,0,676.00,507.00,507.00,642.20,608.40,642.20,642.20,608.40
41506770_1,US RETROPERITONEAL COMP ( RENAL/BLADDER),Outpatient,0402,76770,,,,0,895.00,671.25,671.25,850.25,805.50,850.25,850.25,805.50
41506770_1,US RETROPERITONEAL COMP ( RENAL/BLADDER),Inpatient,0402,76770,,,,0,895.00,671.25,671.25,850.25,805.50,850.25,850.25,805.50
41506775_1,US Renal Arterial Doppler,Inpatient,0402,76775,,,,0,703.00,527.25,527.25,667.85,632.70,667.85,667.85,632.70
41506775_1,US Renal Arterial Doppler,Outpatient,0402,76775,,,,0,703.00,527.25,527.25,667.85,632.70,667.85,667.85,632.70
41506776_1,US TRANSPLANTED KIDNEY REALTIME AND DUPLEX DOPPLER W/IMAGE DOCUMENTATION,Inpatient,0402,76776,,,,0,861.00,645.75,645.75,817.95,774.90,817.95,817.95,774.90
41506776_1,US TRANSPLANTED KIDNEY REALTIME AND DUPLEX DOPPLER W/IMAGE DOCUMENTATION,Outpatient,0402,76776,,,,0,861.00,645.75,645.75,817.95,774.90,817.95,817.95,774.90
41506801_1,US OB < 14 WEEKS 1ST TRIMESTER,Inpatient,0402,76801,,,,0,1317.00,987.75,987.75,1251.15,1185.30,1251.15,1251.15,1185.30
41506801_1,US OB < 14 WEEKS 1ST TRIMESTER,Outpatient,0402,76801,,,,0,1317.00,987.75,987.75,1251.15,1185.30,1251.15,1251.15,1185.30
41506802_1,US OB ADDITIONAL GESTATION,Inpatient,0402,76802,,,,0,1274.00,955.50,955.50,1210.30,1146.60,1210.30,1210.30,1146.60
41506802_1,US OB ADDITIONAL GESTATION,Outpatient,0402,76802,,,,0,1274.00,955.50,955.50,1210.30,1146.60,1210.30,1210.30,1146.60
41506805_1,US OB >14 WEEKS,Inpatient,0402,76805,,,,0,1713.00,1284.75,1284.75,1627.35,1541.70,1627.35,1627.35,1541.70
41506805_1,US OB >14 WEEKS,Outpatient,0402,76805,,,,0,1713.00,1284.75,1284.75,1627.35,1541.70,1627.35,1627.35,1541.70
41506815_1,"OB LIMITED, ONE OR FETUSES",Outpatient,0402,76815,,,,0,820.00,615.00,615.00,779.00,738.00,779.00,779.00,738.00
41506815_1,"OB LIMITED, ONE OR FETUSES",Inpatient,0402,76815,,,,0,820.00,615.00,615.00,779.00,738.00,779.00,779.00,738.00
41506816_1,US OB,Inpatient,0402,76816,,,,0,686.00,514.50,514.50,651.70,617.40,651.70,651.70,617.40
41506816_1,US OB,Outpatient,0402,76816,,,,0,686.00,514.50,514.50,651.70,617.40,651.70,651.70,617.40
41506817_1,US OB TRANSVAGINAL,Outpatient,0402,76817,,,,0,1436.00,1077.00,1077.00,1364.20,1292.40,1364.20,1364.20,1292.40
41506817_1,US OB TRANSVAGINAL,Inpatient,0402,76817,,,,0,1436.00,1077.00,1077.00,1364.20,1292.40,1364.20,1364.20,1292.40
41506818_1,US BIOPHYSICAL PROFILE,Inpatient,0402,76818,,,,0,1212.00,909.00,909.00,1151.40,1090.80,1151.40,1151.40,1090.80
41506818_1,US BIOPHYSICAL PROFILE,Outpatient,0402,76818,,,,0,1212.00,909.00,909.00,1151.40,1090.80,1151.40,1151.40,1090.80
41506830_1,US TRANSVAGINAL,Inpatient,0402,76830,,,,0,685.00,513.75,513.75,650.75,616.50,650.75,650.75,616.50
41506830_1,US TRANSVAGINAL,Outpatient,0402,76830,,,,0,685.00,513.75,513.75,650.75,616.50,650.75,650.75,616.50
41506856_1,US PELVIC,Inpatient,0402,76856,,,,0,926.00,694.50,694.50,879.70,833.40,879.70,879.70,833.40
41506856_1,US PELVIC,Outpatient,0402,76856,,,,0,926.00,694.50,694.50,879.70,833.40,879.70,879.70,833.40
41506857_1,US BLADDER,Inpatient,0402,76857,,,,0,655.00,491.25,491.25,622.25,589.50,622.25,622.25,589.50
41506857_1,US BLADDER,Outpatient,0402,76857,,,,0,655.00,491.25,491.25,622.25,589.50,622.25,622.25,589.50
41506870_1,US SCROTUM & CONTENTS,Inpatient,0402,76870,,,,0,764.00,573.00,573.00,725.80,687.60,725.80,725.80,687.60
41506870_1,US SCROTUM & CONTENTS,Outpatient,0402,76870,,,,0,764.00,573.00,573.00,725.80,687.60,725.80,725.80,687.60
41506881_1,US EXTREMITY NON VASCULAR,Outpatient,0402,76881,,,,0,736.00,552.00,552.00,699.20,662.40,699.20,699.20,662.40
41506881_1,US EXTREMITY NON VASCULAR,Inpatient,0402,76881,,,,0,736.00,552.00,552.00,699.20,662.40,699.20,699.20,662.40
41506882_1,US- Soft Tissue Extremity or Axillary Limited,Outpatient,0402,76882,,,,0,427.00,320.25,320.25,405.65,384.30,405.65,405.65,384.30
41506882_1,US- Soft Tissue Extremity or Axillary Limited,Inpatient,0402,76882,,,,0,427.00,320.25,320.25,405.65,384.30,405.65,405.65,384.30
4150F_3,PT RECVNG ANTIVIR TXMNT HEPC,ProFee,0989,4150F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41510_3,TONGUE TO LIP SURGERY,ProFee,0989,41510,,,,0,3.00,2.25,2.25,654.00,0.00,654.00,654.00,N/A
41512_3,TONGUE SUSPENSION,ProFee,0989,41512,,,,0,3.00,2.25,2.25,947.00,0.00,947.00,947.00,N/A
4151F_3,PT NOT RECVNG ANTIV HEP C,ProFee,0989,4151F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41520_3,"RECONSTRUCTION, TONGUE FOLD",ProFee,0989,41520,,,,0,3.00,2.25,2.25,353.00,0.00,353.00,353.00,N/A
4152F_3,DOC'D PEGINTF/RIB THXY CONSD,ProFee,0989,4152F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
41530_3,TONGUE BASE VOL REDUCTION,ProFee,0989,41530,,,,0,3.00,2.25,2.25,536.50,0.00,536.50,536.50,N/A
4153F_3,COMBO PEGINTF/RIB RX,ProFee,0989,4153F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4154F_3,HEP A VAC SERIES RECOMMENDED,ProFee,0989,4154F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4155F_3,HEP A VAC SERIES PREV RECVD,ProFee,0989,4155F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4156F_3,HEP B VAC SERIES RECOMMENDED,ProFee,0989,4156F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4157F_3,HEP B VAC SERIES PREV RECVD,ProFee,0989,4157F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4158F_3,PT EDU RE: ALCOH DRNKNG DONE,ProFee,0989,4158F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41599_3,TONGUE AND MOUTH SURGERY,ProFee,0989,41599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4159F_3,CONTRCP TALK B/4 ANTIV TXMNT,ProFee,0989,4159F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41600552_1,"INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",Ambulatory Surgical,0761,20552,,,,0,738.00,553.50,553.50,701.10,664.20,701.10,701.10,664.20
41600552_1,"INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",Inpatient,0761,20552,,,,0,738.00,553.50,553.50,701.10,664.20,701.10,701.10,664.20
41600553_1,"Injections: Multiple Trigger Points, 3 or more muscles",Ambulatory Surgical,0761,20553,,,,0,750.00,562.50,562.50,712.50,675.00,712.50,712.50,675.00
41600553_1,"Injections: Multiple Trigger Points, 3 or more muscles",Inpatient,0761,20553,,,,0,750.00,562.50,562.50,712.50,675.00,712.50,712.50,675.00
41600605_1,"arthrocentesis, aspiration, injection: wrist, elbow, ankle",Inpatient,0761,20605,,,,0,695.00,521.25,521.25,660.25,625.50,660.25,660.25,625.50
41600605_1,"arthrocentesis, aspiration, injection: wrist, elbow, ankle",Ambulatory Surgical,0761,20605,,,,0,695.00,521.25,521.25,660.25,625.50,660.25,660.25,625.50
41600606_1,"arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",Ambulatory Surgical,0761,20606,,,,0,1115.00,836.25,836.25,1059.25,1003.50,1059.25,1059.25,1003.50
41600606_1,"arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",Inpatient,0761,20606,,,,0,1115.00,836.25,836.25,1059.25,1003.50,1059.25,1059.25,1003.50
41600610_1,"ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE",Inpatient,0761,20610,,,,0,625.00,468.75,468.75,593.75,562.50,593.75,593.75,562.50
41600610_1,"ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE",Ambulatory Surgical,0761,20610,,,,0,625.00,468.75,468.75,593.75,562.50,593.75,593.75,562.50
41600611_1,"arthrocentesis, aspiration, injection: major joint or bursa w/ ultrasound",Ambulatory Surgical,0761,20611,,,,0,875.00,656.25,656.25,831.25,787.50,831.25,831.25,787.50
41600611_1,"arthrocentesis, aspiration, injection: major joint or bursa w/ ultrasound",Inpatient,0761,20611,,,,0,875.00,656.25,656.25,831.25,787.50,831.25,831.25,787.50
41602321_1,"INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, I",Ambulatory Surgical,0761,62321,,,,0,2009.00,1506.75,1506.75,1908.55,1808.10,1908.55,1908.55,1808.10
41602321_1,"INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, I",Inpatient,0761,62321,,,,0,2009.00,1506.75,1506.75,1908.55,1808.10,1908.55,1908.55,1808.10
41604405_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE",Ambulatory Surgical,0761,64405,,,,0,919.00,689.25,689.25,873.05,827.10,873.05,873.05,827.10
41604405_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE",Inpatient,0761,64405,,,,0,919.00,689.25,689.25,873.05,827.10,873.05,873.05,827.10
41604417_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE",Ambulatory Surgical,0761,64417,,,,0,919.00,689.25,689.25,873.05,827.10,873.05,873.05,827.10
41604417_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE",Inpatient,0761,64417,,,,0,919.00,689.25,689.25,873.05,827.10,873.05,873.05,827.10
41604418_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE",Ambulatory Surgical,0761,64418,,,,0,1247.00,935.25,935.25,1184.65,1122.30,1184.65,1184.65,1122.30
41604418_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE",Inpatient,0761,64418,,,,0,1247.00,935.25,935.25,1184.65,1122.30,1184.65,1184.65,1122.30
41604445_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",Inpatient,0761,64445,,,,0,1247.00,935.25,935.25,1184.65,1122.30,1184.65,1184.65,1122.30
41604445_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",Ambulatory Surgical,0761,64445,,,,0,1247.00,935.25,935.25,1184.65,1122.30,1184.65,1184.65,1122.30
41604450_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH",Inpatient,0761,64450,,,,0,679.00,509.25,509.25,645.05,611.10,645.05,645.05,611.10
41604450_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH",Ambulatory Surgical,0761,64450,,,,0,679.00,509.25,509.25,645.05,611.10,645.05,645.05,611.10
41604454_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED",Ambulatory Surgical,0761,64454,,,,0,2438.00,1828.50,1828.50,2316.10,2194.20,2316.10,2316.10,2194.20
41604454_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED",Inpatient,0761,64454,,,,0,2438.00,1828.50,1828.50,2316.10,2194.20,2316.10,2316.10,2194.20
41604483_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL",Ambulatory Surgical,0761,64483,,,,0,1586.00,1189.50,1189.50,1506.70,1427.40,1506.70,1506.70,1427.40
41604483_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL",Inpatient,0761,64483,,,,0,1586.00,1189.50,1189.50,1506.70,1427.40,1506.70,1506.70,1427.40
41604484_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR P",Inpatient,0761,64484,,,,0,922.00,691.50,691.50,875.90,829.80,875.90,875.90,829.80
41604484_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR P",Outpatient,0761,64484,,,,0,922.00,691.50,691.50,875.90,829.80,875.90,875.90,829.80
41604490_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL",Inpatient,0761,64490,,,,0,2401.00,1800.75,1800.75,2280.95,2160.90,2280.95,2280.95,2160.90
41604490_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL",Ambulatory Surgical,0761,64490,,,,0,2401.00,1800.75,1800.75,2280.95,2160.90,2280.95,2280.95,2160.90
41604491_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL",Inpatient,0761,64491,,,,0,1018.00,763.50,763.50,967.10,916.20,967.10,967.10,916.20
41604491_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL",Outpatient,0761,64491,,,,0,1018.00,763.50,763.50,967.10,916.20,967.10,967.10,916.20
41604492_1,njx; third & add'l levels; facet joint w/ image guide; cervical or thoracic,Ambulatory Surgical,0361,64492,,,,0,1017.00,762.75,762.75,966.15,915.30,966.15,966.15,915.30
41604492_1,njx; third & add'l levels; facet joint w/ image guide; cervical or thoracic,Inpatient,0361,64492,,,,0,1017.00,762.75,762.75,966.15,915.30,966.15,966.15,915.30
41604493_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL",Ambulatory Surgical,0761,64493,,,,0,2141.00,1605.75,1605.75,2033.95,1926.90,2033.95,2033.95,1926.90
41604493_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL",Inpatient,0761,64493,,,,0,2141.00,1605.75,1605.75,2033.95,1926.90,2033.95,2033.95,1926.90
41604494_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIS",Inpatient,0761,64494,,,,0,959.00,719.25,719.25,911.05,863.10,911.05,911.05,863.10
41604494_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIS",Outpatient,0761,64494,,,,0,959.00,719.25,719.25,911.05,863.10,911.05,911.05,863.10
41604495_1,njx; paravertebral facet join w/ fluor or ct; lumbar/sacral; third & add'l level,Inpatient,0761,64495,,,,0,907.00,680.25,680.25,861.65,816.30,861.65,861.65,816.30
41604495_1,njx; paravertebral facet join w/ fluor or ct; lumbar/sacral; third & add'l level,Outpatient,0761,64495,,,,0,907.00,680.25,680.25,861.65,816.30,861.65,861.65,816.30
41604505_1,njx; Sphenopalatine ganglion,Ambulatory Surgical,0761,64505,,,,0,1050.00,787.50,787.50,997.50,945.00,997.50,997.50,945.00
41604505_1,njx; Sphenopalatine ganglion,Inpatient,0761,64505,,,,0,1050.00,787.50,787.50,997.50,945.00,997.50,997.50,945.00
41604624_1,Dstrj nulyt agt gnclr nrv w/ image guide,Inpatient,0761,64624,,,,0,3624.00,2718.00,2718.00,3442.80,3261.60,3442.80,3442.80,3261.60
41604624_1,Dstrj nulyt agt gnclr nrv w/ image guide,Ambulatory Surgical,0761,64624,,,,0,3624.00,2718.00,2718.00,3442.80,3261.60,3442.80,3442.80,3261.60
41604633_1,destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; single joint,Ambulatory Surgical,0361,64633,,,,0,2363.00,1772.25,1772.25,2244.85,2126.70,2244.85,2244.85,2126.70
41604633_1,destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; single joint,Inpatient,0361,64633,,,,0,2363.00,1772.25,1772.25,2244.85,2126.70,2244.85,2244.85,2126.70
41604634_1,destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; ea add'l join,Ambulatory Surgical,0361,64634,,,,0,1477.00,1107.75,1107.75,1403.15,1329.30,1403.15,1403.15,1329.30
41604634_1,destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; ea add'l join,Inpatient,0361,64634,,,,0,1477.00,1107.75,1107.75,1403.15,1329.30,1403.15,1403.15,1329.30
41604635_1,destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,Inpatient,0761,64635,,,,0,2854.00,2140.50,2140.50,2711.30,2568.60,2711.30,2711.30,2568.60
41604635_1,destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,Ambulatory Surgical,0761,64635,,,,0,2854.00,2140.50,2140.50,2711.30,2568.60,2711.30,2711.30,2568.60
41604636_1,destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,Outpatient,0761,64636,,,,0,1210.00,907.50,907.50,1149.50,1089.00,1149.50,1149.50,1089.00
41604636_1,destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,Inpatient,0761,64636,,,,0,1210.00,907.50,907.50,1149.50,1089.00,1149.50,1149.50,1089.00
41604640_1,DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,Inpatient,0761,64640,,,,0,2419.00,1814.25,1814.25,2298.05,2177.10,2298.05,2298.05,2177.10
41604640_1,DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,Ambulatory Surgical,0761,64640,,,,0,2419.00,1814.25,1814.25,2298.05,2177.10,2298.05,2298.05,2177.10
4160493B_1,Inj paravert facet jnt l/s 1 lev - bi-lateral,Ambulatory Surgical,0761,64493,,,,0,2721.00,2040.75,2040.75,2584.95,2448.90,2584.95,2584.95,2448.90
4160493B_1,Inj paravert facet jnt l/s 1 lev - bi-lateral,Inpatient,0761,64493,,,,0,2721.00,2040.75,2040.75,2584.95,2448.90,2584.95,2584.95,2448.90
4160494B_1,Inj paravert facet jnt l/s 2 lev - bi-lateral,Inpatient,0761,64494,,,,0,1360.00,1020.00,1020.00,1292.00,1224.00,1292.00,1292.00,1224.00
4160494B_1,Inj paravert facet jnt l/s 2 lev - bi-lateral,Outpatient,0761,64494,,,,0,1360.00,1020.00,1020.00,1292.00,1224.00,1292.00,1292.00,1224.00
4160495B_1,Inj paravert facet jnt l/s 3 lev - bi-lateral,Inpatient,0761,64495,,,,0,1360.00,1020.00,1020.00,1292.00,1224.00,1292.00,1292.00,1224.00
4160495B_1,Inj paravert facet jnt l/s 3 lev - bi-lateral,Outpatient,0761,64495,,,,0,1360.00,1020.00,1020.00,1292.00,1224.00,1292.00,1292.00,1224.00
41607002_1,Fluoro Guided Needle Placement for Inj or Aspiration,Inpatient,0329,77002,,,,0,443.00,332.25,332.25,420.85,398.70,420.85,420.85,398.70
41607002_1,Fluoro Guided Needle Placement for Inj or Aspiration,Outpatient,0329,77002,,,,0,443.00,332.25,332.25,420.85,398.70,420.85,420.85,398.70
41607003_1,Fluoro Guided Needle Placement for Spine Procedure,Outpatient,0329,77003,,,,0,715.00,536.25,536.25,679.25,643.50,679.25,679.25,643.50
41607003_1,Fluoro Guided Needle Placement for Spine Procedure,Inpatient,0329,77003,,,,0,715.00,536.25,536.25,679.25,643.50,679.25,679.25,643.50
41607096_1,"INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED",Outpatient,0761,27096,,,,0,1575.00,1181.25,1181.25,1496.25,1417.50,1496.25,1496.25,1417.50
41607096_1,"INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED",Inpatient,0761,27096,,,,0,1575.00,1181.25,1181.25,1496.25,1417.50,1496.25,1496.25,1417.50
416072321_1,"INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, I",Ambulatory Surgical,0761,62321,,,,0,2009.00,1506.75,1506.75,1908.55,1808.10,1908.55,1908.55,1808.10
416072321_1,"INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, I",Inpatient,0761,62321,,,,0,2009.00,1506.75,1506.75,1908.55,1808.10,1908.55,1908.55,1808.10
41609152_1,Mod sedation by performing provider 1st 15 min >5 YO,ProFee,0964,99152,,,,0,356.00,267.00,18.00,267.00,0.00,18.00,18.00,N/A
41609153_1,Mod sedation by performing provider ea add'l 15 min,ProFee,0964,99153,,,,0,207.00,155.25,15.50,155.25,0.00,15.50,15.50,N/A
4160942_1,U/S Guidance for Needle Placement for needle placement,Outpatient,0402,76942,,,,0,735.00,551.25,551.25,698.25,661.50,698.25,698.25,661.50
4160942_1,U/S Guidance for Needle Placement for needle placement,Inpatient,0402,76942,,,,0,735.00,551.25,551.25,698.25,661.50,698.25,698.25,661.50
4160B445_1,"bilateral INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",Ambulatory Surgical,0761,64445,,,,0,1870.00,1402.50,1402.50,1776.50,1683.00,1776.50,1776.50,1683.00
4160B445_1,"bilateral INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",Inpatient,0761,64445,,,,0,1870.00,1402.50,1402.50,1776.50,1683.00,1776.50,1776.50,1683.00
4160B483_1,Bilateral Inj foramen epidural l/s (tfesi),Ambulatory Surgical,0761,64483,,,,0,2379.00,1784.25,1784.25,2260.05,2141.10,2260.05,2260.05,2141.10
4160B483_1,Bilateral Inj foramen epidural l/s (tfesi),Inpatient,0761,64483,,,,0,2379.00,1784.25,1784.25,2260.05,2141.10,2260.05,2260.05,2141.10
4160B484_1,Bilateral Inj foramen epidural l/s (tfesi) ea add'l level,Outpatient,0761,64484,,,,0,1383.00,1037.25,1037.25,1313.85,1244.70,1313.85,1313.85,1244.70
4160B484_1,Bilateral Inj foramen epidural l/s (tfesi) ea add'l level,Inpatient,0761,64484,,,,0,1383.00,1037.25,1037.25,1313.85,1244.70,1313.85,1313.85,1244.70
4160B552_1,"Bilateral INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",Ambulatory Surgical,0761,20552,,,,0,937.00,702.75,702.75,890.15,843.30,890.15,890.15,843.30
4160B552_1,"Bilateral INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",Inpatient,0761,20552,,,,0,937.00,702.75,702.75,890.15,843.30,890.15,890.15,843.30
4160B606_1,"Bilateral arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",Ambulatory Surgical,0761,20606,,,,0,1570.00,1177.50,1177.50,1491.50,1413.00,1491.50,1491.50,1413.00
4160B606_1,"Bilateral arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",Inpatient,0761,20606,,,,0,1570.00,1177.50,1177.50,1491.50,1413.00,1491.50,1491.50,1413.00
4160B611_1,"bilateral arthrocentesis, aspiration, injection: major joint or bursa w/ U/S",Ambulatory Surgical,0761,20611,,,,0,1310.00,982.50,982.50,1244.50,1179.00,1244.50,1244.50,1179.00
4160B611_1,"bilateral arthrocentesis, aspiration, injection: major joint or bursa w/ U/S",Inpatient,0761,20611,,,,0,1310.00,982.50,982.50,1244.50,1179.00,1244.50,1244.50,1179.00
4160B624_1,Bilat Dstrj nulyt agt gnclr nrv w/ image guide,Inpatient,0761,64624,,,,0,5046.00,3784.50,3784.50,4793.70,4541.40,4793.70,4793.70,4541.40
4160B624_1,Bilat Dstrj nulyt agt gnclr nrv w/ image guide,Ambulatory Surgical,0761,64624,,,,0,5046.00,3784.50,3784.50,4793.70,4541.40,4793.70,4793.70,4541.40
4160B635_1,Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,Ambulatory Surgical,0761,64635,,,,0,4278.00,3208.50,3208.50,4064.10,3850.20,4064.10,4064.10,3850.20
4160B635_1,Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,Inpatient,0761,64635,,,,0,4278.00,3208.50,3208.50,4064.10,3850.20,4064.10,4064.10,3850.20
4160B636_1,Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,Outpatient,0761,64636,,,,0,1815.00,1361.25,1361.25,1724.25,1633.50,1724.25,1724.25,1633.50
4160B636_1,Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,Inpatient,0761,64636,,,,0,1815.00,1361.25,1361.25,1724.25,1633.50,1724.25,1724.25,1633.50
4160B640_1,Bilateral destx; other peripheral nerve or branch,Ambulatory Surgical,0761,64640,,,,0,3626.00,2719.50,2719.50,3444.70,3263.40,3444.70,3444.70,3263.40
4160B640_1,Bilateral destx; other peripheral nerve or branch,Inpatient,0761,64640,,,,0,3626.00,2719.50,2719.50,3444.70,3263.40,3444.70,3444.70,3263.40
4160BP06_1,"P Bilateral arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",ProFee,0964,20606,,,,0,997.00,747.75,76.50,747.75,0.00,76.50,76.50,N/A
4160BP11_1,"P ilateral arthrocentesis, aspiration, injection: major joint or bursa w/ U/S",ProFee,0964,20611,,,,0,923.00,692.25,88.00,692.25,0.00,88.00,88.00,N/A
4160BP24_1,P Bilat Dstrj nulyt agt gnclr nrv w/ image guide,ProFee,0964,64624,,,,0,4193.00,3144.75,3144.75,3144.75,N/A,N/A,N/A,N/A
4160BP35_1,P Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,ProFee,0964,64635,,,,0,2614.00,1960.50,318.50,1960.50,0.00,318.50,318.50,N/A
4160BP36_1,P Bilateral destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,ProFee,0964,64636,,,,0,1296.00,972.00,85.50,972.00,0.00,85.50,85.50,N/A
4160BP40_1,P Bilateral destx; other peripheral nerve or branch,ProFee,0964,64640,,,,0,2614.00,1960.50,133.50,1960.50,0.00,133.50,133.50,N/A
4160BP45_1,"P bilateral INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",ProFee,0964,64445,,,,0,1156.00,867.00,104.50,867.00,0.00,104.50,104.50,N/A
4160BP83_1,P Bilateral Inj foramen epidural l/s (tfesi),ProFee,0964,64483,,,,0,2249.00,1686.75,161.00,1686.75,0.00,161.00,161.00,N/A
4160BP84_1,P Inj foramen epidural add-on bi-lateral,ProFee,0964,64484,,,,0,1124.00,843.00,74.50,843.00,0.00,74.50,74.50,N/A
4160BP93_1,P Inj paravert facet jnt l/s 1 lev - bi-lateral,ProFee,0964,64493,,,,0,1732.00,1299.00,130.00,1299.00,0.00,130.00,130.00,N/A
4160BP94_1,P Inj paravert facet jnt l/s 2 lev - bi-lateral,ProFee,0964,64494,,,,0,864.00,648.00,74.50,648.00,0.00,74.50,74.50,N/A
4160BP95_1,P Inj paravert facet jnt l/s 3 lev - bi-lateral,ProFee,0964,64495,,,,0,864.00,648.00,75.50,648.00,0.00,75.50,75.50,N/A
4160P096_1,"P mjx sacroiliac joint w/ fluoro or ct, inc arthrography",ProFee,0964,27096,,,,0,972.00,729.00,120.00,729.00,0.00,120.00,120.00,N/A
4160P321_1,"P INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT,",ProFee,0964,62321,,,,0,1215.00,911.25,154.00,911.25,0.00,154.00,154.00,N/A
4160P405_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE",ProFee,0964,64405,,,,0,567.00,425.25,91.50,425.25,0.00,91.50,91.50,N/A
4160P417_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE",ProFee,0964,64417,,,,0,567.00,425.25,101.00,425.25,0.00,101.00,101.00,N/A
4160P418_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE",ProFee,0964,64418,,,,0,567.00,425.25,89.00,425.25,0.00,89.00,89.00,N/A
4160P445_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE",ProFee,0964,64445,,,,0,770.00,577.50,104.50,577.50,0.00,104.50,104.50,N/A
4160P450_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH",ProFee,0964,64450,,,,0,470.00,352.50,65.00,352.50,0.00,65.00,65.00,N/A
4160P454_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED",ProFee,0964,64454,,,,0,1620.00,1215.00,1215.00,1215.00,N/A,N/A,N/A,N/A
4160P483_1,"P INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL",ProFee,0964,64483,,,,0,1499.00,1124.25,161.00,1124.25,0.00,161.00,161.00,N/A
4160P484_1,"INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR P",ProFee,0964,64484,,,,0,750.00,562.50,74.50,562.50,0.00,74.50,74.50,N/A
4160P490_1,"P INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVE",ProFee,0964,64490,,,,0,1256.00,942.00,152.00,942.00,0.00,152.00,152.00,N/A
4160P491_1,"P INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVE",ProFee,0964,64491,,,,0,627.00,470.25,86.50,470.25,0.00,86.50,86.50,N/A
4160P492_1,P njx; third & add'l levels; facet joint w/ image guide; cervical or thoracic,ProFee,0975,64492,,,,0,581.00,435.75,87.50,435.75,0.00,87.50,87.50,N/A
4160P493_1,"P INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL",ProFee,0964,64493,,,,0,1155.00,866.25,130.00,866.25,0.00,130.00,130.00,N/A
4160P494_1,"INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIS",ProFee,0964,64494,,,,0,578.00,433.50,74.50,433.50,0.00,74.50,74.50,N/A
4160P495_1,P njx; paravertebral facet join w/ fluor or ct; lumbar/sacral; third & add'l level,ProFee,0964,64495,,,,0,578.00,433.50,75.50,433.50,0.00,75.50,75.50,N/A
4160P505_1,P njx; Sphenopalatine ganglion,ProFee,0964,64505,,,,0,648.00,486.00,130.00,486.00,0.00,130.00,130.00,N/A
4160P552_1,"P INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",ProFee,0964,20552,,,,0,421.00,315.75,54.50,315.75,0.00,54.50,54.50,N/A
4160P553_1,"P Injections; Multiple Trigger Points, 3 or more muscles",ProFee,0964,20553,,,,0,535.00,401.25,62.00,401.25,0.00,62.00,62.00,N/A
4160P605_1,"P arthrocentesis, aspiration, injection: wrist, elbow, ankle",ProFee,0964,20605,,,,0,567.00,425.25,54.00,425.25,0.00,54.00,54.00,N/A
4160P606_1,"P arthrocentesis, aspiration, injection: wrist, elbow, ankle w/ U/S",ProFee,0964,20606,,,,0,664.00,498.00,76.50,498.00,0.00,76.50,76.50,N/A
4160P610_1,"P ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE",ProFee,0964,20610,,,,0,518.00,388.50,66.50,388.50,0.00,66.50,66.50,N/A
4160P611_1,"P arthrocentesis, aspiration, injection: major joint or bursa w/ ultrasound",ProFee,0964,20611,,,,0,616.00,462.00,88.00,462.00,0.00,88.00,88.00,N/A
4160P624_1,P Dstrj nulyt agt gnclr nrv w/ image guide,ProFee,0964,64624,,,,0,2795.00,2096.25,2096.25,2096.25,N/A,N/A,N/A,N/A
4160P633_1,P destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; single joint,ProFee,0975,64633,,,,0,1688.00,1266.00,323.00,1266.00,0.00,323.00,323.00,N/A
4160P634_1,P destr; paravertebral facet joint nerve w/ fluor or ct; cervical/thoracic; ea add'l join,ProFee,0975,64634,,,,0,844.00,633.00,98.00,633.00,0.00,98.00,98.00,N/A
4160P635_1,P destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral; single joint,ProFee,0964,64635,,,,0,1742.00,1306.50,318.50,1306.50,0.00,318.50,318.50,N/A
4160P636_1,P destr; paravertebral facet joint nerve w/ fluor or ct; lumbar/sacral;ea add'ljoint,ProFee,0964,64636,,,,0,870.00,652.50,85.50,652.50,0.00,85.50,85.50,N/A
4160PB52_1,"P Bilateral INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)",ProFee,0964,20552,,,,0,632.00,474.00,54.50,474.00,0.00,54.50,54.50,N/A
4163F_3,"PT COUNS. 4 TXMNT OPT, PROST",ProFee,0989,4163F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4164F_3,ADJV HRMNL THXPY RX'D,ProFee,0989,4164F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4165F_3,3D-CRT/IMRT) RECEIVED,ProFee,0989,4165F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4167F_3,"HD BED TILTED, 1ST DAY VENT",ProFee,0989,4167F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4168F_3,"PT CARE, ICU&VENT W/IN 24HRS",ProFee,0989,4168F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4169F_3,NO PT CARE ICU/VENT IN 24HRS,ProFee,0989,4169F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
416P4640_1,P DESTR BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH,ProFee,0964,64640,,,,0,1742.00,1306.50,133.50,1306.50,0.00,133.50,133.50,N/A
41700005_1,ADENOSINE INJ per 1 mg,Outpatient,0636,J0153,,,17478-0542-02,6,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41700005_1,ADENOSINE INJ per 1 mg,Inpatient,0636,J0153,,,17478-0542-02,6,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41700007_1,MULTIPLE VITAMIN 10 ML (VIAL 1 AND VIAL 2),Outpatient,0251,,,,54643-5649-01,10,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700007_1,MULTIPLE VITAMIN 10 ML (VIAL 1 AND VIAL 2),Inpatient,0251,,,,54643-5649-01,10,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700008_1,Divalproex Sodium Tab -ER-12H 500 mg tablet,Outpatient,0637,A9270,,,00832-7124-01,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700008_1,Divalproex Sodium Tab -ER-12H 500 mg tablet,Inpatient,0637,A9270,,,00832-7124-01,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700009_1,Morhine 2 mg/ml Carpujects,Outpatient,0636,J2270,,,00409-1890-01,1,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41700009_1,Morhine 2 mg/ml Carpujects,Inpatient,0636,J2270,,,00409-1890-01,1,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41700010_1,MORPHINE 4 mg/mL CARPUJECTS,Outpatient,0636,J2270,,,00641-6125-25,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700010_1,MORPHINE 4 mg/mL CARPUJECTS,Inpatient,0636,J2270,,,00641-6125-25,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700011_1,Ceftriaxone Vial 2gm,Inpatient,0636,J0696,,,60505-6149-04,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41700011_1,Ceftriaxone Vial 2gm,Outpatient,0636,J0696,,,60505-6149-04,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41700016_1,APIXABAN 2.5MG,Outpatient,0637,A9270,,,00003-0893-31,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700016_1,APIXABAN 2.5MG,Inpatient,0637,A9270,,,00003-0893-31,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700017_1,FENTANYL PATCH 25 MCG,Inpatient,0251,A9270,,,60505-7081-02,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700017_1,FENTANYL PATCH 25 MCG,Outpatient,0251,A9270,,,60505-7081-02,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700019_1,CANAGLIFLOZIN 100MG,Inpatient,0637,A9270,,,50458-0140-30,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700019_1,CANAGLIFLOZIN 100MG,Outpatient,0637,A9270,,,50458-0140-30,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700020_1,CYANOCOBALAMIN 1000MCG,Outpatient,0637,A9270,,,50268-0855-15,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41700020_1,CYANOCOBALAMIN 1000MCG,Inpatient,0637,A9270,,,50268-0855-15,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41700022_1,PROTAMINE SULFATE VIAL 250 MG/ 25 mL,Inpatient,0636,J2720,,,63323-0229-30,25,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
41700022_1,PROTAMINE SULFATE VIAL 250 MG/ 25 mL,Outpatient,0636,J2720,,,63323-0229-30,25,133.00,99.75,99.75,126.35,119.70,126.35,126.35,119.70
41700033_1,AMPICILLILN SODIUM 500 MG VIAL,Inpatient,0636,J0290,,,44567-0101-10,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700033_1,AMPICILLILN SODIUM 500 MG VIAL,Outpatient,0636,J0290,,,44567-0101-10,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700054_1,CALCIUM CHLORIDE 10% SYRINGE,Inpatient,0251,,,,00409-1631-10,1,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
41700054_1,CALCIUM CHLORIDE 10% SYRINGE,Outpatient,0251,,,,00409-1631-10,1,43.00,32.25,32.25,40.85,38.70,40.85,40.85,38.70
41700085_1,METRONIDAZOLE 500 mg IVPB,Inpatient,0251,S0030,,,00409-7811-24,100,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41700085_1,METRONIDAZOLE 500 mg IVPB,Outpatient,0251,S0030,,,00409-7811-24,100,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41700100_1,DIGOXIN 125 mcg tablet,Inpatient,0637,A9270,,,00904-5921-61,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700100_1,DIGOXIN 125 mcg tablet,Outpatient,0637,A9270,,,00904-5921-61,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700125_1,Amoxicillin Suspension ER pack,Inpatient,0253,,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
41700125_1,Amoxicillin Suspension ER pack,Outpatient,0253,,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
41700132_1,TRIAMCINOLONE VIAL,Inpatient,0636,J3301,,,00781-3245-72,0.5,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700132_1,TRIAMCINOLONE VIAL,Outpatient,0636,J3301,,,00781-3245-72,0.5,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700164_1,INFLUENZA VACCINE MDV 0.5/5mL,Inpatient,0636,90688,,,49281-0394-15,5,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
41700164_1,INFLUENZA VACCINE MDV 0.5/5mL,Outpatient,0636,90688,,,49281-0394-15,5,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
41700172_1,POTASSIUM CHLORIDE 40 meq VIAL; per 2 meq,Inpatient,0636,J3480,,,63323-0965-20,20,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700172_1,POTASSIUM CHLORIDE 40 meq VIAL; per 2 meq,Outpatient,0636,J3480,,,63323-0965-20,20,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700174_1,NITROFURANTOIN,Outpatient,0637,A9270,,,47781-0307-01,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700174_1,NITROFURANTOIN,Inpatient,0637,A9270,,,47781-0307-01,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700202_1,PROMETHAZINE VIAL 25 MG; up to 50 mg,Inpatient,0636,J2550,,,00641-0928-21,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700202_1,PROMETHAZINE VIAL 25 MG; up to 50 mg,Outpatient,0636,J2550,,,00641-0928-21,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700215_1,LIDOCAINE 1% VIAL,Inpatient,0250,,,,63323-0485-41,20,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700215_1,LIDOCAINE 1% VIAL,Outpatient,0250,,,,63323-0485-41,20,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700221_1,METOCLOPRAMIDE 10 MG VIAL; up to 10 MG,Inpatient,0636,J2765,,,00409-3414-01,2,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41700221_1,METOCLOPRAMIDE 10 MG VIAL; up to 10 MG,Outpatient,0636,J2765,,,00409-3414-01,2,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41700227_1,LEVOTHYROXIN 0.1 MG,Inpatient,0637,A9270,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700227_1,LEVOTHYROXIN 0.1 MG,Outpatient,0637,A9270,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700229_1,TETANUS & DIPTHERIA ADULT,Inpatient,0636,90714,,,,0,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41700229_1,TETANUS & DIPTHERIA ADULT,Outpatient,0636,90714,,,,0,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41700240_1,CYANOCOBALAMIN VIAL,Outpatient,0636,J3420,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700240_1,CYANOCOBALAMIN VIAL,Inpatient,0636,J3420,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700243_1,DIGOXIN AMPULE,Inpatient,0636,J1160,,,00781-3059-95,2,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700243_1,DIGOXIN AMPULE,Outpatient,0636,J1160,,,00781-3059-95,2,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700326_1,FUROSEMIDE 40 mg VIAL up to 20 mg,Outpatient,0636,J1940,,,63323-0280-04,2,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
41700326_1,FUROSEMIDE 40 mg VIAL up to 20 mg,Inpatient,0636,J1940,,,63323-0280-04,2,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
41700331_1,LIDOCAINE 1% W/ EPINEPHRINE MDV,Inpatient,0636,J3490,,,63323-0482-26,20,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700331_1,LIDOCAINE 1% W/ EPINEPHRINE MDV,Outpatient,0636,J3490,,,63323-0482-26,20,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700345_1,FLOVENT INHALER 110 MCG,Outpatient,0250,,,,,0,448.00,336.00,336.00,425.60,403.20,425.60,425.60,403.20
41700345_1,FLOVENT INHALER 110 MCG,Inpatient,0250,,,,,0,448.00,336.00,336.00,425.60,403.20,425.60,425.60,403.20
41700346_1,FLOVENT INHALER 220 MCG,Inpatient,0250,,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
41700346_1,FLOVENT INHALER 220 MCG,Outpatient,0250,,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
41700347_1,FLOVENT INHALER 44 MCG,Outpatient,0250,,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700347_1,FLOVENT INHALER 44 MCG,Inpatient,0250,,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700362_1,LIDOCAINE 2% VIAL,Inpatient,0636,J2001,,,00409-4277-01,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700362_1,LIDOCAINE 2% VIAL,Outpatient,0636,J2001,,,00409-4277-01,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700364_1,PREDNISONE TABS (5MG),Inpatient,0637,J7510,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700364_1,PREDNISONE TABS (5MG),Outpatient,0637,J7510,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700369_1,Cosyntropin .25 Mg Vial,Outpatient,0636,J0834,,,00548-5900-00,1,1814.00,1360.50,1360.50,1723.30,1632.60,1723.30,1723.30,1632.60
41700369_1,Cosyntropin .25 Mg Vial,Inpatient,0636,J0834,,,00548-5900-00,1,1814.00,1360.50,1360.50,1723.30,1632.60,1723.30,1723.30,1632.60
41700370_1,ACETYLCYSTEINE 20% VIAL,Outpatient,0251,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700370_1,ACETYLCYSTEINE 20% VIAL,Inpatient,0251,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700376_1,DOPAMINE 40 MG INJ,Outpatient,0636,J1265,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41700376_1,DOPAMINE 40 MG INJ,Inpatient,0636,J1265,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41700403_1,AMOXICILLIN (500 MG),Outpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700403_1,AMOXICILLIN (500 MG),Inpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700450_1,"LORAZEPAM 2 MG VIAL, per 2 mg",Outpatient,0636,J2060,,,00641-6044-25,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700450_1,"LORAZEPAM 2 MG VIAL, per 2 mg",Inpatient,0636,J2060,,,00641-6044-25,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700452_1,DIPHENYDRAMINE VIAL,Inpatient,0636,J1200,,,72485-0101-25,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700452_1,DIPHENYDRAMINE VIAL,Outpatient,0636,J1200,,,72485-0101-25,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41700454_1,SUCRALFATE,Inpatient,0637,A9270,,,63739-0943-10,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700454_1,SUCRALFATE,Outpatient,0637,A9270,,,63739-0943-10,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700455_1,CALCIUM GLUCONATE 10% INJ,Inpatient,0636,J0610,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700455_1,CALCIUM GLUCONATE 10% INJ,Outpatient,0636,J0610,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700464_1,CORTISPORIN OPTH OINT,Inpatient,0250,,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
41700464_1,CORTISPORIN OPTH OINT,Outpatient,0250,,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
41700488_1,EPINEPHRINE 1:1000 VIAL,Inpatient,0636,J0171,,,42023-0159-25,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700488_1,EPINEPHRINE 1:1000 VIAL,Outpatient,0636,J0171,,,42023-0159-25,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700499_1,HEPARIN VIAL per 1000 units,Inpatient,0636,J1644,,,00409-2723-01,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41700499_1,HEPARIN VIAL per 1000 units,Outpatient,0636,J1644,,,00409-2723-01,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41700501_1,HEPATITIS B VACCINE,Outpatient,0250,,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700501_1,HEPATITIS B VACCINE,Inpatient,0250,,,,,0,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700507_1,MAGNESIUM/ALUMINUM HYDROXIDE ORAL,Inpatient,0637,A9270,,,00121-1761-30,30,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700507_1,MAGNESIUM/ALUMINUM HYDROXIDE ORAL,Outpatient,0637,A9270,,,00121-1761-30,30,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41700508_1,MAG SO4 VIALS 50% INJ,Outpatient,0250,,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41700508_1,MAG SO4 VIALS 50% INJ,Inpatient,0250,,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41700519_1,NYSTATIN ORAL SUSP 500000 units 5 ml UD CUP,Outpatient,0250,,,,,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700519_1,NYSTATIN ORAL SUSP 500000 units 5 ml UD CUP,Inpatient,0250,,,,,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700615_1,GENTAMICIN SULFATE VIAL,Inpatient,0636,J1580,,,63323-0010-94,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700615_1,GENTAMICIN SULFATE VIAL,Outpatient,0636,J1580,,,63323-0010-94,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700639_1,ACETAMINOPHEN CHILDRENS SOLUTION,Inpatient,0637,A9270,,,00121-1781-00,5,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700639_1,ACETAMINOPHEN CHILDRENS SOLUTION,Outpatient,0637,A9270,,,00121-1781-00,5,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41700661_1,KETOROLAC VIAL 60 MG,Outpatient,0636,J1885,,,72611-0725-25,0.5,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41700661_1,KETOROLAC VIAL 60 MG,Inpatient,0636,J1885,,,72611-0725-25,0.5,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41700684_1,VITAMIN E (400 IU),Inpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700684_1,VITAMIN E (400 IU),Outpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700692_1,CEFAZOLIN VIAL per 500 mg,Outpatient,0636,J0690,,,60505-6142-05,1,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
41700692_1,CEFAZOLIN VIAL per 500 mg,Inpatient,0636,J0690,,,60505-6142-05,1,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
41700693_1,Cefepime HCL per 500 mg,Inpatient,0636,J0692,,,00264-3193-11,0,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41700693_1,Cefepime HCL per 500 mg,Outpatient,0636,J0692,,,00264-3193-11,0,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41700696_1,NALOXONE INJ SDV,Inpatient,0636,J2310,,,70069-0071-10,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41700696_1,NALOXONE INJ SDV,Outpatient,0636,J2310,,,70069-0071-10,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41700700_1,ENOXAPARIN SYRINGE 30 MG,Inpatient,0636,J1650,,,00075-0624-30,0.3,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700700_1,ENOXAPARIN SYRINGE 30 MG,Outpatient,0636,J1650,,,00075-0624-30,0.3,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41700702_1,"INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG",Outpatient,0636,J0702,,,00517-0720-01,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700702_1,"INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG",Inpatient,0636,J0702,,,00517-0720-01,0,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41700737_1,CEFUROXIME 250 MG TAB,Outpatient,0637,A9270,,,60687-0272-11,1,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41700737_1,CEFUROXIME 250 MG TAB,Inpatient,0637,A9270,,,60687-0272-11,1,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41700743_1,CLOTRIMAZOLE 1% CREAM,Outpatient,0637,A9270,,,51672-2002-02,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700743_1,CLOTRIMAZOLE 1% CREAM,Inpatient,0637,A9270,,,51672-2002-02,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700753_1,OXYTOCIN 10 ML MDV,Inpatient,0636,J2590,,,42023-0140-25,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41700753_1,OXYTOCIN 10 ML MDV,Outpatient,0636,J2590,,,42023-0140-25,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41700758_1,BACTRIM DS,Outpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700758_1,BACTRIM DS,Inpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700814_1,WARFARIN 5 MG,Outpatient,0637,A9270,,,00308-3212-16,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700814_1,WARFARIN 5 MG,Inpatient,0637,A9270,,,00308-3212-16,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700834_1,CORTROSYN .25MG,Outpatient,0636,J0834,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
41700834_1,CORTROSYN .25MG,Inpatient,0636,J0834,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
41700847_1,KETOROLAC VIAL 30 MG bill per 15 mg,Inpatient,0636,J1885,,,63323-0162-01,0.5,13.00,9.75,9.75,12.35,11.70,12.35,12.35,11.70
41700847_1,KETOROLAC VIAL 30 MG bill per 15 mg,Outpatient,0636,J1885,,,63323-0162-01,0.5,13.00,9.75,9.75,12.35,11.70,12.35,12.35,11.70
41700850_1,SEREVENT INHALER,Outpatient,0250,,,,,1,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700850_1,SEREVENT INHALER,Inpatient,0250,,,,,1,283.00,212.25,212.25,268.85,254.70,268.85,268.85,254.70
41700851_1,MIDAZOLAM 5mg/5ml VIAL per 1mg,Inpatient,0636,J2250,,,00641-6059-10,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41700851_1,MIDAZOLAM 5mg/5ml VIAL per 1mg,Outpatient,0636,J2250,,,00641-6059-10,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41700886_1,PROMETHAZINE TABS ( 25MG),Outpatient,0637,A9270,,,00904-6461-61,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41700886_1,PROMETHAZINE TABS ( 25MG),Inpatient,0637,A9270,,,00904-6461-61,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41700907_1,THIAMINE VIAL 2 ml vial; per 100 mg,Inpatient,0251,J3411,,,25021-0500-02,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700907_1,THIAMINE VIAL 2 ml vial; per 100 mg,Outpatient,0251,J3411,,,25021-0500-02,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41700914_1,FIBERCON,Outpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700914_1,FIBERCON,Inpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700918_1,METOPROLOL TARTRATE VIAL,Inpatient,0251,J3490,,,72611-0740-10,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700918_1,METOPROLOL TARTRATE VIAL,Outpatient,0251,J3490,,,72611-0740-10,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700921_1,BISACODYL EC,Inpatient,0637,A9270,,,00904-6407-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700921_1,BISACODYL EC,Outpatient,0637,A9270,,,00904-6407-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700940_1,FAMOTIDINE IV VIAL 20mg,Outpatient,0636,S0028,,,67457-0433-22,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700940_1,FAMOTIDINE IV VIAL 20mg,Inpatient,0636,S0028,,,67457-0433-22,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41700948_1,EPINEPHRINE SYRINGE 1:10 000 INJ,Inpatient,0636,J0171,,,00409-4921-20,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41700948_1,EPINEPHRINE SYRINGE 1:10 000 INJ,Outpatient,0636,J0171,,,00409-4921-20,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41700980_1,SODIUM BICARBONATE 8.4% SDV,Inpatient,0251,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700980_1,SODIUM BICARBONATE 8.4% SDV,Outpatient,0251,,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41700996_1,VITAMIN C TABS (500 MG),Inpatient,0637,A9270,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41700996_1,VITAMIN C TABS (500 MG),Outpatient,0637,A9270,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41701029_1,GI COCKTAIL,Inpatient,0250,,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
41701029_1,GI COCKTAIL,Outpatient,0250,,,,,0,54.00,40.50,40.50,51.30,48.60,51.30,51.30,48.60
41701038_1,MILK OF MAGNESIA LIQUID,Inpatient,0637,A9270,,,00121-0431-30,30,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41701038_1,MILK OF MAGNESIA LIQUID,Outpatient,0637,A9270,,,00121-0431-30,30,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41701077_1,ATROPINE SULFATE SYRINGE,Outpatient,0636,J0461,,,00409-4911-11,0.1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41701077_1,ATROPINE SULFATE SYRINGE,Inpatient,0636,J0461,,,00409-4911-11,0.1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41701160_1,DIGOXIN .05 MG IMIV,Inpatient,0636,J1160,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41701160_1,DIGOXIN .05 MG IMIV,Outpatient,0636,J1160,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41701516_1,EMLA CREAM,Inpatient,0637,A9270,,,,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41701516_1,EMLA CREAM,Outpatient,0637,A9270,,,,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41701670_1,TETANUS/DIPHTHERIA/PERTUSS SYRINGE,Inpatient,0636,90715,,,49281-0400-15,0.5,140.00,105.00,105.00,133.00,126.00,133.00,133.00,126.00
41701670_1,TETANUS/DIPHTHERIA/PERTUSS SYRINGE,Outpatient,0636,90715,,,49281-0400-15,0.5,140.00,105.00,105.00,133.00,126.00,133.00,133.00,126.00
41702008_1,CARBAMZEPINE,Inpatient,0637,A9270,,,00904-6172-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702008_1,CARBAMZEPINE,Outpatient,0637,A9270,,,00904-6172-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702011_1,ZOLPIDEM,Outpatient,0637,A9270,,,00904-6082-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702011_1,ZOLPIDEM,Inpatient,0637,A9270,,,00904-6082-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702024_1,BUPIVACAINE 0.5% MDV,Inpatient,0251,J3490,,,,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41702024_1,BUPIVACAINE 0.5% MDV,Outpatient,0251,J3490,,,,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41702025_1,MAGNESIUM CITRATE ORAL SOL,Inpatient,0637,A9270,,,00904-6304-77,296,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702025_1,MAGNESIUM CITRATE ORAL SOL,Outpatient,0637,A9270,,,00904-6304-77,296,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702031_1,LIDOCIANE 2% VISCOUS,Outpatient,0637,A9270,,,00603-1393-64,15,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41702031_1,LIDOCIANE 2% VISCOUS,Inpatient,0637,A9270,,,00603-1393-64,15,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41702032_1,INSULIN GLARGINE VIAL,Outpatient,0637,J1815,,,00088-2220-33,50,1.50,1.13,1.13,1.43,1.35,1.43,1.43,1.35
41702032_1,INSULIN GLARGINE VIAL,Inpatient,0637,J1815,,,00088-2220-33,50,1.50,1.13,1.13,1.43,1.35,1.43,1.43,1.35
41702050_1,WARFARIN 2 MG,Inpatient,0637,A9270,,,62584-0984-01,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702050_1,WARFARIN 2 MG,Outpatient,0637,A9270,,,62584-0984-01,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702103_1,LIDOCAINE 2% SYRINGE,Inpatient,0636,J2001,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702103_1,LIDOCAINE 2% SYRINGE,Outpatient,0636,J2001,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702110_1,NOREPINEPHRINE INJ SDV 4 ML,Outpatient,0251,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702110_1,NOREPINEPHRINE INJ SDV 4 ML,Inpatient,0251,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702161_1,PNEUMONIA VACCINE VIAL,Outpatient,0636,90732,,,00006-4943-00,0.5,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41702161_1,PNEUMONIA VACCINE VIAL,Inpatient,0636,90732,,,00006-4943-00,0.5,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41702210_1,LIDOCAINE VISCOUS (2%100 ML),Inpatient,0250,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41702210_1,LIDOCAINE VISCOUS (2%100 ML),Outpatient,0250,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41702218_1,ENOXAPARIN SYRINGE 100 MG; per 10 mg,Inpatient,0636,J1650,,,00075-0623-00,0.1,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41702218_1,ENOXAPARIN SYRINGE 100 MG; per 10 mg,Outpatient,0636,J1650,,,00075-0623-00,0.1,5.00,3.75,3.75,4.75,4.50,4.75,4.75,4.50
41702219_1,ENOXAPARIN SYRINGE 40 MG,Inpatient,0636,J1650,,,00955-1004-10,0.1,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41702219_1,ENOXAPARIN SYRINGE 40 MG,Outpatient,0636,J1650,,,00955-1004-10,0.1,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41702223_1,CEFOXITIN VIAL 1GM,Inpatient,0636,J0694,,,63323-0341-29,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41702223_1,CEFOXITIN VIAL 1GM,Outpatient,0636,J0694,,,63323-0341-29,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41702224_1,MEGACE 20 MG,Inpatient,0250,S0179,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
41702224_1,MEGACE 20 MG,Outpatient,0250,S0179,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
41702238_1,NICARDIPINE SDV,Inpatient,0251,,,,,0,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702238_1,NICARDIPINE SDV,Outpatient,0251,,,,,0,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702241_1,NICOTINE PATCH,Outpatient,0637,A9270,,,68001-0434-90,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41702241_1,NICOTINE PATCH,Inpatient,0637,A9270,,,68001-0434-90,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41702245_1,NITROGLYCERIN IV,Inpatient,0251,J3490,,,00338-1049-02,250,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
41702245_1,NITROGLYCERIN IV,Outpatient,0251,J3490,,,00338-1049-02,250,55.00,41.25,41.25,52.25,49.50,52.25,52.25,49.50
41702251_1,NYSTANTIN CREAM,Outpatient,0637,A9270,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702251_1,NYSTANTIN CREAM,Inpatient,0637,A9270,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702252_1,NYSTATIN POWDER 15 GM,Outpatient,0251,A9270,,,00574-2008-15,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41702252_1,NYSTATIN POWDER 15 GM,Inpatient,0251,A9270,,,00574-2008-15,1,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41702267_1,PHENOBARBITAL 120MG,Inpatient,0636,J2560,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702267_1,PHENOBARBITAL 120MG,Outpatient,0636,J2560,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702295_1,MIRTAZAPINE 15 mg tab,Outpatient,0637,A9270,,,00904-6519-61,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702295_1,MIRTAZAPINE 15 mg tab,Inpatient,0637,A9270,,,00904-6519-61,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702300_1,RISPERIDOL (0.5MG),Inpatient,0250,,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
41702300_1,RISPERIDOL (0.5MG),Outpatient,0250,,,,,0,46.00,34.50,34.50,43.70,41.40,43.70,43.70,41.40
41702304_1,FLUMAZENIL 5ML MDV INJ,Outpatient,0251,J3490,,,,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41702304_1,FLUMAZENIL 5ML MDV INJ,Inpatient,0251,J3490,,,,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41702309_1,SILVADENE CREAM (1% 85 GM),Inpatient,0637,A9270,,,67877-0124-25,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41702309_1,SILVADENE CREAM (1% 85 GM),Outpatient,0637,A9270,,,67877-0124-25,1,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41702312_1,SODIUM CHLORIDE INH SOL,Outpatient,0251,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702312_1,SODIUM CHLORIDE INH SOL,Inpatient,0251,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702313_1,SULFACETAMIDE SODIUM 10% OPHTH 15 ML,Inpatient,0637,A9270,,,24208-0670-04,15,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
41702313_1,SULFACETAMIDE SODIUM 10% OPHTH 15 ML,Outpatient,0637,A9270,,,24208-0670-04,15,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
41702314_1,METHYLPREDNISOLONE VIAL 125 MG,Inpatient,0636,J2930,,,00009-0047-03,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702314_1,METHYLPREDNISOLONE VIAL 125 MG,Outpatient,0636,J2930,,,00009-0047-03,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702315_1,METHYLPREDNISOLONE VIAL 1 GM,Inpatient,0636,J2930,,,00009-0018-20,0.125,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
41702315_1,METHYLPREDNISOLONE VIAL 1 GM,Outpatient,0636,J2930,,,00009-0018-20,0.125,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
41702318_1,STERILE WATER VIAL,Outpatient,0272,A4216,,,00409-4887-17,5,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41702318_1,STERILE WATER VIAL,Inpatient,0272,A4216,,,00409-4887-17,5,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41702319_1,SUCCINYLCHOLINE VIAL,Inpatient,0637,J0330,,,00409-6629-02,1,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
41702319_1,SUCCINYLCHOLINE VIAL,Outpatient,0637,J0330,,,00409-6629-02,1,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
41702343_1,TRAZADONE (50 MG),Inpatient,0250,,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
41702343_1,TRAZADONE (50 MG),Outpatient,0250,,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
41702345_1,TRIPLE ANTIBIOTIC OINT PACKETS,Inpatient,0270,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702345_1,TRIPLE ANTIBIOTIC OINT PACKETS,Outpatient,0270,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702346_1,TUBERSOL VIAL,Inpatient,0300,86580,,,49281-0752-21,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702346_1,TUBERSOL VIAL,Outpatient,0300,86580,,,49281-0752-21,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702349_1,AMPICILLIN/SULBACTAM VIAL 1.5 G,Inpatient,0636,J0295,,,00049-0013-83,1,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41702349_1,AMPICILLIN/SULBACTAM VIAL 1.5 G,Outpatient,0636,J0295,,,00049-0013-83,1,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41702365_1,VITAMIN B COMPLEX,Inpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702365_1,VITAMIN B COMPLEX,Outpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702383_1,CEFUROXIME per 750 mg,Inpatient,0636,J0697,,,00143-9977-22,1,18.00,13.50,13.50,17.10,16.20,17.10,17.10,16.20
41702383_1,CEFUROXIME per 750 mg,Outpatient,0636,J0697,,,00143-9977-22,1,18.00,13.50,13.50,17.10,16.20,17.10,17.10,16.20
41702386_1,SIMVASTATIN,Inpatient,0637,A9270,,,63739-0572-10,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702386_1,SIMVASTATIN,Outpatient,0637,A9270,,,63739-0572-10,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702387_1,ONDANSETRON 4 mg vial: per 1 mg,Outpatient,0636,J2405,,,70860-0776-41,2,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41702387_1,ONDANSETRON 4 mg vial: per 1 mg,Inpatient,0636,J2405,,,70860-0776-41,2,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41702459_1,ONDANSETRON ODT,Inpatient,0637,A9270,,,70860-0776-02,2,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702459_1,ONDANSETRON ODT,Outpatient,0637,A9270,,,70860-0776-02,2,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702506_1,TRICOR FENOFIBRATE,Inpatient,0250,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41702506_1,TRICOR FENOFIBRATE,Outpatient,0250,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41702531_1,HYDROXYZINE PAMOATE,Outpatient,0637,A9270,,,00185-0674-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702531_1,HYDROXYZINE PAMOATE,Inpatient,0637,A9270,,,00185-0674-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702546_1,AMPICILLIN/SULBACTAM VIAL 3 G,Outpatient,0636,J0295,,,00409-2987-03,1,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
41702546_1,AMPICILLIN/SULBACTAM VIAL 3 G,Inpatient,0636,J0295,,,00409-2987-03,1,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
41702552_1,AZITHROMYCIN 200 MG/ 5 ML SUSP,Outpatient,0637,Q0144,,,00093-2026-23,15,60.00,45.00,45.00,57.00,54.00,57.00,57.00,54.00
41702552_1,AZITHROMYCIN 200 MG/ 5 ML SUSP,Inpatient,0637,Q0144,,,00093-2026-23,15,60.00,45.00,45.00,57.00,54.00,57.00,57.00,54.00
41702556_1,ALBUTEROL SULFATE INH,Outpatient,0251,,,,00173-0682-20,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
41702556_1,ALBUTEROL SULFATE INH,Inpatient,0251,,,,00173-0682-20,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
41702561_1,HYDRALAZINE 50 MG TAB,Outpatient,0637,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41702561_1,HYDRALAZINE 50 MG TAB,Inpatient,0637,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41702572_1,GABAPENTIN 600 MG,Inpatient,0637,A9270,,,00904-6823-61,1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41702572_1,GABAPENTIN 600 MG,Outpatient,0637,A9270,,,00904-6823-61,1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41702656_1,LABETALOL HCL,Inpatient,0257,J3490,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702656_1,LABETALOL HCL,Outpatient,0257,J3490,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702658_1,BUDESONIDE SVN NEB,Outpatient,0250,,,,60687-0524-83,2,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702658_1,BUDESONIDE SVN NEB,Inpatient,0250,,,,60687-0524-83,2,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702659_1,ACTIVASE 1 MG,Inpatient,0636,J2997,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
41702659_1,ACTIVASE 1 MG,Outpatient,0636,J2997,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
41702811_1,PIOGLITAZONE 15MG,Inpatient,0637,A9270,,,60687-0391-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702811_1,PIOGLITAZONE 15MG,Outpatient,0637,A9270,,,60687-0391-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702817_1,ALBUTEROL SULFATE 0.5% SOLUTION,Inpatient,0251,,,,,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
41702817_1,ALBUTEROL SULFATE 0.5% SOLUTION,Outpatient,0251,,,,,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
41702820_1,PROPARACAINE 0.5% OPHTH SOL 15 ML,Outpatient,0250,,,,61314-0016-01,15,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702820_1,PROPARACAINE 0.5% OPHTH SOL 15 ML,Inpatient,0250,,,,61314-0016-01,15,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702829_1,AMIODARONE HCL VIAL,Outpatient,0636,J0282,,,63323-0616-03,3,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41702829_1,AMIODARONE HCL VIAL,Inpatient,0636,J0282,,,63323-0616-03,3,6.00,4.50,4.50,5.70,5.40,5.70,5.70,5.40
41702831_1,AMITRIPTYLINE HCL,Inpatient,0637,A9270,,,00904-0202-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702831_1,AMITRIPTYLINE HCL,Outpatient,0637,A9270,,,00904-0202-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702833_1,AMOXICILLIN CHEWABLE (250 MG),Inpatient,0637,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702833_1,AMOXICILLIN CHEWABLE (250 MG),Outpatient,0637,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702839_1,DONEPEZIL,Inpatient,0637,A9270,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702839_1,DONEPEZIL,Outpatient,0637,A9270,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41702852_1,ATENOLOL,Outpatient,0637,A9270,,,00904-5392-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702852_1,ATENOLOL,Inpatient,0637,A9270,,,00904-5392-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702856_1,IPRATROPIUM  BROMIDE INH NEB 0.02%,Outpatient,0251,,,,00378-7970-93,2.5,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702856_1,IPRATROPIUM  BROMIDE INH NEB 0.02%,Inpatient,0251,,,,00378-7970-93,2.5,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702859_1,AUGMENTIN ER PACK,Inpatient,0253,,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
41702859_1,AUGMENTIN ER PACK,Outpatient,0253,,,,,0,64.00,48.00,48.00,60.80,57.60,60.80,60.80,57.60
41702868_1,DICYCLOMINE 480ML ELIXIR,Outpatient,0637,A9270,,,,0,415.00,311.25,311.25,394.25,373.50,394.25,394.25,373.50
41702868_1,DICYCLOMINE 480ML ELIXIR,Inpatient,0637,A9270,,,,0,415.00,311.25,311.25,394.25,373.50,394.25,394.25,373.50
41702873_1,CLARITHROMYCIN,Inpatient,0637,A9270,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702873_1,CLARITHROMYCIN,Outpatient,0637,A9270,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702874_1,BISACODYL,Inpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702874_1,BISACODYL,Outpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702878_1,Insulin 70-30 NPH/REG Vial,Inpatient,0637,J1815,,,00169-1837-11,10,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
41702878_1,Insulin 70-30 NPH/REG Vial,Outpatient,0637,J1815,,,00169-1837-11,10,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
41702882_1,Ertapenem Sodiam Vial,Inpatient,0636,J1335,,,00006-3843-71,2,229.00,171.75,171.75,217.55,206.10,217.55,217.55,206.10
41702882_1,Ertapenem Sodiam Vial,Outpatient,0636,J1335,,,00006-3843-71,2,229.00,171.75,171.75,217.55,206.10,217.55,217.55,206.10
41702898_1,CLINDAMYCIN,Inpatient,0637,A9270,,,00904-5959-61,1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41702898_1,CLINDAMYCIN,Outpatient,0637,A9270,,,00904-5959-61,1,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41702911_1,Zinc Sulfate Capsule 220 MG,Outpatient,0637,A9270,,,50731-0401-06,0,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41702911_1,Zinc Sulfate Capsule 220 MG,Inpatient,0637,A9270,,,50731-0401-06,0,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41702914_1,AMIODARONE HCL TABLET,Inpatient,0637,A9270,,,00904-6556-61,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702914_1,AMIODARONE HCL TABLET,Outpatient,0637,A9270,,,00904-6556-61,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702922_1,DEXAMETHASONE VIAL 4MG/1ML; per 1 mg,Inpatient,0636,J1100,,,63323-0165-01,0.25,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41702922_1,DEXAMETHASONE VIAL 4MG/1ML; per 1 mg,Outpatient,0636,J1100,,,63323-0165-01,0.25,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
41702923_1,FLUCONAZOLE,Outpatient,0637,A9270,,,57237-0005-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702923_1,FLUCONAZOLE,Inpatient,0637,A9270,,,57237-0005-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702924_1,DIGOXIN (0.25 MG),Inpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702924_1,DIGOXIN (0.25 MG),Outpatient,0250,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702925_1,HYDROMORPHONE 2MG VIAL; up to 4 mg,Outpatient,0636,J1170,,,00641-2341-41,20,38.00,28.50,28.50,36.10,34.20,36.10,36.10,34.20
41702925_1,HYDROMORPHONE 2MG VIAL; up to 4 mg,Inpatient,0636,J1170,,,00641-2341-41,20,38.00,28.50,28.50,36.10,34.20,36.10,36.10,34.20
41702926_1,DILTIAZEM VIAL,Inpatient,0251,,,,00409-1171-01,5,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702926_1,DILTIAZEM VIAL,Outpatient,0251,,,,00409-1171-01,5,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702928_1,COUMADIN (1 MG),Outpatient,0637,A9270,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702928_1,COUMADIN (1 MG),Inpatient,0637,A9270,,,,0,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41702939_1,EPSON SALT,Outpatient,0257,,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41702939_1,EPSON SALT,Inpatient,0257,,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41702944_1,FLEETS ENEMA 133 ML BOTTLE,Inpatient,0637,A9270,,,00132-0201-40,133,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702944_1,FLEETS ENEMA 133 ML BOTTLE,Outpatient,0637,A9270,,,00132-0201-40,133,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702952_1,GLUCAGON KIT SYRINGE,Inpatient,0636,J1610,,,00597-0260-10,1,576.00,432.00,432.00,547.20,518.40,547.20,547.20,518.40
41702952_1,GLUCAGON KIT SYRINGE,Outpatient,0636,J1610,,,00597-0260-10,1,576.00,432.00,432.00,547.20,518.40,547.20,547.20,518.40
41702962_1,GLUCOSE ORAL GEL TUBE,Inpatient,0637,A9270,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702962_1,GLUCOSE ORAL GEL TUBE,Outpatient,0637,A9270,,,,0,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41702967_1,HALOPERIDOL VIAL,Inpatient,0636,J1630,,,63323-0474-01,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702967_1,HALOPERIDOL VIAL,Outpatient,0636,J1630,,,63323-0474-01,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41702970_1,HEPARIN LOCK FLUSH 5 ML SYRINGE,Inpatient,0636,J1642,,,08290-3064-13,5,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702970_1,HEPARIN LOCK FLUSH 5 ML SYRINGE,Outpatient,0636,J1642,,,08290-3064-13,5,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41702971_1,HEPATITIS A VACCINE SYRINGE- Adult,Outpatient,0636,90632,,,00006-4841-41,1,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41702971_1,HEPATITIS A VACCINE SYRINGE- Adult,Inpatient,0636,90632,,,00006-4841-41,1,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
41702972_1,HEPATITIS B VACCINE SYRINGE,Outpatient,0636,90476,,,58160-0821-52,1,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
41702972_1,HEPATITIS B VACCINE SYRINGE,Inpatient,0636,90476,,,58160-0821-52,1,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
41702982_1,IBUPROFEN 200MG,Inpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702982_1,IBUPROFEN 200MG,Outpatient,0257,,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702994_1,MAGNESIUM SULFATE 50% VIAL,Outpatient,0636,J3475,,,,10,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41702994_1,MAGNESIUM SULFATE 50% VIAL,Inpatient,0636,J3475,,,,10,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41703002_1,CEFTRIAXONE per 250 mg,Outpatient,0636,J0696,,,60505-6148-04,0.25,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41703002_1,CEFTRIAXONE per 250 mg,Inpatient,0636,J0696,,,60505-6148-04,0.25,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41703004_1,Levofloxacin IVPB 25 MG/ML 750MG,Outpatient,0636,J1956,,,36000-0048-24,50,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41703004_1,Levofloxacin IVPB 25 MG/ML 750MG,Inpatient,0636,J1956,,,36000-0048-24,50,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41703005_1,AZITHROMYCIN 500 MG vial; per 500 mg,Inpatient,0636,J0456,,,70436-0019-82,1,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41703005_1,AZITHROMYCIN 500 MG vial; per 500 mg,Outpatient,0636,J0456,,,70436-0019-82,1,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41703008_1,LEVOFLOXACIN IVPB 500 MG per 100 ML,Inpatient,0636,J1956,,,25021-0132-82,50,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41703008_1,LEVOFLOXACIN IVPB 500 MG per 100 ML,Outpatient,0636,J1956,,,25021-0132-82,50,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41703009_1,CARBIDOPA/LEVODOPA TABLET 25MG/100MG,Outpatient,0637,A9270,,,68084-0093-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41703009_1,CARBIDOPA/LEVODOPA TABLET 25MG/100MG,Inpatient,0637,A9270,,,68084-0093-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41703010_1,INSULIN ASPART INSULIN PEN 100 units/ 1ML,Outpatient,0637,J1815,,,00169-6339-10,3,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41703010_1,INSULIN ASPART INSULIN PEN 100 units/ 1ML,Inpatient,0637,J1815,,,00169-6339-10,3,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41703120_1,METHYLPREDNISOLONE VIAL 40 MG; up to 40 mg,Outpatient,0636,J2920,,,00009-0039-05,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41703120_1,METHYLPREDNISOLONE VIAL 40 MG; up to 40 mg,Inpatient,0636,J2920,,,00009-0039-05,1,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
41703125_1,Fosphenytion Sodium 100MG/2ML,Inpatient,0636,Q2009,,,06745-7516-25,2,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703125_1,Fosphenytion Sodium 100MG/2ML,Outpatient,0636,Q2009,,,06745-7516-25,2,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703210_1,NAMENDA 10 MG,Inpatient,0250,,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703210_1,NAMENDA 10 MG,Outpatient,0250,,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703301_1,TRIAMCINALONE 0.1% CREAM,Inpatient,0637,A9270,,,67877-0251-15,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41703301_1,TRIAMCINALONE 0.1% CREAM,Outpatient,0637,A9270,,,67877-0251-15,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41703488_1,RECLAST INJECTION 5MG100ML,Outpatient,0636,J3489,,,67457-0619-10,20,75.00,56.25,56.25,71.25,67.50,71.25,71.25,67.50
41703488_1,RECLAST INJECTION 5MG100ML,Inpatient,0636,J3489,,,67457-0619-10,20,75.00,56.25,56.25,71.25,67.50,71.25,71.25,67.50
41703492_1,TOPAMAX 100 MG,Outpatient,0250,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41703492_1,TOPAMAX 100 MG,Inpatient,0250,,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41703500_1,VANCOMYCIN 1 GM VIAL; per 500 mg,Outpatient,0636,J3370,,,67457-0340-01,0.5,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703500_1,VANCOMYCIN 1 GM VIAL; per 500 mg,Inpatient,0636,J3370,,,67457-0340-01,0.5,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41703601_1,Heparin Bag 25000 Units 500 ml,Inpatient,0251,J1644,,,63323-0518-77,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41703601_1,Heparin Bag 25000 Units 500 ml,Outpatient,0251,J1644,,,63323-0518-77,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41703642_1,ETOMIDATE INJ 2MG/ML,Inpatient,0251,J3490,,,,0,60.00,45.00,45.00,57.00,54.00,57.00,57.00,54.00
41703642_1,ETOMIDATE INJ 2MG/ML,Outpatient,0251,J3490,,,,0,60.00,45.00,45.00,57.00,54.00,57.00,57.00,54.00
41704640_1,TIOTROPIUM BROMIDE INH,Inpatient,0250,,,,00597-0075-75,1,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
41704640_1,TIOTROPIUM BROMIDE INH,Outpatient,0250,,,,00597-0075-75,1,151.00,113.25,113.25,143.45,135.90,143.45,143.45,135.90
41705003_1,EPOETIN VIAL 4000 UNITS,Outpatient,0636,J0885,,,,4,415.00,311.25,311.25,394.25,373.50,394.25,394.25,373.50
41705003_1,EPOETIN VIAL 4000 UNITS,Inpatient,0636,J0885,,,,4,415.00,311.25,311.25,394.25,373.50,394.25,394.25,373.50
41705234_1,OCCUVITE (1VIT),Outpatient,0250,,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41705234_1,OCCUVITE (1VIT),Inpatient,0250,,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
41705487_1,LIDOCAINE 5% PATCH,Outpatient,0637,A9270,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41705487_1,LIDOCAINE 5% PATCH,Inpatient,0637,A9270,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41707501_1,BUPROPION 150 MG XL TAB,Inpatient,0637,A9270,,,50268-0140-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41707501_1,BUPROPION 150 MG XL TAB,Outpatient,0637,A9270,,,50268-0140-11,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41707509_1,METHYLPREDNISOLONE 4MG 21TABS,Outpatient,0637,J7509,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
41707509_1,METHYLPREDNISOLONE 4MG 21TABS,Inpatient,0637,J7509,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
41707633_1,BUDESONIDE INHALER,Outpatient,0250,,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,513.00,486.00
41707633_1,BUDESONIDE INHALER,Inpatient,0250,,,,,0,540.00,405.00,405.00,513.00,486.00,513.00,513.00,486.00
41708701_1,Donnatal Elixir UD Cup,Inpatient,0637,A9270,,,17856-0423-03,10,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
41708701_1,Donnatal Elixir UD Cup,Outpatient,0637,A9270,,,17856-0423-03,10,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
41709200_1,FLONASE 50 MCG PER SPRAY,Outpatient,0637,A9270,,,60505-0829-01,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41709200_1,FLONASE 50 MCG PER SPRAY,Inpatient,0637,A9270,,,60505-0829-01,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41709201_1,HYDROCORTISONE SUCCINATE VIAL,Outpatient,0636,J1720,,,00009-0825-01,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41709201_1,HYDROCORTISONE SUCCINATE VIAL,Inpatient,0636,J1720,,,00009-0825-01,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41709202_1,FENTANYL AMPULE 0.1mg/2mL,Inpatient,0636,J3010,,,00409-9094-22,2,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41709202_1,FENTANYL AMPULE 0.1mg/2mL,Outpatient,0636,J3010,,,00409-9094-22,2,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
41709204_1,SODIUM BICARBONATE 8.4% SYRINGE,Inpatient,0251,,,,76329-3352-01,1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41709204_1,SODIUM BICARBONATE 8.4% SYRINGE,Outpatient,0251,,,,76329-3352-01,1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41709210_1,BANANA BAG,Inpatient,0250,,,,,0,337.00,252.75,252.75,320.15,303.30,320.15,320.15,303.30
41709210_1,BANANA BAG,Outpatient,0250,,,,,0,337.00,252.75,252.75,320.15,303.30,320.15,320.15,303.30
41709211_1,DOPAMINE IV BAG,Outpatient,0636,J1265,,,00338-1007-02,10,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41709211_1,DOPAMINE IV BAG,Inpatient,0636,J1265,,,00338-1007-02,10,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41709212_1,CATHFLO ACTIVASE 2 MG Vial,Inpatient,0636,J2997,,,50242-0041-64,1,495.00,371.25,371.25,470.25,445.50,470.25,470.25,445.50
41709212_1,CATHFLO ACTIVASE 2 MG Vial,Outpatient,0636,J2997,,,50242-0041-64,1,495.00,371.25,371.25,470.25,445.50,470.25,470.25,445.50
41709216_1,enalaprilat,Outpatient,0251,,,,00143-9786-10,2,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41709216_1,enalaprilat,Inpatient,0251,,,,00143-9786-10,2,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41709217_1,ER-HYDROCODONE/APAP 5 MG/325 MG-6 TABS-PREPAK,Outpatient,0253,,,,52544-0913-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41709217_1,ER-HYDROCODONE/APAP 5 MG/325 MG-6 TABS-PREPAK,Inpatient,0253,,,,52544-0913-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41709218_1,OSELTAMIVIR 75 MG,Outpatient,0637,A9270,,,00004-0800-85,1,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
41709218_1,OSELTAMIVIR 75 MG,Inpatient,0637,A9270,,,00004-0800-85,1,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
41709220_1,Bupivacaine PF 0.5% in a 10 mL vial,Inpatient,0250,,,,00409-1162-01,10,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41709220_1,Bupivacaine PF 0.5% in a 10 mL vial,Outpatient,0250,,,,00409-1162-01,10,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41709236_1,Cefepime HCL per 500 mg,Outpatient,0636,J0692,,,60505-6147-00,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41709236_1,Cefepime HCL per 500 mg,Inpatient,0636,J0692,,,60505-6147-00,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
41709237_1,Ofloxacin Otic 10mL,Inpatient,0251,,,,60505-0363-02,10,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
41709237_1,Ofloxacin Otic 10mL,Outpatient,0251,,,,60505-0363-02,10,158.00,118.50,118.50,150.10,142.20,150.10,150.10,142.20
4171F_3,PT. RCVNG ESA THXPY,ProFee,0989,4171F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4172F_3,PT. NOT RCVNG ESA THXPY,ProFee,0989,4172F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4174F_3,"COUNS., POTENT. GLAUC IMPCT",ProFee,0989,4174F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4175F_3,VIS OF >= 20/40 W/IN 90 DAYS,ProFee,0989,4175F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4176F_3,"TALK RE UV LIGHT, PT/CRGVR",ProFee,0989,4176F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4177F_3,"TALK PT/CRGVR RE: AREDS,PREV",ProFee,0989,4177F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4178F_3,ANTID GLBLN RCV'D W/IN 26WKS,ProFee,0989,4178F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4179F_3,TAMOXIFEN/AI PRESCRIBED,ProFee,0989,4179F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41800_3,DRAINAGE OF GUM LESION,ProFee,0989,41800,,,,0,3.00,2.25,2.25,217.00,0.00,217.00,217.00,N/A
41800000_1,FOLIC ACID 10 ML,Inpatient,0251,J3490,,,63323-0184-10,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
41800000_1,FOLIC ACID 10 ML,Outpatient,0251,J3490,,,63323-0184-10,0,162.00,121.50,121.50,153.90,145.80,153.90,153.90,145.80
41800001_1,MAGNESIUM SULFATE 50% SDV,Outpatient,0636,J3475,,,63323-0064-02,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800001_1,MAGNESIUM SULFATE 50% SDV,Inpatient,0636,J3475,,,63323-0064-02,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800003_1,AZITHROMYCIN 100 MG/ 5 ML SUSP,Inpatient,0637,Q0144,,,00093-2027-23,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
41800003_1,AZITHROMYCIN 100 MG/ 5 ML SUSP,Outpatient,0637,Q0144,,,00093-2027-23,0,88.00,66.00,66.00,83.60,79.20,83.60,83.60,79.20
41800006_1,Pantoprazole 40 MG Vial,Inpatient,0251,S0164,,,55150-0202-10,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41800006_1,Pantoprazole 40 MG Vial,Outpatient,0251,S0164,,,55150-0202-10,1,32.00,24.00,24.00,30.40,28.80,30.40,30.40,28.80
41800007_1,CLONAZEPAM,Inpatient,0637,A9270,,,16729-0136-00,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800007_1,CLONAZEPAM,Outpatient,0637,A9270,,,16729-0136-00,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800011_1,DICYCLOMINE,Inpatient,0637,A9270,,,51079-0118-20,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800011_1,DICYCLOMINE,Outpatient,0637,A9270,,,51079-0118-20,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800012_1,IRON SUCROSE COMPLEX VIAL 100mg/5mL; per 1 mg,Inpatient,0636,J1756,,,00517-2340-10,0.05,2.40,1.80,1.80,2.28,2.16,2.28,2.28,2.16
41800012_1,IRON SUCROSE COMPLEX VIAL 100mg/5mL; per 1 mg,Outpatient,0636,J1756,,,00517-2340-10,0.05,2.40,1.80,1.80,2.28,2.16,2.28,2.28,2.16
41800023_1,IV D5 1/2 NS,Inpatient,0258,J7042,,,00990-7926-09,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
41800023_1,IV D5 1/2 NS,Outpatient,0258,J7042,,,00990-7926-09,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
41800024_1,IV D5NS,Outpatient,0258,J7042,,,00338-0089-04,0,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800024_1,IV D5NS,Inpatient,0258,J7042,,,00338-0089-04,0,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800025_1,IV LACTATED RINGERS,Inpatient,0258,J7120,,,00338-0117-04,1000,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
41800025_1,IV LACTATED RINGERS,Outpatient,0258,J7120,,,00338-0117-04,1000,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
41800026_1,IV SODIUM CHLORIDE 0.9% 1000 ML,Inpatient,0258,J7030,,,00338-0049-04,1000,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
41800026_1,IV SODIUM CHLORIDE 0.9% 1000 ML,Outpatient,0258,J7030,,,00338-0049-04,1000,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
41800027_1,IV SODIUM CHLORIDE 0.9% 250 ML,Inpatient,0258,J7060,,,00338-0049-02,250,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
41800027_1,IV SODIUM CHLORIDE 0.9% 250 ML,Outpatient,0258,J7060,,,00338-0049-02,250,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
41800028_1,IV SODIUM CHLORIDE 0.9% 100 ML,Inpatient,0258,J7050,,,00338-0049-38,100,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
41800028_1,IV SODIUM CHLORIDE 0.9% 100 ML,Outpatient,0258,J7050,,,00338-0049-38,100,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
41800031_1,LABETALOL INJ MDV; per ml,Inpatient,0251,J3490,,,00143-9622-01,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800031_1,LABETALOL INJ MDV; per ml,Outpatient,0251,J3490,,,00143-9622-01,0,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800033_1,LIDOCAINE 2% JELLY TOPICAL,Inpatient,0250,,,,17478-0711-10,5,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800033_1,LIDOCAINE 2% JELLY TOPICAL,Outpatient,0250,,,,17478-0711-10,5,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800034_1,IV Sodium Chloride 0.9% 500 ML,Inpatient,0258,J7060,,,00338-0049-03,250,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
41800034_1,IV Sodium Chloride 0.9% 500 ML,Outpatient,0258,J7060,,,00338-0049-03,250,62.00,46.50,46.50,58.90,55.80,58.90,58.90,55.80
41800037_1,MORPHINE SULFATE IV,Outpatient,0636,J2270,,,00641-6073-25,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800037_1,MORPHINE SULFATE IV,Inpatient,0636,J2270,,,00641-6073-25,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
41800038_1,NITROGLYCERIN 2% OINT,Outpatient,0637,A9270,,,00281-0326-08,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41800038_1,NITROGLYCERIN 2% OINT,Inpatient,0637,A9270,,,00281-0326-08,1,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41800040_1,OLANZAPINE VIAL per 2.5 mg,Inpatient,0251,S0166,,,00781-3159-72,0.25,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41800040_1,OLANZAPINE VIAL per 2.5 mg,Outpatient,0251,S0166,,,00781-3159-72,0.25,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
41800046_1,PIPERCILLIN / TAZOBACTAM per 1.125 gram VIAL,Inpatient,0636,J2543,,,63323-0983-53,0.333,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800046_1,PIPERCILLIN / TAZOBACTAM per 1.125 gram VIAL,Outpatient,0636,J2543,,,63323-0983-53,0.333,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800050_1,SODIUM CHLORIDE 0.9% SYRINGE,Outpatient,0251,,,,08290-3065-00,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800050_1,SODIUM CHLORIDE 0.9% SYRINGE,Inpatient,0251,,,,08290-3065-00,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800055_1,TPA ALTEPLASE VIAL,Outpatient,0636,J2997,,,50242-0085-27,1,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
41800055_1,TPA ALTEPLASE VIAL,Inpatient,0636,J2997,,,50242-0085-27,1,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
41800058_1,PHYTONADIONE (NEONATAL) AMP,Outpatient,0636,J3430,,,00409-9157-01,0.5,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41800058_1,PHYTONADIONE (NEONATAL) AMP,Inpatient,0636,J3430,,,00409-9157-01,0.5,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
41800059_1,PHYTONADIONE AMP,Outpatient,0636,J3430,,,00409-9158-01,0.1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800059_1,PHYTONADIONE AMP,Inpatient,0636,J3430,,,00409-9158-01,0.1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800060_1,METHOCARBAMOL 500 MG,Outpatient,0637,A9270,,,70010-0754-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800060_1,METHOCARBAMOL 500 MG,Inpatient,0637,A9270,,,70010-0754-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800066_1,ACETAMINOPHEN ER 650 MG,Inpatient,0637,A9270,,,68084-0777-25,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800066_1,ACETAMINOPHEN ER 650 MG,Outpatient,0637,A9270,,,68084-0777-25,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
41800072_1,KETAMINE HCL VIAL,Inpatient,0636,J3490,,,67477-0001-10,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41800072_1,KETAMINE HCL VIAL,Outpatient,0636,J3490,,,67477-0001-10,0,31.00,23.25,23.25,29.45,27.90,29.45,29.45,27.90
41800075_1,DILTIAZEM 125MG/25ML INJ,Inpatient,0250,,,,00641-6015-01,25,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
41800075_1,DILTIAZEM 125MG/25ML INJ,Outpatient,0250,,,,00641-6015-01,25,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
41800079_1,TRIAMCINOLONE 400MG/10ML INJ,Outpatient,0636,J3301,,,70121-1655-01,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41800079_1,TRIAMCINOLONE 400MG/10ML INJ,Inpatient,0636,J3301,,,70121-1655-01,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
41800080_1,TRIAMCINOLONE 40MG/ML INJ; per 10 mg,Inpatient,0636,J3301,,,70121-1049-02,1,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41800080_1,TRIAMCINOLONE 40MG/ML INJ; per 10 mg,Outpatient,0636,J3301,,,70121-1049-02,1,9.00,6.75,6.75,8.55,8.10,8.55,8.55,8.10
41800084_1,LEVETIRACETAM 500MG INJ,Inpatient,0636,J1953,,,63323-0400-41,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41800084_1,LEVETIRACETAM 500MG INJ,Outpatient,0636,J1953,,,63323-0400-41,0,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41800085_1,SULFA/TRIMETH 800/160 #4 ER PREPACK,Outpatient,0637,90670,,,00005-1971-01,0.5,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41800085_1,SULFA/TRIMETH 800/160 #4 ER PREPACK,Inpatient,0637,90670,,,00005-1971-01,0.5,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41800095_1,CEFTAZIDIME 1GM INJ,Inpatient,0636,J0713,,,25021-0127-20,0,33.71,25.28,25.28,32.02,30.34,32.02,32.02,30.34
41800095_1,CEFTAZIDIME 1GM INJ,Outpatient,0636,J0713,,,25021-0127-20,0,33.71,25.28,25.28,32.02,30.34,32.02,32.02,30.34
41800096_1,CLINDAMYCIN 600MG/4ML INJ,Outpatient,0636,S0077,,,25021-0115-04,4,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41800096_1,CLINDAMYCIN 600MG/4ML INJ,Inpatient,0636,S0077,,,25021-0115-04,4,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
41800099_1,FENTANYL 50 MCG/HR PATCH,Inpatient,0250,,,,60505-7082-02,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800099_1,FENTANYL 50 MCG/HR PATCH,Outpatient,0250,,,,60505-7082-02,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800101_1,Orencia per 250mg,Inpatient,0636,J0129,,,00003-2187-13,25,3291.00,2468.25,2468.25,3126.45,2961.90,3126.45,3126.45,2961.90
41800101_1,Orencia per 250mg,Outpatient,0636,J0129,,,00003-2187-13,25,3291.00,2468.25,2468.25,3126.45,2961.90,3126.45,3126.45,2961.90
41800104_1,SITAGLIPTIN 100MG TAB,Outpatient,0637,A9270,,,00006-0277-28,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800104_1,SITAGLIPTIN 100MG TAB,Inpatient,0637,A9270,,,00006-0277-28,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800105_1,EXENATIDE ER 2MG SYR,Outpatient,0637,A9270,,,00310-6530-04,1,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
41800105_1,EXENATIDE ER 2MG SYR,Inpatient,0637,A9270,,,00310-6530-04,1,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
41800106_1,BIMATOPROST 0.03% OPTH,Outpatient,0637,A9270,,,70069-0401-01,1,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
41800106_1,BIMATOPROST 0.03% OPTH,Inpatient,0637,A9270,,,70069-0401-01,1,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
41800112_1,MEROPENEM 1 GM INJ,Outpatient,0636,J2185,,,63323-0508-30,1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800112_1,MEROPENEM 1 GM INJ,Inpatient,0636,J2185,,,63323-0508-30,1,41.00,30.75,30.75,38.95,36.90,38.95,38.95,36.90
41800113_1,TRANEXAMIC ACID 1000MG/10ML INJ,Outpatient,0636,J3490,,,70860-0400-10,10,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
41800113_1,TRANEXAMIC ACID 1000MG/10ML INJ,Inpatient,0636,J3490,,,70860-0400-10,10,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
41800114_1,MAGNESIUM SULFATE 2GM/50ML INJ,Inpatient,0636,J3475,,,63323-0106-03,50,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
41800114_1,MAGNESIUM SULFATE 2GM/50ML INJ,Outpatient,0636,J3475,,,63323-0106-03,50,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
41800115_1,BRINZOLAMIDE 1% OPTH,Outpatient,0637,A9270,,,00065-0275-10,10,612.00,459.00,459.00,581.40,550.80,581.40,581.40,550.80
41800115_1,BRINZOLAMIDE 1% OPTH,Inpatient,0637,A9270,,,00065-0275-10,10,612.00,459.00,459.00,581.40,550.80,581.40,581.40,550.80
41800116_1,VIMPAT 100 MG TAB,Inpatient,0637,A9270,,,00131-2478-60,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41800116_1,VIMPAT 100 MG TAB,Outpatient,0637,A9270,,,00131-2478-60,1,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41800117_1,LATANOPROST 0.005% OPTH,Inpatient,0637,A9270,,,61314-0547-01,2.5,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41800117_1,LATANOPROST 0.005% OPTH,Outpatient,0637,A9270,,,61314-0547-01,2.5,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41800118_1,BUDESONIDE 90MCG FLEXHALER,Inpatient,0637,A9270,,,00186-0917-06,90,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
41800118_1,BUDESONIDE 90MCG FLEXHALER,Outpatient,0637,A9270,,,00186-0917-06,90,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
4180012_1,MEROPENEM 1 GM INJ,Inpatient,0636,J2185,,,63323-0508-30,0,40.51,30.38,30.38,38.48,36.46,38.48,38.48,36.46
4180012_1,MEROPENEM 1 GM INJ,Outpatient,0636,J2185,,,63323-0508-30,0,40.51,30.38,30.38,38.48,36.46,38.48,38.48,36.46
41800120_1,TROSPIUM 20 MG TAB,Inpatient,0637,A9270,,,68462-0461-60,1,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
41800120_1,TROSPIUM 20 MG TAB,Outpatient,0637,A9270,,,68462-0461-60,1,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
41800122_1,BAMLANIVIMAB 700 MG/20 ML INJ,Outpatient,0637,J3490,,,00002-7910-01,20,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41800122_1,BAMLANIVIMAB 700 MG/20 ML INJ,Inpatient,0637,J3490,,,00002-7910-01,20,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
41800124_1,LINEZOLID 600 MG TAB,Outpatient,0637,A9270,,,67877-0419-84,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800124_1,LINEZOLID 600 MG TAB,Inpatient,0637,A9270,,,67877-0419-84,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800126_1,COMBIVENT HFA 20MCG/100MCG,Inpatient,0637,A9270,,,00597-0024-02,4,672.00,504.00,504.00,638.40,604.80,638.40,638.40,604.80
41800126_1,COMBIVENT HFA 20MCG/100MCG,Outpatient,0637,A9270,,,00597-0024-02,4,672.00,504.00,504.00,638.40,604.80,638.40,638.40,604.80
41800129_1,ROCURONIUM 100MG/10ML INJ,Outpatient,0636,J3490,,,00143-9251-10,10,35.00,26.25,26.25,33.25,31.50,33.25,33.25,31.50
41800129_1,ROCURONIUM 100MG/10ML INJ,Inpatient,0636,J3490,,,00143-9251-10,10,35.00,26.25,26.25,33.25,31.50,33.25,33.25,31.50
41800130_1,OXYMETAZOLINE NASAL 0.05% 30 ML,Inpatient,0637,A9270,,,24385-0067-10,30,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800130_1,OXYMETAZOLINE NASAL 0.05% 30 ML,Outpatient,0637,A9270,,,24385-0067-10,30,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800132_1,BUMETANIDE 1 MG/4 ML INJ,Inpatient,0636,S0171,,,00409-1412-04,4,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41800132_1,BUMETANIDE 1 MG/4 ML INJ,Outpatient,0636,S0171,,,00409-1412-04,4,28.00,21.00,21.00,26.60,25.20,26.60,26.60,25.20
41800137_1,AMPICILLIN 2 GM INJ,Inpatient,0636,J0290,,,67850-0022-10,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41800137_1,AMPICILLIN 2 GM INJ,Outpatient,0636,J0290,,,67850-0022-10,1,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
41800138_1,LEVALBUTEROL 0.63 MG NEB,Outpatient,0637,A9270,,,76204-0800-01,3,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800138_1,LEVALBUTEROL 0.63 MG NEB,Inpatient,0637,A9270,,,76204-0800-01,3,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800140_1,BRILINTA 90 MG TAB,Inpatient,0637,A9270,,,00186-0777-39,1,12.00,9.00,9.00,11.40,10.80,11.40,11.40,10.80
41800140_1,BRILINTA 90 MG TAB,Outpatient,0637,A9270,,,00186-0777-39,1,12.00,9.00,9.00,11.40,10.80,11.40,11.40,10.80
41800141_1,ROPIVACAINE 0.2% INJ,Outpatient,0636,J2795,,,00409-9300-10,10,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41800141_1,ROPIVACAINE 0.2% INJ,Inpatient,0636,J2795,,,00409-9300-10,10,30.00,22.50,22.50,28.50,27.00,28.50,28.50,27.00
41800142_1,ROPIVACAINE 0.5% INJ,Inpatient,0636,J2795,,,63323-0286-27,20,35.00,26.25,26.25,33.25,31.50,33.25,33.25,31.50
41800142_1,ROPIVACAINE 0.5% INJ,Outpatient,0636,J2795,,,63323-0286-27,20,35.00,26.25,26.25,33.25,31.50,33.25,33.25,31.50
41800143_1,DOTAREM 5 MMOL/10 ML INJ,Outpatient,0636,A9575,,,67684-2001-01,10,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
41800143_1,DOTAREM 5 MMOL/10 ML INJ,Inpatient,0636,A9575,,,67684-2001-01,10,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
41800146_1,CHLOROPROCAINE 2% INJ 20 ML,Outpatient,0636,J2400,,,00143-9209-10,20,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
41800146_1,CHLOROPROCAINE 2% INJ 20 ML,Inpatient,0636,J2400,,,00143-9209-10,20,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
41800147_1,OMNIPAQUE 300 MG/ML INJ,Inpatient,0636,J3490,,,00407-1413-59,30,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
41800147_1,OMNIPAQUE 300 MG/ML INJ,Outpatient,0636,J3490,,,00407-1413-59,30,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
41800148_1,BUPIVACAINE 0.25% INJ 10ML,Inpatient,0636,J3490,,,00409-1559-10,10,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
41800148_1,BUPIVACAINE 0.25% INJ 10ML,Outpatient,0636,J3490,,,00409-1559-10,10,33.00,24.75,24.75,31.35,29.70,31.35,31.35,29.70
41800151_1,AMPICILLIN 1GM INJ,Outpatient,0636,J0290,,,00781-3404-85,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800151_1,AMPICILLIN 1GM INJ,Inpatient,0636,J0290,,,00781-3404-85,1,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
41800153_1,Midazolam 2mg/2ml per 1 mg,Inpatient,0636,J2250,,,00641-6057-01,2,13.00,9.75,9.75,12.35,11.70,12.35,12.35,11.70
41800153_1,Midazolam 2mg/2ml per 1 mg,Outpatient,0636,J2250,,,00641-6057-01,2,13.00,9.75,9.75,12.35,11.70,12.35,12.35,11.70
41800155_1,EPOETIN ALFA,Outpatient,0250,J0885,,,59676-0310-01,1,512.00,384.00,384.00,486.40,460.80,486.40,486.40,460.80
41800155_1,EPOETIN ALFA,Inpatient,0250,J0885,,,59676-0310-01,1,512.00,384.00,384.00,486.40,460.80,486.40,486.40,460.80
41800158_1,REMDESIVIR 100MG INJ,Inpatient,0636,J3490,,,61958-2901-02,1,1585.00,1188.75,1188.75,1505.75,1426.50,1505.75,1505.75,1426.50
41800158_1,REMDESIVIR 100MG INJ,Outpatient,0636,J3490,,,61958-2901-02,1,1585.00,1188.75,1188.75,1505.75,1426.50,1505.75,1505.75,1426.50
41800161_1,Dexamethasone 10 mg/1mL Vial,Inpatient,0636,J1100,,,63323-0506-16,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800161_1,Dexamethasone 10 mg/1mL Vial,Outpatient,0636,J1100,,,63323-0506-16,1,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
41800162_1,Vancomycin 125 mg tab,Inpatient,0637,A9270,,,00121-0867-20,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800162_1,Vancomycin 125 mg tab,Outpatient,0637,A9270,,,00121-0867-20,1,2.00,1.50,1.50,1.90,1.80,1.90,1.90,1.80
41800164_1,ER Naloxone Spray Prepack,Inpatient,0250,,,,69547-0353-02,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
41800164_1,ER Naloxone Spray Prepack,Outpatient,0250,,,,69547-0353-02,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
41800166_1,Hydrocortisone Cream 2.5%,Inpatient,0637,A9270,,,45802-0004-03,0,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41800166_1,Hydrocortisone Cream 2.5%,Outpatient,0637,A9270,,,45802-0004-03,0,4.00,3.00,3.00,3.80,3.60,3.80,3.80,3.60
41801008_1,SMALL VOLUME NEBULIZER TX,Outpatient,0419,94640,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
41801008_1,SMALL VOLUME NEBULIZER TX,Inpatient,0419,94640,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
41801009_1,PULSE OXIMITERY SINGLE,Inpatient,0460,94760,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
41801009_1,PULSE OXIMITERY SINGLE,Outpatient,0460,94760,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
41801014_1,SPIROMETRY OR PEAK FLOW,Inpatient,0410,94010,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,228.95,216.90
41801014_1,SPIROMETRY OR PEAK FLOW,Outpatient,0410,94010,,,,0,241.00,180.75,180.75,228.95,216.90,228.95,228.95,216.90
41801015_1,PRE AND POST BRONKODILATOR,Outpatient,0410,94060,,,,0,445.00,333.75,333.75,422.75,400.50,422.75,422.75,400.50
41801015_1,PRE AND POST BRONKODILATOR,Inpatient,0410,94060,,,,0,445.00,333.75,333.75,422.75,400.50,422.75,422.75,400.50
41801016_1,PULMONARY FUNCTION TEST COMPLETE,Inpatient,0410,94200,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,209.95,198.90
41801016_1,PULMONARY FUNCTION TEST COMPLETE,Outpatient,0410,94200,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,209.95,198.90
41801018_1,OXYGEN CHARGEPER HOUR,Outpatient,0270,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41801018_1,OXYGEN CHARGEPER HOUR,Inpatient,0270,,,,,0,34.00,25.50,25.50,32.30,30.60,32.30,32.30,30.60
41805_3,"REMOVAL FOREIGN BODY, GUM",ProFee,0989,41805,,,,0,3.00,2.25,2.25,271.50,0.00,271.50,271.50,N/A
41806_3,"REMOVAL FOREIGN BODY,JAWBONE",ProFee,0989,41806,,,,0,3.00,2.25,2.25,398.00,0.00,398.00,398.00,N/A
4180F_3,ADJV THXPYRX'D/RCV'D STG3A-C,ProFee,0989,4180F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4181F_3,CONFORMAL RAD'N THXPY RCV'D,ProFee,0989,4181F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41820_3,"EXCISION, GUM, EACH QUADRANT",ProFee,0989,41820,,,,0,3.00,2.25,2.25,350.00,0.00,350.00,350.00,N/A
41821_3,EXCISION OF GUM FLAP,ProFee,0989,41821,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
41822_3,EXCISION OF GUM LESION,ProFee,0989,41822,,,,0,3.00,2.25,2.25,263.00,0.00,263.00,263.00,N/A
41823_3,EXCISION OF GUM LESION,ProFee,0989,41823,,,,0,3.00,2.25,2.25,477.50,0.00,477.50,477.50,N/A
41825_3,EXCISION OF GUM LESION,ProFee,0989,41825,,,,0,3.00,2.25,2.25,177.50,0.00,177.50,177.50,N/A
41826_3,EXCISION OF GUM LESION,ProFee,0989,41826,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
41827_3,EXCISION OF GUM LESION,ProFee,0989,41827,,,,0,3.00,2.25,2.25,445.50,0.00,445.50,445.50,N/A
41828_3,EXCISION OF GUM LESION,ProFee,0989,41828,,,,0,3.00,2.25,2.25,306.00,0.00,306.00,306.00,N/A
4182F_3,NO CONFORMAL RAD'N THXPY,ProFee,0989,4182F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41830_3,REMOVAL OF GUM TISSUE,ProFee,0989,41830,,,,0,3.00,2.25,2.25,411.00,0.00,411.00,411.00,N/A
41850_3,TREATMENT OF GUM LESION,ProFee,0989,41850,,,,0,3.00,2.25,2.25,175.00,0.00,175.00,175.00,N/A
4185F_3,CONTINUOUS PPI OR H2RA RCV'D,ProFee,0989,4185F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4186F_3,NO CONT. PPI OR H2RA RCV'D,ProFee,0989,4186F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41870_3,GUM GRAFT,ProFee,0989,41870,,,,0,3.00,2.25,2.25,437.00,0.00,437.00,437.00,N/A
41872_3,REPAIR GUM,ProFee,0989,41872,,,,0,3.00,2.25,2.25,353.00,0.00,353.00,353.00,N/A
41874_3,REPAIR TOOTH SOCKET,ProFee,0989,41874,,,,0,3.00,2.25,2.25,374.50,0.00,374.50,374.50,N/A
4187F_3,ANTI RHEUM DRUGTHXPYRX'D/GVN,ProFee,0989,4187F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4188F_3,APPROP ACE/ARB TSTNG DONE,ProFee,0989,4188F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
41899_3,DENTAL SURGERY PROCEDURE,ProFee,0989,41899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4189F_3,APPROP DIGOXIN TSTNG DONE,ProFee,0989,4189F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4190F_3,APPROP DIURETIC TSTNG DONE,ProFee,0989,4190F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4191F_3,APPROP ANTICONVULS TSTNG,ProFee,0989,4191F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4192F_3,PT NOT RCVNG GLUCOCO THXPY,ProFee,0989,4192F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4193F_3,PT RCVNG<10MG DAILY PREDNISO,ProFee,0989,4193F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4194F_3,PT RCVNG>10MG DAILY PREDNISO,ProFee,0989,4194F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4195F_3,PT RCVNG ANTI-RHEUM THXPY RA,ProFee,0989,4195F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4196F_3,PTNOT RCVNG ANTI-RHM THXPYRA,ProFee,0989,4196F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42000_3,DRAINAGE MOUTH ROOF LESION,ProFee,0989,42000,,,,0,3.00,2.25,2.25,147.50,0.00,147.50,147.50,N/A
42000001_1,Exersise Charge-Private Pay,Outpatient,0420,,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
42000001_1,Exersise Charge-Private Pay,Inpatient,0420,,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
42000533_1,Sensory Integrative Techniques SPEECH,Inpatient,0441,97533,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
42000533_1,Sensory Integrative Techniques SPEECH,Outpatient,0441,97533,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
42002507_1,"Treatment of speech, language, voice, communication, and/or auditory processing disorder",Inpatient,0441,92507,,,,0,258.00,193.50,193.50,245.10,232.20,245.10,245.10,232.20
42002507_1,"Treatment of speech, language, voice, communication, and/or auditory processing disorder",Outpatient,0441,92507,,,,0,258.00,193.50,193.50,245.10,232.20,245.10,245.10,232.20
42002508_1,Group Speech Therapy:  2 or more,Inpatient,0443,92508,,,,0,168.00,126.00,126.00,159.60,151.20,159.60,159.60,151.20
42002508_1,Group Speech Therapy:  2 or more,Outpatient,0443,92508,,,,0,168.00,126.00,126.00,159.60,151.20,159.60,159.60,151.20
42002521_1,SPEECH EVALUATION OF SPEECH FLUENCY,Outpatient,0444,92521,,,,0,401.00,300.75,300.75,380.95,360.90,380.95,380.95,360.90
42002521_1,SPEECH EVALUATION OF SPEECH FLUENCY,Inpatient,0444,92521,,,,0,401.00,300.75,300.75,380.95,360.90,380.95,380.95,360.90
42002522_1,SPEECH EVALUATION OF SOUND PRODUCTION,Inpatient,0444,92522,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,330.60,313.20
42002522_1,SPEECH EVALUATION OF SOUND PRODUCTION,Outpatient,0444,92522,,,,0,348.00,261.00,261.00,330.60,313.20,330.60,330.60,313.20
42002523_1,SPEECH EVALUATION OF SOUND PRODUCTION & LANGUAGE COMPREHENSION,Outpatient,0444,92523,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
42002523_1,SPEECH EVALUATION OF SOUND PRODUCTION & LANGUAGE COMPREHENSION,Inpatient,0444,92523,,,,0,378.00,283.50,283.50,359.10,340.20,359.10,359.10,340.20
42002524_1,SPEECH EVALUATION BEHAVIORIAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,Outpatient,0444,92524,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42002524_1,SPEECH EVALUATION BEHAVIORIAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONANCE,Inpatient,0444,92524,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42002526_1,tREATMENT OF SWALLOWING DYSFUNCTION AND/ OR ORAL FUNCTION FOR FEEDING,Inpatient,0440,92526,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42002526_1,tREATMENT OF SWALLOWING DYSFUNCTION AND/ OR ORAL FUNCTION FOR FEEDING,Outpatient,0440,92526,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42002551_1,"Screening Test, Pure Tone, Air Only",Inpatient,0444,92551,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42002551_1,"Screening Test, Pure Tone, Air Only",Outpatient,0444,92551,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42002568_1,"Acoustic Reflex Testing, Threshold",Inpatient,0444,92568,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
42002568_1,"Acoustic Reflex Testing, Threshold",Outpatient,0444,92568,,,,0,142.00,106.50,106.50,134.90,127.80,134.90,134.90,127.80
42002570_1,Acoustic Immittance Testing,Outpatient,0444,92570,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
42002570_1,Acoustic Immittance Testing,Inpatient,0444,92570,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
42002607_1,"Eval for Speech Device, 1st Hour",Outpatient,0444,92607,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42002607_1,"Eval for Speech Device, 1st Hour",Inpatient,0444,92607,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42002608_1,"Eval for Speech Device, Ea Addl 30 Min",Outpatient,0444,92608,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42002608_1,"Eval for Speech Device, Ea Addl 30 Min",Inpatient,0444,92608,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42002609_1,Therapy for Use of Speech Device,Outpatient,0440,92609,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
42002609_1,Therapy for Use of Speech Device,Inpatient,0440,92609,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
42002610_1,sPEECH eVALUATION ORAL SWALLOWING,Inpatient,0444,92610,,,,0,356.00,267.00,267.00,338.20,320.40,338.20,338.20,320.40
42002610_1,sPEECH eVALUATION ORAL SWALLOWING,Outpatient,0444,92610,,,,0,356.00,267.00,267.00,338.20,320.40,338.20,338.20,320.40
42002630_1,Auditory Rehab; Prelingual Hearing Loss,Outpatient,0440,92630,,,,0,388.00,291.00,291.00,368.60,349.20,368.60,368.60,349.20
42002630_1,Auditory Rehab; Prelingual Hearing Loss,Inpatient,0440,92630,,,,0,388.00,291.00,291.00,368.60,349.20,368.60,368.60,349.20
42002633_1,Auditory Rehab; Postlingual Hearing Loss,Outpatient,0440,92633,,,,0,268.00,201.00,201.00,254.60,241.20,254.60,254.60,241.20
42002633_1,Auditory Rehab; Postlingual Hearing Loss,Inpatient,0440,92633,,,,0,268.00,201.00,201.00,254.60,241.20,254.60,254.60,241.20
42006105_1,Aphasia Assessment w/ interp & report; per hour,Inpatient,0444,96105,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
42006105_1,Aphasia Assessment w/ interp & report; per hour,Outpatient,0444,96105,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
42006125_1,STANDARDIZE COGNITIVE PERFORMANCE TESTING,Inpatient,0918,96125,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42006125_1,STANDARDIZE COGNITIVE PERFORMANCE TESTING,Outpatient,0918,96125,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42007014_1,APP MODALITY Electrical Stimulation (unattended),Inpatient,0420,97014,,,,0,79.00,59.25,59.25,75.05,71.10,75.05,75.05,71.10
42007014_1,APP MODALITY Electrical Stimulation (unattended),Outpatient,0420,97014,,,,0,79.00,59.25,59.25,75.05,71.10,75.05,75.05,71.10
42007032_1,APP MODALITY ELEC STIMULATION MANUAL EACH 15 MINS,Outpatient,0420,97032,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
42007032_1,APP MODALITY ELEC STIMULATION MANUAL EACH 15 MINS,Inpatient,0420,97032,,,,0,76.00,57.00,57.00,72.20,68.40,72.20,72.20,68.40
42007035_1,"Physical Therapy-Ultrasound, Each 15 Min",Inpatient,0420,97035,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
42007035_1,"Physical Therapy-Ultrasound, Each 15 Min",Outpatient,0420,97035,,,,0,71.00,53.25,53.25,67.45,63.90,67.45,67.45,63.90
42007110_1,Therapeutic Exercise,Inpatient,0420,97110,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
42007110_1,Therapeutic Exercise,Outpatient,0420,97110,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
42007111_1,Therapeutic Excerise OT,Inpatient,0430,97110,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
42007111_1,Therapeutic Excerise OT,Outpatient,0430,97110,,,,0,106.00,79.50,79.50,100.70,95.40,100.70,100.70,95.40
42007112_1,Physical Therapy-Neuromuscular Re-Education,Outpatient,0420,97112,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
42007112_1,Physical Therapy-Neuromuscular Re-Education,Inpatient,0420,97112,,,,0,109.00,81.75,81.75,103.55,98.10,103.55,103.55,98.10
42007116_1,Gait Training per 15 min,Inpatient,0420,97116,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
42007116_1,Gait Training per 15 min,Outpatient,0420,97116,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
42007124_1,Massage Therapy,Outpatient,0420,97124,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
42007124_1,Massage Therapy,Inpatient,0420,97124,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
42007129_1,Cognitive Function Therapy Initial 15 minutes,Outpatient,0420,97129,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
42007129_1,Cognitive Function Therapy Initial 15 minutes,Inpatient,0420,97129,,,,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
42007130_1,Cognitive Function Therapy Ea Add'l 15 minutes,Inpatient,0420,97130,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42007130_1,Cognitive Function Therapy Ea Add'l 15 minutes,Outpatient,0420,97130,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42007140_1,Manual Therapy Technique,Outpatient,0420,97140,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
42007140_1,Manual Therapy Technique,Inpatient,0420,97140,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
42007141_1,Manual therapy technique OT,Outpatient,0430,97140,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
42007141_1,Manual therapy technique OT,Inpatient,0430,97140,,,,0,118.00,88.50,88.50,112.10,106.20,112.10,112.10,106.20
42007161_1,Physical therapy evaluation: low complexity,Inpatient,0424,97161,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
42007161_1,Physical therapy evaluation: low complexity,Outpatient,0424,97161,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
42007162_1,Physical therapy evaluation: moderate complexity,Outpatient,0424,97162,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
42007162_1,Physical therapy evaluation: moderate complexity,Inpatient,0424,97162,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
42007163_1,Physical therapy evaluation: high complexity,Outpatient,0424,97163,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42007163_1,Physical therapy evaluation: high complexity,Inpatient,0424,97163,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42007164_1,Re-evaluation of physical therapy established plan of care,Outpatient,0424,97164,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
42007164_1,Re-evaluation of physical therapy established plan of care,Inpatient,0424,97164,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
42007165_1,Occupational therapy evaluation: low complexity,Outpatient,0434,97165,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
42007165_1,Occupational therapy evaluation: low complexity,Inpatient,0434,97165,,,,0,184.00,138.00,138.00,174.80,165.60,174.80,174.80,165.60
42007166_1,Occupational therapy evaluation: moderate complexity,Inpatient,0434,97166,,,,0,213.00,159.75,159.75,202.35,191.70,202.35,202.35,191.70
42007166_1,Occupational therapy evaluation: moderate complexity,Outpatient,0434,97166,,,,0,213.00,159.75,159.75,202.35,191.70,202.35,202.35,191.70
42007167_1,Occupational therapy evaluation: high complexity,Inpatient,0434,97167,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,244.15,231.30
42007167_1,Occupational therapy evaluation: high complexity,Outpatient,0434,97167,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,244.15,231.30
42007168_1,Re-evaluation of occupational therapy established plan of care,Outpatient,0430,97168,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
42007168_1,Re-evaluation of occupational therapy established plan of care,Inpatient,0430,97168,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
42007530_1,Physical Therapy-Therapeutic Activities Each 15 Min,Inpatient,0420,97530,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
42007530_1,Physical Therapy-Therapeutic Activities Each 15 Min,Outpatient,0420,97530,,,,0,111.00,83.25,83.25,105.45,99.90,105.45,105.45,99.90
42007533_1,SENSORY INTERGRATIVE TECH 15 MIN E - Physical Therapy,Inpatient,0420,97533,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
42007533_1,SENSORY INTERGRATIVE TECH 15 MIN E - Physical Therapy,Outpatient,0420,97533,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
42007535_1,Physical Therapy-Self Care/Home Management Each 15 Min,Inpatient,0430,97535,,,,0,128.00,96.00,96.00,121.60,115.20,121.60,121.60,115.20
42007535_1,Physical Therapy-Self Care/Home Management Each 15 Min,Outpatient,0430,97535,,,,0,128.00,96.00,96.00,121.60,115.20,121.60,121.60,115.20
42007542_1,WHEELCHAIR MANAGEMENT EACH 15 MINU,Outpatient,0430,97542,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
42007542_1,WHEELCHAIR MANAGEMENT EACH 15 MINU,Inpatient,0430,97542,,,,0,93.00,69.75,69.75,88.35,83.70,88.35,88.35,83.70
42009152_1,Speech Therapy re-eval,Inpatient,0444,S9152,,,,0,382.00,286.50,286.50,362.90,343.80,362.90,362.90,343.80
42009152_1,Speech Therapy re-eval,Outpatient,0444,S9152,,,,0,382.00,286.50,286.50,362.90,343.80,362.90,362.90,343.80
4200F_3,EXTERNAL BEAM TO PROST ONLY,ProFee,0989,4200F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4201F_3,EXTRNL BEAM OTHER THAN PROST,ProFee,0989,4201F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42100_3,BIOPSY ROOF OF MOUTH,ProFee,0989,42100,,,,0,3.00,2.25,2.25,158.00,0.00,158.00,158.00,N/A
42104_3,"EXCISION LESION, MOUTH ROOF",ProFee,0989,42104,,,,0,3.00,2.25,2.25,200.50,0.00,200.50,200.50,N/A
42106_3,"EXCISION LESION, MOUTH ROOF",ProFee,0989,42106,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
42107_3,"EXCISION LESION, MOUTH ROOF",ProFee,0989,42107,,,,0,3.00,2.25,2.25,499.50,0.00,499.50,499.50,N/A
4210F_3,ACE/ARB THXPY FOR >= 6 MONS,ProFee,0989,4210F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42120_3,REMOVE PALATE/LESION,ProFee,0989,42120,,,,0,3.00,2.25,2.25,1457.00,0.00,1457.00,1457.00,N/A
42140_3,EXCISION OF UVULA,ProFee,0989,42140,,,,0,3.00,2.25,2.25,221.00,0.00,221.00,221.00,N/A
42145_3,"REPAIR PALATE, PHARYNX/UVULA",ProFee,0989,42145,,,,0,3.00,2.25,2.25,1002.50,0.00,1002.50,1002.50,N/A
42160_3,TREATMENT MOUTH ROOF LESION,ProFee,0989,42160,,,,0,3.00,2.25,2.25,211.00,0.00,211.00,211.00,N/A
42180_3,REPAIR PALATE,ProFee,0989,42180,,,,0,3.00,2.25,2.25,261.50,0.00,261.50,261.50,N/A
42182_3,REPAIR PALATE,ProFee,0989,42182,,,,0,3.00,2.25,2.25,365.00,0.00,365.00,365.00,N/A
42200_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42200,,,,0,3.00,2.25,2.25,1378.00,0.00,1378.00,1378.00,N/A
42205_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42205,,,,0,3.00,2.25,2.25,1436.50,0.00,1436.50,1436.50,N/A
4220F_3,DIGOXIN THXPY FOR >= 6 MONS,ProFee,0989,4220F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42210_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42210,,,,0,3.00,2.25,2.25,1599.50,0.00,1599.50,1599.50,N/A
42215_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42215,,,,0,3.00,2.25,2.25,1047.50,0.00,1047.50,1047.50,N/A
4221F_3,DIURETIC THXPY FOR >= 6 MONS,ProFee,0989,4221F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42220_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42220,,,,0,3.00,2.25,2.25,864.50,0.00,864.50,864.50,N/A
42225_3,RECONSTRUCT CLEFT PALATE,ProFee,0989,42225,,,,0,3.00,2.25,2.25,1437.00,0.00,1437.00,1437.00,N/A
42226_3,LENGTHENING OF PALATE,ProFee,0989,42226,,,,0,3.00,2.25,2.25,1267.00,0.00,1267.00,1267.00,N/A
42227_3,LENGTHENING OF PALATE,ProFee,0989,42227,,,,0,3.00,2.25,2.25,1189.50,0.00,1189.50,1189.50,N/A
42235_3,REPAIR PALATE,ProFee,0989,42235,,,,0,3.00,2.25,2.25,1041.00,0.00,1041.00,1041.00,N/A
42260_3,REPAIR NOSE TO LIP FISTULA,ProFee,0989,42260,,,,0,3.00,2.25,2.25,938.50,0.00,938.50,938.50,N/A
42280_3,"PREPARATION, PALATE MOLD",ProFee,0989,42280,,,,0,3.00,2.25,2.25,159.00,0.00,159.00,159.00,N/A
42281_3,"INSERTION, PALATE PROSTHESIS",ProFee,0989,42281,,,,0,3.00,2.25,2.25,237.50,0.00,237.50,237.50,N/A
42299_3,PALATE/UVULA SURGERY,ProFee,0989,42299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42300_3,DRAINAGE OF SALIVARY GLAND,ProFee,0989,42300,,,,0,3.00,2.25,2.25,218.50,0.00,218.50,218.50,N/A
42300060_1,I&D ABSCESS,Inpatient,0450,10060,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42300060_1,I&D ABSCESS,Emergency,0450,10060,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42300061_1,I & D ABCESS COMP.,Inpatient,0450,10061,,,,0,420.00,315.00,315.00,399.00,378.00,399.00,399.00,378.00
42300061_1,I & D ABCESS COMP.,Emergency,0450,10061,,,,0,420.00,315.00,315.00,399.00,378.00,399.00,399.00,378.00
42300103_1,ER Level 1,Emergency,0450,99281,,,,0,286.00,214.50,214.50,271.70,257.40,271.70,271.70,257.40
42300103_1,ER Level 1,Inpatient,0450,99281,,,,0,286.00,214.50,214.50,271.70,257.40,271.70,271.70,257.40
42300120_1,"Foreign Body Removal, Skin Simple",Inpatient,0450,24201,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
42300120_1,"Foreign Body Removal, Skin Simple",Emergency,0450,24201,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
42300121_1,"Foreign Body Removal, Skin Complex",Inpatient,0450,24201,,,,0,961.00,720.75,720.75,912.95,864.90,912.95,912.95,864.90
42300121_1,"Foreign Body Removal, Skin Complex",Emergency,0450,24201,,,,0,961.00,720.75,720.75,912.95,864.90,912.95,912.95,864.90
42300129_1,ER Level 2,Emergency,0450,99282,,,,0,480.00,360.00,360.00,456.00,432.00,456.00,456.00,432.00
42300129_1,ER Level 2,Inpatient,0450,99282,,,,0,480.00,360.00,360.00,456.00,432.00,456.00,456.00,432.00
42300145_1,ER Level 3,Inpatient,0450,99283,,,,0,728.00,546.00,546.00,691.60,655.20,691.60,691.60,655.20
42300145_1,ER Level 3,Emergency,0450,99283,,,,0,728.00,546.00,546.00,691.60,655.20,691.60,691.60,655.20
42300160_1,ER Level 4,Emergency,0450,99284,,,,0,1308.00,981.00,981.00,1242.60,1177.20,1242.60,1242.60,1177.20
42300160_1,ER Level 4,Inpatient,0450,99284,,,,0,1308.00,981.00,981.00,1242.60,1177.20,1242.60,1242.60,1177.20
42300168_1,Dermabond,Outpatient,0270,,,,,0,131.00,98.25,98.25,124.45,117.90,124.45,124.45,117.90
42300168_1,Dermabond,Inpatient,0270,,,,,0,131.00,98.25,98.25,124.45,117.90,124.45,124.45,117.90
42300300_1,"Foreign Body Removal, Intranasal",Inpatient,0450,30300,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
42300300_1,"Foreign Body Removal, Intranasal",Emergency,0450,30300,,,,0,150.00,112.50,112.50,142.50,135.00,142.50,142.50,135.00
42300471_1,IMMUNIZATION ADMINISTRATION,Inpatient,0771,90471,,,,0,95.00,71.25,71.25,90.25,85.50,90.25,90.25,85.50
42300471_1,IMMUNIZATION ADMINISTRATION,Outpatient,0771,90471,,,,0,95.00,71.25,71.25,90.25,85.50,90.25,90.25,85.50
42300472_1,INJ EACH ADDTL IMSQ VACCINEINJ,Inpatient,0771,90472,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42300472_1,INJ EACH ADDTL IMSQ VACCINEINJ,Outpatient,0771,90472,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42300525_1,ER Level 5,Inpatient,0450,99285,,,,0,2835.00,2126.25,2126.25,2693.25,2551.50,2693.25,2693.25,2551.50
42300525_1,ER Level 5,Emergency,0450,99285,,,,0,2835.00,2126.25,2126.25,2693.25,2551.50,2693.25,2693.25,2551.50
42300554_1,Urinary Leg Bag,Inpatient,0270,A5112,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
42300554_1,Urinary Leg Bag,Outpatient,0270,A5112,,,,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
42300605_1,Arthrocentesis; Aspiration and/or injection of major joint or bursa,Emergency,0450,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
42300605_1,Arthrocentesis; Aspiration and/or injection of major joint or bursa,Inpatient,0450,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
42300610_1,ARTHROCENTESIS; MAJOR JOINT,Inpatient,0450,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
42300610_1,ARTHROCENTESIS; MAJOR JOINT,Emergency,0450,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
423007055_1,Clavicle Splint (ALL SIZES),Outpatient,0274,L3650,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
423007055_1,Clavicle Splint (ALL SIZES),Inpatient,0274,L3650,,,,0,125.00,93.75,93.75,118.75,112.50,118.75,118.75,112.50
42300900_1,"Control Hemorrhage, Simple",Inpatient,0450,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42300900_1,"Control Hemorrhage, Simple",Emergency,0450,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42300901_1,NASAL HEMMORR FACILITATED,Emergency,0450,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42300901_1,NASAL HEMMORR FACILITATED,Inpatient,0450,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42300903_1,"Nasal Hemmorrhag anterior, Complex",Inpatient,0450,30903,,,,0,700.00,525.00,525.00,665.00,630.00,665.00,665.00,630.00
42300903_1,"Nasal Hemmorrhag anterior, Complex",Emergency,0450,30903,,,,0,700.00,525.00,525.00,665.00,630.00,665.00,665.00,630.00
42301025_1,"Pregnancy, Urine",Inpatient,0300,81025,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42301025_1,"Pregnancy, Urine",Outpatient,0300,81025,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42301042_1,DEBRIDEMENT; SKIN & SUBC TISSUE,Inpatient,0761,11042,,,,0,814.00,610.50,610.50,773.30,732.60,773.30,773.30,732.60
42301042_1,DEBRIDEMENT; SKIN & SUBC TISSUE,Ambulatory Surgical,0761,11042,,,,0,814.00,610.50,610.50,773.30,732.60,773.30,773.30,732.60
42301105_1,GASTRIC INTUBATIONLAVAGE,Inpatient,0450,43752,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42301105_1,GASTRIC INTUBATIONLAVAGE,Emergency,0450,43752,,,,0,354.00,265.50,265.50,336.30,318.60,336.30,336.30,318.60
42301200_1,REMOVAL SKIN TAG UP TO 15,Ambulatory Surgical,0360,11200,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
42301200_1,REMOVAL SKIN TAG UP TO 15,Inpatient,0360,11200,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
42301480_1,REDUCTIONJAW DISLOCATION,Inpatient,0450,21480,,,,0,881.00,660.75,660.75,836.95,792.90,836.95,836.95,792.90
42301480_1,REDUCTIONJAW DISLOCATION,Emergency,0450,21480,,,,0,881.00,660.75,660.75,836.95,792.90,836.95,836.95,792.90
42301500_1,INTUBATION ENDOTRACHEAL ER PROCE,Inpatient,0450,31500,,,,0,752.00,564.00,564.00,714.40,676.80,714.40,714.40,676.80
42301500_1,INTUBATION ENDOTRACHEAL ER PROCE,Emergency,0450,31500,,,,0,752.00,564.00,564.00,714.40,676.80,714.40,714.40,676.80
42301505_1,LARYNGOSCOPY INDIRECT DIAGNOSTIC,Inpatient,0450,31505,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
42301505_1,LARYNGOSCOPY INDIRECT DIAGNOSTIC,Emergency,0450,31505,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
42301700_1,Bladder Irrigation,Ambulatory Surgical,0761,51700,,,,0,350.00,262.50,262.50,332.50,315.00,332.50,332.50,315.00
42301700_1,Bladder Irrigation,Inpatient,0761,51700,,,,0,350.00,262.50,262.50,332.50,315.00,332.50,332.50,315.00
42301701_1,CATHERIZATION STRAIT,Emergency,0450,51701,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
42301701_1,CATHERIZATION STRAIT,Inpatient,0450,51701,,,,0,200.00,150.00,150.00,190.00,180.00,190.00,190.00,180.00
42301702_1,CATHERIZATION FOLEY,Outpatient,0761,51702,,,,0,265.00,198.75,198.75,251.75,238.50,251.75,251.75,238.50
42301702_1,CATHERIZATION FOLEY,Inpatient,0761,51702,,,,0,265.00,198.75,198.75,251.75,238.50,251.75,251.75,238.50
42301705_1,"Suprapubic Catheter Change, Simple",Ambulatory Surgical,0761,51705,,,,0,1168.00,876.00,876.00,1109.60,1051.20,1109.60,1109.60,1051.20
42301705_1,"Suprapubic Catheter Change, Simple",Inpatient,0761,51705,,,,0,1168.00,876.00,876.00,1109.60,1051.20,1109.60,1109.60,1051.20
42301730_1,AVULSION NAIL SIMPLE SINGLE,Inpatient,0450,11730,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
42301730_1,AVULSION NAIL SIMPLE SINGLE,Emergency,0450,11730,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
42301798_1,Bladder Scan,Emergency,0450,51798,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
42301798_1,Bladder Scan,Inpatient,0450,51798,,,,0,202.00,151.50,151.50,191.90,181.80,191.90,191.90,181.80
42302001_1,2.5 CM OR LESS REPAIR EXTREMITIES,Inpatient,0450,12001,,,,0,296.00,222.00,222.00,281.20,266.40,281.20,281.20,266.40
42302001_1,2.5 CM OR LESS REPAIR EXTREMITIES,Emergency,0450,12001,,,,0,296.00,222.00,222.00,281.20,266.40,281.20,281.20,266.40
42302002_1,2.6  7.5 CM EXTREMITIES,Inpatient,0450,12002,,,,0,361.00,270.75,270.75,342.95,324.90,342.95,342.95,324.90
42302002_1,2.6  7.5 CM EXTREMITIES,Emergency,0450,12002,,,,0,361.00,270.75,270.75,342.95,324.90,342.95,342.95,324.90
42302004_1,7.6 TO 12.5 CM EXTREMITIES,Ambulatory Surgical,0360,12004,,,,0,390.00,292.50,292.50,370.50,351.00,370.50,370.50,351.00
42302004_1,7.6 TO 12.5 CM EXTREMITIES,Inpatient,0360,12004,,,,0,390.00,292.50,292.50,370.50,351.00,370.50,370.50,351.00
42302005_1,12.6 cm to 20.0 Cm Extremities,Emergency,0450,12005,,,,0,571.00,428.25,428.25,542.45,513.90,542.45,542.45,513.90
42302005_1,12.6 cm to 20.0 Cm Extremities,Inpatient,0450,12005,,,,0,571.00,428.25,428.25,542.45,513.90,542.45,542.45,513.90
42302006_1,20.1  30.0 CM EXTREMITIES,Inpatient,0450,12006,,,,0,383.00,287.25,287.25,363.85,344.70,363.85,363.85,344.70
42302006_1,20.1  30.0 CM EXTREMITIES,Emergency,0450,12006,,,,0,383.00,287.25,287.25,363.85,344.70,363.85,363.85,344.70
42302011_1,2.5 CM OR LESS SEENHEAD,Ambulatory Surgical,0360,12011,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
42302011_1,2.5 CM OR LESS SEENHEAD,Inpatient,0360,12011,,,,0,326.00,244.50,244.50,309.70,293.40,309.70,309.70,293.40
42302013_1,2.6 TO 5.0 CM SEENHEAD,Inpatient,0360,12013,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
42302013_1,2.6 TO 5.0 CM SEENHEAD,Ambulatory Surgical,0360,12013,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
42302014_1,5.1 TO 7.5 CM SEENHEAD,Inpatient,0450,12014,,,,0,467.00,350.25,350.25,443.65,420.30,443.65,443.65,420.30
42302014_1,5.1 TO 7.5 CM SEENHEAD,Emergency,0450,12014,,,,0,467.00,350.25,350.25,443.65,420.30,443.65,443.65,420.30
42302015_1,7.6 cm to 12.5 cm face,ProFee,0982,12015,,,,0,474.00,355.50,134.50,355.50,0.00,134.50,134.50,N/A
42302016_1,"12.6 Cm to 20.0 CM face, ears, eyelids, nose, lips...",Emergency,0450,12016,,,,0,398.00,298.50,298.50,378.10,358.20,378.10,378.10,358.20
42302016_1,"12.6 Cm to 20.0 CM face, ears, eyelids, nose, lips...",Inpatient,0450,12016,,,,0,398.00,298.50,298.50,378.10,358.20,378.10,378.10,358.20
42302017_1,20.1 to 30.0 cm Face ears Nose Lips eyelids,Ambulatory Surgical,0360,12017,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
42302017_1,20.1 to 30.0 cm Face ears Nose Lips eyelids,Inpatient,0360,12017,,,,0,357.00,267.75,267.75,339.15,321.30,339.15,339.15,321.30
42302020_1,CHEST TUBE INSERTION,Ambulatory Surgical,0761,32554,,,,0,1676.00,1257.00,1257.00,1592.20,1508.40,1592.20,1592.20,1508.40
42302020_1,CHEST TUBE INSERTION,Inpatient,0761,32554,,,,0,1676.00,1257.00,1257.00,1592.20,1508.40,1592.20,1592.20,1508.40
42302021_1,Treatment of superficial wound dehiscence; with packing,Emergency,0450,12021,,,,0,223.00,167.25,167.25,211.85,200.70,211.85,211.85,200.70
42302021_1,Treatment of superficial wound dehiscence; with packing,Inpatient,0450,12021,,,,0,223.00,167.25,167.25,211.85,200.70,211.85,211.85,200.70
42302032_1,2.67.5 CM INTERMEDIANT EXTREMITIES,Ambulatory Surgical,0360,12032,,,,0,585.00,438.75,438.75,555.75,526.50,555.75,555.75,526.50
42302032_1,2.67.5 CM INTERMEDIANT EXTREMITIES,Inpatient,0360,12032,,,,0,585.00,438.75,438.75,555.75,526.50,555.75,555.75,526.50
42302035_1,160CM X 40 CM Intermediate Layer Closure,ProFee,0960,12035,,,,0,931.00,698.25,346.00,698.25,0.00,346.00,346.00,N/A
42302041_1,INT. REPAIR 2.5 CM OR LESS,Inpatient,0450,12041,,,,0,690.00,517.50,517.50,655.50,621.00,655.50,655.50,621.00
42302041_1,INT. REPAIR 2.5 CM OR LESS,Emergency,0450,12041,,,,0,690.00,517.50,517.50,655.50,621.00,655.50,655.50,621.00
42302042_1,2.6 cm to 7.5 cm intermediate extermities,Emergency,0450,12042,,,,0,638.00,478.50,478.50,606.10,574.20,606.10,606.10,574.20
42302042_1,2.6 cm to 7.5 cm intermediate extermities,Inpatient,0450,12042,,,,0,638.00,478.50,478.50,606.10,574.20,606.10,606.10,574.20
42302052_1,2.6 TO 5CM INTERMEDIANT SEENHEAD,Emergency,0450,12052,,,,0,573.00,429.75,429.75,544.35,515.70,544.35,544.35,515.70
42302052_1,2.6 TO 5CM INTERMEDIANT SEENHEAD,Inpatient,0450,12052,,,,0,573.00,429.75,429.75,544.35,515.70,544.35,544.35,515.70
42302270_1,Guaiac Stool,Outpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
42302270_1,Guaiac Stool,Inpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
42302950_1,CPR,Inpatient,0450,92950,,,,0,993.00,744.75,744.75,943.35,893.70,943.35,943.35,893.70
42302950_1,CPR,Emergency,0450,92950,,,,0,993.00,744.75,744.75,943.35,893.70,943.35,943.35,893.70
42302960_1,DEFIBRILATIONCARDIOVER,Inpatient,0450,92960,,,,0,1416.00,1062.00,1062.00,1345.20,1274.40,1345.20,1345.20,1274.40
42302960_1,DEFIBRILATIONCARDIOVER,Emergency,0450,92960,,,,0,1416.00,1062.00,1062.00,1345.20,1274.40,1345.20,1345.20,1274.40
42302962_1,Glucose one touch,Inpatient,0300,82962,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
42302962_1,Glucose one touch,Outpatient,0300,82962,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
42303121_1,2.67.5CM COMPLICATED,Inpatient,0450,13121,,,,0,1272.00,954.00,954.00,1208.40,1144.80,1208.40,1208.40,1144.80
42303121_1,2.67.5CM COMPLICATED,Emergency,0450,13121,,,,0,1272.00,954.00,954.00,1208.40,1144.80,1208.40,1208.40,1144.80
42303225_1,HOLTER MONITOR RECORDING,Inpatient,0450,93225,,,,0,320.00,240.00,240.00,304.00,288.00,304.00,304.00,288.00
42303225_1,HOLTER MONITOR RECORDING,Emergency,0450,93225,,,,0,320.00,240.00,240.00,304.00,288.00,304.00,304.00,288.00
42303650_1,CLOSED SHOULDER DISLOC WO,Emergency,0450,23650,,,,0,934.00,700.50,700.50,887.30,840.60,887.30,887.30,840.60
42303650_1,CLOSED SHOULDER DISLOC WO,Inpatient,0450,23650,,,,0,934.00,700.50,700.50,887.30,840.60,887.30,887.30,840.60
42303655_1,CLOSED SHOULDER DISLOC WANESTH,ProFee,0982,23655,,,,0,970.00,727.50,576.00,727.50,0.00,576.00,576.00,N/A
42303752_1,PLACEMENT NG TUBE,Emergency,0450,43752,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
42303752_1,PLACEMENT NG TUBE,Inpatient,0450,43752,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
42304420_1,NERVE BLOCK INTERCOSTAL NERVE SING,Inpatient,0360,64420,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,383.80,363.60
42304420_1,NERVE BLOCK INTERCOSTAL NERVE SING,Ambulatory Surgical,0360,64420,,,,0,404.00,303.00,303.00,383.80,363.60,383.80,383.80,363.60
42304421_1,NERVE BLOCK INTERCOSTALS MULTUPLE,Inpatient,0360,12032,,,,0,740.00,555.00,555.00,703.00,666.00,703.00,703.00,666.00
42304421_1,NERVE BLOCK INTERCOSTALS MULTUPLE,Ambulatory Surgical,0360,12032,,,,0,740.00,555.00,555.00,703.00,666.00,703.00,703.00,666.00
42304450_1,"Injection, anesthetic agent; other peripheral nerve or branch",Ambulatory Surgical,0360,64450,,,,0,924.00,693.00,693.00,877.80,831.60,877.80,877.80,831.60
42304450_1,"Injection, anesthetic agent; other peripheral nerve or branch",Inpatient,0360,64450,,,,0,924.00,693.00,693.00,877.80,831.60,877.80,877.80,831.60
42304640_1,Closed Treatment of Radial Head subluxation in child,ProFee,0981,24640,,,,0,280.00,210.00,111.00,210.00,0.00,111.00,111.00,N/A
42305_3,DRAINAGE OF SALIVARY GLAND,ProFee,0989,42305,,,,0,3.00,2.25,2.25,616.00,0.00,616.00,616.00,N/A
42305205_1,EXTERNAL EYE,Inpatient,0360,65205,,,,0,560.00,420.00,420.00,532.00,504.00,532.00,532.00,504.00
42305205_1,EXTERNAL EYE,Ambulatory Surgical,0360,65205,,,,0,560.00,420.00,420.00,532.00,504.00,532.00,532.00,504.00
42305210_1,CONJUNCTIVAL,Ambulatory Surgical,0360,65210,,,,0,316.00,237.00,237.00,300.20,284.40,300.20,300.20,284.40
42305210_1,CONJUNCTIVAL,Inpatient,0360,65210,,,,0,316.00,237.00,237.00,300.20,284.40,300.20,300.20,284.40
42305220_1,CORNEAL WO SLIT,Emergency,0450,65220,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
42305220_1,CORNEAL WO SLIT,Inpatient,0450,65220,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
42305271_1,"Application of skin substitute Trunk, ARMS, AND LEGS",Ambulatory Surgical,0761,15271,,,,0,1900.00,1425.00,1425.00,1805.00,1710.00,1805.00,1805.00,1710.00
42305271_1,"Application of skin substitute Trunk, ARMS, AND LEGS",Inpatient,0761,15271,,,,0,1900.00,1425.00,1425.00,1805.00,1710.00,1805.00,1805.00,1710.00
42305275_1,"APPLICATION OF SKIN SUBSTITUTE FACE, SCALP, ETC.",Ambulatory Surgical,0761,15275,,,,0,1900.00,1425.00,1425.00,1805.00,1710.00,1805.00,1805.00,1710.00
42305275_1,"APPLICATION OF SKIN SUBSTITUTE FACE, SCALP, ETC.",Inpatient,0761,15275,,,,0,1900.00,1425.00,1425.00,1805.00,1710.00,1805.00,1805.00,1710.00
42305605_1,TREAT OF DISTAL RADIAL FX MANUAL,Emergency,0450,25605,,,,0,1254.00,940.50,940.50,1191.30,1128.60,1191.30,1191.30,1128.60
42305605_1,TREAT OF DISTAL RADIAL FX MANUAL,Inpatient,0450,25605,,,,0,1254.00,940.50,940.50,1191.30,1128.60,1191.30,1191.30,1128.60
42306020_1,"Burn Dressings and/or debridement, small",Outpatient,0761,16020,,,,0,347.00,260.25,260.25,329.65,312.30,329.65,329.65,312.30
42306020_1,"Burn Dressings and/or debridement, small",Inpatient,0761,16020,,,,0,347.00,260.25,260.25,329.65,312.30,329.65,329.65,312.30
42306227_1,"Lumbar Puncture, Diagnostic",ProFee,0960,62270,,,,0,456.00,342.00,112.50,342.00,0.00,112.50,112.50,N/A
42306360_1,IV HYDRATION 3160 MINUTES,Inpatient,0260,96360,,,,0,400.00,300.00,300.00,380.00,360.00,380.00,380.00,360.00
42306360_1,IV HYDRATION 3160 MINUTES,Outpatient,0260,96360,,,,0,400.00,300.00,300.00,380.00,360.00,380.00,380.00,360.00
42306361_1,IV HYDRATION EACH ADDTL HOUR,Inpatient,0260,96361,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
42306361_1,IV HYDRATION EACH ADDTL HOUR,Outpatient,0260,96361,,,,0,146.00,109.50,109.50,138.70,131.40,138.70,138.70,131.40
42306365_1,IV INFUSION UP TO 1 HOUR,Outpatient,0260,96365,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42306365_1,IV INFUSION UP TO 1 HOUR,Inpatient,0260,96365,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42306366_1,IV INFUSION EACH ADDTL HOUR,Outpatient,0260,96366,,,,0,244.00,183.00,183.00,231.80,219.60,231.80,231.80,219.60
42306366_1,IV INFUSION EACH ADDTL HOUR,Inpatient,0260,96366,,,,0,244.00,183.00,183.00,231.80,219.60,231.80,231.80,219.60
42306367_1,IV INF UP TO 1HR SEQUENTIAL INFUSI,Inpatient,0260,96367,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42306367_1,IV INF UP TO 1HR SEQUENTIAL INFUSI,Outpatient,0260,96367,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42306368_1,IV INF CONCURRENT,Outpatient,0260,96368,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
42306368_1,IV INF CONCURRENT,Inpatient,0260,96368,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
42306372_1,INJ IMSQ,Emergency,0450,96372,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
42306372_1,INJ IMSQ,Inpatient,0450,96372,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
42306374_1,IV PUSH < 16 MINUTES,Inpatient,0260,96374,,,,0,302.00,226.50,226.50,286.90,271.80,286.90,286.90,271.80
42306374_1,IV PUSH < 16 MINUTES,Outpatient,0260,96374,,,,0,302.00,226.50,226.50,286.90,271.80,286.90,286.90,271.80
42306375_1,IV PUSH EACH ADDTL NEW DRUG,Inpatient,0260,96375,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
42306375_1,IV PUSH EACH ADDTL NEW DRUG,Outpatient,0260,96375,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
42306376_1,IV PUSH SAME DRUG AFTER 30 MIN,Inpatient,0260,96376,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,151.05,143.10
42306376_1,IV PUSH SAME DRUG AFTER 30 MIN,Outpatient,0260,96376,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,151.05,143.10
42306523_1,IRRIGATION OF PORTACATH,Inpatient,0940,96523,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
42306523_1,IRRIGATION OF PORTACATH,Outpatient,0940,96523,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
42306556_1,CENTRAL LINE PLACEMENT,Emergency,0450,36556,,,,0,3175.00,2381.25,2381.25,3016.25,2857.50,3016.25,3016.25,2857.50
42306556_1,CENTRAL LINE PLACEMENT,Inpatient,0450,36556,,,,0,3175.00,2381.25,2381.25,3016.25,2857.50,3016.25,3016.25,2857.50
42306680_1,INTRAOSSEOUS INFUSION,Inpatient,0450,36680,,,,0,338.00,253.50,253.50,321.10,304.20,321.10,321.10,304.20
42306680_1,INTRAOSSEOUS INFUSION,Emergency,0450,36680,,,,0,338.00,253.50,253.50,321.10,304.20,321.10,321.10,304.20
42306725_1,Treatment of Phlangeal shaft FX,Inpatient,0450,26725,,,,0,252.00,189.00,189.00,239.40,226.80,239.40,239.40,226.80
42306725_1,Treatment of Phlangeal shaft FX,Emergency,0450,26725,,,,0,252.00,189.00,189.00,239.40,226.80,239.40,239.40,226.80
42306770_1,CLOSED REDUC OF FINGER DISLO WO A,Inpatient,0450,26770,,,,0,997.00,747.75,747.75,947.15,897.30,947.15,947.15,897.30
42306770_1,CLOSED REDUC OF FINGER DISLO WO A,Emergency,0450,26770,,,,0,997.00,747.75,747.75,947.15,897.30,947.15,947.15,897.30
42307250_1,Chemical Wound Cauterization,Outpatient,0761,17250,,,,0,226.00,169.50,169.50,214.70,203.40,214.70,214.70,203.40
42307250_1,Chemical Wound Cauterization,Inpatient,0761,17250,,,,0,226.00,169.50,169.50,214.70,203.40,214.70,214.70,203.40
42307252_1,HIP REDUCTION WANESTHESIA,Emergency,0450,27252,,,,0,1962.00,1471.50,1471.50,1863.90,1765.80,1863.90,1863.90,1765.80
42307252_1,HIP REDUCTION WANESTHESIA,Inpatient,0450,27252,,,,0,1962.00,1471.50,1471.50,1863.90,1765.80,1863.90,1863.90,1765.80
42307605_1,Negative Pressure Wound Therapy less than 50 square centimeters,Inpatient,0761,97605,,,,0,282.00,211.50,211.50,267.90,253.80,267.90,267.90,253.80
42307605_1,Negative Pressure Wound Therapy less than 50 square centimeters,Outpatient,0761,97605,,,,0,282.00,211.50,211.50,267.90,253.80,267.90,267.90,253.80
42307810_1,Ankle Dislocation,Inpatient,0450,27846,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
42307810_1,Ankle Dislocation,Emergency,0450,27846,,,,0,267.00,200.25,200.25,253.65,240.30,253.65,253.65,240.30
42308111_1,CCOLLAR  UNIVERSAL (4"),Outpatient,0274,L0120,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
42308111_1,CCOLLAR  UNIVERSAL (4"),Inpatient,0274,L0120,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
42309105_1,SPLINT LONG ARM,ProFee,0982,29105,,,,0,215.00,161.25,85.00,161.25,0.00,85.00,85.00,N/A
42309125_1,SPLINT  SHORT ARM,ProFee,0982,29125,,,,0,179.00,134.25,57.00,134.25,0.00,57.00,57.00,N/A
42309130_1,SPLINT FINGER,ProFee,0982,29130,,,,0,138.00,103.50,41.50,103.50,0.00,41.50,41.50,N/A
42309149_1,"Moderate Sedation Services age 5 or older, first 30 minutes",ProFee,0982,99152,,,,0,311.00,233.25,18.00,233.25,0.00,18.00,18.00,N/A
42309150_1,Moderate Sedation 5 years old and up each additional 15 minuntes,ProFee,0982,99153,,,,0,79.00,59.25,15.50,59.25,0.00,15.50,15.50,N/A
42309195_1,Therapeutic Phlebotomy,ProFee,0960,99195,,,,0,153.00,114.75,114.75,144.50,0.00,144.50,144.50,N/A
42309200_1,"Foreign Body Removal, Ear W/O Anesthesia",Inpatient,0450,69200,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,266.95,252.90
42309200_1,"Foreign Body Removal, Ear W/O Anesthesia",Emergency,0450,69200,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,266.95,252.90
42309205_1,"Foreign Body removal, Ear W/Anesthesia",Inpatient,0450,69205,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
42309205_1,"Foreign Body removal, Ear W/Anesthesia",Emergency,0450,69205,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
42309209_1,Ear Lavage,Inpatient,0450,69209,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42309209_1,Ear Lavage,Emergency,0450,69209,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
42309211_1,Treatment Room Level 1,Inpatient,0761,99211,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
42309211_1,Treatment Room Level 1,Outpatient,0761,99211,,,,0,107.00,80.25,80.25,101.65,96.30,101.65,101.65,96.30
42309212_1,Treatment Room Level 2,Outpatient,0761,99212,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,209.95,198.90
42309212_1,Treatment Room Level 2,Inpatient,0761,99212,,,,0,221.00,165.75,165.75,209.95,198.90,209.95,209.95,198.90
42309213_1,Treatment Room Level 3,Outpatient,0761,99213,,,,0,269.00,201.75,201.75,255.55,242.10,255.55,255.55,242.10
42309213_1,Treatment Room Level 3,Inpatient,0761,99213,,,,0,269.00,201.75,201.75,255.55,242.10,255.55,255.55,242.10
42309214_1,Treatment Room Level 4,Inpatient,0761,99214,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
42309214_1,Treatment Room Level 4,Outpatient,0761,99214,,,,0,339.00,254.25,254.25,322.05,305.10,322.05,322.05,305.10
42309215_1,Treatment Room Level 5,Inpatient,0761,99215,,,,0,422.00,316.50,316.50,400.90,379.80,400.90,400.90,379.80
42309215_1,Treatment Room Level 5,Outpatient,0761,99215,,,,0,422.00,316.50,316.50,400.90,379.80,400.90,400.90,379.80
42309285_1,Modified Trauma Activation,Outpatient,0689,99285,,,,0,1115.00,836.25,836.25,1059.25,1003.50,1059.25,1059.25,1003.50
42309285_1,Modified Trauma Activation,Inpatient,0689,99285,,,,0,1115.00,836.25,836.25,1059.25,1003.50,1059.25,1059.25,1003.50
42309291_1,Critical Care 31-74 Min.,Inpatient,0450,99291,,,,0,6985.00,5238.75,5238.75,6635.75,6286.50,6635.75,6635.75,6286.50
42309291_1,Critical Care 31-74 Min.,Emergency,0450,99291,,,,0,6985.00,5238.75,5238.75,6635.75,6286.50,6635.75,6635.75,6286.50
42309292_1,Critical Care Additional 30 minutes,Emergency,0450,99292,,,,0,1213.00,909.75,909.75,1152.35,1091.70,1152.35,1152.35,1091.70
42309292_1,Critical Care Additional 30 minutes,Inpatient,0450,99292,,,,0,1213.00,909.75,909.75,1152.35,1091.70,1152.35,1152.35,1091.70
42309406_1,SMOKINGTOBACCO CENSSATION 310 MI,Inpatient,0942,99406,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
42309406_1,SMOKINGTOBACCO CENSSATION 310 MI,Outpatient,0942,99406,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
42309407_1,SMOKINGTOBACCO CONS. OVER 10 MIN,Inpatient,0942,99407,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
42309407_1,SMOKINGTOBACCO CONS. OVER 10 MIN,Outpatient,0942,99407,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
42309409_1,Vaginal Delivery,Inpatient,0722,59409,,,,0,8228.00,6171.00,6171.00,7816.60,7405.20,7816.60,7816.60,7405.20
42309409_1,Vaginal Delivery,Ambulatory Surgical,0722,59409,,,,0,8228.00,6171.00,6171.00,7816.60,7405.20,7816.60,7816.60,7405.20
42309505_1,SPLINT LONG LEG,Emergency,0450,29505,,,,0,437.00,327.75,327.75,415.15,393.30,415.15,415.15,393.30
42309505_1,SPLINT LONG LEG,Inpatient,0450,29505,,,,0,437.00,327.75,327.75,415.15,393.30,415.15,415.15,393.30
42309515_1,SPLINT  SHORT LEG,Inpatient,0450,29515,,,,0,304.00,228.00,228.00,288.80,273.60,288.80,288.80,273.60
42309515_1,SPLINT  SHORT LEG,Emergency,0450,29515,,,,0,304.00,228.00,228.00,288.80,273.60,288.80,288.80,273.60
42309540_1,ANKLE SPLINT APPLICATION,ProFee,0982,29540,,,,0,179.00,134.25,26.00,134.25,0.00,26.00,26.00,N/A
4230F_3,ANTICONV THXPY FOR >= 6 MONS,ProFee,0989,4230F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42310_3,DRAINAGE OF SALIVARY GLAND,ProFee,0989,42310,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
42320_3,DRAINAGE OF SALIVARY GLAND,ProFee,0989,42320,,,,0,3.00,2.25,2.25,249.50,0.00,249.50,249.50,N/A
42330_3,REMOVAL OF SALIVARY STONE,ProFee,0989,42330,,,,0,3.00,2.25,2.25,235.50,0.00,235.50,235.50,N/A
42335_3,REMOVAL OF SALIVARY STONE,ProFee,0989,42335,,,,0,3.00,2.25,2.25,368.00,0.00,368.00,368.00,N/A
42340_3,REMOVAL OF SALIVARY STONE,ProFee,0989,42340,,,,0,3.00,2.25,2.25,482.50,0.00,482.50,482.50,N/A
42400_3,BIOPSY OF SALIVARY GLAND,ProFee,0989,42400,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
42400427_1,AMBULANCE BASE ALS LEVEL1,Inpatient,0540,A0427,,,,0,990.00,742.50,742.50,940.50,891.00,940.50,940.50,891.00
42400427_1,AMBULANCE BASE ALS LEVEL1,Outpatient,0540,A0427,,,,0,990.00,742.50,742.50,940.50,891.00,940.50,940.50,891.00
42400999_1,UNLISTED AMBULANCE SERVICE,Inpatient,0540,A0999,,,,0,1077.00,807.75,807.75,1023.15,969.30,1023.15,1023.15,969.30
42400999_1,UNLISTED AMBULANCE SERVICE,Outpatient,0540,A0999,,,,0,1077.00,807.75,807.75,1023.15,969.30,1023.15,1023.15,969.30
42401000_1,AMBULANCE BASE BLS,Outpatient,0540,A0429,,,,0,729.00,546.75,546.75,692.55,656.10,692.55,692.55,656.10
42401000_1,AMBULANCE BASE BLS,Inpatient,0540,A0429,,,,0,729.00,546.75,546.75,692.55,656.10,692.55,692.55,656.10
42401001_1,AMBULANCE MILEAGE PER MILE,Outpatient,0540,A0425,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
42401001_1,AMBULANCE MILEAGE PER MILE,Inpatient,0540,A0425,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
42401009_1,AMBULANCE BASE ALS LEVEL 2,Outpatient,0540,A0433,,,,0,1255.00,941.25,941.25,1192.25,1129.50,1192.25,1192.25,1129.50
42401009_1,AMBULANCE BASE ALS LEVEL 2,Inpatient,0540,A0433,,,,0,1255.00,941.25,941.25,1192.25,1129.50,1192.25,1192.25,1129.50
42405_3,BIOPSY OF SALIVARY GLAND,ProFee,0989,42405,,,,0,3.00,2.25,2.25,323.50,0.00,323.50,323.50,N/A
42408_3,EXCISION OF SALIVARY CYST,ProFee,0989,42408,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
42409_3,DRAINAGE OF SALIVARY CYST,ProFee,0989,42409,,,,0,3.00,2.25,2.25,316.00,0.00,316.00,316.00,N/A
4240F_3,INSTR XRCZ 4BK PN >12 WEEKS,ProFee,0989,4240F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42410_3,EXCISE PAROTID GLAND/LESION,ProFee,0989,42410,,,,0,3.00,2.25,2.25,888.00,0.00,888.00,888.00,N/A
42415_3,EXCISE PAROTID GLAND/LESION,ProFee,0989,42415,,,,0,3.00,2.25,2.25,1503.50,0.00,1503.50,1503.50,N/A
42420_3,EXCISE PAROTID GLAND/LESION,ProFee,0989,42420,,,,0,3.00,2.25,2.25,1689.00,0.00,1689.00,1689.00,N/A
42425_3,EXCISE PAROTID GLAND/LESION,ProFee,0989,42425,,,,0,3.00,2.25,2.25,1192.50,0.00,1192.50,1192.50,N/A
42426_3,EXCISE PAROTID GLAND/LESION,ProFee,0989,42426,,,,0,3.00,2.25,2.25,1923.50,0.00,1923.50,1923.50,N/A
4242F_3,SPRVSD XRCZ BK PN >12 WEEKS,ProFee,0989,4242F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42440_3,EXCISE SUBMAXILLARY GLAND,ProFee,0989,42440,,,,0,3.00,2.25,2.25,587.00,0.00,587.00,587.00,N/A
42450_3,EXCISE SUBLINGUAL GLAND,ProFee,0989,42450,,,,0,3.00,2.25,2.25,512.50,0.00,512.50,512.50,N/A
4245F_3,"PT INSTR, RESUME NRML LIFEST",ProFee,0989,4245F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4248F_3,PT INSTR-NO BD REST>= 4 DAYS,ProFee,0989,4248F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42500_3,REPAIR SALIVARY DUCT,ProFee,0989,42500,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
42500471_1,IMSQ VACCINE,Inpatient,0771,90471,,,,0,95.00,71.25,71.25,90.25,85.50,90.25,90.25,85.50
42500471_1,IMSQ VACCINE,Outpatient,0771,90471,,,,0,95.00,71.25,71.25,90.25,85.50,90.25,90.25,85.50
42500472_1,EACH ADD IMSQ,Inpatient,0771,90472,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42500472_1,EACH ADD IMSQ,Outpatient,0771,90472,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
42500610_1,ARTHROCENTESIS,Inpatient,0761,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
42500610_1,ARTHROCENTESIS,Ambulatory Surgical,0761,20610,,,,0,322.00,241.50,241.50,305.90,289.80,305.90,305.90,289.80
42500901_1,NASAL HEMMORR CONTROL FACIL,Inpatient,0761,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42500901_1,NASAL HEMMORR CONTROL FACIL,Outpatient,0761,30901,,,,0,365.00,273.75,273.75,346.75,328.50,346.75,346.75,328.50
42500906_1,REPEAT CONTROL OF NOSEBLEED,Inpatient,0761,30906,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42500906_1,REPEAT CONTROL OF NOSEBLEED,Ambulatory Surgical,0761,30906,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42501105_1,GASTRIC INTUBLAVAGE,Inpatient,0750,43753,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42501105_1,GASTRIC INTUBLAVAGE,Ambulatory Surgical,0750,43753,,,,0,236.00,177.00,177.00,224.20,212.40,224.20,224.20,212.40
42501500_1,INTUBATION ENDOTRACH,Inpatient,0761,31500,,,,0,752.00,564.00,564.00,714.40,676.80,714.40,714.40,676.80
42501500_1,INTUBATION ENDOTRACH,Ambulatory Surgical,0761,31500,,,,0,752.00,564.00,564.00,714.40,676.80,714.40,714.40,676.80
42501701_1,CATH STRAIT,Observation,0762,51701,,,,0,220.00,165.00,165.00,209.00,198.00,209.00,209.00,198.00
42501702_1,CATH FOLEY,Inpatient,0761,51702,,,,0,265.00,198.75,198.75,251.75,238.50,251.75,251.75,238.50
42501702_1,CATH FOLEY,Outpatient,0761,51702,,,,0,265.00,198.75,198.75,251.75,238.50,251.75,251.75,238.50
42502270_1,GUAIAC,Inpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
42502270_1,GUAIAC,Outpatient,0300,82270,,,,0,44.00,33.00,33.00,41.80,39.60,41.80,41.80,39.60
42502950_1,CPR,Emergency,0450,92950,,,,0,993.00,744.75,744.75,943.35,893.70,943.35,943.35,893.70
42502950_1,CPR,Inpatient,0450,92950,,,,0,993.00,744.75,744.75,943.35,893.70,943.35,943.35,893.70
42502960_1,DEFIBCARDIOVERSION,Emergency,0450,92960,,,,0,1416.00,1062.00,1062.00,1345.20,1274.40,1345.20,1345.20,1274.40
42502960_1,DEFIBCARDIOVERSION,Inpatient,0450,92960,,,,0,1416.00,1062.00,1062.00,1345.20,1274.40,1345.20,1345.20,1274.40
42503000_1,EKG,Inpatient,0730,93000,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
42503000_1,EKG,Outpatient,0730,93000,,,,0,340.00,255.00,255.00,323.00,306.00,323.00,323.00,306.00
42504250_1,"OBS Services, per hour",Observation,0762,G0378,,,,0,668.00,501.00,501.00,634.60,601.20,634.60,634.60,601.20
42504251_1,OBSERVATION EACH ADDITIONAL HOUR,Observation,0762,G0378,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
42505_3,REPAIR SALIVARY DUCT,ProFee,0989,42505,,,,0,3.00,2.25,2.25,646.50,0.00,646.50,646.50,N/A
42506360_1,INITIAL HYDRATN 31 MINS 1 HR,Inpatient,0260,96360,,,,0,400.00,300.00,300.00,380.00,360.00,380.00,380.00,360.00
42506360_1,INITIAL HYDRATN 31 MINS 1 HR,Outpatient,0260,96360,,,,0,400.00,300.00,300.00,380.00,360.00,380.00,380.00,360.00
42506365_1,INITIAL INFUSION UP TO 1 HR,Inpatient,0260,96365,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42506365_1,INITIAL INFUSION UP TO 1 HR,Outpatient,0260,96365,,,,0,502.00,376.50,376.50,476.90,451.80,476.90,476.90,451.80
42506367_1,SEQUENTIAL INFUSION UP TO 1 HR,Inpatient,0260,96367,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42506367_1,SEQUENTIAL INFUSION UP TO 1 HR,Outpatient,0260,96367,,,,0,263.00,197.25,197.25,249.85,236.70,249.85,249.85,236.70
42506368_1,CONCURRENT INFUSION,Outpatient,0260,96368,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
42506368_1,CONCURRENT INFUSION,Inpatient,0260,96368,,,,0,224.00,168.00,168.00,212.80,201.60,212.80,212.80,201.60
42506372_1,IMSQ INJ,Inpatient,0940,96372,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
42506372_1,IMSQ INJ,Outpatient,0940,96372,,,,0,112.00,84.00,84.00,106.40,100.80,106.40,106.40,100.80
42506374_1,INITIAL PUSH OR INFUSION <16 MINS,Inpatient,0260,96374,,,,0,302.00,226.50,226.50,286.90,271.80,286.90,286.90,271.80
42506374_1,INITIAL PUSH OR INFUSION <16 MINS,Outpatient,0260,96374,,,,0,302.00,226.50,226.50,286.90,271.80,286.90,286.90,271.80
42506375_1,IV PUSH DIFFERENT DRUG,Inpatient,0260,96375,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
42506375_1,IV PUSH DIFFERENT DRUG,Outpatient,0260,96375,,,,0,165.00,123.75,123.75,156.75,148.50,156.75,156.75,148.50
42506376_1,IV PUSH SAME DRUG > 30 MINS,Inpatient,0260,96376,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,151.05,143.10
42506376_1,IV PUSH SAME DRUG > 30 MINS,Outpatient,0260,96376,,,,0,159.00,119.25,119.25,151.05,143.10,151.05,151.05,143.10
42506523_1,PORTACATH IRRIGATION,Outpatient,0260,96523,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
42506523_1,PORTACATH IRRIGATION,Inpatient,0260,96523,,,,0,170.00,127.50,127.50,161.50,153.00,161.50,161.50,153.00
42507_3,PAROTID DUCT DIVERSION,ProFee,0989,42507,,,,0,3.00,2.25,2.25,728.50,0.00,728.50,728.50,N/A
42508_3,PAROTID DUCT DIVERSION,ProFee,0989,42508,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42509_3,PAROTID DUCT DIVERSION,ProFee,0989,42509,,,,0,3.00,2.25,2.25,1201.50,0.00,1201.50,1201.50,N/A
42509212_1,OBSERVATION VISIT LEVEL 2,ProFee,0982,99212,,,,0,244.00,183.00,36.00,183.00,0.00,36.00,36.00,N/A
42509213_1,OBSERVATION VISIT LEVEL 3,ProFee,0982,99224,,,,0,442.00,331.50,56.50,331.50,0.00,56.50,56.50,N/A
42509217_1,OBSERVATION STAYDISCHARGE,ProFee,0982,99217,,,,0,208.00,156.00,103.50,156.00,0.00,103.50,103.50,N/A
42509218_1,OBSERVATION INITIALCOMPLOW,ProFee,0982,99218,,,,0,215.00,161.25,141.50,161.25,0.00,141.50,141.50,N/A
42509219_1,OBSERVATION INITIALCOMPMOD,ProFee,0982,99219,,,,0,318.00,238.50,192.50,238.50,0.00,192.50,192.50,N/A
42509220_1,OBSERVATION INITIALCOMPHIGH,ProFee,0982,99220,,,,0,391.00,293.25,263.50,293.25,0.00,263.50,263.50,N/A
42509224_1,OBS SUBSEQUENT VISIT LEVEL 1,ProFee,0987,99224,,,,0,123.00,92.25,56.50,92.25,0.00,56.50,56.50,N/A
42509225_1,OBS SUBSEQUENT VISIT LEVEL 2,ProFee,0987,99225,,,,0,141.00,105.75,103.50,105.75,0.00,103.50,103.50,N/A
42509234_1,OBSERVATION ADMIT & DISCHARGE LEV,ProFee,0982,99234,,,,0,353.00,264.75,188.50,264.75,0.00,188.50,188.50,N/A
42509235_1,OBSERVATION ADMIT & DISCHARGE LEV,ProFee,0982,99235,,,,0,480.00,360.00,239.50,360.00,0.00,239.50,239.50,N/A
42509236_1,OBSERVATION ADMIT & DISCHARGE LEV,ProFee,0982,99236,,,,0,567.00,425.25,309.00,425.25,0.00,309.00,309.00,N/A
4250F_3,WRMNG 4 SURG - NORMOTHERMIA,ProFee,0989,4250F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42510_3,PAROTID DUCT DIVERSION,ProFee,0989,42510,,,,0,3.00,2.25,2.25,892.50,0.00,892.50,892.50,N/A
42550_3,INJECTION FOR SALIVARY X-RAY,ProFee,0989,42550,,,,0,3.00,2.25,2.25,91.50,0.00,91.50,91.50,N/A
4255F_3,ANESTH >= 60 MIN AS DOCD,ProFee,0989,4255F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4256F_3,ANESTH < 60 MIN AS DOCD,ProFee,0989,4256F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600_3,CLOSURE OF SALIVARY FISTULA,ProFee,0989,42600,,,,0,3.00,2.25,2.25,495.50,0.00,495.50,495.50,N/A
42600000_2,SPECIAL REPORTS OR FORMS,ProFee,0989,99080,,,,0,83.00,62.25,62.25,62.25,0.00,N/A,N/A,N/A
42600000_3,SPECIAL REPORTS OR FORMS,ProFee,0989,99080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600008_2,Admin influenza virus vac,ProFee,0989,G0008,,,,0,38.00,28.50,28.50,29.00,0.00,29.00,29.00,N/A
42600008_3,Admin influenza virus vac,ProFee,0989,G0008,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
42600009_2,Admin pneumococcal vaccine,ProFee,0989,G0009,,,,0,38.00,28.50,28.50,29.00,0.00,29.00,29.00,N/A
42600009_3,Admin pneumococcal vaccine,ProFee,0989,G0009,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
42600060_2,DRAINAGE OF SKIN ABSCESS,ProFee,0989,10060,,,,0,222.00,166.50,139.50,166.50,0.00,139.50,139.50,N/A
42600060_3,DRAINAGE OF SKIN ABSCESS,ProFee,0989,10060,,,,0,3.00,2.25,2.25,139.50,0.00,139.50,139.50,N/A
42600061_2,DRAINAGE OF SKIN ABSCESS,ProFee,0989,10061,,,,0,349.00,261.75,257.00,261.75,0.00,257.00,257.00,N/A
42600061_3,DRAINAGE OF SKIN ABSCESS,ProFee,0989,10061,,,,0,3.00,2.25,2.25,257.00,0.00,257.00,257.00,N/A
42600080_2,DRAINAGE OF PILONIDAL CYST,ProFee,0989,10080,,,,0,278.00,208.50,147.00,208.50,0.00,147.00,147.00,N/A
42600080_3,DRAINAGE OF PILONIDAL CYST,ProFee,0989,10080,,,,0,3.00,2.25,2.25,147.00,0.00,147.00,147.00,N/A
42600090_2,Obtaining screen pap smear,ProFee,0989,Q0091,,,,0,32.00,24.00,24.00,28.00,0.00,28.00,28.00,N/A
42600090_3,Obtaining screen pap smear,ProFee,0989,Q0091,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
42600100_2,"DRUG SCREEN, QUALITATE/MULTI",ProFee,0989,80100,,,,0,104.00,78.00,78.00,78.00,N/A,N/A,N/A,N/A
42600100_3,"DRUG SCREEN, QUALITATE/MULTI",ProFee,0989,80100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600107_2,CA screen; fecal blood test,ProFee,0989,G0107,,,,0,62.00,46.50,46.50,46.50,N/A,N/A,N/A,N/A
42600107_3,CA screen; fecal blood test,ProFee,0989,G0107,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600120_2,REMOVE FOREIGN BODY,ProFee,0989,10120,,,,0,250.00,187.50,148.50,187.50,0.00,148.50,148.50,N/A
42600120_3,REMOVE FOREIGN BODY,ProFee,0989,10120,,,,0,3.00,2.25,2.25,148.50,0.00,148.50,148.50,N/A
42600121_2,REMOVE FOREIGN BODY,ProFee,0989,10121,,,,0,453.00,339.75,265.50,339.75,0.00,265.50,265.50,N/A
42600121_3,REMOVE FOREIGN BODY,ProFee,0989,10121,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
42600140_2,DRAINAGE OF HEMATOMA/FLUID,ProFee,0989,10140,,,,0,278.00,208.50,170.00,208.50,0.00,170.00,170.00,N/A
42600140_3,DRAINAGE OF HEMATOMA/FLUID,ProFee,0989,10140,,,,0,3.00,2.25,2.25,170.00,0.00,170.00,170.00,N/A
42600160_2,PUNCTURE DRAINAGE OF LESION,ProFee,0989,10160,,,,0,167.00,125.25,125.25,136.50,0.00,136.50,136.50,N/A
42600160_3,PUNCTURE DRAINAGE OF LESION,ProFee,0989,10160,,,,0,3.00,2.25,2.25,136.50,0.00,136.50,136.50,N/A
42600168_2,Wound closure by adhesive,ProFee,0989,G0168,,,,0,210.00,157.50,40.50,157.50,0.00,40.50,40.50,N/A
42600168_3,Wound closure by adhesive,ProFee,0989,G0168,,,,0,3.00,2.25,2.25,40.50,0.00,40.50,40.50,N/A
42600170_2,Adrenalin epinephrine inject,ProFee,0989,J0171,,,,0,16.00,12.00,12.00,12.00,0.00,N/A,N/A,N/A
42600170_3,Adrenalin epinephrine inject,ProFee,0989,J0171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600210_2,Thoracic rib belt,ProFee,0989,L0210,,,,0,33.00,24.75,24.75,24.75,N/A,N/A,N/A,N/A
42600210_3,Thoracic rib belt,ProFee,0989,L0210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600240_2,Straight tip urine catheter,ProFee,0989,A4351,,,,0,36.00,27.00,27.00,27.00,0.00,N/A,N/A,N/A
42600240_3,Straight tip urine catheter,ProFee,0989,A4351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600281_2,"HUMAN IG, IM",ProFee,0989,90281,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600281_3,"HUMAN IG, IM",ProFee,0989,90281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600300_2,REMOVE NASAL FOREIGN BODY,ProFee,0989,30300,,,,0,313.00,234.75,150.00,234.75,0.00,150.00,150.00,N/A
42600300_3,REMOVE NASAL FOREIGN BODY,ProFee,0989,30300,,,,0,3.00,2.25,2.25,150.00,0.00,150.00,150.00,N/A
42600372_2,MD service required for PMD,ProFee,0989,G0372,,,,0,32.00,24.00,13.00,24.00,0.00,13.00,13.00,N/A
42600372_3,MD service required for PMD,ProFee,0989,G0372,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
42600471_2,IMMUNIZATION ADMIN,ProFee,0989,90471,,,,0,38.00,28.50,28.50,29.00,0.00,29.00,29.00,N/A
42600471_3,IMMUNIZATION ADMIN,ProFee,0989,90471,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
42600472_2,"IMMUNIZATION ADMIN, EACH ADD",ProFee,0989,90472,,,,0,24.00,18.00,18.00,18.00,0.00,18.00,18.00,N/A
42600472_3,"IMMUNIZATION ADMIN, EACH ADD",ProFee,0989,90472,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
42600525_2,REMOVAL OF FOREIGN BODY,ProFee,0989,20525,,,,0,628.00,471.00,356.00,471.00,0.00,356.00,356.00,N/A
42600525_3,REMOVAL OF FOREIGN BODY,ProFee,0989,20525,,,,0,3.00,2.25,2.25,356.00,0.00,356.00,356.00,N/A
42600550_2,INJ TENDON SHEATH/LIGAMENT,ProFee,0989,20550,,,,0,167.00,125.25,56.50,125.25,0.00,56.50,56.50,N/A
42600550_3,INJ TENDON SHEATH/LIGAMENT,ProFee,0989,20550,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
42600552_2,"INJ TRIGGER POINT, 1/2 MUSCL",ProFee,0989,20552,,,,0,187.00,140.25,54.50,140.25,0.00,54.50,54.50,N/A
42600552_3,"INJ TRIGGER POINT, 1/2 MUSCL",ProFee,0989,20552,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
42600553_2,"INJECT TRIGGER POINTS, =/> 3",ProFee,0989,20553,,,,0,187.00,140.25,62.00,140.25,0.00,62.00,62.00,N/A
42600553_3,"INJECT TRIGGER POINTS, =/> 3",ProFee,0989,20553,,,,0,3.00,2.25,2.25,62.00,0.00,62.00,62.00,N/A
42600570_2,Penicillin g benzathine inj,ProFee,0989,J0561,,,,0,55.00,41.25,41.25,41.25,0.00,N/A,N/A,N/A
42600570_3,Penicillin g benzathine inj,ProFee,0989,J0561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600595_2,Butorphanol tartrate 1 mg,ProFee,0989,J0595,,,,0,40.00,30.00,30.00,30.00,0.00,N/A,N/A,N/A
42600595_3,Butorphanol tartrate 1 mg,ProFee,0989,J0595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600600_2,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20600,,,,0,153.00,114.75,51.00,114.75,0.00,51.00,51.00,N/A
42600600_3,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20600,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
42600605_2,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20605,,,,0,159.00,119.25,54.00,119.25,0.00,54.00,54.00,N/A
42600605_3,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20605,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
42600610_2,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20610,,,,0,167.00,125.25,66.50,125.25,0.00,66.50,66.50,N/A
42600610_3,"DRAIN/INJECT, JOINT/BURSA",ProFee,0989,20610,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
42600612_2,ASPIRATE/INJ GANGLION CYST,ProFee,0989,20612,,,,0,167.00,125.25,60.50,125.25,0.00,60.50,60.50,N/A
42600612_3,ASPIRATE/INJ GANGLION CYST,ProFee,0989,20612,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
42600632_2,"HEP A VACCINE, ADULT IM",ProFee,0989,90632,,,,0,104.00,78.00,78.00,78.00,0.00,N/A,N/A,N/A
42600632_3,"HEP A VACCINE, ADULT IM",ProFee,0989,90632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600633_2,"HEP A VACC, PED/ADOL, 2 DOSE",ProFee,0989,90633,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600633_3,"HEP A VACC, PED/ADOL, 2 DOSE",ProFee,0989,90633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600648_2,"HIB VACCINE, PRP-T, IM",ProFee,0989,90648,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600648_3,"HIB VACCINE, PRP-T, IM",ProFee,0989,90648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600649_2,H PAPILLOMA VACC 3 DOSE IM,ProFee,0989,90649,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600649_3,H PAPILLOMA VACC 3 DOSE IM,ProFee,0989,90649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600650_2,HPV TYP BIVAL 3 DOSE IM,ProFee,0989,90650,,,,0,265.00,198.75,198.75,198.75,0.00,N/A,N/A,N/A
42600650_3,HPV TYP BIVAL 3 DOSE IM,ProFee,0989,90650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600656_2,FLU VACCINE NO PRESERV 6-35M,ProFee,0989,90655,,,n4492810419,0,21.00,15.75,15.75,15.75,0.00,N/A,N/A,N/A
42600656_3,FLU VACCINE NO PRESERV 6-35M,ProFee,0989,90655,,,n4492810419,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600657_2,"FLU VACCINE, 3 YRS, IM",ProFee,0989,90657,,,N4492810519,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600657_3,"FLU VACCINE, 3 YRS, IM",ProFee,0989,90657,,,N4492810519,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600658_2,"FLU VACCINE, 3 YRS & >, IM",ProFee,0989,90658,,,N4492810631,0,21.00,15.75,15.75,15.75,0.00,N/A,N/A,N/A
42600658_3,"FLU VACCINE, 3 YRS & >, IM",ProFee,0989,90658,,,N4492810631,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600696_2,Ceftriaxone sodium injection,Outpatient,0251,J0696,,,00004-1964-04,0,72.00,54.00,54.00,68.40,64.80,68.40,68.40,64.80
42600696_2,Ceftriaxone sodium injection,Inpatient,0251,J0696,,,00004-1964-04,0,72.00,54.00,54.00,68.40,64.80,68.40,68.40,64.80
42600696_3,Ceftriaxone sodium injection,Inpatient,0251,J0696,,,00004-1964-04,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42600696_3,Ceftriaxone sodium injection,Outpatient,0251,J0696,,,00004-1964-04,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42600698_2,"DTAP-HIB-IP VACCINE, IM",ProFee,0989,90698,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600698_3,"DTAP-HIB-IP VACCINE, IM",ProFee,0989,90698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600700_2,"DTAP VACCINE, < 7 YRS, IM",ProFee,0989,90700,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600700_3,"DTAP VACCINE, < 7 YRS, IM",ProFee,0989,90700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600703_2,"TETANUS VACCINE, IM",ProFee,0989,90703,,,,0,16.00,12.00,12.00,12.00,N/A,N/A,N/A,N/A
42600703_3,"TETANUS VACCINE, IM",ProFee,0989,90703,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600706_2,"RUBELLA VACCINE, SC",ProFee,0989,90706,,,,0,63.00,47.25,47.25,47.25,N/A,N/A,N/A,N/A
42600706_3,"RUBELLA VACCINE, SC",ProFee,0989,90706,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600707_2,"MMR VACCINE, SC",ProFee,0989,90707,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600707_3,"MMR VACCINE, SC",ProFee,0989,90707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600710_2,"MMRV VACCINE, SC",ProFee,0989,90710,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600710_3,"MMRV VACCINE, SC",ProFee,0989,90710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600713_2,"POLIOVIRUS, IPV, SC",ProFee,0989,90713,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600713_3,"POLIOVIRUS, IPV, SC",ProFee,0989,90713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600714_2,TD VACCINE >7 IM,ProFee,0989,90714,,,,0,73.00,54.75,54.75,54.75,0.00,N/A,N/A,N/A
42600714_3,TD VACCINE >7 IM,ProFee,0989,90714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600715_2,TDAP VACCINE >7 IM,ProFee,0989,90715,,,,0,73.00,54.75,54.75,54.75,0.00,N/A,N/A,N/A
42600715_3,TDAP VACCINE >7 IM,ProFee,0989,90715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600716_2,"CHICKEN POX VACCINE, SC",ProFee,0989,90716,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600716_3,"CHICKEN POX VACCINE, SC",ProFee,0989,90716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600718_2,"TD VACCINE > 7, IM",ProFee,0989,90718,,,,0,70.00,52.50,52.50,52.50,N/A,N/A,N/A,N/A
42600718_3,"TD VACCINE > 7, IM",ProFee,0989,90718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600732_2,PNEUMOCOCCAL VACCINE,ProFee,0989,90732,,,,0,75.00,56.25,56.25,56.25,0.00,N/A,N/A,N/A
42600732_3,PNEUMOCOCCAL VACCINE,ProFee,0989,90732,,,,0,76.00,57.00,57.00,57.00,0.00,N/A,N/A,N/A
42600733_2,"MENINGOCOCCAL VACCINE, SC",ProFee,0989,90733,,,,0,181.00,135.75,135.75,135.75,0.00,N/A,N/A,N/A
42600733_3,"MENINGOCOCCAL VACCINE, SC",ProFee,0989,90733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600734_2,"MENINGOCOCCAL VACCINE, IM",ProFee,0989,90734,,,,0,154.00,115.50,115.50,115.50,0.00,N/A,N/A,N/A
42600734_3,"MENINGOCOCCAL VACCINE, IM",ProFee,0989,90734,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600736_2,"ZOSTER VACC, SC",ProFee,0989,90736,,,,0,282.00,211.50,211.50,211.50,0.00,N/A,N/A,N/A
42600736_3,"ZOSTER VACC, SC",ProFee,0989,90736,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600744_2,HEPB VACC PED/ADOL 3 DOSE IM,ProFee,0989,90744,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600744_3,HEPB VACC PED/ADOL 3 DOSE IM,ProFee,0989,90744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600746_2,"HEP B VACCINE, ADULT, IM",ProFee,0989,90746,,,,0,104.00,78.00,78.00,78.00,0.00,N/A,N/A,N/A
42600746_3,"HEP B VACCINE, ADULT, IM",ProFee,0989,90746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600772_2,"THER/PROPH/DIAG INJ, SC/IM",ProFee,0989,96372,,,,0,38.00,28.50,28.50,29.00,0.00,29.00,29.00,N/A
42600772_3,"THER/PROPH/DIAG INJ, SC/IM",ProFee,0989,96372,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
42600780_2,Prochlorperazine injection,ProFee,0989,J0780,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42600780_3,Prochlorperazine injection,ProFee,0989,J0780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600782_2,"THER/PROPH/DIAG INJ, SC/IM",ProFee,0989,90772,,,,0,38.00,28.50,28.50,28.50,N/A,N/A,N/A,N/A
42600782_3,"THER/PROPH/DIAG INJ, SC/IM",ProFee,0989,90772,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600784_2,Glucagon hydrochloride/1 MG,ProFee,0989,J1610,,,,0,87.00,65.25,65.25,65.25,0.00,N/A,N/A,N/A
42600784_3,Glucagon hydrochloride/1 MG,ProFee,0989,J1610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600800_2,Corticotropin injection,ProFee,0989,J0800,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42600800_3,Corticotropin injection,ProFee,0989,J0800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42600901_2,CONTROL OF NOSEBLEED,ProFee,0989,30901,,,,0,210.00,157.50,81.00,157.50,0.00,81.00,81.00,N/A
42600901_3,CONTROL OF NOSEBLEED,ProFee,0989,30901,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
42600903_2,CONTROL OF NOSEBLEED,ProFee,0989,30903,,,,0,263.00,197.25,112.50,197.25,0.00,112.50,112.50,N/A
42600903_3,CONTROL OF NOSEBLEED,ProFee,0989,30903,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
42600936_2,Ko elastic knee cap,ProFee,0989,L1825,,,,0,40.00,30.00,30.00,30.00,N/A,N/A,N/A,N/A
42600936_3,Ko elastic knee cap,ProFee,0989,L1825,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42600970_2,Estradiol valerate 10 MG inj,ProFee,0989,J1380,,,,0,31.00,23.25,23.25,23.25,0.00,N/A,N/A,N/A
42600970_3,Estradiol valerate 10 MG inj,ProFee,0989,J1380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601001_2,DRAIN BLADDER BY NEEDLE,ProFee,0989,51100,,,,0,138.00,103.50,56.00,103.50,0.00,56.00,56.00,N/A
42601001_3,DRAIN BLADDER BY NEEDLE,ProFee,0989,51100,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
42601010_2,INCISION OF TONGUE FOLD,ProFee,0989,41010,,,,0,418.00,313.50,155.00,313.50,0.00,155.00,155.00,N/A
42601010_3,INCISION OF TONGUE FOLD,ProFee,0989,41010,,,,0,3.00,2.25,2.25,155.00,0.00,155.00,155.00,N/A
42601040_2,Methylprednisolone 80 MG inj,ProFee,0989,J1040,,,,0,60.00,45.00,45.00,45.00,0.00,N/A,N/A,N/A
42601040_3,Methylprednisolone 80 MG inj,ProFee,0989,J1040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601042_2,DEBRIDE SKIN/TISSUE,ProFee,0989,11042,,,,0,334.00,250.50,89.00,250.50,0.00,89.00,89.00,N/A
42601042_3,DEBRIDE SKIN/TISSUE,ProFee,0989,11042,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
42601055_2,TRIM SKIN LESION,ProFee,0989,11055,,,,0,104.00,78.00,23.00,78.00,0.00,23.00,23.00,N/A
42601055_3,TRIM SKIN LESION,ProFee,0989,11055,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
42601056_2,"TRIM SKIN LESIONS, 2 TO 4",ProFee,0989,11056,,,,0,118.00,88.50,32.50,88.50,0.00,32.50,32.50,N/A
42601056_3,"TRIM SKIN LESIONS, 2 TO 4",ProFee,0989,11056,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
42601070_2,Testosterone cypionat 100 MG,ProFee,0989,J1070,,,,0,7.00,5.25,5.25,5.25,N/A,N/A,N/A,N/A
42601070_3,Testosterone cypionat 100 MG,ProFee,0989,J1070,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42601080_2,Testosterone cypionat 200 MG,ProFee,0989,J1080,,,,0,7.00,5.25,5.25,5.25,N/A,N/A,N/A,N/A
42601080_3,Testosterone cypionat 200 MG,ProFee,0989,J1080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42601101_2,"BIOPSY, SKIN ADD-ON",ProFee,0989,11101,,,,0,118.00,88.50,36.00,88.50,0.00,36.00,36.00,N/A
42601101_3,"BIOPSY, SKIN ADD-ON",ProFee,0989,11101,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
42601105_2,GASTRIC INTUBATION TREATMENT,ProFee,0989,91105,,,,0,50.00,37.50,37.50,37.50,N/A,N/A,N/A,N/A
42601105_3,GASTRIC INTUBATION TREATMENT,ProFee,0989,91105,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42601110_2,EXCISION OF TONGUE LESION,ProFee,0989,41110,,,,0,389.00,291.75,189.00,291.75,0.00,189.00,189.00,N/A
42601110_3,EXCISION OF TONGUE LESION,ProFee,0989,41110,,,,0,3.00,2.25,2.25,189.00,0.00,189.00,189.00,N/A
42601111_2,MEDICAL TESTIMONY,ProFee,0989,99075,,,,0,523.00,392.25,392.25,392.25,0.00,N/A,N/A,N/A
42601111_3,MEDICAL TESTIMONY,ProFee,0989,99075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601170_2,Hydromorphone injection,ProFee,0989,J1170,,,,0,27.00,20.25,20.25,20.25,0.00,N/A,N/A,N/A
42601170_3,Hydromorphone injection,ProFee,0989,J1170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601201_2,REMOVE SKIN TAGS ADD-ON,ProFee,0989,11201,,,,0,124.00,93.00,24.50,93.00,0.00,24.50,24.50,N/A
42601201_3,REMOVE SKIN TAGS ADD-ON,ProFee,0989,11201,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
42601300_2,SHAVE SKIN LESION,ProFee,0989,11300,,,,0,140.00,105.00,51.00,105.00,0.00,51.00,51.00,N/A
42601300_3,SHAVE SKIN LESION,ProFee,0989,11300,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
42601301_2,SHAVE SKIN LESION,ProFee,0989,11301,,,,0,167.00,125.25,77.00,125.25,0.00,77.00,77.00,N/A
42601301_3,SHAVE SKIN LESION,ProFee,0989,11301,,,,0,3.00,2.25,2.25,77.00,0.00,77.00,77.00,N/A
42601302_2,SHAVE SKIN LESION,ProFee,0989,11302,,,,0,181.00,135.75,91.00,135.75,0.00,91.00,91.00,N/A
42601302_3,SHAVE SKIN LESION,ProFee,0989,11302,,,,0,3.00,2.25,2.25,91.00,0.00,91.00,91.00,N/A
42601303_2,SHAVE SKIN LESION,ProFee,0989,11303,,,,0,222.00,166.50,107.00,166.50,0.00,107.00,107.00,N/A
42601303_3,SHAVE SKIN LESION,ProFee,0989,11303,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
42601305_2,SHAVE SKIN LESION,ProFee,0989,11305,,,,0,140.00,105.00,56.00,105.00,0.00,56.00,56.00,N/A
42601305_3,SHAVE SKIN LESION,ProFee,0989,11305,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
42601306_2,SHAVE SKIN LESION,ProFee,0989,11306,,,,0,167.00,125.25,75.00,125.25,0.00,75.00,75.00,N/A
42601306_3,SHAVE SKIN LESION,ProFee,0989,11306,,,,0,3.00,2.25,2.25,75.00,0.00,75.00,75.00,N/A
42601307_2,SHAVE SKIN LESION,ProFee,0989,11307,,,,0,210.00,157.50,96.50,157.50,0.00,96.50,96.50,N/A
42601307_3,SHAVE SKIN LESION,ProFee,0989,11307,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
42601308_2,SHAVE SKIN LESION,ProFee,0989,11308,,,,0,263.00,197.25,106.50,197.25,0.00,106.50,106.50,N/A
42601308_3,SHAVE SKIN LESION,ProFee,0989,11308,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
42601311_2,SHAVE SKIN LESION,ProFee,0989,11311,,,,0,187.00,140.25,94.50,140.25,0.00,94.50,94.50,N/A
42601311_3,SHAVE SKIN LESION,ProFee,0989,11311,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
42601312_2,SHAVE SKIN LESION,ProFee,0989,11312,,,,0,228.00,171.00,112.50,171.00,0.00,112.50,112.50,N/A
42601312_3,SHAVE SKIN LESION,ProFee,0989,11312,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
42601313_2,SHAVE SKIN LESION,ProFee,0989,11313,,,,0,263.00,197.25,145.00,197.25,0.00,145.00,145.00,N/A
42601313_3,SHAVE SKIN LESION,ProFee,0989,11313,,,,0,3.00,2.25,2.25,145.00,0.00,145.00,145.00,N/A
42601314_2,Ko immobilizer canvas longit,ProFee,0989,L1830,,,,0,117.00,87.75,87.75,87.75,0.00,N/A,N/A,N/A
42601314_3,Ko immobilizer canvas longit,ProFee,0989,L1830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601400_2,EXC TR-EXT B9+MARG 0.5 < CM,ProFee,0989,11400,,,,0,193.00,144.75,116.00,144.75,0.00,116.00,116.00,N/A
42601400_3,EXC TR-EXT B9+MARG 0.5 < CM,ProFee,0989,11400,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
42601401_2,EXC TR-EXT B9+MARG 0.6-1 CM,ProFee,0989,11401,,,,0,278.00,208.50,149.00,208.50,0.00,149.00,149.00,N/A
42601401_3,EXC TR-EXT B9+MARG 0.6-1 CM,ProFee,0989,11401,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
42601402_2,EXC TR-EXT B9+MARG 1.1-2 CM,ProFee,0989,11402,,,,0,349.00,261.75,164.50,261.75,0.00,164.50,164.50,N/A
42601402_3,EXC TR-EXT B9+MARG 1.1-2 CM,ProFee,0989,11402,,,,0,3.00,2.25,2.25,164.50,0.00,164.50,164.50,N/A
42601403_2,EXC TR-EXT B9+MARG 2.1-3 CM,ProFee,0989,11403,,,,0,389.00,291.75,212.00,291.75,0.00,212.00,212.00,N/A
42601403_3,EXC TR-EXT B9+MARG 2.1-3 CM,ProFee,0989,11403,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
42601404_2,EXC TR-EXT B9+MARG 3.1-4 CM,ProFee,0989,11404,,,,0,418.00,313.50,233.00,313.50,0.00,233.00,233.00,N/A
42601404_3,EXC TR-EXT B9+MARG 3.1-4 CM,ProFee,0989,11404,,,,0,3.00,2.25,2.25,233.00,0.00,233.00,233.00,N/A
42601406_2,EXC TR-EXT B9+MARG > 4.0 CM,ProFee,0989,11406,,,,0,481.00,360.75,355.50,360.75,0.00,355.50,355.50,N/A
42601406_3,EXC TR-EXT B9+MARG > 4.0 CM,ProFee,0989,11406,,,,0,3.00,2.25,2.25,355.50,0.00,355.50,355.50,N/A
42601420_2,EXC H-F-NK-SP B9+MARG 0.5 <,ProFee,0989,11420,,,,0,210.00,157.50,116.50,157.50,0.00,116.50,116.50,N/A
42601420_3,EXC H-F-NK-SP B9+MARG 0.5 <,ProFee,0989,11420,,,,0,3.00,2.25,2.25,116.50,0.00,116.50,116.50,N/A
42601421_2,EXC H-F-NK-SP B9+MARG 0.6-1,ProFee,0989,11421,,,,0,278.00,208.50,157.50,208.50,0.00,157.50,157.50,N/A
42601421_3,EXC H-F-NK-SP B9+MARG 0.6-1,ProFee,0989,11421,,,,0,3.00,2.25,2.25,157.50,0.00,157.50,157.50,N/A
42601422_2,EXC H-F-NK-SP B9+MARG 1.1-2,ProFee,0989,11422,,,,0,349.00,261.75,196.00,261.75,0.00,196.00,196.00,N/A
42601422_3,EXC H-F-NK-SP B9+MARG 1.1-2,ProFee,0989,11422,,,,0,3.00,2.25,2.25,196.00,0.00,196.00,196.00,N/A
42601423_2,EXC H-F-NK-SP B9+MARG 2.1-3,ProFee,0989,11423,,,,0,418.00,313.50,224.50,313.50,0.00,224.50,224.50,N/A
42601423_3,EXC H-F-NK-SP B9+MARG 2.1-3,ProFee,0989,11423,,,,0,3.00,2.25,2.25,224.50,0.00,224.50,224.50,N/A
42601424_2,EXC H-F-NK-SP B9+MARG 3.1-4,ProFee,0989,11424,,,,0,488.00,366.00,258.00,366.00,0.00,258.00,258.00,N/A
42601424_3,EXC H-F-NK-SP B9+MARG 3.1-4,ProFee,0989,11424,,,,0,3.00,2.25,2.25,258.00,0.00,258.00,258.00,N/A
42601426_2,EXC H-F-NK-SP B9+MARG > 4 CM,ProFee,0989,11426,,,,0,576.00,432.00,396.50,432.00,0.00,396.50,396.50,N/A
42601426_3,EXC H-F-NK-SP B9+MARG > 4 CM,ProFee,0989,11426,,,,0,3.00,2.25,2.25,396.50,0.00,396.50,396.50,N/A
42601440_2,EXC FACE-MM B9+MARG 0.5 < CM,ProFee,0989,11440,,,,0,278.00,208.50,148.00,208.50,0.00,148.00,148.00,N/A
42601440_3,EXC FACE-MM B9+MARG 0.5 < CM,ProFee,0989,11440,,,,0,3.00,2.25,2.25,148.00,0.00,148.00,148.00,N/A
42601441_2,EXC FACE-MM B9+MARG 0.6-1 CM,ProFee,0989,11441,,,,0,349.00,261.75,188.50,261.75,0.00,188.50,188.50,N/A
42601441_3,EXC FACE-MM B9+MARG 0.6-1 CM,ProFee,0989,11441,,,,0,3.00,2.25,2.25,188.50,0.00,188.50,188.50,N/A
42601442_2,EXC FACE-MM B9+MARG 1.1-2 CM,ProFee,0989,11442,,,,0,413.00,309.75,208.00,309.75,0.00,208.00,208.00,N/A
42601442_3,EXC FACE-MM B9+MARG 1.1-2 CM,ProFee,0989,11442,,,,0,3.00,2.25,2.25,208.00,0.00,208.00,208.00,N/A
42601443_2,EXC FACE-MM B9+MARG 2.1-3 CM,ProFee,0989,11443,,,,0,488.00,366.00,255.00,366.00,0.00,255.00,255.00,N/A
42601443_3,EXC FACE-MM B9+MARG 2.1-3 CM,ProFee,0989,11443,,,,0,3.00,2.25,2.25,255.00,0.00,255.00,255.00,N/A
42601444_2,EXC FACE-MM B9+MARG 3.1-4 CM,ProFee,0989,11444,,,,0,542.00,406.50,325.50,406.50,0.00,325.50,325.50,N/A
42601444_3,EXC FACE-MM B9+MARG 3.1-4 CM,ProFee,0989,11444,,,,0,3.00,2.25,2.25,325.50,0.00,325.50,325.50,N/A
42601446_2,EXC FACE-MM B9+MARG > 4 CM,ProFee,0989,11446,,,,0,622.00,466.50,466.50,467.00,0.00,467.00,467.00,N/A
42601446_3,EXC FACE-MM B9+MARG > 4 CM,ProFee,0989,11446,,,,0,3.00,2.25,2.25,467.00,0.00,467.00,467.00,N/A
42601451_2,TREAT LOWER JAW FRACTURE,ProFee,0989,21451,,,,0,837.00,627.75,627.75,902.50,0.00,902.50,902.50,N/A
42601451_3,TREAT LOWER JAW FRACTURE,ProFee,0989,21451,,,,0,3.00,2.25,2.25,902.50,0.00,902.50,902.50,N/A
42601500_2,INSERT EMERGENCY AIRWAY,ProFee,0989,31500,,,,0,330.00,247.50,203.00,247.50,0.00,203.00,203.00,N/A
42601500_3,INSERT EMERGENCY AIRWAY,ProFee,0989,31500,,,,0,3.00,2.25,2.25,203.00,0.00,203.00,203.00,N/A
42601505_2,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31505,,,,0,318.00,238.50,69.50,238.50,0.00,69.50,69.50,N/A
42601505_3,DIAGNOSTIC LARYNGOSCOPY,ProFee,0989,31505,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
42601600_2,EXC TR-EXT MLG+MARG 0.5 < CM,ProFee,0989,11600,,,,0,313.00,234.75,172.00,234.75,0.00,172.00,172.00,N/A
42601600_3,EXC TR-EXT MLG+MARG 0.5 < CM,ProFee,0989,11600,,,,0,3.00,2.25,2.25,172.00,0.00,172.00,172.00,N/A
42601601_2,EXC TR-EXT MLG+MARG 0.6-1 CM,ProFee,0989,11601,,,,0,354.00,265.50,214.00,265.50,0.00,214.00,214.00,N/A
42601601_3,EXC TR-EXT MLG+MARG 0.6-1 CM,ProFee,0989,11601,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
42601602_2,EXC TR-EXT MLG+MARG 1.1-2 CM,ProFee,0989,11602,,,,0,362.00,271.50,235.50,271.50,0.00,235.50,235.50,N/A
42601602_3,EXC TR-EXT MLG+MARG 1.1-2 CM,ProFee,0989,11602,,,,0,3.00,2.25,2.25,235.50,0.00,235.50,235.50,N/A
42601604_2,EXC TR-EXT MLG+MARG 3.1-4 CM,ProFee,0989,11604,,,,0,473.00,354.75,310.50,354.75,0.00,310.50,310.50,N/A
42601604_3,EXC TR-EXT MLG+MARG 3.1-4 CM,ProFee,0989,11604,,,,0,3.00,2.25,2.25,310.50,0.00,310.50,310.50,N/A
42601606_2,EXC TR-EXT MLG+MARG > 4 CM,ProFee,0989,11606,,,,0,628.00,471.00,462.00,471.00,0.00,462.00,462.00,N/A
42601606_3,EXC TR-EXT MLG+MARG > 4 CM,ProFee,0989,11606,,,,0,3.00,2.25,2.25,462.00,0.00,462.00,462.00,N/A
42601620_2,EXC H-F-NK-SP MLG+MARG 0.5 <,ProFee,0989,11620,,,,0,293.00,219.75,174.00,219.75,0.00,174.00,174.00,N/A
42601620_3,EXC H-F-NK-SP MLG+MARG 0.5 <,ProFee,0989,11620,,,,0,3.00,2.25,2.25,174.00,0.00,174.00,174.00,N/A
42601621_2,EXC H-F-NK-SP MLG+MARG 0.6-1,ProFee,0989,11621,,,,0,349.00,261.75,215.50,261.75,0.00,215.50,215.50,N/A
42601621_3,EXC H-F-NK-SP MLG+MARG 0.6-1,ProFee,0989,11621,,,,0,3.00,2.25,2.25,215.50,0.00,215.50,215.50,N/A
42601623_2,EXC H-F-NK-SP MLG+MARG 2.1-3,ProFee,0989,11623,,,,0,786.00,589.50,306.00,589.50,0.00,306.00,306.00,N/A
42601623_3,EXC H-F-NK-SP MLG+MARG 2.1-3,ProFee,0989,11623,,,,0,3.00,2.25,2.25,306.00,0.00,306.00,306.00,N/A
42601624_2,EXC H-F-NK-SP MLG+MARG 3.1-4,ProFee,0989,11624,,,,0,610.00,457.50,346.50,457.50,0.00,346.50,346.50,N/A
42601624_3,EXC H-F-NK-SP MLG+MARG 3.1-4,ProFee,0989,11624,,,,0,3.00,2.25,2.25,346.50,0.00,346.50,346.50,N/A
42601630_2,Haloperidol injection,ProFee,0989,J1630,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42601630_3,Haloperidol injection,ProFee,0989,J1630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601640_2,EXC FACE-MM MALIG+MARG 0.5 <,ProFee,0989,11640,,,,0,349.00,261.75,180.00,261.75,0.00,180.00,180.00,N/A
42601640_3,EXC FACE-MM MALIG+MARG 0.5 <,ProFee,0989,11640,,,,0,3.00,2.25,2.25,180.00,0.00,180.00,180.00,N/A
42601641_2,EXC FACE-MM MALIG+MARG 0.6-1,ProFee,0989,11641,,,,0,418.00,313.50,224.50,313.50,0.00,224.50,224.50,N/A
42601641_3,EXC FACE-MM MALIG+MARG 0.6-1,ProFee,0989,11641,,,,0,3.00,2.25,2.25,224.50,0.00,224.50,224.50,N/A
42601642_2,EXC FACE-MM MALIG+MARG 1.1-2,ProFee,0989,11642,,,,0,853.00,639.75,264.50,639.75,0.00,264.50,264.50,N/A
42601642_3,EXC FACE-MM MALIG+MARG 1.1-2,ProFee,0989,11642,,,,0,3.00,2.25,2.25,264.50,0.00,264.50,264.50,N/A
42601644_2,Inj heparin sodium per 1000u,ProFee,0989,J1644,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42601644_3,Inj heparin sodium per 1000u,ProFee,0989,J1644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601650_2,Inj enoxaparin sodium,ProFee,0989,J1650,,,,0,32.00,24.00,24.00,24.00,0.00,N/A,N/A,N/A
42601650_3,Inj enoxaparin sodium,ProFee,0989,J1650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601719_2,TRIM NAIL(S),ProFee,0989,11719,,,,0,48.00,36.00,11.00,36.00,0.00,11.00,11.00,N/A
42601719_3,TRIM NAIL(S),ProFee,0989,11719,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
42601720_2,"DEBRIDE NAIL, 1-5",ProFee,0989,11720,,,,0,73.00,54.75,21.00,54.75,0.00,21.00,21.00,N/A
42601720_3,"DEBRIDE NAIL, 1-5",ProFee,0989,11720,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
42601721_2,"DEBRIDE NAIL, 6 OR MORE",ProFee,0989,11721,,,,0,132.00,99.00,35.50,99.00,0.00,35.50,35.50,N/A
42601721_3,"DEBRIDE NAIL, 6 OR MORE",ProFee,0989,11721,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
42601730_2,REMOVAL OF NAIL PLATE,ProFee,0989,11730,,,,0,167.00,125.25,79.50,125.25,0.00,79.50,79.50,N/A
42601730_3,REMOVAL OF NAIL PLATE,ProFee,0989,11730,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
42601732_2,"REMOVE NAIL PLATE, ADD-ON",ProFee,0989,11732,,,,0,112.00,84.00,25.50,84.00,0.00,25.50,25.50,N/A
42601732_3,"REMOVE NAIL PLATE, ADD-ON",ProFee,0989,11732,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
42601740_2,DRAIN BLOOD FROM UNDER NAIL,ProFee,0989,11740,,,,0,76.00,57.00,47.00,57.00,0.00,47.00,47.00,N/A
42601740_3,DRAIN BLOOD FROM UNDER NAIL,ProFee,0989,11740,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
42601750_2,REMOVAL OF NAIL BED,ProFee,0989,11750,,,,0,285.00,213.75,145.50,213.75,0.00,145.50,145.50,N/A
42601750_3,REMOVAL OF NAIL BED,ProFee,0989,11750,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
42601765_2,"EXCISION OF NAIL FOLD, TOE",ProFee,0989,11765,,,,0,98.00,73.50,73.50,134.00,0.00,134.00,134.00,N/A
42601765_3,"EXCISION OF NAIL FOLD, TOE",ProFee,0989,11765,,,,0,3.00,2.25,2.25,134.00,0.00,134.00,134.00,N/A
42601815_2,Insulin injection,ProFee,0989,J1815,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42601815_3,Insulin injection,ProFee,0989,J1815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601885_2,Ketorolac tromethamine inj,Outpatient,0251,J1885,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
42601885_2,Ketorolac tromethamine inj,Inpatient,0251,J1885,,,,0,17.00,12.75,12.75,16.15,15.30,16.15,16.15,15.30
42601885_3,Ketorolac tromethamine inj,Outpatient,0251,J1885,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42601885_3,Ketorolac tromethamine inj,Inpatient,0251,J1885,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42601906_2,Afo multiligamentus ankle su,ProFee,0989,L1906,,,,0,103.00,77.25,77.25,77.25,0.00,N/A,N/A,N/A
42601906_3,Afo multiligamentus ankle su,ProFee,0989,L1906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42601940_2,Furosemide injection,ProFee,0989,J1940,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42601940_3,Furosemide injection,ProFee,0989,J1940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602000_2,DRAINAGE OF CHEST,ProFee,0989,32000,,,,0,362.00,271.50,271.50,271.50,N/A,N/A,N/A,N/A
42602000_3,DRAINAGE OF CHEST,ProFee,0989,32000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42602001_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12001,,,,0,284.00,213.00,63.50,213.00,0.00,63.50,63.50,N/A
42602001_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12001,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
42602005_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12005,,,,0,460.00,345.00,136.00,345.00,0.00,136.00,136.00,N/A
42602005_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12005,,,,0,3.00,2.25,2.25,136.00,0.00,136.00,136.00,N/A
42602007_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12007,,,,0,628.00,471.00,210.00,471.00,0.00,210.00,210.00,N/A
42602007_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12007,,,,0,3.00,2.25,2.25,210.00,0.00,210.00,210.00,N/A
42602008_2,Surgical trays,ProFee,0989,A4550,,,,0,50.00,37.50,37.50,37.50,0.00,N/A,N/A,N/A
42602008_3,Surgical trays,ProFee,0989,A4550,,,,0,52.00,39.00,39.00,39.00,0.00,N/A,N/A,N/A
42602011_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12011,,,,0,315.00,236.25,79.00,236.25,0.00,79.00,79.00,N/A
42602011_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12011,,,,0,3.00,2.25,2.25,79.00,0.00,79.00,79.00,N/A
42602013_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12013,,,,0,349.00,261.75,83.00,261.75,0.00,83.00,83.00,N/A
42602013_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12013,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
42602014_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12014,,,,0,418.00,313.50,107.00,313.50,0.00,107.00,107.00,N/A
42602014_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12014,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
42602015_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12015,,,,0,384.00,288.00,134.50,288.00,0.00,134.50,134.50,N/A
42602015_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12015,,,,0,3.00,2.25,2.25,134.50,0.00,134.50,134.50,N/A
42602016_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12016,,,,0,488.00,366.00,183.00,366.00,0.00,183.00,183.00,N/A
42602016_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12016,,,,0,3.00,2.25,2.25,183.00,0.00,183.00,183.00,N/A
42602017_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12017,,,,0,641.00,480.75,219.50,480.75,0.00,219.50,219.50,N/A
42602017_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12017,,,,0,3.00,2.25,2.25,219.50,0.00,219.50,219.50,N/A
42602018_2,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12018,,,,0,662.00,496.50,248.50,496.50,0.00,248.50,248.50,N/A
42602018_3,REPAIR SUPERFICIAL WOUND(S),ProFee,0989,12018,,,,0,3.00,2.25,2.25,248.50,0.00,248.50,248.50,N/A
42602020_2,THORACENTESIS FOR ASPIRATION,ProFee,0989,32421,,,,0,438.00,328.50,328.50,328.50,N/A,N/A,N/A,N/A
42602020_3,THORACENTESIS FOR ASPIRATION,ProFee,0989,32421,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42602031_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12031,,,,0,349.00,261.75,220.50,261.75,0.00,220.50,220.50,N/A
42602031_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12031,,,,0,3.00,2.25,2.25,220.50,0.00,220.50,220.50,N/A
42602034_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12034,,,,0,473.00,354.75,299.50,354.75,0.00,299.50,299.50,N/A
42602034_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12034,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
42602035_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12035,,,,0,558.00,418.50,346.00,418.50,0.00,346.00,346.00,N/A
42602035_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12035,,,,0,3.00,2.25,2.25,346.00,0.00,346.00,346.00,N/A
42602036_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12036,,,,0,683.00,512.25,404.00,512.25,0.00,404.00,404.00,N/A
42602036_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12036,,,,0,3.00,2.25,2.25,404.00,0.00,404.00,404.00,N/A
42602040_2,EO w/o joints CF,ProFee,0989,L3702,,,,0,47.00,35.25,35.25,35.25,0.00,N/A,N/A,N/A
42602040_3,EO w/o joints CF,ProFee,0989,L3702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602041_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12041,,,,0,389.00,291.75,216.50,291.75,0.00,216.50,216.50,N/A
42602041_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12041,,,,0,3.00,2.25,2.25,216.50,0.00,216.50,216.50,N/A
42602044_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12044,,,,0,508.00,381.00,310.00,381.00,0.00,310.00,310.00,N/A
42602044_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12044,,,,0,3.00,2.25,2.25,310.00,0.00,310.00,310.00,N/A
42602045_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12045,,,,0,586.00,439.50,387.50,439.50,0.00,387.50,387.50,N/A
42602045_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12045,,,,0,3.00,2.25,2.25,387.50,0.00,387.50,387.50,N/A
42602046_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12046,,,,0,680.00,510.00,448.50,510.00,0.00,448.50,448.50,N/A
42602046_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12046,,,,0,3.00,2.25,2.25,448.50,0.00,448.50,448.50,N/A
42602051_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12051,,,,0,453.00,339.75,247.00,339.75,0.00,247.00,247.00,N/A
42602051_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12051,,,,0,3.00,2.25,2.25,247.00,0.00,247.00,247.00,N/A
42602052_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12052,,,,0,488.00,366.00,294.00,366.00,0.00,294.00,294.00,N/A
42602052_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12052,,,,0,3.00,2.25,2.25,294.00,0.00,294.00,294.00,N/A
42602053_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12053,,,,0,593.00,444.75,314.50,444.75,0.00,314.50,314.50,N/A
42602053_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12053,,,,0,3.00,2.25,2.25,314.50,0.00,314.50,314.50,N/A
42602054_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12054,,,,0,702.00,526.50,320.50,526.50,0.00,320.50,320.50,N/A
42602054_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12054,,,,0,3.00,2.25,2.25,320.50,0.00,320.50,320.50,N/A
42602055_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12055,,,,0,803.00,602.25,438.00,602.25,0.00,438.00,438.00,N/A
42602055_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12055,,,,0,3.00,2.25,2.25,438.00,0.00,438.00,438.00,N/A
42602056_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12056,,,,0,906.00,679.50,553.50,679.50,0.00,553.50,553.50,N/A
42602056_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12056,,,,0,3.00,2.25,2.25,553.50,0.00,553.50,553.50,N/A
42602075_2,ASSAY OF BREATH ETHANOL,ProFee,0989,82075,,,,0,63.00,47.25,47.25,47.25,0.00,N/A,N/A,N/A
42602075_3,ASSAY OF BREATH ETHANOL,ProFee,0989,82075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602100_2,SERIAL TONOMETRY EXAM(S),ProFee,0989,92100,,,,0,48.00,36.00,36.00,48.50,0.00,48.50,48.50,N/A
42602100_3,SERIAL TONOMETRY EXAM(S),ProFee,0989,92100,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
42602144_2,TREAT DENTAL RIDGE FRACTURE,ProFee,0989,21440,,,,0,1858.00,1393.50,673.50,1393.50,0.00,673.50,673.50,N/A
42602144_3,TREAT DENTAL RIDGE FRACTURE,ProFee,0989,21440,,,,0,3.00,2.25,2.25,673.50,0.00,673.50,673.50,N/A
42602272_2,"TEST FOR BLOOD, FECES",ProFee,0989,82270,,,,0,62.00,46.50,46.50,46.50,0.00,N/A,N/A,N/A
42602272_3,"TEST FOR BLOOD, FECES",ProFee,0989,82270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602405_2,Ondansetron hcl injection,ProFee,0989,J2405,,,00009-3169-06,0,64.00,48.00,48.00,48.00,0.00,N/A,N/A,N/A
42602405_3,Ondansetron hcl injection,ProFee,0989,J2405,,,00009-3169-06,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602550_2,Promethazine hcl injection,ProFee,0989,J2550,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42602550_3,Promethazine hcl injection,ProFee,0989,J2550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602675_2,Inj progesterone per 50 MG,ProFee,0989,J2675,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42602675_3,Inj progesterone per 50 MG,ProFee,0989,J2675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602819_2,Albuterol comp unit,ProFee,0989,J7609,,,00487-9501-03,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42602819_3,Albuterol comp unit,ProFee,0989,J7609,,,00487-9501-03,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602920_2,Methylprednisolone injection,ProFee,0989,J2920,,,00009-0018-20,0,42.00,31.50,31.50,31.50,0.00,N/A,N/A,N/A
42602920_3,Methylprednisolone injection,ProFee,0989,J2920,,,00009-0018-20,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42602960_2,"CARDIOVERSION ELECTRIC, EXT",ProFee,0989,92960,,,,0,413.00,309.75,157.00,309.75,0.00,157.00,157.00,N/A
42602960_3,"CARDIOVERSION ELECTRIC, EXT",ProFee,0989,92960,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
42602962_2,GLUCOSE BLOOD TEST,ProFee,0989,82962,,,,0,47.00,35.25,35.25,35.25,0.00,N/A,N/A,N/A
42602962_3,GLUCOSE BLOOD TEST,ProFee,0989,82962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603030_2,Sumatriptan succinate / 6 MG,ProFee,0989,J3030,,,,0,98.00,73.50,73.50,73.50,0.00,N/A,N/A,N/A
42603030_3,Sumatriptan succinate / 6 MG,ProFee,0989,J3030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603100_2,REPAIR OF WOUND OR LESION,ProFee,0989,13100,,,,0,418.00,313.50,297.00,313.50,0.00,297.00,297.00,N/A
42603100_3,REPAIR OF WOUND OR LESION,ProFee,0989,13100,,,,0,3.00,2.25,2.25,297.00,0.00,297.00,297.00,N/A
42603101_2,REPAIR OF WOUND OR LESION,ProFee,0989,13101,,,,0,535.00,401.25,365.00,401.25,0.00,365.00,365.00,N/A
42603101_3,REPAIR OF WOUND OR LESION,ProFee,0989,13101,,,,0,3.00,2.25,2.25,365.00,0.00,365.00,365.00,N/A
42603120_2,REPAIR OF WOUND OR LESION,ProFee,0989,13120,,,,0,460.00,345.00,341.00,345.00,0.00,341.00,341.00,N/A
42603120_3,REPAIR OF WOUND OR LESION,ProFee,0989,13120,,,,0,3.00,2.25,2.25,341.00,0.00,341.00,341.00,N/A
42603121_2,REPAIR OF WOUND OR LESION,ProFee,0989,13121,,,,0,712.00,534.00,385.50,534.00,0.00,385.50,385.50,N/A
42603121_3,REPAIR OF WOUND OR LESION,ProFee,0989,13121,,,,0,3.00,2.25,2.25,385.50,0.00,385.50,385.50,N/A
42603131_2,REPAIR OF WOUND OR LESION,ProFee,0989,13131,,,,0,535.00,401.25,361.00,401.25,0.00,361.00,361.00,N/A
42603131_3,REPAIR OF WOUND OR LESION,ProFee,0989,13131,,,,0,3.00,2.25,2.25,361.00,0.00,361.00,361.00,N/A
42603132_2,REPAIR OF WOUND OR LESION,ProFee,0989,13132,,,,0,877.00,657.75,454.00,657.75,0.00,454.00,454.00,N/A
42603132_3,REPAIR OF WOUND OR LESION,ProFee,0989,13132,,,,0,3.00,2.25,2.25,454.00,0.00,454.00,454.00,N/A
42603150_2,REPAIR OF WOUND OR LESION,ProFee,0989,13150,,,,0,565.00,423.75,423.75,423.75,N/A,N/A,N/A,N/A
42603150_3,REPAIR OF WOUND OR LESION,ProFee,0989,13150,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42603151_2,REPAIR OF WOUND OR LESION,ProFee,0989,13151,,,,0,712.00,534.00,414.00,534.00,0.00,414.00,414.00,N/A
42603151_3,REPAIR OF WOUND OR LESION,ProFee,0989,13151,,,,0,3.00,2.25,2.25,414.00,0.00,414.00,414.00,N/A
42603152_2,REPAIR OF WOUND OR LESION,ProFee,0989,13152,,,,0,1046.00,784.50,502.00,784.50,0.00,502.00,502.00,N/A
42603152_3,REPAIR OF WOUND OR LESION,ProFee,0989,13152,,,,0,3.00,2.25,2.25,502.00,0.00,502.00,502.00,N/A
42603153_2,REPAIR WOUND/LESION ADD-ON,ProFee,0989,13153,,,,0,504.00,378.00,204.00,378.00,0.00,204.00,204.00,N/A
42603153_3,REPAIR WOUND/LESION ADD-ON,ProFee,0989,13153,,,,0,3.00,2.25,2.25,204.00,0.00,204.00,204.00,N/A
42603225_2,"ECG MONITOR/RECORD, 24 HRS",ProFee,0989,93225,,,,0,112.00,84.00,37.50,84.00,0.00,37.50,37.50,N/A
42603225_3,"ECG MONITOR/RECORD, 24 HRS",ProFee,0989,93225,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
42603226_2,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93226,,,,0,181.00,135.75,53.50,135.75,0.00,53.50,53.50,N/A
42603226_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93226,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
42603227_2,"ECG MONITOR/REVIEW, 24 HRS",ProFee,0989,93227,,,,0,125.00,93.75,38.00,93.75,0.00,38.00,38.00,N/A
42603227_3,"ECG MONITOR/REVIEW, 24 HRS",ProFee,0989,93227,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
42603230_2,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93224,,,,0,387.00,290.25,129.00,290.25,0.00,129.00,129.00,N/A
42603230_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93224,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
42603260_2,Ambulatory surgical boot eac,ProFee,0989,L3260,,,,0,104.00,78.00,78.00,78.00,0.00,N/A,N/A,N/A
42603260_3,Ambulatory surgical boot eac,ProFee,0989,L3260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603301_2,Kenalog,ProFee,0989,J3301,,,00003-0293-28,0,28.00,21.00,21.00,21.00,0.00,N/A,N/A,N/A
42603301_3,Kenalog,ProFee,0989,J3301,,,00003-0293-28,0,28.00,21.00,21.00,21.00,0.00,N/A,N/A,N/A
42603360_2,Diazepam injection,ProFee,0989,J3360,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42603360_3,Diazepam injection,ProFee,0989,J3360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603365_2,Inj midazolam hydrochloride,ProFee,0989,J2250,,,,0,12.00,9.00,9.00,9.00,0.00,N/A,N/A,N/A
42603365_3,Inj midazolam hydrochloride,ProFee,0989,J2250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603410_2,Hydroxyzine hcl injection,ProFee,0989,J3410,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42603410_3,Hydroxyzine hcl injection,ProFee,0989,J3410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603411_2,Thiamine hcl 100 mg,Inpatient,0251,J3411,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
42603411_2,Thiamine hcl 100 mg,Outpatient,0251,J3411,,,,0,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
42603411_3,Thiamine hcl 100 mg,Outpatient,0251,J3411,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42603411_3,Thiamine hcl 100 mg,Inpatient,0251,J3411,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
42603420_2,Vitamin b12 injection,ProFee,0989,J3420,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
42603420_3,Vitamin b12 injection,ProFee,0989,J3420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603650_2,TREAT SHOULDER DISLOCATION,ProFee,0989,23650,,,,0,697.00,522.75,412.00,522.75,0.00,412.00,412.00,N/A
42603650_3,TREAT SHOULDER DISLOCATION,ProFee,0989,23650,,,,0,3.00,2.25,2.25,412.00,0.00,412.00,412.00,N/A
42603655_2,TREAT SHOULDER DISLOCATION,ProFee,0989,23655,,,,0,766.00,574.50,574.50,576.00,0.00,576.00,576.00,N/A
42603655_3,TREAT SHOULDER DISLOCATION,ProFee,0989,23655,,,,0,3.00,2.25,2.25,576.00,0.00,576.00,576.00,N/A
42603670_2,INSERT BLADDER CATHETER,ProFee,0989,51701,,,,0,202.00,151.50,37.00,151.50,0.00,37.00,37.00,N/A
42603670_3,INSERT BLADDER CATHETER,ProFee,0989,51701,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
42603752_2,NASAL/OROGASTRIC W/STENT,ProFee,0989,43752,,,,0,160.00,120.00,59.00,120.00,0.00,59.00,59.00,N/A
42603752_3,NASAL/OROGASTRIC W/STENT,ProFee,0989,43752,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
42603908_2,Wrist cock-up non-molded,ProFee,0989,L3908,,,,0,67.00,50.25,50.25,50.25,0.00,N/A,N/A,N/A
42603908_3,Wrist cock-up non-molded,ProFee,0989,L3908,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42603911_2,WHO wrist extension cock-up,ProFee,0989,L3914,,,,0,107.00,80.25,80.25,80.25,N/A,N/A,N/A,N/A
42603911_3,WHO wrist extension cock-up,ProFee,0989,L3914,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42604001_2,Hydrocolld drg <=16 in w/bdr,ProFee,0989,A6237,,,,0,50.00,37.50,37.50,37.50,0.00,N/A,N/A,N/A
42604001_3,Hydrocolld drg <=16 in w/bdr,ProFee,0989,A6237,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42604010_2,BREATHING CAPACITY TEST,ProFee,0989,94010,,,,0,90.00,67.50,12.00,67.50,0.00,12.00,12.00,N/A
42604010_3,BREATHING CAPACITY TEST,ProFee,0989,94010,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
42604060_2,EVALUATION OF WHEEZING,ProFee,0989,94060,,,,0,155.00,116.25,18.50,116.25,0.00,18.50,18.50,N/A
42604060_3,EVALUATION OF WHEEZING,ProFee,0989,94060,,,,0,3.00,2.25,2.25,18.50,0.00,18.50,18.50,N/A
42604150_2,CIRCUMCISION,ProFee,0989,54150,,,,0,523.00,392.25,142.00,392.25,0.00,142.00,142.00,N/A
42604150_3,CIRCUMCISION,ProFee,0989,54150,,,,0,3.00,2.25,2.25,142.00,0.00,142.00,142.00,N/A
42604152_2,CIRCUMCISION,ProFee,0989,54160,,,,0,306.00,229.50,208.00,229.50,0.00,208.00,208.00,N/A
42604152_3,CIRCUMCISION,ProFee,0989,54160,,,,0,3.00,2.25,2.25,208.00,0.00,208.00,208.00,N/A
42604160_2,VITAL CAPACITY TEST,ProFee,0989,94150,,,,0,35.00,26.25,5.50,26.25,0.00,5.50,5.50,N/A
42604160_3,VITAL CAPACITY TEST,ProFee,0989,94150,,,,0,3.00,2.25,2.25,5.50,0.00,5.50,5.50,N/A
42604201_2,REMOVAL OF ARM FOREIGN BODY,ProFee,0989,24201,,,,0,819.00,614.25,522.50,614.25,0.00,522.50,522.50,N/A
42604201_3,REMOVAL OF ARM FOREIGN BODY,ProFee,0989,24201,,,,0,3.00,2.25,2.25,522.50,0.00,522.50,522.50,N/A
42604300_2,MANIPULATE ELBOW W/ANESTH,ProFee,0989,24300,,,,0,735.00,551.25,551.25,596.50,0.00,596.50,596.50,N/A
42604300_3,MANIPULATE ELBOW W/ANESTH,ProFee,0989,24300,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
42604420_2,"N BLOCK INJ, INTERCOST, SNG",ProFee,0989,64420,,,,0,290.00,217.50,96.50,217.50,0.00,96.50,96.50,N/A
42604420_3,"N BLOCK INJ, INTERCOST, SNG",ProFee,0989,64420,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
42604421_2,LAYER CLOSURE OF WOUND(S),ProFee,0989,12032,,,,0,533.00,399.75,280.50,399.75,0.00,280.50,280.50,N/A
42604421_3,LAYER CLOSURE OF WOUND(S),ProFee,0989,12032,,,,0,3.00,2.25,2.25,280.50,0.00,280.50,280.50,N/A
42604561_2,"Pessary rubber, any type",ProFee,0989,A4561,,,,0,359.00,269.25,269.25,269.25,0.00,N/A,N/A,N/A
42604561_3,"Pessary rubber, any type",ProFee,0989,A4561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42604597_2,Vitamin k phytonadione inj,ProFee,0989,J3430,,,,0,6.00,4.50,4.50,4.50,0.00,N/A,N/A,N/A
42604597_3,Vitamin k phytonadione inj,ProFee,0989,J3430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42604600_2,TREAT ELBOW DISLOCATION,ProFee,0989,24600,,,,0,697.00,522.75,477.00,522.75,0.00,477.00,477.00,N/A
42604600_3,TREAT ELBOW DISLOCATION,ProFee,0989,24600,,,,0,3.00,2.25,2.25,477.00,0.00,477.00,477.00,N/A
42604615_2,Cannula nasal,ProFee,0989,A4615,,,,0,14.00,10.50,10.50,10.50,0.00,N/A,N/A,N/A
42604615_3,Cannula nasal,ProFee,0989,A4615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42604640_2,TREAT ELBOW DISLOCATION,ProFee,0989,24640,,,,0,389.00,291.75,111.00,291.75,0.00,111.00,111.00,N/A
42604640_3,TREAT ELBOW DISLOCATION,ProFee,0989,24640,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
42604650_2,TREAT RADIUS FRACTURE,ProFee,0989,24650,,,,0,488.00,366.00,343.00,366.00,0.00,343.00,343.00,N/A
42604650_3,TREAT RADIUS FRACTURE,ProFee,0989,24650,,,,0,3.00,2.25,2.25,343.00,0.00,343.00,343.00,N/A
42604703_2,CHORIONIC GONADOTROPIN ASSAY,ProFee,0989,84703,,,,0,76.00,57.00,57.00,57.00,0.00,N/A,N/A,N/A
42604703_3,CHORIONIC GONADOTROPIN ASSAY,ProFee,0989,84703,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42604760_2,MEASURE BLOOD OXYGEN LEVEL,ProFee,0989,94760,,,,0,26.00,19.50,4.00,19.50,0.00,4.00,4.00,N/A
42604760_3,MEASURE BLOOD OXYGEN LEVEL,ProFee,0989,94760,,,,0,3.00,2.25,2.25,4.00,0.00,4.00,4.00,N/A
42604762_2,MEASURE BLOOD OXYGEN LEVEL,ProFee,0989,94762,,,,0,70.00,52.50,35.00,52.50,0.00,35.00,35.00,N/A
42604762_3,MEASURE BLOOD OXYGEN LEVEL,ProFee,0989,94762,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
42604922_2,Cast supplies (plaster),ProFee,0989,A4580,,,,0,14.00,10.50,10.50,10.50,0.00,N/A,N/A,N/A
42604922_3,Cast supplies (plaster),ProFee,0989,A4580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42605000_2,DRAINAGE OF HYDROCELE,ProFee,0989,55000,,,,0,210.00,157.50,123.00,157.50,0.00,123.00,123.00,N/A
42605000_3,DRAINAGE OF HYDROCELE,ProFee,0989,55000,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
42605013_2,SPUN MICROHEMATOCRIT,ProFee,0989,85013,,,,0,35.00,26.25,26.25,26.25,0.00,N/A,N/A,N/A
42605013_3,SPUN MICROHEMATOCRIT,ProFee,0989,85013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42605205_2,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65205,,,,0,299.00,224.25,63.00,224.25,0.00,63.00,63.00,N/A
42605205_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65205,,,,0,3.00,2.25,2.25,63.00,0.00,63.00,63.00,N/A
42605210_2,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65210,,,,0,320.00,240.00,75.50,240.00,0.00,75.50,75.50,N/A
42605210_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65210,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
42605220_2,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65220,,,,0,378.00,283.50,60.50,283.50,0.00,60.50,60.50,N/A
42605220_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65220,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
42605222_2,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65222,,,,0,327.00,245.25,74.50,245.25,0.00,74.50,74.50,N/A
42605222_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65222,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
42605250_2,REMOVAL OF SPERM DUCT(S),ProFee,0989,55250,,,,0,821.00,615.75,329.50,615.75,0.00,329.50,329.50,N/A
42605250_3,REMOVAL OF SPERM DUCT(S),ProFee,0989,55250,,,,0,3.00,2.25,2.25,329.50,0.00,329.50,329.50,N/A
42605413_2,Slings,ProFee,0989,A4565,,,,0,35.00,26.25,26.25,26.25,0.00,N/A,N/A,N/A
42605413_3,Slings,ProFee,0989,A4565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42605605_2,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25605,,,,0,906.00,679.50,679.50,729.00,0.00,729.00,729.00,N/A
42605605_3,TREAT FRACTURE RADIUS/ULNA,ProFee,0989,25605,,,,0,3.00,2.25,2.25,729.00,0.00,729.00,729.00,N/A
42606000_2,INITIAL TREATMENT OF BURN(S),ProFee,0989,16000,,,,0,167.00,125.25,66.50,125.25,0.00,66.50,66.50,N/A
42606000_3,INITIAL TREATMENT OF BURN(S),ProFee,0989,16000,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
42606020_2,TREATMENT OF BURN(S),ProFee,0989,16020,,,,0,167.00,125.25,78.50,125.25,0.00,78.50,78.50,N/A
42606020_3,TREATMENT OF BURN(S),ProFee,0989,16020,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
42606025_2,TREATMENT OF BURN(S),ProFee,0989,16025,,,,0,278.00,208.50,160.50,208.50,0.00,160.50,160.50,N/A
42606025_3,TREATMENT OF BURN(S),ProFee,0989,16025,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
42606030_2,TREATMENT OF BURN(S),ProFee,0989,16030,,,,0,453.00,339.75,194.00,339.75,0.00,194.00,194.00,N/A
42606030_3,TREATMENT OF BURN(S),ProFee,0989,16030,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
42606083_2,INCISE EXTERNAL HEMORRHOID,ProFee,0989,46083,,,,0,153.00,114.75,114.75,154.00,0.00,154.00,154.00,N/A
42606083_3,INCISE EXTERNAL HEMORRHOID,ProFee,0989,46083,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
42606211_2,Insert tray w/o bag/cath,ProFee,0989,A4310,,,,0,76.00,57.00,57.00,57.00,0.00,N/A,N/A,N/A
42606211_3,Insert tray w/o bag/cath,ProFee,0989,A4310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42606231_2,Thor rib belt custom fabrica,ProFee,0989,L0220,,,,0,35.00,26.25,26.25,26.25,0.00,N/A,N/A,N/A
42606231_3,Thor rib belt custom fabrica,ProFee,0989,L0220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42606312_2,Special casting material,ProFee,0989,A4590,,,,0,38.00,28.50,28.50,28.50,0.00,N/A,N/A,N/A
42606312_3,Special casting material,ProFee,0989,A4590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42606418_2,REPAIR FINGER TENDON,ProFee,0989,26418,,,,0,1081.00,810.75,810.75,817.00,0.00,817.00,817.00,N/A
42606418_3,REPAIR FINGER TENDON,ProFee,0989,26418,,,,0,3.00,2.25,2.25,817.00,0.00,817.00,817.00,N/A
42606441_2,LYSIS OF LABIAL LESION(S),ProFee,0989,56441,,,,0,341.00,255.75,197.50,255.75,0.00,197.50,197.50,N/A
42606441_3,LYSIS OF LABIAL LESION(S),ProFee,0989,56441,,,,0,3.00,2.25,2.25,197.50,0.00,197.50,197.50,N/A
42606578_2,High compres band w>=3""<5""yd,ProFee,0989,A6452,,,,0,14.00,10.50,10.50,10.50,0.00,N/A,N/A,N/A
42606578_3,High compres band w>=3""<5""yd,ProFee,0989,A6452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42606580_2,TB INTRADERMAL TEST,ProFee,0989,86580,,,,0,29.00,21.75,11.50,21.75,0.00,11.50,11.50,N/A
42606580_3,TB INTRADERMAL TEST,ProFee,0989,86580,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
42606600_2,DIAGNOSTIC ANOSCOPY,ProFee,0989,46600,,,,0,140.00,105.00,59.50,105.00,0.00,59.50,59.50,N/A
42606600_3,DIAGNOSTIC ANOSCOPY,ProFee,0989,46600,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
42606604_2,ANOSCOPY AND DILATION,ProFee,0989,46604,,,,0,210.00,157.50,96.00,157.50,0.00,96.00,96.00,N/A
42606604_3,ANOSCOPY AND DILATION,ProFee,0989,46604,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
42606606_2,ANOSCOPY AND BIOPSY,ProFee,0989,46606,,,,0,167.00,125.25,110.00,125.25,0.00,110.00,110.00,N/A
42606606_3,ANOSCOPY AND BIOPSY,ProFee,0989,46606,,,,0,3.00,2.25,2.25,110.00,0.00,110.00,110.00,N/A
42606608_2,"ANOSCOPY, REMOVE FOR BODY",ProFee,0989,46608,,,,0,271.00,203.25,121.50,203.25,0.00,121.50,121.50,N/A
42606608_3,"ANOSCOPY, REMOVE FOR BODY",ProFee,0989,46608,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
42606610_2,"ANOSCOPY, REMOVE LESION",ProFee,0989,46610,,,,0,238.00,178.50,117.50,178.50,0.00,117.50,117.50,N/A
42606610_3,"ANOSCOPY, REMOVE LESION",ProFee,0989,46610,,,,0,3.00,2.25,2.25,117.50,0.00,117.50,117.50,N/A
42606641_2,TREAT THUMB DISLOCATION,ProFee,0989,26641,,,,0,641.00,480.75,480.75,498.00,0.00,498.00,498.00,N/A
42606641_3,TREAT THUMB DISLOCATION,ProFee,0989,26641,,,,0,3.00,2.25,2.25,498.00,0.00,498.00,498.00,N/A
42606680_2,"INSERT NEEDLE, BONE CAVITY",ProFee,0989,36680,,,,0,222.00,166.50,84.50,166.50,0.00,84.50,84.50,N/A
42606680_3,"INSERT NEEDLE, BONE CAVITY",ProFee,0989,36680,,,,0,3.00,2.25,2.25,84.50,0.00,84.50,84.50,N/A
42606725_2,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26725,,,,0,219.00,164.25,164.25,433.00,0.00,433.00,433.00,N/A
42606725_3,"TREAT FINGER FRACTURE, EACH",ProFee,0989,26725,,,,0,3.00,2.25,2.25,433.00,0.00,433.00,433.00,N/A
42606960_2,DTAP-IPV VACC 4-6 YR IM,ProFee,0989,90696,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42606960_3,DTAP-IPV VACC 4-6 YR IM,ProFee,0989,90696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607000_2,DESTROY BENIGN/PREMLG LESION,ProFee,0989,17000,,,,0,167.00,125.25,75.50,125.25,0.00,75.50,75.50,N/A
42607000_3,DESTROY BENIGN/PREMLG LESION,ProFee,0989,17000,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
42607003_2,"DESTROY LESIONS, 2-14",ProFee,0989,17003,,,,0,40.00,30.00,3.50,30.00,0.00,3.50,3.50,N/A
42607003_3,"DESTROY LESIONS, 2-14",ProFee,0989,17003,,,,0,3.00,2.25,2.25,3.50,0.00,3.50,3.50,N/A
42607004_2,"DESTROY LESIONS, 15 OR MORE",ProFee,0989,17004,,,,0,553.00,414.75,142.50,414.75,0.00,142.50,142.50,N/A
42607004_3,"DESTROY LESIONS, 15 OR MORE",ProFee,0989,17004,,,,0,3.00,2.25,2.25,142.50,0.00,142.50,142.50,N/A
42607055_2,Shlder fig 8 abduct restrain,ProFee,0989,L3650,,,,0,48.00,36.00,36.00,36.00,0.00,N/A,N/A,N/A
42607055_3,Shlder fig 8 abduct restrain,ProFee,0989,L3650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607110_2,"DESTRUCT LESION, 1-14",ProFee,0989,17110,,,,0,167.00,125.25,100.00,125.25,0.00,100.00,100.00,N/A
42607110_3,"DESTRUCT LESION, 1-14",ProFee,0989,17110,,,,0,3.00,2.25,2.25,100.00,0.00,100.00,100.00,N/A
42607111_2,"DESTRUCT LESION, 15 OR MORE",ProFee,0989,17111,,,,0,167.00,125.25,123.00,125.25,0.00,123.00,123.00,N/A
42607111_3,"DESTRUCT LESION, 15 OR MORE",ProFee,0989,17111,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
42607120_2,Ringers lactate infusion,ProFee,0989,J7120,,,,0,22.00,16.50,16.50,16.50,0.00,N/A,N/A,N/A
42607120_3,Ringers lactate infusion,ProFee,0989,J7120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607121_2,Morphine sulfate injection,ProFee,0989,J2270,,,,0,21.00,15.75,15.75,15.75,0.00,N/A,N/A,N/A
42607121_3,Morphine sulfate injection,ProFee,0989,J2270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607160_2,INSERT PESSARY/OTHER DEVICE,ProFee,0989,57160,,,,0,323.00,242.25,66.50,242.25,0.00,66.50,66.50,N/A
42607160_3,INSERT PESSARY/OTHER DEVICE,ProFee,0989,57160,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
42607210_2,"SMEAR, WET MOUNT, SALINE/INK",ProFee,0989,87210,,,,0,40.00,30.00,30.00,30.00,0.00,N/A,N/A,N/A
42607210_3,"SMEAR, WET MOUNT, SALINE/INK",ProFee,0989,87210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607220_2,TISSUE EXAM FOR FUNGI,ProFee,0989,87220,,,,0,40.00,30.00,30.00,30.00,0.00,N/A,N/A,N/A
42607220_3,TISSUE EXAM FOR FUNGI,ProFee,0989,87220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607252_2,TREAT HIP DISLOCATION,ProFee,0989,27252,,,,0,1673.00,1254.75,1089.50,1254.75,0.00,1089.50,1089.50,N/A
42607252_3,TREAT HIP DISLOCATION,ProFee,0989,27252,,,,0,3.00,2.25,2.25,1089.50,0.00,1089.50,1089.50,N/A
42607320_2,Synvisc or Synvisc-One,ProFee,0989,J7325,,,,0,413.00,309.75,309.75,309.75,0.00,N/A,N/A,N/A
42607320_3,Synvisc or Synvisc-One,ProFee,0989,J7325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607402_2,5% dextrose/water,ProFee,0989,J7060,,,,0,28.00,21.00,21.00,21.00,0.00,N/A,N/A,N/A
42607402_3,5% dextrose/water,ProFee,0989,J7060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607452_2,EXAM OF CERVIX W/SCOPE,ProFee,0989,57452,,,,0,278.00,208.50,131.50,208.50,0.00,131.50,131.50,N/A
42607452_3,EXAM OF CERVIX W/SCOPE,ProFee,0989,57452,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
42607454_2,BX/CURETT OF CERVIX W/SCOPE,ProFee,0989,57454,,,,0,278.00,208.50,192.00,208.50,0.00,192.00,192.00,N/A
42607454_3,BX/CURETT OF CERVIX W/SCOPE,ProFee,0989,57454,,,,0,3.00,2.25,2.25,192.00,0.00,192.00,192.00,N/A
42607509_2,Methylprednisolone oral,ProFee,0989,J7509,,,,0,15.00,11.25,11.25,11.25,0.00,N/A,N/A,N/A
42607509_3,Methylprednisolone oral,ProFee,0989,J7509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607511_2,CRYOCAUTERY OF CERVIX,ProFee,0989,57511,,,,0,334.00,250.50,186.50,250.50,0.00,186.50,186.50,N/A
42607511_3,CRYOCAUTERY OF CERVIX,ProFee,0989,57511,,,,0,3.00,2.25,2.25,186.50,0.00,186.50,186.50,N/A
42607560_2,TREAT KNEECAP DISLOCATION,ProFee,0989,27560,,,,0,488.00,366.00,366.00,479.50,0.00,479.50,479.50,N/A
42607560_3,TREAT KNEECAP DISLOCATION,ProFee,0989,27560,,,,0,3.00,2.25,2.25,479.50,0.00,479.50,479.50,N/A
42607602_2,WOUND(S) CARE NON-SELECTIVE,ProFee,0989,97602,,,,0,584.00,438.00,37.95,438.00,0.00,37.95,37.95,N/A
42607602_3,WOUND(S) CARE NON-SELECTIVE,ProFee,0989,97602,,,,0,3.00,2.25,2.25,37.95,0.00,37.95,37.95,N/A
42607624_2,Splint,ProFee,0989,A4570,,,,0,29.00,21.75,21.75,21.75,0.00,N/A,N/A,N/A
42607624_3,Splint,ProFee,0989,A4570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42607750_2,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27750,,,,0,127.00,95.25,95.25,454.50,0.00,454.50,454.50,N/A
42607750_3,TREATMENT OF TIBIA FRACTURE,ProFee,0989,27750,,,,0,3.00,2.25,2.25,454.50,0.00,454.50,454.50,N/A
42607810_2,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27810,,,,0,389.00,291.75,291.75,604.00,0.00,604.00,604.00,N/A
42607810_3,TREATMENT OF ANKLE FRACTURE,ProFee,0989,27810,,,,0,3.00,2.25,2.25,604.00,0.00,604.00,604.00,N/A
42607938_2,REMOVE EYELID FOREIGN BODY,ProFee,0989,67938,,,,0,488.00,366.00,166.50,366.00,0.00,166.50,166.50,N/A
42607938_3,REMOVE EYELID FOREIGN BODY,ProFee,0989,67938,,,,0,3.00,2.25,2.25,166.50,0.00,166.50,166.50,N/A
42608100_2,BIOPSY OF UTERUS LINING,ProFee,0989,58100,,,,0,250.00,187.50,124.00,187.50,0.00,124.00,124.00,N/A
42608100_3,BIOPSY OF UTERUS LINING,ProFee,0989,58100,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
42608111_2,Cerv flexible non-adjustable,ProFee,0989,L0120,,,,0,33.00,24.75,24.75,24.75,0.00,N/A,N/A,N/A
42608111_3,Cerv flexible non-adjustable,ProFee,0989,L0120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42608130_2,Gc stocking thighlngth 18-30,ProFee,0989,A6533,,,,0,47.00,35.25,35.25,35.25,0.00,N/A,N/A,N/A
42608130_3,Gc stocking thighlngth 18-30,ProFee,0989,A6533,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42608190_2,REMOVAL OF FOOT FOREIGN BODY,ProFee,0989,28190,,,,0,389.00,291.75,193.00,291.75,0.00,193.00,193.00,N/A
42608190_3,REMOVAL OF FOOT FOREIGN BODY,ProFee,0989,28190,,,,0,3.00,2.25,2.25,193.00,0.00,193.00,193.00,N/A
42608192_2,REMOVAL OF FOOT FOREIGN BODY,ProFee,0989,28192,,,,0,732.00,549.00,450.00,549.00,0.00,450.00,450.00,N/A
42608192_3,REMOVAL OF FOOT FOREIGN BODY,ProFee,0989,28192,,,,0,3.00,2.25,2.25,450.00,0.00,450.00,450.00,N/A
42608301_2,REMOVE INTRAUTERINE DEVICE,ProFee,0989,58301,,,,0,112.00,84.00,84.00,96.00,0.00,96.00,96.00,N/A
42608301_3,REMOVE INTRAUTERINE DEVICE,ProFee,0989,58301,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
42608966_2,HC PRO PHONE CALL 5-10 MIN,ProFee,0989,98966,,,,0,38.00,28.50,18.00,28.50,0.00,18.00,18.00,N/A
42608966_3,HC PRO PHONE CALL 5-10 MIN,ProFee,0989,98966,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
42608967_2,HC PRO PHONE CALL 11-20 MIN,ProFee,0989,98967,,,,0,76.00,57.00,36.00,57.00,0.00,36.00,36.00,N/A
42608967_3,HC PRO PHONE CALL 11-20 MIN,ProFee,0989,98967,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
42608968_2,HC PRO PHONE CALL 21-30 MIN,ProFee,0989,98968,,,,0,114.00,85.50,54.00,85.50,0.00,54.00,54.00,N/A
42608968_3,HC PRO PHONE CALL 21-30 MIN,ProFee,0989,98968,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
42608969_2,ONLINE SERVICE BY HC PRO,ProFee,0989,98969,,,,0,76.00,57.00,33.00,57.00,0.00,33.00,33.00,N/A
42608969_3,ONLINE SERVICE BY HC PRO,ProFee,0989,98969,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
42609000_2,SPECIMEN HANDLING,ProFee,0989,99000,,,,0,35.00,26.25,8.00,26.25,0.00,8.00,8.00,N/A
42609000_3,SPECIMEN HANDLING,ProFee,0989,99000,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
42609024_3,POSTOP FOLLOW-UP VISIT,ProFee,0989,99024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609065_2,APPLICATION OF LONG ARM CAST,ProFee,0989,29065,,,,0,212.00,159.00,98.00,159.00,0.00,98.00,98.00,N/A
42609065_3,APPLICATION OF LONG ARM CAST,ProFee,0989,29065,,,,0,3.00,2.25,2.25,98.00,0.00,98.00,98.00,N/A
42609075_2,APPLICATION OF FOREARM CAST,ProFee,0989,29075,,,,0,185.00,138.75,89.50,138.75,0.00,89.50,89.50,N/A
42609075_3,APPLICATION OF FOREARM CAST,ProFee,0989,29075,,,,0,3.00,2.25,2.25,89.50,0.00,89.50,89.50,N/A
42609084_2,PERITONEAL LAVAGE,ProFee,0989,49084,,,,0,284.00,213.00,157.50,213.00,0.00,157.50,157.50,N/A
42609084_3,PERITONEAL LAVAGE,ProFee,0989,49084,,,,0,3.00,2.25,2.25,157.50,0.00,157.50,157.50,N/A
42609085_2,APPLY HAND/WRIST CAST,ProFee,0989,29085,,,,0,185.00,138.75,97.00,138.75,0.00,97.00,97.00,N/A
42609085_3,APPLY HAND/WRIST CAST,ProFee,0989,29085,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
42609104_2,Sports Physical,ProFee,0989,99394,,,,0,25.00,18.75,18.75,123.00,0.00,123.00,123.00,N/A
42609104_3,Sports Physical,ProFee,0989,99394,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
42609125_2,APPLY FOREARM SPLINT,ProFee,0989,29125,,,,0,140.00,105.00,57.00,105.00,0.00,57.00,57.00,N/A
42609125_3,APPLY FOREARM SPLINT,ProFee,0989,29125,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
42609130_2,APPLICATION OF FINGER SPLINT,ProFee,0989,29130,,,,0,109.00,81.75,41.50,81.75,0.00,41.50,41.50,N/A
42609130_3,APPLICATION OF FINGER SPLINT,ProFee,0989,29130,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
42609175_2,INDUCTION OF VOMITING,ProFee,0989,99175,,,,0,70.00,52.50,36.50,52.50,0.00,36.50,36.50,N/A
42609175_3,INDUCTION OF VOMITING,ProFee,0989,99175,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
42609200_2,CLEAR OUTER EAR CANAL,ProFee,0989,69200,,,,0,181.00,135.75,67.50,135.75,0.00,67.50,67.50,N/A
42609200_3,CLEAR OUTER EAR CANAL,ProFee,0989,69200,,,,0,3.00,2.25,2.25,67.50,0.00,67.50,67.50,N/A
42609201_2,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99202,,,,0,72.00,54.00,54.00,71.50,0.00,71.50,71.50,N/A
42609201_3,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99202,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
42609202_2,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99202,,,,0,132.00,99.00,71.50,99.00,0.00,71.50,71.50,N/A
42609202_3,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99202,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
42609203_2,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99203,,,,0,191.00,143.25,108.50,143.25,0.00,108.50,108.50,N/A
42609203_3,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99203,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
42609204_2,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99204,,,,0,290.00,217.50,183.00,217.50,0.00,183.00,183.00,N/A
42609204_3,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99204,,,,0,3.00,2.25,2.25,183.00,0.00,183.00,183.00,N/A
42609205_2,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99205,,,,0,361.00,270.75,239.00,270.75,0.00,239.00,239.00,N/A
42609205_3,"OFFICE/OUTPATIENT VISIT, NEW",ProFee,0989,99205,,,,0,3.00,2.25,2.25,239.00,0.00,239.00,239.00,N/A
42609211_2,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99211,,,,0,41.00,30.75,13.00,30.75,0.00,13.00,13.00,N/A
42609211_3,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99211,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
42609212_2,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99212,,,,0,78.00,58.50,36.00,58.50,0.00,36.00,36.00,N/A
42609212_3,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99212,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
42609213_2,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99213,,,,0,119.00,89.25,72.50,89.25,0.00,72.50,72.50,N/A
42609213_3,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99213,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
42609214_2,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99214,,,,0,186.00,139.50,111.00,139.50,0.00,111.00,111.00,N/A
42609214_3,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99214,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
42609215_2,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99215,,,,0,253.00,189.75,157.00,189.75,0.00,157.00,157.00,N/A
42609215_3,"OFFICE/OUTPATIENT VISIT, EST",ProFee,0989,99215,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
42609241_2,OFFICE CONSULTATION,ProFee,0989,99241,,,,0,103.00,77.25,77.25,77.25,0.00,N/A,N/A,N/A
42609241_3,OFFICE CONSULTATION,ProFee,0989,99241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609242_2,OFFICE CONSULTATION,ProFee,0989,99242,,,,0,186.00,139.50,139.50,139.50,0.00,N/A,N/A,N/A
42609242_3,OFFICE CONSULTATION,ProFee,0989,99242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609243_2,OFFICE CONSULTATION,ProFee,0989,99243,,,,0,253.00,189.75,189.75,189.75,0.00,N/A,N/A,N/A
42609243_3,OFFICE CONSULTATION,ProFee,0989,99243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609244_2,OFFICE CONSULTATION,ProFee,0989,99244,,,,0,373.00,279.75,279.75,279.75,0.00,N/A,N/A,N/A
42609244_3,OFFICE CONSULTATION,ProFee,0989,99244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609245_2,OFFICE CONSULTATION,ProFee,0989,99245,,,,0,463.00,347.25,347.25,347.25,0.00,N/A,N/A,N/A
42609245_3,OFFICE CONSULTATION,ProFee,0989,99245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609252_2,INITIAL INPATIENT CONSULT,ProFee,0989,99252,,,,0,263.00,197.25,197.25,197.25,0.00,N/A,N/A,N/A
42609252_3,INITIAL INPATIENT CONSULT,ProFee,0989,99252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609254_2,INITIAL INPATIENT CONSULT,ProFee,0989,99254,,,,0,369.00,276.75,276.75,276.75,0.00,N/A,N/A,N/A
42609254_3,INITIAL INPATIENT CONSULT,ProFee,0989,99254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42609345_2,APPLICATION OF LONG LEG CAST,ProFee,0989,29345,,,,0,285.00,213.75,145.00,213.75,0.00,145.00,145.00,N/A
42609345_3,APPLICATION OF LONG LEG CAST,ProFee,0989,29345,,,,0,3.00,2.25,2.25,145.00,0.00,145.00,145.00,N/A
42609355_2,APPLICATION OF LONG LEG CAST,ProFee,0989,29355,,,,0,303.00,227.25,152.50,227.25,0.00,152.50,152.50,N/A
42609355_3,APPLICATION OF LONG LEG CAST,ProFee,0989,29355,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
42609358_2,"PROLONGED SERV, W/O CONTACT",ProFee,0989,99358,,,,0,662.00,496.50,158.00,496.50,0.00,158.00,158.00,N/A
42609358_3,"PROLONGED SERV, W/O CONTACT",ProFee,0989,99358,,,,0,3.00,2.25,2.25,158.00,0.00,158.00,158.00,N/A
42609366_2,TEAM CONF W/PAT BY HC PRO,ProFee,0989,99366,,,,0,140.00,105.00,59.50,105.00,0.00,59.50,59.50,N/A
42609366_3,TEAM CONF W/PAT BY HC PRO,ProFee,0989,99366,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
42609367_2,TEAM CONF W/O PAT BY PHYS,ProFee,0989,99367,,,,0,278.00,208.50,80.00,208.50,0.00,80.00,80.00,N/A
42609367_3,TEAM CONF W/O PAT BY PHYS,ProFee,0989,99367,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
42609381_2,"PREV VISIT, NEW, INFANT",ProFee,0989,99381,,,,0,210.00,157.50,108.50,157.50,0.00,108.50,108.50,N/A
42609381_3,"PREV VISIT, NEW, INFANT",ProFee,0989,99381,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
42609382_2,"PREV VISIT, NEW, AGE 1-4",ProFee,0989,99382,,,,0,228.00,171.00,116.00,171.00,0.00,116.00,116.00,N/A
42609382_3,"PREV VISIT, NEW, AGE 1-4",ProFee,0989,99382,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
42609383_2,"PREV VISIT, NEW, AGE 5-11",ProFee,0989,99383,,,,0,222.00,166.50,123.00,166.50,0.00,123.00,123.00,N/A
42609383_3,"PREV VISIT, NEW, AGE 5-11",ProFee,0989,99383,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
42609384_2,"PREV VISIT, NEW, AGE 12-17",ProFee,0989,99384,,,,0,250.00,187.50,144.50,187.50,0.00,144.50,144.50,N/A
42609384_3,"PREV VISIT, NEW, AGE 12-17",ProFee,0989,99384,,,,0,3.00,2.25,2.25,144.50,0.00,144.50,144.50,N/A
42609385_2,"PREV VISIT, NEW, AGE 18-39",ProFee,0989,99385,,,,0,250.00,187.50,138.50,187.50,0.00,138.50,138.50,N/A
42609385_3,"PREV VISIT, NEW, AGE 18-39",ProFee,0989,99385,,,,0,3.00,2.25,2.25,138.50,0.00,138.50,138.50,N/A
42609386_2,"PREV VISIT, NEW, AGE 40-64",ProFee,0989,99386,,,,0,278.00,208.50,168.50,208.50,0.00,168.50,168.50,N/A
42609386_3,"PREV VISIT, NEW, AGE 40-64",ProFee,0989,99386,,,,0,3.00,2.25,2.25,168.50,0.00,168.50,168.50,N/A
42609391_2,"PREV VISIT, EST, INFANT",ProFee,0989,99391,,,,0,167.00,125.25,99.00,125.25,0.00,99.00,99.00,N/A
42609391_3,"PREV VISIT, EST, INFANT",ProFee,0989,99391,,,,0,3.00,2.25,2.25,99.00,0.00,99.00,99.00,N/A
42609392_2,"PREV VISIT, EST, AGE 1-4",ProFee,0989,99392,,,,0,181.00,135.75,108.50,135.75,0.00,108.50,108.50,N/A
42609392_3,"PREV VISIT, EST, AGE 1-4",ProFee,0989,99392,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
42609393_2,"PREV VISIT, EST, AGE 5-11",ProFee,0989,99393,,,,0,181.00,135.75,108.50,135.75,0.00,108.50,108.50,N/A
42609393_3,"PREV VISIT, EST, AGE 5-11",ProFee,0989,99393,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
42609394_2,"PREV VISIT, EST, AGE 12-17",ProFee,0989,99394,,,,0,220.00,165.00,123.00,165.00,0.00,123.00,123.00,N/A
42609394_3,"PREV VISIT, EST, AGE 12-17",ProFee,0989,99394,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
42609395_2,"PREV VISIT, EST, AGE 18-39",ProFee,0989,99395,,,,0,226.00,169.50,126.50,169.50,0.00,126.50,126.50,N/A
42609395_3,"PREV VISIT, EST, AGE 18-39",ProFee,0989,99395,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
42609396_2,"PREV VISIT, EST, AGE 40-64",ProFee,0989,99396,,,,0,217.00,162.75,137.00,162.75,0.00,137.00,137.00,N/A
42609396_3,"PREV VISIT, EST, AGE 40-64",ProFee,0989,99396,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
42609397_2,"PREV VISIT, NEW, 65 & OVER",ProFee,0989,99387,,,,0,250.00,187.50,180.50,187.50,0.00,180.50,180.50,N/A
42609397_3,"PREV VISIT, NEW, 65 & OVER",ProFee,0989,99387,,,,0,3.00,2.25,2.25,180.50,0.00,180.50,180.50,N/A
42609405_2,APPLY SHORT LEG CAST,ProFee,0989,29405,,,,0,198.00,148.50,86.00,148.50,0.00,86.00,86.00,N/A
42609405_3,APPLY SHORT LEG CAST,ProFee,0989,29405,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
42609406_2,BEHAV CHNG SMOKING 3-10 MIN,ProFee,0989,99406,,,,0,32.00,24.00,17.50,24.00,0.00,17.50,17.50,N/A
42609406_3,BEHAV CHNG SMOKING 3-10 MIN,ProFee,0989,99406,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
42609407_2,BEHAV CHNG SMOKING < 10 MIN,ProFee,0989,99407,,,,0,43.00,32.25,32.25,36.50,0.00,36.50,36.50,N/A
42609407_3,BEHAV CHNG SMOKING < 10 MIN,ProFee,0989,99407,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
42609425_2,APPLY SHORT LEG CAST,ProFee,0989,29425,,,,0,209.00,156.75,81.00,156.75,0.00,81.00,81.00,N/A
42609425_3,APPLY SHORT LEG CAST,ProFee,0989,29425,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
42609441_2,PHONE E/M BY PHYS 5-10 MIN,ProFee,0989,99441,,,,0,38.00,28.50,18.00,28.50,0.00,18.00,18.00,N/A
42609441_3,PHONE E/M BY PHYS 5-10 MIN,ProFee,0989,99441,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
42609442_2,PHONE E/M BY PHYS 11-20 MIN,ProFee,0989,99442,,,,0,76.00,57.00,36.00,57.00,0.00,36.00,36.00,N/A
42609442_3,PHONE E/M BY PHYS 11-20 MIN,ProFee,0989,99442,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
42609443_2,PHONE E/M BY PHYS 21-30 MIN,ProFee,0989,99443,,,,0,114.00,85.50,54.00,85.50,0.00,54.00,54.00,N/A
42609443_3,PHONE E/M BY PHYS 21-30 MIN,ProFee,0989,99443,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
42609444_2,ONLINE E/M BY PHYS,ProFee,0989,99444,,,,0,76.00,57.00,46.00,57.00,0.00,46.00,46.00,N/A
42609444_3,ONLINE E/M BY PHYS,ProFee,0989,99444,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
42609464_2,AIRWAY INHALATION TREATMENT,ProFee,0989,94640,,,,0,26.00,19.50,19.50,26.50,0.00,26.50,26.50,N/A
42609464_3,AIRWAY INHALATION TREATMENT,ProFee,0989,94640,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
42609505_2,"APPLICATION, LONG LEG SPLINT",ProFee,0989,29505,,,,0,159.00,119.25,72.50,119.25,0.00,72.50,72.50,N/A
42609505_3,"APPLICATION, LONG LEG SPLINT",ProFee,0989,29505,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
42609515_2,APPLICATION LOWER LEG SPLINT,ProFee,0989,29515,,,,0,140.00,105.00,71.50,105.00,0.00,71.50,71.50,N/A
42609515_3,APPLICATION LOWER LEG SPLINT,ProFee,0989,29515,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
42609540_2,STRAPPING OF ANKLE AND/OR FT,ProFee,0989,29540,,,,0,140.00,105.00,26.00,105.00,0.00,26.00,26.00,N/A
42609540_3,STRAPPING OF ANKLE AND/OR FT,ProFee,0989,29540,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
42609700_2,REMOVAL/REVISION OF CAST,ProFee,0989,29700,,,,0,89.00,66.75,48.50,66.75,0.00,48.50,48.50,N/A
42609700_3,REMOVAL/REVISION OF CAST,ProFee,0989,29700,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
42609705_2,REMOVAL/REVISION OF CAST,ProFee,0989,29705,,,,0,85.00,63.75,63.75,67.50,0.00,67.50,67.50,N/A
42609705_3,REMOVAL/REVISION OF CAST,ProFee,0989,29705,,,,0,3.00,2.25,2.25,67.50,0.00,67.50,67.50,N/A
42609730_2,WINDOWING OF CAST,ProFee,0989,29730,,,,0,83.00,62.25,62.25,63.50,0.00,63.50,63.50,N/A
42609730_3,WINDOWING OF CAST,ProFee,0989,29730,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
42609740_2,WEDGING OF CAST,ProFee,0989,29740,,,,0,176.00,132.00,102.00,132.00,0.00,102.00,102.00,N/A
42609740_3,WEDGING OF CAST,ProFee,0989,29740,,,,0,3.00,2.25,2.25,102.00,0.00,102.00,102.00,N/A
4260F_3,WOUND SRFC CULTURETECH USED,ProFee,0989,4260F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4261F_3,TECH OTHER THAN SURFC CULTR,ProFee,0989,4261F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42629217_1,OBS Visit,ProFee,0987,99217,,,,0,203.00,152.25,103.50,152.25,0.00,103.50,103.50,N/A
42629218_1,OBS Initial-Comp-Low,ProFee,0987,99218,,,,0,210.00,157.50,141.50,157.50,0.00,141.50,141.50,N/A
42629219_1,OBS Initial-Comp-Mod,ProFee,0987,99219,,,,0,308.00,231.00,192.50,231.00,0.00,192.50,192.50,N/A
42629220_1,OBS Initial-Comp-High,ProFee,0987,99220,,,,0,381.00,285.75,263.50,285.75,0.00,263.50,263.50,N/A
42629234_1,OBS Admit & Discharge Level 1,ProFee,0987,99234,,,,0,345.00,258.75,188.50,258.75,0.00,188.50,188.50,N/A
42629235_1,OBS Admit & Discharge Level 2,ProFee,0987,99235,,,,0,467.00,350.25,239.50,350.25,0.00,239.50,239.50,N/A
42629236_1,OBS Admit & Discharge Level 3,ProFee,0987,99236,,,,0,567.00,425.25,309.00,425.25,0.00,309.00,309.00,N/A
42639304_1,SNF Admit Level 1,Inpatient,0524,99304,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
42639304_1,SNF Admit Level 1,Outpatient,0524,99304,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,0.00,159.30
42639305_1,SNF Admit Level 2,Inpatient,0524,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
42639305_1,SNF Admit Level 2,Outpatient,0524,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,0.00,205.20
42639306_1,SNF Admit Level 3,Inpatient,0524,99306,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,266.95,252.90
42639306_1,SNF Admit Level 3,Outpatient,0524,99306,,,,0,281.00,210.75,210.75,266.95,252.90,266.95,0.00,252.90
42639307_1,SNF Visit Mod,Inpatient,0524,99307,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,108.30,102.60
42639307_1,SNF Visit Mod,Outpatient,0524,99307,,,,0,114.00,85.50,85.50,108.30,102.60,108.30,0.00,102.60
42639308_1,SNF Visit Expanded,Outpatient,0524,99308,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,0.00,129.60
42639308_1,SNF Visit Expanded,Inpatient,0524,99308,,,,0,144.00,108.00,108.00,136.80,129.60,136.80,136.80,129.60
42639309_1,SNF Visit Detailed,Inpatient,0524,99309,,,,0,194.00,145.50,145.50,184.30,174.60,184.30,184.30,174.60
42639309_1,SNF Visit Detailed,Outpatient,0524,99309,,,,0,194.00,145.50,145.50,184.30,174.60,184.30,0.00,174.60
42639315_1,SNF Discharge Level 1,Outpatient,0524,99315,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,0.00,159.30
42639315_1,SNF Discharge Level 1,Inpatient,0524,99315,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
42639316_1,SNF Discharge Level 2,Inpatient,0524,99316,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
42639316_1,SNF Discharge Level 2,Outpatient,0524,99316,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,0.00,205.20
42641976_2,REMOVAL OF CONTRACEPTIVE CAP,ProFee,0989,11976,,,,0,278.00,208.50,134.50,208.50,0.00,134.50,134.50,N/A
42641976_3,REMOVAL OF CONTRACEPTIVE CAP,ProFee,0989,11976,,,,0,3.00,2.25,2.25,134.50,0.00,134.50,134.50,N/A
42650_3,DILATION OF SALIVARY DUCT,ProFee,0989,42650,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
42659281_2,EMERGENCY DEPT VISIT,ProFee,0989,99281,,,,0,76.00,57.00,30.00,57.00,0.00,30.00,30.00,N/A
42659281_3,EMERGENCY DEPT VISIT,ProFee,0989,99281,,,,0,3.00,2.25,2.25,30.00,0.00,30.00,30.00,N/A
42659282_2,EMERGENCY DEPT VISIT,ProFee,0989,99282,,,,0,112.00,84.00,58.50,84.00,0.00,58.50,58.50,N/A
42659282_3,EMERGENCY DEPT VISIT,ProFee,0989,99282,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
42659283_2,EMERGENCY DEPT VISIT,ProFee,0989,99283,,,,0,153.00,114.75,87.50,114.75,0.00,87.50,87.50,N/A
42659283_3,EMERGENCY DEPT VISIT,ProFee,0989,99283,,,,0,3.00,2.25,2.25,87.50,0.00,87.50,87.50,N/A
42659284_2,EMERGENCY DEPT VISIT,ProFee,0989,99284,,,,0,222.00,166.50,166.00,166.50,0.00,166.00,166.00,N/A
42659284_3,EMERGENCY DEPT VISIT,ProFee,0989,99284,,,,0,3.00,2.25,2.25,166.00,0.00,166.00,166.00,N/A
42659285_2,EMERGENCY DEPT VISIT,ProFee,0989,99285,,,,0,349.00,261.75,244.50,261.75,0.00,244.50,244.50,N/A
42659285_3,EMERGENCY DEPT VISIT,ProFee,0989,99285,,,,0,3.00,2.25,2.25,244.50,0.00,244.50,244.50,N/A
42659291_2,"CRITICAL CARE, FIRST HOUR",ProFee,0989,99291,,,,0,418.00,313.50,313.50,315.00,0.00,315.00,315.00,N/A
42659291_3,"CRITICAL CARE, FIRST HOUR",ProFee,0989,99291,,,,0,3.00,2.25,2.25,315.00,0.00,315.00,315.00,N/A
42659292_2,"CRITICAL CARE, ADD'L 30 MIN",ProFee,0989,99292,,,,0,210.00,157.50,157.50,158.00,0.00,158.00,158.00,N/A
42659292_3,"CRITICAL CARE, ADD'L 30 MIN",ProFee,0989,99292,,,,0,3.00,2.25,2.25,158.00,0.00,158.00,158.00,N/A
4265F_3,WET-DRY DRESSINGS RX-RECMD,ProFee,0989,4265F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42660_3,DILATION OF SALIVARY DUCT,ProFee,0989,42660,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
42665_3,LIGATION OF SALIVARY DUCT,ProFee,0989,42665,,,,0,3.00,2.25,2.25,294.00,0.00,294.00,294.00,N/A
42669221_1,IP Initial Visit-Comp-Low,ProFee,0987,99221,,,,0,219.00,164.25,143.50,164.25,0.00,143.50,143.50,N/A
42669222_1,IP Initial Visit-Comp-Mod,ProFee,0987,99222,,,,0,309.00,231.75,193.50,231.75,0.00,193.50,193.50,N/A
42669223_1,IP Initial Visit-Comp-High,ProFee,0987,99223,,,,0,396.00,297.00,287.00,297.00,0.00,287.00,287.00,N/A
42669231_1,Sub IP Care,ProFee,0987,99231,,,,0,105.00,78.75,55.50,78.75,0.00,55.50,55.50,N/A
42669232_1,Sub IP Care Expanded,ProFee,0987,99232,,,,0,156.00,117.00,103.00,117.00,0.00,103.00,103.00,N/A
42669233_1,Sub IP Care Hign,ProFee,0987,99233,,,,0,219.00,164.25,147.50,164.25,0.00,147.50,147.50,N/A
42669234_1,IP Admit & Discharge Level 1,ProFee,0987,99234,,,,0,345.00,258.75,188.50,258.75,0.00,188.50,188.50,N/A
42669235_1,IP Admit & Discharge Level 2,ProFee,0987,99235,,,,0,467.00,350.25,239.50,350.25,0.00,239.50,239.50,N/A
42669236_1,IP Admit & Discharge Level 3,ProFee,0987,99236,,,,0,550.00,412.50,309.00,412.50,0.00,309.00,309.00,N/A
42669238_1,Inpatient Hospital Discharge,ProFee,0987,99238,,,,0,191.00,143.25,103.50,143.25,0.00,103.50,103.50,N/A
42669239_1,IP Hospital Discharge Level 2,ProFee,0987,99239,,,,0,213.00,159.75,152.50,159.75,0.00,152.50,152.50,N/A
42669281_1,ER Visit,ProFee,0981,99281,,,,0,97.00,72.75,30.00,72.75,0.00,30.00,30.00,N/A
42669282_1,ER Visit-Expanded Low,ProFee,0981,99282,,,,0,141.00,105.75,58.50,105.75,0.00,58.50,58.50,N/A
42669283_1,ER Visit-Expanded Mod,ProFee,0981,99283,,,,0,191.00,143.25,87.50,143.25,0.00,87.50,87.50,N/A
42669284_1,ER Visit-Detailed Mod,ProFee,0981,99284,,,,0,275.00,206.25,166.00,206.25,0.00,166.00,166.00,N/A
42669285_1,ER Visit-Comp High,ProFee,0981,99285,,,,0,430.00,322.50,244.50,322.50,0.00,244.50,244.50,N/A
42669291_1,Critical Care 30-74 Min,ProFee,0981,99291,,,,0,517.00,387.75,315.00,387.75,0.00,315.00,315.00,N/A
42669292_1,Critical Care Each Add'L 30 Min,ProFee,0981,99292,,,,0,262.00,196.50,158.00,196.50,0.00,158.00,158.00,N/A
4266F_3,NO WET-DRY DRSSINGS RX-RECMD,ProFee,0989,4266F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4267F_3,COMPRSSION THXPY PRESCRIBED,ProFee,0989,4267F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4268F_3,PT ED RE COMP THXPY RCVD,ProFee,0989,4268F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42699_3,SALIVARY SURGERY PROCEDURE,ProFee,0989,42699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4269F_3,APPROPOS MTHD OFFLOADING RXD,ProFee,0989,4269F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42700_3,DRAINAGE OF TONSIL ABSCESS,ProFee,0989,42700,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
4270F_3,PT RCVNG ANTI R-VIRAL THXPY,ProFee,0989,4270F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4271F_3,PT RCVNG ANTI R-VIRAL THXPY,ProFee,0989,4271F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42720_3,DRAINAGE OF THROAT ABSCESS,ProFee,0989,42720,,,,0,3.00,2.25,2.25,561.50,0.00,561.50,561.50,N/A
42725_3,DRAINAGE OF THROAT ABSCESS,ProFee,0989,42725,,,,0,3.00,2.25,2.25,1174.00,0.00,1174.00,1174.00,N/A
4274F_3,FLU IMMUNO ADMIN'D RCVD,ProFee,0989,4274F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4275F_3,HEP B VAC INJ ADMIN/ RCVD,ProFee,0989,4275F,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4276F_3,ANTI R-VIRAL THXPY RXD,ProFee,0989,4276F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4279F_3,PCP PROPHYLAXIS RXD,ProFee,0989,4279F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42800_3,BIOPSY OF THROAT,ProFee,0989,42800,,,,0,3.00,2.25,2.25,159.50,0.00,159.50,159.50,N/A
42802_3,BIOPSY OF THROAT,ProFee,0989,42802,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
42804_3,BIOPSY OF UPPER NOSE/THROAT,ProFee,0989,42804,,,,0,3.00,2.25,2.25,161.00,0.00,161.00,161.00,N/A
42806_3,BIOPSY OF UPPER NOSE/THROAT,ProFee,0989,42806,,,,0,3.00,2.25,2.25,188.50,0.00,188.50,188.50,N/A
42808_3,EXCISE PHARYNX LESION,ProFee,0989,42808,,,,0,3.00,2.25,2.25,231.00,0.00,231.00,231.00,N/A
42809_3,REMOVE PHARYNX FOREIGN BODY,ProFee,0989,42809,,,,0,3.00,2.25,2.25,174.50,0.00,174.50,174.50,N/A
4280F_3,PCP PROPHYLAX RXD 3MON LOW %,ProFee,0989,4280F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42810_3,EXCISION OF NECK CYST,ProFee,0989,42810,,,,0,3.00,2.25,2.25,412.00,0.00,412.00,412.00,N/A
42815_3,EXCISION OF NECK CYST,ProFee,0989,42815,,,,0,3.00,2.25,2.25,794.00,0.00,794.00,794.00,N/A
42820_3,REMOVE TONSILS AND ADENOIDS,ProFee,0989,42820,,,,0,3.00,2.25,2.25,412.50,0.00,412.50,412.50,N/A
42821_3,REMOVE TONSILS AND ADENOIDS,ProFee,0989,42821,,,,0,3.00,2.25,2.25,428.00,0.00,428.00,428.00,N/A
42825_3,REMOVAL OF TONSILS,ProFee,0989,42825,,,,0,3.00,2.25,2.25,372.50,0.00,372.50,372.50,N/A
42826_3,REMOVAL OF TONSILS,ProFee,0989,42826,,,,0,3.00,2.25,2.25,358.00,0.00,358.00,358.00,N/A
42830_3,REMOVAL OF ADENOIDS,ProFee,0989,42830,,,,0,3.00,2.25,2.25,294.50,0.00,294.50,294.50,N/A
42831_3,REMOVAL OF ADENOIDS,ProFee,0989,42831,,,,0,3.00,2.25,2.25,318.00,0.00,318.00,318.00,N/A
42831002_2,URINALYSIS NONAUTO W/O SCOPE,ProFee,0989,81002,,,,0,48.00,36.00,36.00,36.00,0.00,N/A,N/A,N/A
42831002_3,URINALYSIS NONAUTO W/O SCOPE,ProFee,0989,81002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42835_3,REMOVAL OF ADENOIDS,ProFee,0989,42835,,,,0,3.00,2.25,2.25,273.50,0.00,273.50,273.50,N/A
42836_3,REMOVAL OF ADENOIDS,ProFee,0989,42836,,,,0,3.00,2.25,2.25,342.50,0.00,342.50,342.50,N/A
42842_3,EXTENSIVE SURGERY OF THROAT,ProFee,0989,42842,,,,0,3.00,2.25,2.25,1454.00,0.00,1454.00,1454.00,N/A
42844_3,EXTENSIVE SURGERY OF THROAT,ProFee,0989,42844,,,,0,3.00,2.25,2.25,2002.00,0.00,2002.00,2002.00,N/A
42845_3,EXTENSIVE SURGERY OF THROAT,ProFee,0989,42845,,,,0,3.00,2.25,2.25,3217.50,0.00,3217.50,3217.50,N/A
42860_3,EXCISION OF TONSIL TAGS,ProFee,0989,42860,,,,0,3.00,2.25,2.25,267.00,0.00,267.00,267.00,N/A
42870_3,EXCISION OF LINGUAL TONSIL,ProFee,0989,42870,,,,0,3.00,2.25,2.25,854.50,0.00,854.50,854.50,N/A
42890_3,PARTIAL REMOVAL OF PHARYNX,ProFee,0989,42890,,,,0,3.00,2.25,2.25,2066.00,0.00,2066.00,2066.00,N/A
42892_3,REVISION OF PHARYNGEAL WALLS,ProFee,0989,42892,,,,0,3.00,2.25,2.25,2712.00,0.00,2712.00,2712.00,N/A
42894_3,REVISION OF PHARYNGEAL WALLS,ProFee,0989,42894,,,,0,3.00,2.25,2.25,3420.00,0.00,3420.00,3420.00,N/A
42900_3,REPAIR THROAT WOUND,ProFee,0989,42900,,,,0,3.00,2.25,2.25,482.00,0.00,482.00,482.00,N/A
4290F_3,PT SCRNED FOR INJ DRUG USE,ProFee,0989,4290F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4293F_3,PT SCRND - HGH-RSK SEX BEHAV,ProFee,0989,4293F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
42950_3,RECONSTRUCTION OF THROAT,ProFee,0989,42950,,,,0,3.00,2.25,2.25,1174.00,0.00,1174.00,1174.00,N/A
42953_3,"REPAIR THROAT, ESOPHAGUS",ProFee,0989,42953,,,,0,3.00,2.25,2.25,1408.00,0.00,1408.00,1408.00,N/A
42955_3,SURGICAL OPENING OF THROAT,ProFee,0989,42955,,,,0,3.00,2.25,2.25,1108.00,0.00,1108.00,1108.00,N/A
42960_3,CONTROL THROAT BLEEDING,ProFee,0989,42960,,,,0,3.00,2.25,2.25,242.00,0.00,242.00,242.00,N/A
42961_3,CONTROL THROAT BLEEDING,ProFee,0989,42961,,,,0,3.00,2.25,2.25,599.50,0.00,599.50,599.50,N/A
42962_3,CONTROL THROAT BLEEDING,ProFee,0989,42962,,,,0,3.00,2.25,2.25,740.00,0.00,740.00,740.00,N/A
42970_3,CONTROL NOSE/THROAT BLEEDING,ProFee,0989,42970,,,,0,3.00,2.25,2.25,589.50,0.00,589.50,589.50,N/A
42971_3,CONTROL NOSE/THROAT BLEEDING,ProFee,0989,42971,,,,0,3.00,2.25,2.25,650.50,0.00,650.50,650.50,N/A
42972_3,CONTROL NOSE/THROAT BLEEDING,ProFee,0989,42972,,,,0,3.00,2.25,2.25,728.00,0.00,728.00,728.00,N/A
42999_3,THROAT SURGERY PROCEDURE,ProFee,0989,42999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4300F_3,PT RCVNG WARF THXPY,ProFee,0989,4300F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4301F_3,PT NOT RCVNG WARF THXPY,ProFee,0989,4301F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43020_3,INCISION OF ESOPHAGUS,ProFee,0989,43020,,,,0,3.00,2.25,2.25,805.50,0.00,805.50,805.50,N/A
43030_3,THROAT MUSCLE SURGERY,ProFee,0989,43030,,,,0,3.00,2.25,2.25,740.00,0.00,740.00,740.00,N/A
43045_3,INCISION OF ESOPHAGUS,ProFee,0989,43045,,,,0,3.00,2.25,2.25,1882.00,0.00,1882.00,1882.00,N/A
4305F_3,PT ED RE FT CARE INSPCT RCVD,ProFee,0989,4305F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4306F_3,PT TLK PSYCH & RX OPD ADDIC,ProFee,0989,4306F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43100_3,EXCISION OF ESOPHAGUS LESION,ProFee,0989,43100,,,,0,3.00,2.25,2.25,891.00,0.00,891.00,891.00,N/A
43101_3,EXCISION OF ESOPHAGUS LESION,ProFee,0989,43101,,,,0,3.00,2.25,2.25,1455.00,0.00,1455.00,1455.00,N/A
43107_3,REMOVAL OF ESOPHAGUS,ProFee,0989,43107,,,,0,3.00,2.25,2.25,4317.50,0.00,4317.50,4317.50,N/A
43108_3,REMOVAL OF ESOPHAGUS,ProFee,0989,43108,,,,0,3.00,2.25,2.25,6440.50,0.00,6440.50,6440.50,N/A
43112_3,REMOVAL OF ESOPHAGUS,ProFee,0989,43112,,,,0,3.00,2.25,2.25,5060.00,0.00,5060.00,5060.00,N/A
43113_3,REMOVAL OF ESOPHAGUS,ProFee,0989,43113,,,,0,3.00,2.25,2.25,6292.50,0.00,6292.50,6292.50,N/A
43116_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43116,,,,0,3.00,2.25,2.25,7193.00,0.00,7193.00,7193.00,N/A
43117_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43117,,,,0,3.00,2.25,2.25,4702.00,0.00,4702.00,4702.00,N/A
43118_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43118,,,,0,3.00,2.25,2.25,5256.50,0.00,5256.50,5256.50,N/A
43121_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43121,,,,0,3.00,2.25,2.25,4141.00,0.00,4141.00,4141.00,N/A
43122_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43122,,,,0,3.00,2.25,2.25,3702.00,0.00,3702.00,3702.00,N/A
43123_3,PARTIAL REMOVAL OF ESOPHAGUS,ProFee,0989,43123,,,,0,3.00,2.25,2.25,6521.50,0.00,6521.50,6521.50,N/A
43124_3,REMOVAL OF ESOPHAGUS,ProFee,0989,43124,,,,0,3.00,2.25,2.25,5510.50,0.00,5510.50,5510.50,N/A
43130_3,REMOVAL OF ESOPHAGUS POUCH,ProFee,0989,43130,,,,0,3.00,2.25,2.25,1123.00,0.00,1123.00,1123.00,N/A
43135_3,REMOVAL OF ESOPHAGUS POUCH,ProFee,0989,43135,,,,0,3.00,2.25,2.25,2158.50,0.00,2158.50,2158.50,N/A
43180_3,ESOPHAGOSCOPY RIGID TRNSO,ProFee,0989,43180,,,,0,3.00,2.25,2.25,783.50,0.00,783.50,783.50,N/A
43191_3,ESOPHAGOSCOPY RIGID TRNSO DX,ProFee,0989,43191,,,,0,3.00,2.25,2.25,222.50,0.00,222.50,222.50,N/A
43192_3,ESOPHAGOSCP RIG TRNSO INJECT,ProFee,0989,43192,,,,0,3.00,2.25,2.25,242.50,0.00,242.50,242.50,N/A
43193_3,ESOPHAGOSCP RIG TRNSO BIOPSY,ProFee,0989,43193,,,,0,3.00,2.25,2.25,243.50,0.00,243.50,243.50,N/A
43194_3,ESOPHAGOSCP RIG TRNSO REM FB,ProFee,0989,43194,,,,0,3.00,2.25,2.25,278.50,0.00,278.50,278.50,N/A
43195_3,ESOPHAGOSCOPY RIGID BALLOON,ProFee,0989,43195,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
43196_3,ESOPHAGOSCP GUIDE WIRE DILAT,ProFee,0989,43196,,,,0,3.00,2.25,2.25,283.50,0.00,283.50,283.50,N/A
43197_3,ESOPHAGOSCOPY FLEX DX BRUSH,ProFee,0989,43197,,,,0,3.00,2.25,2.25,119.50,0.00,119.50,119.50,N/A
43198_3,ESOPHAGOSC FLEX TRNSN BIOPSY,ProFee,0989,43198,,,,0,3.00,2.25,2.25,142.00,0.00,142.00,142.00,N/A
43200_3,ESOPHAGUS ENDOSCOPY,ProFee,0989,43200,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
43201_3,ESOPH SCOPE W/SUBMUCOUS INJ,ProFee,0989,43201,,,,0,3.00,2.25,2.25,150.50,0.00,150.50,150.50,N/A
43202_3,"ESOPHAGUS ENDOSCOPY, BIOPSY",ProFee,0989,43202,,,,0,3.00,2.25,2.25,151.00,0.00,151.00,151.00,N/A
43204_3,ESOPH SCOPE W/SCLEROSIS INJ,ProFee,0989,43204,,,,0,3.00,2.25,2.25,198.50,0.00,198.50,198.50,N/A
43205_3,ESOPHAGUS ENDOSCOPY/LIGATION,ProFee,0989,43205,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
43206_3,ESOPH OPTICAL ENDOMICROSCOPY,ProFee,0989,43206,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
4320F_3,PT TALK PSYCHSOC+RX OH DPND,ProFee,0989,4320F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43210_3,EGD ESOPHAGOGASTRC FNDOPLSTY,ProFee,0989,43210,,,,0,3.00,2.25,2.25,651.50,0.00,651.50,651.50,N/A
43211_3,ESOPHAGOSCOP MUCOSAL RESECT,ProFee,0989,43211,,,,0,3.00,2.25,2.25,345.00,0.00,345.00,345.00,N/A
43212_3,ESOPHAGOSCOP STENT PLACEMENT,ProFee,0989,43212,,,,0,3.00,2.25,2.25,278.00,0.00,278.00,278.00,N/A
43213_3,ESOPHAGOSCOPY RETRO BALLOON,ProFee,0989,43213,,,,0,3.00,2.25,2.25,378.50,0.00,378.50,378.50,N/A
43214_3,ESOPHAGOSC DILATE BALLOON 30,ProFee,0989,43214,,,,0,3.00,2.25,2.25,282.00,0.00,282.00,282.00,N/A
43215_3,ESOPHAGUS ENDOSCOPY,ProFee,0989,43215,,,,0,3.00,2.25,2.25,207.00,0.00,207.00,207.00,N/A
43216_3,ESOPHAGUS ENDOSCOPY/LESION,ProFee,0989,43216,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
43217_3,ESOPHAGUS ENDOSCOPY,ProFee,0989,43217,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
43219_3,ESOPHAGUS ENDOSCOPY,ProFee,0989,43219,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43220_3,"ESOPH ENDOSCOPY, DILATION",ProFee,0989,43220,,,,0,3.00,2.25,2.25,172.50,0.00,172.50,172.50,N/A
43226_3,"ESOPH ENDOSCOPY, DILATION",ProFee,0989,43226,,,,0,3.00,2.25,2.25,190.00,0.00,190.00,190.00,N/A
43227_3,"ESOPH ENDOSCOPY, REPAIR",ProFee,0989,43227,,,,0,3.00,2.25,2.25,242.50,0.00,242.50,242.50,N/A
43228_3,"ESOPH ENDOSCOPY, ABLATION",ProFee,0989,43228,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43229_3,ESOPHAGOSCOPY LESION ABLATE,ProFee,0989,43229,,,,0,3.00,2.25,2.25,290.00,0.00,290.00,290.00,N/A
4322F_3,CRGVR PROV W/ ED ADDL RSRCS,ProFee,0989,4322F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43231_3,ESOPH ENDOSCOPY W/US EXAM,ProFee,0989,43231,,,,0,3.00,2.25,2.25,234.00,0.00,234.00,234.00,N/A
43232_3,ESOPH ENDOSCOPY W/US FN BX,ProFee,0989,43232,,,,0,3.00,2.25,2.25,291.50,0.00,291.50,291.50,N/A
43233_3,EGD BALLOON DIL ESOPH30 MM/>,ProFee,0989,43233,,,,0,3.00,2.25,2.25,335.50,0.00,335.50,335.50,N/A
43234_3,"UPPER GI ENDOSCOPY, EXAM",ProFee,0989,43234,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43235_3,"UPPR GI ENDOSCOPY, DIAGNOSIS",ProFee,0989,43235,,,,0,3.00,2.25,2.25,180.50,0.00,180.50,180.50,N/A
43236_3,UPPR GI SCOPE W/SUBMUC INJ,ProFee,0989,43236,,,,0,3.00,2.25,2.25,203.50,0.00,203.50,203.50,N/A
43237_3,"ENDOSCOPIC US EXAM, ESOPH",ProFee,0989,43237,,,,0,3.00,2.25,2.25,288.50,0.00,288.50,288.50,N/A
43238_3,UPPR GI ENDOSCOPY W/US FN BX,ProFee,0989,43238,,,,0,3.00,2.25,2.25,342.00,0.00,342.00,342.00,N/A
43239_3,"UPPER GI ENDOSCOPY, BIOPSY",ProFee,0989,43239,,,,0,3.00,2.25,2.25,203.00,0.00,203.00,203.00,N/A
43240_3,ESOPH ENDOSCOPE W/DRAIN CYST,ProFee,0989,43240,,,,0,3.00,2.25,2.25,576.50,0.00,576.50,576.50,N/A
43241_3,UPPER GI ENDOSCOPY WITH TUBE,ProFee,0989,43241,,,,0,3.00,2.25,2.25,209.00,0.00,209.00,209.00,N/A
43242_3,UPPR GI ENDOSCOPY W/US FN BX,ProFee,0989,43242,,,,0,3.00,2.25,2.25,386.50,0.00,386.50,386.50,N/A
43243_3,UPPER GI ENDOSCOPY & INJECT,ProFee,0989,43243,,,,0,3.00,2.25,2.25,348.50,0.00,348.50,348.50,N/A
43244_3,UPPER GI ENDOSCOPY/LIGATION,ProFee,0989,43244,,,,0,3.00,2.25,2.25,360.50,0.00,360.50,360.50,N/A
43245_3,UPPR GI SCOPE DILATE STRICTR,ProFee,0989,43245,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
43246_3,PLACE GASTROSTOMY TUBE,ProFee,0989,43246,,,,0,3.00,2.25,2.25,294.00,0.00,294.00,294.00,N/A
43247_3,OPERATIVE UPPER GI ENDOSCOPY,ProFee,0989,43247,,,,0,3.00,2.25,2.25,261.00,0.00,261.00,261.00,N/A
43248_3,UPPR GI ENDOSCOPY/GUIDE WIRE,ProFee,0989,43248,,,,0,3.00,2.25,2.25,244.00,0.00,244.00,244.00,N/A
43249_3,"ESOPH ENDOSCOPY, DILATION",ProFee,0989,43249,,,,0,3.00,2.25,2.25,225.00,0.00,225.00,225.00,N/A
4324F_3,PT QUERIED PRKNS COMPLIC,ProFee,0989,4324F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43250_3,UPPER GI ENDOSCOPY/TUMOR,ProFee,0989,43250,,,,0,3.00,2.25,2.25,250.50,0.00,250.50,250.50,N/A
43251_3,OPERATIVE UPPER GI ENDOSCOPY,ProFee,0989,43251,,,,0,3.00,2.25,2.25,289.00,0.00,289.00,289.00,N/A
43252_3,EGD OPTICAL ENDOMICROSCOPY,ProFee,0989,43252,,,,0,3.00,2.25,2.25,247.50,0.00,247.50,247.50,N/A
43253_3,EGD US TRANSMURAL INJXN/MARK,ProFee,0989,43253,,,,0,3.00,2.25,2.25,386.50,0.00,386.50,386.50,N/A
43254_3,EGD ENDO MUCOSAL RESECTION,ProFee,0989,43254,,,,0,3.00,2.25,2.25,397.50,0.00,397.50,397.50,N/A
43255_3,OPERATIVE UPPER GI ENDOSCOPY,ProFee,0989,43255,,,,0,3.00,2.25,2.25,295.50,0.00,295.50,295.50,N/A
43256_3,UPPR GI ENDOSCOPY W/STENT,ProFee,0989,43256,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43257_3,UPPR GI SCOPE W/THRML TXMNT,ProFee,0989,43257,,,,0,3.00,2.25,2.25,341.50,0.00,341.50,341.50,N/A
43258_3,OPERATIVE UPPER GI ENDOSCOPY,ProFee,0989,43258,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43259_3,ENDOSCOPIC ULTRASOUND EXAM,ProFee,0989,43259,,,,0,3.00,2.25,2.25,332.50,0.00,332.50,332.50,N/A
4325F_3,MED TXMNT OPTIONS RVWD W/PT,ProFee,0989,4325F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43260_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43260,,,,0,3.00,2.25,2.25,474.50,0.00,474.50,474.50,N/A
43261_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43261,,,,0,3.00,2.25,2.25,498.50,0.00,498.50,498.50,N/A
43262_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43262,,,,0,3.00,2.25,2.25,525.00,0.00,525.00,525.00,N/A
43263_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43263,,,,0,3.00,2.25,2.25,525.50,0.00,525.50,525.50,N/A
43264_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43264,,,,0,3.00,2.25,2.25,535.50,0.00,535.50,535.50,N/A
43265_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43265,,,,0,3.00,2.25,2.25,636.50,0.00,636.50,636.50,N/A
43266_3,EGD ENDOSCOPIC STENT PLACE,ProFee,0989,43266,,,,0,3.00,2.25,2.25,320.50,0.00,320.50,320.50,N/A
43267_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43267,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43268_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43268,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43269_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43269,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
4326F_3,PT ASKED RE SYMP AUTO DYSFXN,ProFee,0989,4326F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43270_3,EGD LESION ABLATION,ProFee,0989,43270,,,,0,3.00,2.25,2.25,330.00,0.00,330.00,330.00,N/A
43271_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43271,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43272_3,ENDO CHOLANGIOPANCREATOGRAPH,ProFee,0989,43272,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43273_3,ENDOSCOPIC PANCREATOSCOPY,ProFee,0989,43273,,,,0,3.00,2.25,2.25,175.50,0.00,175.50,175.50,N/A
43274_3,ERCP DUCT STENT PLACEMENT,ProFee,0989,43274,,,,0,3.00,2.25,2.25,680.50,0.00,680.50,680.50,N/A
43275_3,ERCP REMOVE FORGN BODY DUCT,ProFee,0989,43275,,,,0,3.00,2.25,2.25,554.00,0.00,554.00,554.00,N/A
43276_3,ERCP STENT EXCHANGE W/DILATE,ProFee,0989,43276,,,,0,3.00,2.25,2.25,708.50,0.00,708.50,708.50,N/A
43277_3,ERCP EA DUCT/AMPULLA DILATE,ProFee,0989,43277,,,,0,3.00,2.25,2.25,557.00,0.00,557.00,557.00,N/A
43278_3,ERCP LESION ABLATE W/DILATE,ProFee,0989,43278,,,,0,3.00,2.25,2.25,637.00,0.00,637.00,637.00,N/A
43279_3,"LAP MYOTOMY, HELLER",ProFee,0989,43279,,,,0,3.00,2.25,2.25,1867.00,0.00,1867.00,1867.00,N/A
43280_3,"LAPAROSCOPY, FUNDOPLASTY",ProFee,0989,43280,,,,0,3.00,2.25,2.25,1565.50,0.00,1565.50,1565.50,N/A
43281_3,LAP PARAESOPHAG HERN REPAIR,ProFee,0989,43281,,,,0,3.00,2.25,2.25,2236.00,0.00,2236.00,2236.00,N/A
43282_3,LAP PARAESOPH HER RPR W/MESH,ProFee,0989,43282,,,,0,3.00,2.25,2.25,2514.50,0.00,2514.50,2514.50,N/A
43283_3,LAP ESOPH LENGTHENING,ProFee,0989,43283,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
43284_3,LAPS ESOPHGL SPHNCTR AGMNTJ,ProFee,0989,43284,,,,0,3.00,2.25,2.25,941.50,0.00,941.50,941.50,N/A
43285_3,RMVL ESOPHGL SPHNCTR DEV,ProFee,0989,43285,,,,0,3.00,2.25,2.25,902.00,0.00,902.00,902.00,N/A
43286_3,ESPHG TOT W/LAPS MOBLJ,ProFee,0989,43286,,,,0,3.00,2.25,2.25,4553.00,0.00,4553.00,4553.00,N/A
43287_3,ESPHG DSTL 2/3 W/LAPS MOBLJ,ProFee,0989,43287,,,,0,3.00,2.25,2.25,5200.00,0.00,5200.00,5200.00,N/A
43288_3,ESPHG THRSC MOBLJ,ProFee,0989,43288,,,,0,3.00,2.25,2.25,5425.50,0.00,5425.50,5425.50,N/A
43289_3,"LAPAROSCOPE PROC, ESOPH",ProFee,0989,43289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4328F_3,PT ASKED RE SLEEP DISTURB,ProFee,0989,4328F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43300_3,REPAIR OF ESOPHAGUS,ProFee,0989,43300,,,,0,3.00,2.25,2.25,875.00,0.00,875.00,875.00,N/A
43305_3,REPAIR ESOPHAGUS AND FISTULA,ProFee,0989,43305,,,,0,3.00,2.25,2.25,1552.50,0.00,1552.50,1552.50,N/A
4330F_3,CNSLNG EPI SPEC SFTY ISSUES,ProFee,0989,4330F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43310_3,REPAIR OF ESOPHAGUS,ProFee,0989,43310,,,,0,3.00,2.25,2.25,2148.50,0.00,2148.50,2148.50,N/A
43312_3,REPAIR ESOPHAGUS AND FISTULA,ProFee,0989,43312,,,,0,3.00,2.25,2.25,2314.00,0.00,2314.00,2314.00,N/A
43313_3,ESOPHAGOPLASTY CONGENITAL,ProFee,0989,43313,,,,0,3.00,2.25,2.25,3956.50,0.00,3956.50,3956.50,N/A
43314_3,TRACHEO-ESOPHAGOPLASTY CONG,ProFee,0989,43314,,,,0,3.00,2.25,2.25,4259.00,0.00,4259.00,4259.00,N/A
43320_3,FUSE ESOPHAGUS & STOMACH,ProFee,0989,43320,,,,0,3.00,2.25,2.25,2023.50,0.00,2023.50,2023.50,N/A
43324_3,REVISE ESOPHAGUS & STOMACH,ProFee,0989,43324,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43325_3,REVISE ESOPHAGUS & STOMACH,ProFee,0989,43325,,,,0,3.00,2.25,2.25,1968.50,0.00,1968.50,1968.50,N/A
43326_3,REVISE ESOPHAGUS & STOMACH,ProFee,0989,43326,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43327_3,ESOPH FUNDOPLASTY LAP,ProFee,0989,43327,,,,0,3.00,2.25,2.25,1190.00,0.00,1190.00,1190.00,N/A
43328_3,ESOPH FUNDOPLASTY THOR,ProFee,0989,43328,,,,0,3.00,2.25,2.25,1634.50,0.00,1634.50,1634.50,N/A
43330_3,REPAIR OF ESOPHAGUS,ProFee,0989,43330,,,,0,3.00,2.25,2.25,1935.50,0.00,1935.50,1935.50,N/A
43331_3,REPAIR OF ESOPHAGUS,ProFee,0989,43331,,,,0,3.00,2.25,2.25,1942.50,0.00,1942.50,1942.50,N/A
43332_3,TRANSAB ESOPH HIAT HERN RPR,ProFee,0989,43332,,,,0,3.00,2.25,2.25,1680.00,0.00,1680.00,1680.00,N/A
43333_3,TRANSAB ESOPH HIAT HERN RPR,ProFee,0989,43333,,,,0,3.00,2.25,2.25,1830.50,0.00,1830.50,1830.50,N/A
43334_3,TRANSTHOR DIAPHRAG HERN RPR,ProFee,0989,43334,,,,0,3.00,2.25,2.25,1809.50,0.00,1809.50,1809.50,N/A
43335_3,TRANSTHOR DIAPHRAG HERN RPR,ProFee,0989,43335,,,,0,3.00,2.25,2.25,1941.50,0.00,1941.50,1941.50,N/A
43336_3,THORABD DIAPHR HERN REPAIR,ProFee,0989,43336,,,,0,3.00,2.25,2.25,2179.00,0.00,2179.00,2179.00,N/A
43337_3,THORABD DIAPHR HERN REPAIR,ProFee,0989,43337,,,,0,3.00,2.25,2.25,2244.00,0.00,2244.00,2244.00,N/A
43338_3,ESOPH LENGTHENING,ProFee,0989,43338,,,,0,3.00,2.25,2.25,168.50,0.00,168.50,168.50,N/A
43340_3,FUSE ESOPHAGUS & INTESTINE,ProFee,0989,43340,,,,0,3.00,2.25,2.25,1998.50,0.00,1998.50,1998.50,N/A
43341_3,FUSE ESOPHAGUS & INTESTINE,ProFee,0989,43341,,,,0,3.00,2.25,2.25,2029.00,0.00,2029.00,2029.00,N/A
43350_3,"SURGICAL OPENING, ESOPHAGUS",ProFee,0989,43350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43351_3,"SURGICAL OPENING, ESOPHAGUS",ProFee,0989,43351,,,,0,3.00,2.25,2.25,1904.00,0.00,1904.00,1904.00,N/A
43352_3,"SURGICAL OPENING, ESOPHAGUS",ProFee,0989,43352,,,,0,3.00,2.25,2.25,1544.00,0.00,1544.00,1544.00,N/A
43360_3,GASTROINTESTINAL REPAIR,ProFee,0989,43360,,,,0,3.00,2.25,2.25,3266.00,0.00,3266.00,3266.00,N/A
43361_3,GASTROINTESTINAL REPAIR,ProFee,0989,43361,,,,0,3.00,2.25,2.25,3904.50,0.00,3904.50,3904.50,N/A
43400_3,LIGATE ESOPHAGUS VEINS,ProFee,0989,43400,,,,0,3.00,2.25,2.25,2206.50,0.00,2206.50,2206.50,N/A
43405_3,LIGATE/STAPLE ESOPHAGUS,ProFee,0989,43405,,,,0,3.00,2.25,2.25,2107.00,0.00,2107.00,2107.00,N/A
4340F_3,CNSLNG CHLDBRNG+ WOMEN EPI,ProFee,0989,4340F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43410_3,REPAIR ESOPHAGUS WOUND,ProFee,0989,43410,,,,0,3.00,2.25,2.25,1463.50,0.00,1463.50,1463.50,N/A
43415_3,REPAIR ESOPHAGUS WOUND,ProFee,0989,43415,,,,0,3.00,2.25,2.25,3741.00,0.00,3741.00,3741.00,N/A
43420_3,REPAIR ESOPHAGUS OPENING,ProFee,0989,43420,,,,0,3.00,2.25,2.25,1447.50,0.00,1447.50,1447.50,N/A
43425_3,REPAIR ESOPHAGUS OPENING,ProFee,0989,43425,,,,0,3.00,2.25,2.25,2091.00,0.00,2091.00,2091.00,N/A
43450_3,DILATE ESOPHAGUS,ProFee,0989,43450,,,,0,3.00,2.25,2.25,116.50,0.00,116.50,116.50,N/A
43453_3,DILATE ESOPHAGUS,ProFee,0989,43453,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
43456_3,DILATE ESOPHAGUS,ProFee,0989,43456,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43458_3,DILATE ESOPHAGUS,ProFee,0989,43458,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43460_3,PRESSURE TREATMENT ESOPHAGUS,ProFee,0989,43460,,,,0,3.00,2.25,2.25,313.50,0.00,313.50,313.50,N/A
43496_3,"FREE JEJUNUM FLAP, MICROVASC",ProFee,0989,43496,,,,0,3.00,2.25,2.25,2989.50,0.00,2989.50,2989.50,N/A
43499_3,ESOPHAGUS SURGERY PROCEDURE,ProFee,0989,43499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43500_3,SURGICAL OPENING OF STOMACH,ProFee,0989,43500,,,,0,3.00,2.25,2.25,1135.50,0.00,1135.50,1135.50,N/A
43501_3,SURGICAL REPAIR OF STOMACH,ProFee,0989,43501,,,,0,3.00,2.25,2.25,1946.50,0.00,1946.50,1946.50,N/A
43502_3,SURGICAL REPAIR OF STOMACH,ProFee,0989,43502,,,,0,3.00,2.25,2.25,2211.00,0.00,2211.00,2211.00,N/A
4350F_3,CNSLNG PROVIDED SYMP MNGMNT,ProFee,0989,4350F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43510_3,SURGICAL OPENING OF STOMACH,ProFee,0989,43510,,,,0,3.00,2.25,2.25,1369.50,0.00,1369.50,1369.50,N/A
43520_3,INCISION OF PYLORIC MUSCLE,ProFee,0989,43520,,,,0,3.00,2.25,2.25,989.00,0.00,989.00,989.00,N/A
43600_3,BIOPSY OF STOMACH,ProFee,0989,43600,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43605_3,BIOPSY OF STOMACH,ProFee,0989,43605,,,,0,3.00,2.25,2.25,1211.00,0.00,1211.00,1211.00,N/A
43610_3,EXCISION OF STOMACH LESION,ProFee,0989,43610,,,,0,3.00,2.25,2.25,1416.50,0.00,1416.50,1416.50,N/A
43611_3,EXCISION OF STOMACH LESION,ProFee,0989,43611,,,,0,3.00,2.25,2.25,1773.00,0.00,1773.00,1773.00,N/A
43620_3,REMOVAL OF STOMACH,ProFee,0989,43620,,,,0,3.00,2.25,2.25,2862.50,0.00,2862.50,2862.50,N/A
43621_3,REMOVAL OF STOMACH,ProFee,0989,43621,,,,0,3.00,2.25,2.25,3287.50,0.00,3287.50,3287.50,N/A
43622_3,REMOVAL OF STOMACH,ProFee,0989,43622,,,,0,3.00,2.25,2.25,3353.50,0.00,3353.50,3353.50,N/A
43631_3,"REMOVAL OF STOMACH, PARTIAL",ProFee,0989,43631,,,,0,3.00,2.25,2.25,2098.00,0.00,2098.00,2098.00,N/A
43632_3,"REMOVAL OF STOMACH, PARTIAL",ProFee,0989,43632,,,,0,3.00,2.25,2.25,2944.00,0.00,2944.00,2944.00,N/A
43633_3,"REMOVAL OF STOMACH, PARTIAL",ProFee,0989,43633,,,,0,3.00,2.25,2.25,2783.00,0.00,2783.00,2783.00,N/A
43634_3,"REMOVAL OF STOMACH, PARTIAL",ProFee,0989,43634,,,,0,3.00,2.25,2.25,3084.50,0.00,3084.50,3084.50,N/A
43635_3,"REMOVAL OF STOMACH, PARTIAL",ProFee,0989,43635,,,,0,3.00,2.25,2.25,164.00,0.00,164.00,164.00,N/A
43640_3,VAGOTOMY & PYLORUS REPAIR,ProFee,0989,43640,,,,0,3.00,2.25,2.25,1707.00,0.00,1707.00,1707.00,N/A
43641_3,VAGOTOMY & PYLORUS REPAIR,ProFee,0989,43641,,,,0,3.00,2.25,2.25,1743.00,0.00,1743.00,1743.00,N/A
43644_3,LAP GASTRIC BYPASS/ROUX-EN-Y,ProFee,0989,43644,,,,0,3.00,2.25,2.25,2507.50,0.00,2507.50,2507.50,N/A
43645_3,LAP GASTR BYPASS INCL SMLL I,ProFee,0989,43645,,,,0,3.00,2.25,2.25,2670.50,0.00,2670.50,2670.50,N/A
43647_3,"LAP IMPL ELECTRODE, ANTRUM",ProFee,0989,43647,,,,0,3.00,2.25,2.25,1094.00,0.00,1094.00,1094.00,N/A
43648_3,LAP REVISE/REMV ELTRD ANTRUM,ProFee,0989,43648,,,,0,3.00,2.25,2.25,970.00,0.00,970.00,970.00,N/A
43651_3,"LAPAROSCOPY, VAGUS NERVE",ProFee,0989,43651,,,,0,3.00,2.25,2.25,947.50,0.00,947.50,947.50,N/A
43652_3,"LAPAROSCOPY, VAGUS NERVE",ProFee,0989,43652,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
43653_3,"LAPAROSCOPY, GASTROSTOMY",ProFee,0989,43653,,,,0,3.00,2.25,2.25,829.00,0.00,829.00,829.00,N/A
43659_3,"LAPAROSCOPE PROC, STOM",ProFee,0989,43659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43750_3,PLACE GASTROSTOMY TUBE,ProFee,0989,43750,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
43753_3,TX GASTRO INTUB W/ASP,ProFee,0989,43753,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
43754_3,DX GASTR INTUB W/ASP SPEC,ProFee,0989,43754,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
43755_3,DX GASTR INTUB W/ASP SPECS,ProFee,0989,43755,,,,0,3.00,2.25,2.25,88.00,0.00,88.00,88.00,N/A
43756_3,DX DUOD INTUB W/ASP SPEC,ProFee,0989,43756,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
43757_3,DX DUOD INTUB W/ASP SPECS,ProFee,0989,43757,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
43760_3,CHANGE GASTROSTOMY TUBE,ProFee,0989,43760,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
43761_3,REPOSITION GASTROSTOMY TUBE,ProFee,0989,43761,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
43762_3,RPLC GTUBE NO REVJ TRC,ProFee,0989,43762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43763_3,RPLC GTUBE REVJ GSTRST TRC,ProFee,0989,43763,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
43770_3,"LAP, PLACE GASTR ADJUST BAND",ProFee,0989,43770,,,,0,3.00,2.25,2.25,1622.50,0.00,1622.50,1622.50,N/A
43771_3,"LAP, REVISE ADJUST GAST BAND",ProFee,0989,43771,,,,0,3.00,2.25,2.25,1847.00,0.00,1847.00,1847.00,N/A
43772_3,"LAP, REMOVE ADJUST GAST BAND",ProFee,0989,43772,,,,0,3.00,2.25,2.25,1381.00,0.00,1381.00,1381.00,N/A
43773_3,"LAP, CHANGE ADJUST GAST BAND",ProFee,0989,43773,,,,0,3.00,2.25,2.25,1851.50,0.00,1851.50,1851.50,N/A
43774_3,LAP REMOV ADJ GAST BAND/PORT,ProFee,0989,43774,,,,0,3.00,2.25,2.25,1389.50,0.00,1389.50,1389.50,N/A
43775_3,LAP SLEEVE GASTRECTOMY,ProFee,0989,43775,,,,0,3.00,2.25,2.25,1616.50,0.00,1616.50,1616.50,N/A
43800_3,RECONSTRUCTION OF PYLORUS,ProFee,0989,43800,,,,0,3.00,2.25,2.25,1344.50,0.00,1344.50,1344.50,N/A
43810_3,FUSION OF STOMACH AND BOWEL,ProFee,0989,43810,,,,0,3.00,2.25,2.25,1475.50,0.00,1475.50,1475.50,N/A
43820_3,FUSION OF STOMACH AND BOWEL,ProFee,0989,43820,,,,0,3.00,2.25,2.25,1944.50,0.00,1944.50,1944.50,N/A
43825_3,FUSION OF STOMACH AND BOWEL,ProFee,0989,43825,,,,0,3.00,2.25,2.25,1897.50,0.00,1897.50,1897.50,N/A
43830_3,PLACE GASTROSTOMY TUBE,ProFee,0989,43830,,,,0,3.00,2.25,2.25,1012.00,0.00,1012.00,1012.00,N/A
43831_3,PLACE GASTROSTOMY TUBE,ProFee,0989,43831,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
43832_3,PLACE GASTROSTOMY TUBE,ProFee,0989,43832,,,,0,3.00,2.25,2.25,1499.50,0.00,1499.50,1499.50,N/A
43840_3,REPAIR OF STOMACH LESION,ProFee,0989,43840,,,,0,3.00,2.25,2.25,1968.50,0.00,1968.50,1968.50,N/A
43842_3,V-BAND GASTROPLASTY,ProFee,0989,43842,,,,0,3.00,2.25,2.25,1728.00,0.00,1728.00,1728.00,N/A
43843_3,GASTROPLASTY W/O V-BAND,ProFee,0989,43843,,,,0,3.00,2.25,2.25,1856.00,0.00,1856.00,1856.00,N/A
43845_3,GASTROPLASTY DUODENAL SWITCH,ProFee,0989,43845,,,,0,3.00,2.25,2.25,2850.00,0.00,2850.00,2850.00,N/A
43846_3,GASTRIC BYPASS FOR OBESITY,ProFee,0989,43846,,,,0,3.00,2.25,2.25,2343.50,0.00,2343.50,2343.50,N/A
43847_3,GASTRIC BYPASS INCL SMALL I,ProFee,0989,43847,,,,0,3.00,2.25,2.25,2613.50,0.00,2613.50,2613.50,N/A
43848_3,REVISION GASTROPLASTY,ProFee,0989,43848,,,,0,3.00,2.25,2.25,2787.50,0.00,2787.50,2787.50,N/A
43850_3,REVISE STOMACH-BOWEL FUSION,ProFee,0989,43850,,,,0,3.00,2.25,2.25,2361.50,0.00,2361.50,2361.50,N/A
43855_3,REVISE STOMACH-BOWEL FUSION,ProFee,0989,43855,,,,0,3.00,2.25,2.25,2449.50,0.00,2449.50,2449.50,N/A
43860_3,REVISE STOMACH-BOWEL FUSION,ProFee,0989,43860,,,,0,3.00,2.25,2.25,2370.50,0.00,2370.50,2370.50,N/A
43865_3,REVISE STOMACH-BOWEL FUSION,ProFee,0989,43865,,,,0,3.00,2.25,2.25,2479.00,0.00,2479.00,2479.00,N/A
43870_3,REPAIR STOMACH OPENING,ProFee,0989,43870,,,,0,3.00,2.25,2.25,1027.50,0.00,1027.50,1027.50,N/A
43880_3,REPAIR STOMACH-BOWEL FISTULA,ProFee,0989,43880,,,,0,3.00,2.25,2.25,2314.50,0.00,2314.50,2314.50,N/A
43881_3,"IMPL/REDO ELECTRD, ANTRUM",ProFee,0989,43881,,,,0,3.00,2.25,2.25,1041.50,0.00,1041.50,1041.50,N/A
43882_3,REVISE/REMOVE ELECTRD ANTRUM,ProFee,0989,43882,,,,0,3.00,2.25,2.25,1245.50,0.00,1245.50,1245.50,N/A
43886_3,"REVISE GASTRIC PORT, OPEN",ProFee,0989,43886,,,,0,3.00,2.25,2.25,524.50,0.00,524.50,524.50,N/A
43887_3,"REMOVE GASTRIC PORT, OPEN",ProFee,0989,43887,,,,0,3.00,2.25,2.25,473.00,0.00,473.00,473.00,N/A
43888_3,"CHANGE GASTRIC PORT, OPEN",ProFee,0989,43888,,,,0,3.00,2.25,2.25,667.50,0.00,667.50,667.50,N/A
43999_3,STOMACH SURGERY PROCEDURE,ProFee,0989,43999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44005_3,FREEING OF BOWEL ADHESION,ProFee,0989,44005,,,,0,3.00,2.25,2.25,1586.50,0.00,1586.50,1586.50,N/A
4400F_3,REHAB THXPY OPTIONS W/PT,ProFee,0989,4400F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44010_3,INCISION OF SMALL BOWEL,ProFee,0989,44010,,,,0,3.00,2.25,2.25,1245.50,0.00,1245.50,1245.50,N/A
44015_3,INSERT NEEDLE CATH BOWEL,ProFee,0989,44015,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
44020_3,EXPLORE SMALL INTESTINE,ProFee,0989,44020,,,,0,3.00,2.25,2.25,1408.50,0.00,1408.50,1408.50,N/A
44021_3,DECOMPRESS SMALL BOWEL,ProFee,0989,44021,,,,0,3.00,2.25,2.25,1410.50,0.00,1410.50,1410.50,N/A
44025_3,INCISION OF LARGE BOWEL,ProFee,0989,44025,,,,0,3.00,2.25,2.25,1422.50,0.00,1422.50,1422.50,N/A
44050_3,REDUCE BOWEL OBSTRUCTION,ProFee,0989,44050,,,,0,3.00,2.25,2.25,1352.50,0.00,1352.50,1352.50,N/A
44055_3,CORRECT MALROTATION OF BOWEL,ProFee,0989,44055,,,,0,3.00,2.25,2.25,2159.00,0.00,2159.00,2159.00,N/A
44100_3,BIOPSY OF BOWEL,ProFee,0989,44100,,,,0,3.00,2.25,2.25,158.00,0.00,158.00,158.00,N/A
44110_3,EXCISE INTESTINE LESION(S),ProFee,0989,44110,,,,0,3.00,2.25,2.25,1230.50,0.00,1230.50,1230.50,N/A
44111_3,EXCISION OF BOWEL LESION(S),ProFee,0989,44111,,,,0,3.00,2.25,2.25,1421.50,0.00,1421.50,1421.50,N/A
44120_3,REMOVAL OF SMALL INTESTINE,ProFee,0989,44120,,,,0,3.00,2.25,2.25,1773.50,0.00,1773.50,1773.50,N/A
44121_3,REMOVAL OF SMALL INTESTINE,ProFee,0989,44121,,,,0,3.00,2.25,2.25,351.50,0.00,351.50,351.50,N/A
44125_3,REMOVAL OF SMALL INTESTINE,ProFee,0989,44125,,,,0,3.00,2.25,2.25,1709.00,0.00,1709.00,1709.00,N/A
44126_3,"ENTERECTOMY W/O TAPER, CONG",ProFee,0989,44126,,,,0,3.00,2.25,2.25,3575.50,0.00,3575.50,3575.50,N/A
44127_3,"ENTERECTOMY W/TAPER, CONG",ProFee,0989,44127,,,,0,3.00,2.25,2.25,4134.50,0.00,4134.50,4134.50,N/A
44128_3,"ENTERECTOMY CONG, ADD-ON",ProFee,0989,44128,,,,0,3.00,2.25,2.25,354.50,0.00,354.50,354.50,N/A
44130_3,BOWEL TO BOWEL FUSION,ProFee,0989,44130,,,,0,3.00,2.25,2.25,1901.50,0.00,1901.50,1901.50,N/A
44132_3,"ENTERECTOMY, CADAVER DONOR",ProFee,0989,44132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44133_3,"ENTERECTOMY, LIVE DONOR",ProFee,0989,44133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44135_3,"INTESTINE TRANSPLNT, CADAVER",ProFee,0989,44135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44136_3,"INTESTINE TRANSPLANT, LIVE",ProFee,0989,44136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44137_3,REMOVE INTESTINAL ALLOGRAFT,ProFee,0989,44137,,,,0,3.00,2.25,2.25,1869.50,0.00,1869.50,1869.50,N/A
44139_3,MOBILIZATION OF COLON,ProFee,0989,44139,,,,0,3.00,2.25,2.25,176.50,0.00,176.50,176.50,N/A
44140_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44140,,,,0,3.00,2.25,2.25,1943.50,0.00,1943.50,1943.50,N/A
44141_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44141,,,,0,3.00,2.25,2.25,2646.50,0.00,2646.50,2646.50,N/A
44143_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44143,,,,0,3.00,2.25,2.25,2412.50,0.00,2412.50,2412.50,N/A
44144_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44144,,,,0,3.00,2.25,2.25,2563.50,0.00,2563.50,2563.50,N/A
44145_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44145,,,,0,3.00,2.25,2.25,2402.00,0.00,2402.00,2402.00,N/A
44146_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44146,,,,0,3.00,2.25,2.25,3072.00,0.00,3072.00,3072.00,N/A
44147_3,PARTIAL REMOVAL OF COLON,ProFee,0989,44147,,,,0,3.00,2.25,2.25,2813.50,0.00,2813.50,2813.50,N/A
44150_3,REMOVAL OF COLON,ProFee,0989,44150,,,,0,3.00,2.25,2.25,2709.50,0.00,2709.50,2709.50,N/A
44151_3,REMOVAL OF COLON/ILEOSTOMY,ProFee,0989,44151,,,,0,3.00,2.25,2.25,3132.00,0.00,3132.00,3132.00,N/A
44152_3,REMOVAL OF COLON/ILEOSTOMY,ProFee,0989,44152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44153_3,REMOVAL OF COLON/ILEOSTOMY,ProFee,0989,44153,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44155_3,REMOVAL OF COLON/ILEOSTOMY,ProFee,0989,44155,,,,0,3.00,2.25,2.25,3017.00,0.00,3017.00,3017.00,N/A
44156_3,REMOVAL OF COLON/ILEOSTOMY,ProFee,0989,44156,,,,0,3.00,2.25,2.25,3355.00,0.00,3355.00,3355.00,N/A
44157_3,COLECTOMY W/ILEOANAL ANAST,ProFee,0989,44157,,,,0,3.00,2.25,2.25,3179.50,0.00,3179.50,3179.50,N/A
44158_3,COLECTOMY W/NEO-RECTUM POUCH,ProFee,0989,44158,,,,0,3.00,2.25,2.25,3260.50,0.00,3260.50,3260.50,N/A
44160_3,REMOVAL OF COLON,ProFee,0989,44160,,,,0,3.00,2.25,2.25,1799.00,0.00,1799.00,1799.00,N/A
44180_3,"LAP, ENTEROLYSIS",ProFee,0989,44180,,,,0,3.00,2.25,2.25,1331.50,0.00,1331.50,1331.50,N/A
44186_3,"LAP, JEJUNOSTOMY",ProFee,0989,44186,,,,0,3.00,2.25,2.25,941.00,0.00,941.00,941.00,N/A
44187_3,"LAP, ILEO/JEJUNO-STOMY",ProFee,0989,44187,,,,0,3.00,2.25,2.25,1599.50,0.00,1599.50,1599.50,N/A
44188_3,"LAP, COLOSTOMY",ProFee,0989,44188,,,,0,3.00,2.25,2.25,1776.50,0.00,1776.50,1776.50,N/A
44202_3,LAP RESECT S/INTESTINE SINGL,ProFee,0989,44202,,,,0,3.00,2.25,2.25,2006.00,0.00,2006.00,2006.00,N/A
44203_3,"LAP RESECT S/INTESTINE, ADDL",ProFee,0989,44203,,,,0,3.00,2.25,2.25,355.00,0.00,355.00,355.00,N/A
44204_3,LAPARO PARTIAL COLECTOMY,ProFee,0989,44204,,,,0,3.00,2.25,2.25,2229.50,0.00,2229.50,2229.50,N/A
44205_3,LAP COLECTOMY PART W/ILEUM,ProFee,0989,44205,,,,0,3.00,2.25,2.25,1938.50,0.00,1938.50,1938.50,N/A
44206_3,LAP PART COLECTOMY W/STOMA,ProFee,0989,44206,,,,0,3.00,2.25,2.25,2538.00,0.00,2538.00,2538.00,N/A
44207_3,L COLECTOMY/COLOPROCTOSTOMY,ProFee,0989,44207,,,,0,3.00,2.25,2.25,2638.00,0.00,2638.00,2638.00,N/A
44208_3,L COLECTOMY/COLOPROCTOSTOMY,ProFee,0989,44208,,,,0,3.00,2.25,2.25,2878.00,0.00,2878.00,2878.00,N/A
44210_3,LAPARO TOTAL PROCTOCOLECTOMY,ProFee,0989,44210,,,,0,3.00,2.25,2.25,2582.50,0.00,2582.50,2582.50,N/A
44211_3,LAPARO TOTAL PROCTOCOLECTOMY,ProFee,0989,44211,,,,0,3.00,2.25,2.25,3101.00,0.00,3101.00,3101.00,N/A
44212_3,LAPARO TOTAL PROCTOCOLECTOMY,ProFee,0989,44212,,,,0,3.00,2.25,2.25,2963.50,0.00,2963.50,2963.50,N/A
44213_3,"LAP, MOBIL SPLENIC FL ADD-ON",ProFee,0989,44213,,,,0,3.00,2.25,2.25,273.50,0.00,273.50,273.50,N/A
44227_3,"LAP, CLOSE ENTEROSTOMY",ProFee,0989,44227,,,,0,3.00,2.25,2.25,2413.00,0.00,2413.00,2413.00,N/A
44238_3,"LAPAROSCOPE PROC, INTESTINE",ProFee,0989,44238,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44300_3,OPEN BOWEL TO SKIN,ProFee,0989,44300,,,,0,3.00,2.25,2.25,1220.00,0.00,1220.00,1220.00,N/A
44310_3,ILEOSTOMY/JEJUNOSTOMY,ProFee,0989,44310,,,,0,3.00,2.25,2.25,1513.00,0.00,1513.00,1513.00,N/A
44312_3,REVISION OF ILEOSTOMY,ProFee,0989,44312,,,,0,3.00,2.25,2.25,856.50,0.00,856.50,856.50,N/A
44314_3,REVISION OF ILEOSTOMY,ProFee,0989,44314,,,,0,3.00,2.25,2.25,1455.50,0.00,1455.50,1455.50,N/A
44316_3,DEVISE BOWEL POUCH,ProFee,0989,44316,,,,0,3.00,2.25,2.25,2050.00,0.00,2050.00,2050.00,N/A
44320_3,COLOSTOMY,ProFee,0989,44320,,,,0,3.00,2.25,2.25,1740.50,0.00,1740.50,1740.50,N/A
44322_3,COLOSTOMY WITH BIOPSIES,ProFee,0989,44322,,,,0,3.00,2.25,2.25,1449.50,0.00,1449.50,1449.50,N/A
44340_3,REVISION OF COLOSTOMY,ProFee,0989,44340,,,,0,3.00,2.25,2.25,902.50,0.00,902.50,902.50,N/A
44345_3,REVISION OF COLOSTOMY,ProFee,0989,44345,,,,0,3.00,2.25,2.25,1524.00,0.00,1524.00,1524.00,N/A
44346_3,REVISION OF COLOSTOMY,ProFee,0989,44346,,,,0,3.00,2.25,2.25,1715.00,0.00,1715.00,1715.00,N/A
44360_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44360,,,,0,3.00,2.25,2.25,211.00,0.00,211.00,211.00,N/A
44361_3,SMALL BOWEL ENDOSCOPY/BIOPSY,ProFee,0989,44361,,,,0,3.00,2.25,2.25,233.00,0.00,233.00,233.00,N/A
44363_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44363,,,,0,3.00,2.25,2.25,282.50,0.00,282.50,282.50,N/A
44364_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44364,,,,0,3.00,2.25,2.25,301.00,0.00,301.00,301.00,N/A
44365_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44365,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
44366_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44366,,,,0,3.00,2.25,2.25,353.00,0.00,353.00,353.00,N/A
44369_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44369,,,,0,3.00,2.25,2.25,361.00,0.00,361.00,361.00,N/A
44370_3,SMALL BOWEL ENDOSCOPY/STENT,ProFee,0989,44370,,,,0,3.00,2.25,2.25,391.50,0.00,391.50,391.50,N/A
44372_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44372,,,,0,3.00,2.25,2.25,352.50,0.00,352.50,352.50,N/A
44373_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44373,,,,0,3.00,2.25,2.25,282.50,0.00,282.50,282.50,N/A
44376_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44376,,,,0,3.00,2.25,2.25,418.00,0.00,418.00,418.00,N/A
44377_3,SMALL BOWEL ENDOSCOPY/BIOPSY,ProFee,0989,44377,,,,0,3.00,2.25,2.25,440.50,0.00,440.50,440.50,N/A
44378_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44378,,,,0,3.00,2.25,2.25,565.50,0.00,565.50,565.50,N/A
44379_3,S BOWEL ENDOSCOPE W/STENT,ProFee,0989,44379,,,,0,3.00,2.25,2.25,601.50,0.00,601.50,601.50,N/A
44380_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44380,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
44381_3,SMALL BOWEL ENDOSCOPY BR/WA,ProFee,0989,44381,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
44382_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44382,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
44383_3,ILEOSCOPY W/STENT,ProFee,0989,44383,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44384_3,SMALL BOWEL ENDOSCOPY,ProFee,0989,44384,,,,0,3.00,2.25,2.25,224.50,0.00,224.50,224.50,N/A
44385_3,ENDOSCOPY OF BOWEL POUCH,ProFee,0989,44385,,,,0,3.00,2.25,2.25,105.50,0.00,105.50,105.50,N/A
44386_3,"ENDOSCOPY, BOWEL POUCH/BIOP",ProFee,0989,44386,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
44388_3,COLONOSCOPY,ProFee,0989,44388,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
44389_3,COLONOSCOPY WITH BIOPSY,ProFee,0989,44389,,,,0,3.00,2.25,2.25,253.00,0.00,253.00,253.00,N/A
44390_3,COLONOSCOPY FOR FOREIGN BODY,ProFee,0989,44390,,,,0,3.00,2.25,2.25,310.50,0.00,310.50,310.50,N/A
44391_3,COLONOSCOPY FOR BLEEDING,ProFee,0989,44391,,,,0,3.00,2.25,2.25,337.50,0.00,337.50,337.50,N/A
44392_3,COLONOSCOPY & POLYPECTOMY,ProFee,0989,44392,,,,0,3.00,2.25,2.25,292.00,0.00,292.00,292.00,N/A
44393_3,"COLONOSCOPY, LESION REMOVAL",ProFee,0989,44393,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44394_3,COLONOSCOPY W/SNARE,ProFee,0989,44394,,,,0,3.00,2.25,2.25,332.00,0.00,332.00,332.00,N/A
44397_3,COLONOSCOPY W/STENT,ProFee,0989,44397,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44401_3,COLONOSCOPY WITH ABLATION,ProFee,0989,44401,,,,0,3.00,2.25,2.25,355.00,0.00,355.00,355.00,N/A
44402_3,COLONOSCOPY W/STENT PLCMT,ProFee,0989,44402,,,,0,3.00,2.25,2.25,385.00,0.00,385.00,385.00,N/A
44403_3,COLONOSCOPY W/RESECTION,ProFee,0989,44403,,,,0,3.00,2.25,2.25,447.00,0.00,447.00,447.00,N/A
44404_3,COLONOSCOPY W/INJECTION,ProFee,0989,44404,,,,0,3.00,2.25,2.25,254.00,0.00,254.00,254.00,N/A
44405_3,COLONOSCOPY W/DILATION,ProFee,0989,44405,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
44406_3,COLONOSCOPY W/ULTRASOUND,ProFee,0989,44406,,,,0,3.00,2.25,2.25,338.00,0.00,338.00,338.00,N/A
44407_3,COLONOSCOPY W/NDL ASPIR/BX,ProFee,0989,44407,,,,0,3.00,2.25,2.25,405.50,0.00,405.50,405.50,N/A
44408_3,COLONOSCOPY W/DECOMPRESSION,ProFee,0989,44408,,,,0,3.00,2.25,2.25,341.00,0.00,341.00,341.00,N/A
44500_3,"INTRO, GASTROINTESTINAL TUBE",ProFee,0989,44500,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
4450F_3,SELF-CARE ED PROVIDED TO PT,ProFee,0989,4450F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44602_3,"SUTURE, SMALL INTESTINE",ProFee,0989,44602,,,,0,3.00,2.25,2.25,2045.00,0.00,2045.00,2045.00,N/A
44603_3,"SUTURE, SMALL INTESTINE",ProFee,0989,44603,,,,0,3.00,2.25,2.25,2348.50,0.00,2348.50,2348.50,N/A
44604_3,"SUTURE, LARGE INTESTINE",ProFee,0989,44604,,,,0,3.00,2.25,2.25,1533.50,0.00,1533.50,1533.50,N/A
44605_3,REPAIR OF BOWEL LESION,ProFee,0989,44605,,,,0,3.00,2.25,2.25,1889.00,0.00,1889.00,1889.00,N/A
44615_3,INTESTINAL STRICTUROPLASTY,ProFee,0989,44615,,,,0,3.00,2.25,2.25,1557.50,0.00,1557.50,1557.50,N/A
44620_3,REPAIR BOWEL OPENING,ProFee,0989,44620,,,,0,3.00,2.25,2.25,1257.00,0.00,1257.00,1257.00,N/A
44625_3,REPAIR BOWEL OPENING,ProFee,0989,44625,,,,0,3.00,2.25,2.25,1473.00,0.00,1473.00,1473.00,N/A
44626_3,REPAIR BOWEL OPENING,ProFee,0989,44626,,,,0,3.00,2.25,2.25,2321.50,0.00,2321.50,2321.50,N/A
44640_3,REPAIR BOWEL-SKIN FISTULA,ProFee,0989,44640,,,,0,3.00,2.25,2.25,2030.00,0.00,2030.00,2030.00,N/A
44650_3,REPAIR BOWEL FISTULA,ProFee,0989,44650,,,,0,3.00,2.25,2.25,2094.00,0.00,2094.00,2094.00,N/A
44660_3,REPAIR BOWEL-BLADDER FISTULA,ProFee,0989,44660,,,,0,3.00,2.25,2.25,1935.50,0.00,1935.50,1935.50,N/A
44661_3,REPAIR BOWEL-BLADDER FISTULA,ProFee,0989,44661,,,,0,3.00,2.25,2.25,2248.00,0.00,2248.00,2248.00,N/A
44680_3,"SURGICAL REVISION, INTESTINE",ProFee,0989,44680,,,,0,3.00,2.25,2.25,1537.00,0.00,1537.00,1537.00,N/A
44700_3,SUSPEND BOWEL W/PROSTHESIS,ProFee,0989,44700,,,,0,3.00,2.25,2.25,1464.50,0.00,1464.50,1464.50,N/A
44701_3,INTRAOP COLON LAVAGE ADD-ON,ProFee,0989,44701,,,,0,3.00,2.25,2.25,248.00,0.00,248.00,248.00,N/A
44705_3,PREPARE FECAL MICROBIOTA,ProFee,0989,44705,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
4470F_3,ICD COUNSELING PROVIDED,ProFee,0989,4470F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44715_3,PREPARE DONOR INTESTINE,ProFee,0989,44715,,,,0,3.00,2.25,2.25,499.00,0.00,499.00,499.00,N/A
44720_3,PREP DONOR INTESTINE/VENOUS,ProFee,0989,44720,,,,0,3.00,2.25,2.25,399.50,0.00,399.50,399.50,N/A
44721_3,PREP DONOR INTESTINE/ARTERY,ProFee,0989,44721,,,,0,3.00,2.25,2.25,559.00,0.00,559.00,559.00,N/A
44799_3,UNLISTED PROCEDURE INTESTINE,ProFee,0989,44799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44800_3,EXCISION OF BOWEL POUCH,ProFee,0989,44800,,,,0,3.00,2.25,2.25,1105.00,0.00,1105.00,1105.00,N/A
4480F_3,PT RCVNG ACE/ARB B-BLOCKERTX,ProFee,0989,4480F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4481F_3,PT RCVNG ACE/ARB BLKER<3MONS,ProFee,0989,4481F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44820_3,EXCISION OF MESENTERY LESION,ProFee,0989,44820,,,,0,3.00,2.25,2.25,1224.50,0.00,1224.50,1224.50,N/A
44850_3,REPAIR OF MESENTERY,ProFee,0989,44850,,,,0,3.00,2.25,2.25,1083.50,0.00,1083.50,1083.50,N/A
44899_3,BOWEL SURGERY PROCEDURE,ProFee,0989,44899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
44900_3,"DRAIN APP ABSCESS, OPEN",ProFee,0989,44900,,,,0,3.00,2.25,2.25,1122.50,0.00,1122.50,1122.50,N/A
44901_3,"DRAIN APP ABSCESS, PERCUT",ProFee,0989,44901,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
44950_3,APPENDECTOMY,ProFee,0989,44950,,,,0,3.00,2.25,2.25,929.00,0.00,929.00,929.00,N/A
44955_3,APPENDECTOMY ADD-ON,ProFee,0989,44955,,,,0,3.00,2.25,2.25,122.00,0.00,122.00,122.00,N/A
44960_3,APPENDECTOMY,ProFee,0989,44960,,,,0,3.00,2.25,2.25,1265.50,0.00,1265.50,1265.50,N/A
44970_3,"LAPAROSCOPY, APPENDECTOMY",ProFee,0989,44970,,,,0,3.00,2.25,2.25,870.00,0.00,870.00,870.00,N/A
44979_3,"LAPAROSCOPE PROC, APP",ProFee,0989,44979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45000_3,DRAINAGE OF PELVIC ABSCESS,ProFee,0989,45000,,,,0,3.00,2.25,2.25,616.50,0.00,616.50,616.50,N/A
45005_3,DRAINAGE OF RECTAL ABSCESS,ProFee,0989,45005,,,,0,3.00,2.25,2.25,233.00,0.00,233.00,233.00,N/A
4500F_3,REF TO OUTPT CARD REHAB PROG,ProFee,0989,4500F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45020_3,DRAINAGE OF RECTAL ABSCESS,ProFee,0989,45020,,,,0,3.00,2.25,2.25,831.50,0.00,831.50,831.50,N/A
45100_3,BIOPSY OF RECTUM,ProFee,0989,45100,,,,0,3.00,2.25,2.25,433.00,0.00,433.00,433.00,N/A
45108_3,REMOVAL OF ANORECTAL LESION,ProFee,0989,45108,,,,0,3.00,2.25,2.25,534.50,0.00,534.50,534.50,N/A
4510F_3,PREV CARDREHAB QUALCARDEVENT,ProFee,0989,4510F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45110_3,REMOVAL OF RECTUM,ProFee,0989,45110,,,,0,3.00,2.25,2.25,2674.50,0.00,2674.50,2674.50,N/A
45111_3,PARTIAL REMOVAL OF RECTUM,ProFee,0989,45111,,,,0,3.00,2.25,2.25,1572.50,0.00,1572.50,1572.50,N/A
45112_3,REMOVAL OF RECTUM,ProFee,0989,45112,,,,0,3.00,2.25,2.25,2711.50,0.00,2711.50,2711.50,N/A
45113_3,PARTIAL PROCTECTOMY,ProFee,0989,45113,,,,0,3.00,2.25,2.25,2753.00,0.00,2753.00,2753.00,N/A
45114_3,PARTIAL REMOVAL OF RECTUM,ProFee,0989,45114,,,,0,3.00,2.25,2.25,2636.00,0.00,2636.00,2636.00,N/A
45116_3,PARTIAL REMOVAL OF RECTUM,ProFee,0989,45116,,,,0,3.00,2.25,2.25,2265.50,0.00,2265.50,2265.50,N/A
45119_3,REMOVE RECTUM W/RESERVOIR,ProFee,0989,45119,,,,0,3.00,2.25,2.25,2763.50,0.00,2763.50,2763.50,N/A
45120_3,REMOVAL OF RECTUM,ProFee,0989,45120,,,,0,3.00,2.25,2.25,2306.50,0.00,2306.50,2306.50,N/A
45121_3,REMOVAL OF RECTUM AND COLON,ProFee,0989,45121,,,,0,3.00,2.25,2.25,2520.50,0.00,2520.50,2520.50,N/A
45123_3,PARTIAL PROCTECTOMY,ProFee,0989,45123,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
45126_3,PELVIC EXENTERATION,ProFee,0989,45126,,,,0,3.00,2.25,2.25,3975.00,0.00,3975.00,3975.00,N/A
45130_3,EXCISION OF RECTAL PROLAPSE,ProFee,0989,45130,,,,0,3.00,2.25,2.25,1577.50,0.00,1577.50,1577.50,N/A
45135_3,EXCISION OF RECTAL PROLAPSE,ProFee,0989,45135,,,,0,3.00,2.25,2.25,1892.00,0.00,1892.00,1892.00,N/A
45136_3,EXCISE ILEOANAL RESERVIOR,ProFee,0989,45136,,,,0,3.00,2.25,2.25,2630.00,0.00,2630.00,2630.00,N/A
45150_3,EXCISION OF RECTAL STRICTURE,ProFee,0989,45150,,,,0,3.00,2.25,2.25,600.00,0.00,600.00,600.00,N/A
45160_3,EXCISION OF RECTAL LESION,ProFee,0989,45160,,,,0,3.00,2.25,2.25,1481.00,0.00,1481.00,1481.00,N/A
45170_3,EXCISION OF RECTAL LESION,ProFee,0989,45170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45171_3,EXC RECT TUM TRANSANAL PART,ProFee,0989,45171,,,,0,3.00,2.25,2.25,870.50,0.00,870.50,870.50,N/A
45172_3,EXC RECT TUM TRANSANAL FULL,ProFee,0989,45172,,,,0,3.00,2.25,2.25,1176.50,0.00,1176.50,1176.50,N/A
45190_3,"DESTRUCTION, RECTAL TUMOR",ProFee,0989,45190,,,,0,3.00,2.25,2.25,1006.00,0.00,1006.00,1006.00,N/A
4525F_3,NEUROPSYCHIA INTERVEN ORDER,ProFee,0989,4525F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4526F_3,NEUROPSYCHIA INTERVEN RCVD,ProFee,0989,4526F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45300_3,PROCTOSIGMOIDOSCOPY DX,ProFee,0989,45300,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
45303_3,PROCTOSIGMOIDOSCOPY DILATE,ProFee,0989,45303,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
45305_3,PROCTOSIGMOIDOSCOPY W/BX,ProFee,0989,45305,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
45307_3,PROCTOSIGMOIDOSCOPY FB,ProFee,0989,45307,,,,0,3.00,2.25,2.25,140.00,0.00,140.00,140.00,N/A
45308_3,PROCTOSIGMOIDOSCOPY REMOVAL,ProFee,0989,45308,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
45309_3,PROCTOSIGMOIDOSCOPY REMOVAL,ProFee,0989,45309,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
45315_3,PROCTOSIGMOIDOSCOPY REMOVAL,ProFee,0989,45315,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
45317_3,PROCTOSIGMOIDOSCOPY BLEED,ProFee,0989,45317,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
45320_3,PROCTOSIGMOIDOSCOPY ABLATE,ProFee,0989,45320,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
45321_3,PROCTOSIGMOIDOSCOPY VOLVUL,ProFee,0989,45321,,,,0,3.00,2.25,2.25,149.50,0.00,149.50,149.50,N/A
45327_3,PROCTOSIGMOIDOSCOPY W/STENT,ProFee,0989,45327,,,,0,3.00,2.25,2.25,170.50,0.00,170.50,170.50,N/A
45330_3,DIAGNOSTIC SIGMOIDOSCOPY,ProFee,0989,45330,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
45331_3,SIGMOIDOSCOPY AND BIOPSY,ProFee,0989,45331,,,,0,3.00,2.25,2.25,105.00,0.00,105.00,105.00,N/A
45332_3,SIGMOIDOSCOPY W/FB REMOVAL,ProFee,0989,45332,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
45333_3,SIGMOIDOSCOPY & POLYPECTOMY,ProFee,0989,45333,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
45334_3,SIGMOIDOSCOPY FOR BLEEDING,ProFee,0989,45334,,,,0,3.00,2.25,2.25,172.50,0.00,172.50,172.50,N/A
45335_3,SIGMOIDOSCOPY W/SUBMUC INJ,ProFee,0989,45335,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
45337_3,SIGMOIDOSCOPY & DECOMPRESS,ProFee,0989,45337,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
45338_3,SIGMOIDOSCOPY W/TUMR REMOVE,ProFee,0989,45338,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
45339_3,SIGMOIDOSCOPY W/ABLATE TUMR,ProFee,0989,45339,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45340_3,SIG W/BALLOON DILATION,ProFee,0989,45340,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
45341_3,SIGMOIDOSCOPY W/ULTRASOUND,ProFee,0989,45341,,,,0,3.00,2.25,2.25,181.00,0.00,181.00,181.00,N/A
45342_3,SIGMOIDOSCOPY W/US GUIDE BX,ProFee,0989,45342,,,,0,3.00,2.25,2.25,249.50,0.00,249.50,249.50,N/A
45345_3,SIGMOIDOSCOPY W/STENT,ProFee,0989,45345,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45346_3,SIGMOIDOSCOPY W/ABLATION,ProFee,0989,45346,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
45347_3,SIGMOIDOSCOPY W/PLCMT STENT,ProFee,0989,45347,,,,0,3.00,2.25,2.25,226.50,0.00,226.50,226.50,N/A
45349_3,SIGMOIDOSCOPY W/RESECTION,ProFee,0989,45349,,,,0,3.00,2.25,2.25,292.50,0.00,292.50,292.50,N/A
45350_3,SGMDSC W/BAND LIGATION,ProFee,0989,45350,,,,0,3.00,2.25,2.25,148.00,0.00,148.00,148.00,N/A
45355_3,SURGICAL COLONOSCOPY,ProFee,0989,45355,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45378_3,DIAGNOSTIC COLONOSCOPY,ProFee,0989,45378,,,,0,3.00,2.25,2.25,272.00,0.00,272.00,272.00,N/A
45379_3,COLONOSCOPY W/FB REMOVAL,ProFee,0989,45379,,,,0,3.00,2.25,2.25,351.00,0.00,351.00,351.00,N/A
45380_3,COLONOSCOPY AND BIOPSY,ProFee,0989,45380,,,,0,3.00,2.25,2.25,295.50,0.00,295.50,295.50,N/A
45381_3,"COLONOSCOPY, SUBMUCOUS INJ",ProFee,0989,45381,,,,0,3.00,2.25,2.25,295.50,0.00,295.50,295.50,N/A
45382_3,COLONOSCOPY/CONTROL BLEEDING,ProFee,0989,45382,,,,0,3.00,2.25,2.25,381.00,0.00,381.00,381.00,N/A
45383_3,LESION REMOVAL COLONOSCOPY,ProFee,0989,45383,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45384_3,LESION REMOVE COLONOSCOPY,ProFee,0989,45384,,,,0,3.00,2.25,2.25,335.50,0.00,335.50,335.50,N/A
45385_3,LESION REMOVAL COLONOSCOPY,ProFee,0989,45385,,,,0,3.00,2.25,2.25,374.00,0.00,374.00,374.00,N/A
45386_3,COLONOSCOPY DILATE STRICTURE,ProFee,0989,45386,,,,0,3.00,2.25,2.25,311.50,0.00,311.50,311.50,N/A
45387_3,COLONOSCOPY W/STENT,ProFee,0989,45387,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
45388_3,COLONOSCOPY W/ABLATION,ProFee,0989,45388,,,,0,3.00,2.25,2.25,398.00,0.00,398.00,398.00,N/A
45389_3,COLONOSCOPY W/STENT PLCMT,ProFee,0989,45389,,,,0,3.00,2.25,2.25,426.50,0.00,426.50,426.50,N/A
45390_3,COLONOSCOPY W/RESECTION,ProFee,0989,45390,,,,0,3.00,2.25,2.25,489.50,0.00,489.50,489.50,N/A
45391_3,COLONOSCOPY W/ENDOSCOPE US,ProFee,0989,45391,,,,0,3.00,2.25,2.25,379.00,0.00,379.00,379.00,N/A
45392_3,COLONOSCOPY W/ENDOSCOPIC FNB,ProFee,0989,45392,,,,0,3.00,2.25,2.25,447.50,0.00,447.50,447.50,N/A
45393_3,COLONOSCOPY W/DECOMPRESSION,ProFee,0989,45393,,,,0,3.00,2.25,2.25,371.50,0.00,371.50,371.50,N/A
45395_3,"LAP, REMOVAL OF RECTUM",ProFee,0989,45395,,,,0,3.00,2.25,2.25,2865.00,0.00,2865.00,2865.00,N/A
45397_3,"LAP, REMOVE RECTUM W/POUCH",ProFee,0989,45397,,,,0,3.00,2.25,2.25,3121.00,0.00,3121.00,3121.00,N/A
45398_3,COLONOSCOPY W/BAND LIGATION,ProFee,0989,45398,,,,0,3.00,2.25,2.25,345.00,0.00,345.00,345.00,N/A
45399_3,UNLISTED PROCEDURE COLON,ProFee,0989,45399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45400_3,LAPAROSCOPIC PROCTOPEXY,ProFee,0989,45400,,,,0,3.00,2.25,2.25,1654.00,0.00,1654.00,1654.00,N/A
45402_3,LAP PROCTOPEXY W/SIG RESECT,ProFee,0989,45402,,,,0,3.00,2.25,2.25,2201.50,0.00,2201.50,2201.50,N/A
4540F_3,DISEASE MODIF PHARMACOTHXPY,ProFee,0989,4540F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4541F_3,PT OFFERED TX FOR PSEUDOBULB,ProFee,0989,4541F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45499_3,"LAPAROSCOPE PROC, RECTUM",ProFee,0989,45499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45500_3,REPAIR OF RECTUM,ProFee,0989,45500,,,,0,3.00,2.25,2.25,800.50,0.00,800.50,800.50,N/A
45505_3,REPAIR OF RECTUM,ProFee,0989,45505,,,,0,3.00,2.25,2.25,856.00,0.00,856.00,856.00,N/A
4550F_3,NONINVAS RESP SUPPORT TALK,ProFee,0989,4550F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4551F_3,NUTRITIONAL SUPPORT OFFERED,ProFee,0989,4551F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45520_3,TREATMENT OF RECTAL PROLAPSE,ProFee,0989,45520,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
4552F_3,PT REF FOR SPEECH LANG PATH,ProFee,0989,4552F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4553F_3,PT ASST RE END LIFE ISSUES,ProFee,0989,4553F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45540_3,CORRECT RECTAL PROLAPSE,ProFee,0989,45540,,,,0,3.00,2.25,2.25,1530.50,0.00,1530.50,1530.50,N/A
45541_3,CORRECT RECTAL PROLAPSE,ProFee,0989,45541,,,,0,3.00,2.25,2.25,1362.50,0.00,1362.50,1362.50,N/A
4554F_3,PT RECVD INHAL ANESTHETIC,ProFee,0989,4554F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45550_3,REPAIR RECTUM/REMOVE SIGMOID,ProFee,0989,45550,,,,0,3.00,2.25,2.25,2113.50,0.00,2113.50,2113.50,N/A
4555F_3,PT RECVD NO INHAL ANESTHIC,ProFee,0989,4555F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45560_3,REPAIR OF RECTOCELE,ProFee,0989,45560,,,,0,3.00,2.25,2.25,990.00,0.00,990.00,990.00,N/A
45562_3,EXPLORATION/REPAIR OF RECTUM,ProFee,0989,45562,,,,0,3.00,2.25,2.25,1613.50,0.00,1613.50,1613.50,N/A
45563_3,EXPLORATION/REPAIR OF RECTUM,ProFee,0989,45563,,,,0,3.00,2.25,2.25,2390.00,0.00,2390.00,2390.00,N/A
4556F_3,PT W/3+ POST-OP NAUSEA&VOM,ProFee,0989,4556F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4557F_3,PT W/O 3+ POST-OPNAUSEA&VOM,ProFee,0989,4557F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4558F_3,PT RECVD 2 RX ANTI-EMET AGT,ProFee,0989,4558F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4559F_3,1 BODYTEMP >=35.5CW/IN 30MIN,ProFee,0989,4559F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4560F_3,ANESTH W/O GEN/NEURAX ANESTH,ProFee,0989,4560F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4561F_3,PT W/ CORONARY ARTERY STENT,ProFee,0989,4561F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4562F_3,PT W/O CORONARY ARTERY STENT,ProFee,0989,4562F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
4563F_3,PT RECVD ASPIRIN W/IN 24 HRS,ProFee,0989,4563F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
45800_3,REPAIR RECT/BLADDER FISTULA,ProFee,0989,45800,,,,0,3.00,2.25,2.25,1805.00,0.00,1805.00,1805.00,N/A
45805_3,REPAIR FISTULA W/COLOSTOMY,ProFee,0989,45805,,,,0,3.00,2.25,2.25,2119.50,0.00,2119.50,2119.50,N/A
45820_3,REPAIR RECTOURETHRAL FISTULA,ProFee,0989,45820,,,,0,3.00,2.25,2.25,1831.50,0.00,1831.50,1831.50,N/A
45825_3,REPAIR FISTULA W/COLOSTOMY,ProFee,0989,45825,,,,0,3.00,2.25,2.25,2212.50,0.00,2212.50,2212.50,N/A
45900_3,REDUCTION OF RECTAL PROLAPSE,ProFee,0989,45900,,,,0,3.00,2.25,2.25,305.00,0.00,305.00,305.00,N/A
45905_3,DILATION OF ANAL SPHINCTER,ProFee,0989,45905,,,,0,3.00,2.25,2.25,244.50,0.00,244.50,244.50,N/A
45910_3,DILATION OF RECTAL NARROWING,ProFee,0989,45910,,,,0,3.00,2.25,2.25,279.50,0.00,279.50,279.50,N/A
45915_3,REMOVE RECTAL OBSTRUCTION,ProFee,0989,45915,,,,0,3.00,2.25,2.25,328.50,0.00,328.50,328.50,N/A
45990_3,"SURG DX EXAM, ANORECTAL",ProFee,0989,45990,,,,0,3.00,2.25,2.25,155.00,0.00,155.00,155.00,N/A
45999_3,RECTUM SURGERY PROCEDURE,ProFee,0989,45999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
46020_3,PLACEMENT OF SETON,ProFee,0989,46020,,,,0,3.00,2.25,2.25,338.50,0.00,338.50,338.50,N/A
46030_3,REMOVAL OF RECTAL MARKER,ProFee,0989,46030,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
46040_3,INCISION OF RECTAL ABSCESS,ProFee,0989,46040,,,,0,3.00,2.25,2.25,599.50,0.00,599.50,599.50,N/A
46045_3,INCISION OF RECTAL ABSCESS,ProFee,0989,46045,,,,0,3.00,2.25,2.25,625.50,0.00,625.50,625.50,N/A
46050_3,INCISION OF ANAL ABSCESS,ProFee,0989,46050,,,,0,3.00,2.25,2.25,140.50,0.00,140.50,140.50,N/A
46060_3,INCISION OF RECTAL ABSCESS,ProFee,0989,46060,,,,0,3.00,2.25,2.25,688.00,0.00,688.00,688.00,N/A
46070_3,INCISION OF ANAL SEPTUM,ProFee,0989,46070,,,,0,3.00,2.25,2.25,371.00,0.00,371.00,371.00,N/A
46080_3,INCISION OF ANAL SPHINCTER,ProFee,0989,46080,,,,0,3.00,2.25,2.25,230.50,0.00,230.50,230.50,N/A
46083_2,INCISE EXTERNAL HEMORRHOID,Inpatient,0521,46083,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,167.20,158.40
46083_2,INCISE EXTERNAL HEMORRHOID,Ambulatory Surgical,0521,46083,,,,0,176.00,132.00,132.00,167.20,158.40,167.20,0.00,158.40
46083_3,INCISE EXTERNAL HEMORRHOID,Ambulatory Surgical,0521,46083,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,0.00,156.60
46083_3,INCISE EXTERNAL HEMORRHOID,Inpatient,0521,46083,,,,0,174.00,130.50,130.50,165.30,156.60,165.30,165.30,156.60
46200_3,REMOVAL OF ANAL FISSURE,ProFee,0989,46200,,,,0,3.00,2.25,2.25,470.50,0.00,470.50,470.50,N/A
46210_3,REMOVAL OF ANAL CRYPT,ProFee,0989,46210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46211_3,REMOVAL OF ANAL CRYPTS,ProFee,0989,46211,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46220_3,REMOVAL OF ANAL TAG,ProFee,0989,46220,,,,0,3.00,2.25,2.25,171.00,0.00,171.00,171.00,N/A
46221_3,LIGATION OF HEMORRHOID(S),ProFee,0989,46221,,,,0,3.00,2.25,2.25,274.50,0.00,274.50,274.50,N/A
46230_3,REMOVAL OF ANAL TAGS,ProFee,0989,46230,,,,0,3.00,2.25,2.25,249.50,0.00,249.50,249.50,N/A
46250_3,HEMORRHOIDECTOMY,ProFee,0989,46250,,,,0,3.00,2.25,2.25,455.50,0.00,455.50,455.50,N/A
46255_3,HEMORRHOIDECTOMY,ProFee,0989,46255,,,,0,3.00,2.25,2.25,510.50,0.00,510.50,510.50,N/A
46257_3,REMOVE HEMORRHOIDS & FISSURE,ProFee,0989,46257,,,,0,3.00,2.25,2.25,613.50,0.00,613.50,613.50,N/A
46258_3,REMOVE HEMORRHOIDS & FISTULA,ProFee,0989,46258,,,,0,3.00,2.25,2.25,672.50,0.00,672.50,672.50,N/A
46260_3,HEMORRHOIDECTOMY,ProFee,0989,46260,,,,0,3.00,2.25,2.25,687.50,0.00,687.50,687.50,N/A
46261_3,REMOVE HEMORRHOIDS & FISSURE,ProFee,0989,46261,,,,0,3.00,2.25,2.25,756.50,0.00,756.50,756.50,N/A
46262_3,REMOVE HEMORRHOIDS & FISTULA,ProFee,0989,46262,,,,0,3.00,2.25,2.25,798.50,0.00,798.50,798.50,N/A
46270_3,REMOVAL OF ANAL FISTULA,ProFee,0989,46270,,,,0,3.00,2.25,2.25,565.50,0.00,565.50,565.50,N/A
46275_3,REMOVAL OF ANAL FISTULA,ProFee,0989,46275,,,,0,3.00,2.25,2.25,598.00,0.00,598.00,598.00,N/A
46280_3,REMOVAL OF ANAL FISTULA,ProFee,0989,46280,,,,0,3.00,2.25,2.25,678.50,0.00,678.50,678.50,N/A
46285_3,REMOVAL OF ANAL FISTULA,ProFee,0989,46285,,,,0,3.00,2.25,2.25,599.50,0.00,599.50,599.50,N/A
46288_3,REPAIR ANAL FISTULA,ProFee,0989,46288,,,,0,3.00,2.25,2.25,792.00,0.00,792.00,792.00,N/A
46320_3,REMOVAL OF HEMORRHOID CLOT,ProFee,0989,46320,,,,0,3.00,2.25,2.25,160.00,0.00,160.00,160.00,N/A
46500_3,INJECTION INTO HEMORRHOID(S),ProFee,0989,46500,,,,0,3.00,2.25,2.25,179.00,0.00,179.00,179.00,N/A
46505_3,CHEMODENERVATION ANAL MUSC,ProFee,0989,46505,,,,0,3.00,2.25,2.25,344.50,0.00,344.50,344.50,N/A
46601_3,DIAGNOSTIC ANOSCOPY,ProFee,0989,46601,,,,0,3.00,2.25,2.25,136.00,0.00,136.00,136.00,N/A
46607_3,DIAGNOSTIC ANOSCOPY & BIOPSY,ProFee,0989,46607,,,,0,3.00,2.25,2.25,183.50,0.00,183.50,183.50,N/A
46611_3,ANOSCOPY,ProFee,0989,46611,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
46612_3,"ANOSCOPY, REMOVE LESIONS",ProFee,0989,46612,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
46614_3,"ANOSCOPY, CONTROL BLEEDING",ProFee,0989,46614,,,,0,3.00,2.25,2.25,94.00,0.00,94.00,94.00,N/A
46615_3,ANOSCOPY,ProFee,0989,46615,,,,0,3.00,2.25,2.25,133.50,0.00,133.50,133.50,N/A
46700_3,REPAIR OF ANAL STRICTURE,ProFee,0989,46700,,,,0,3.00,2.25,2.25,947.00,0.00,947.00,947.00,N/A
46705_3,REPAIR OF ANAL STRICTURE,ProFee,0989,46705,,,,0,3.00,2.25,2.25,797.00,0.00,797.00,797.00,N/A
46706_3,REPR OF ANAL FISTULA W/GLUE,ProFee,0989,46706,,,,0,3.00,2.25,2.25,254.50,0.00,254.50,254.50,N/A
46707_3,REPAIR ANORECTAL FIST W/PLUG,ProFee,0989,46707,,,,0,3.00,2.25,2.25,697.50,0.00,697.50,697.50,N/A
46710_3,REPR PER/VAG POUCH SNGL PROC,ProFee,0989,46710,,,,0,3.00,2.25,2.25,1601.00,0.00,1601.00,1601.00,N/A
46712_3,REPR PER/VAG POUCH DBL PROC,ProFee,0989,46712,,,,0,3.00,2.25,2.25,3231.00,0.00,3231.00,3231.00,N/A
46715_3,REP PERF ANOPER FISTU,ProFee,0989,46715,,,,0,3.00,2.25,2.25,781.50,0.00,781.50,781.50,N/A
46716_3,REP PERF ANOPER/VESTIB FISTU,ProFee,0989,46716,,,,0,3.00,2.25,2.25,1747.00,0.00,1747.00,1747.00,N/A
46730_3,CONSTRUCTION OF ABSENT ANUS,ProFee,0989,46730,,,,0,3.00,2.25,2.25,2839.50,0.00,2839.50,2839.50,N/A
46735_3,CONSTRUCTION OF ABSENT ANUS,ProFee,0989,46735,,,,0,3.00,2.25,2.25,3276.50,0.00,3276.50,3276.50,N/A
46740_3,CONSTRUCTION OF ABSENT ANUS,ProFee,0989,46740,,,,0,3.00,2.25,2.25,3104.00,0.00,3104.00,3104.00,N/A
46742_3,REPAIR OF IMPERFORATED ANUS,ProFee,0989,46742,,,,0,3.00,2.25,2.25,3594.50,0.00,3594.50,3594.50,N/A
46744_3,REPAIR OF CLOACAL ANOMALY,ProFee,0989,46744,,,,0,3.00,2.25,2.25,5095.00,0.00,5095.00,5095.00,N/A
46746_3,REPAIR OF CLOACAL ANOMALY,ProFee,0989,46746,,,,0,3.00,2.25,2.25,5613.50,0.00,5613.50,5613.50,N/A
46748_3,REPAIR OF CLOACAL ANOMALY,ProFee,0989,46748,,,,0,3.00,2.25,2.25,6086.00,0.00,6086.00,6086.00,N/A
46750_3,REPAIR OF ANAL SPHINCTER,ProFee,0989,46750,,,,0,3.00,2.25,2.25,1084.50,0.00,1084.50,1084.50,N/A
46751_3,REPAIR OF ANAL SPHINCTER,ProFee,0989,46751,,,,0,3.00,2.25,2.25,941.50,0.00,941.50,941.50,N/A
46753_3,RECONSTRUCTION OF ANUS,ProFee,0989,46753,,,,0,3.00,2.25,2.25,882.00,0.00,882.00,882.00,N/A
46754_3,REMOVAL OF SUTURE FROM ANUS,ProFee,0989,46754,,,,0,3.00,2.25,2.25,338.00,0.00,338.00,338.00,N/A
46760_3,REPAIR OF ANAL SPHINCTER,ProFee,0989,46760,,,,0,3.00,2.25,2.25,1583.50,0.00,1583.50,1583.50,N/A
46761_3,REPAIR OF ANAL SPHINCTER,ProFee,0989,46761,,,,0,3.00,2.25,2.25,1324.50,0.00,1324.50,1324.50,N/A
46762_3,IMPLANT ARTIFICIAL SPHINCTER,ProFee,0989,46762,,,,0,3.00,2.25,2.25,1337.00,0.00,1337.00,1337.00,N/A
46900_3,"DESTRUCTION, ANAL LESION(S)",ProFee,0989,46900,,,,0,3.00,2.25,2.25,197.00,0.00,197.00,197.00,N/A
46910_3,"DESTRUCTION, ANAL LESION(S)",ProFee,0989,46910,,,,0,3.00,2.25,2.25,193.50,0.00,193.50,193.50,N/A
46916_3,"CRYOSURGERY, ANAL LESION(S)",ProFee,0989,46916,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
46917_3,"LASER SURGERY, ANAL LESIONS",ProFee,0989,46917,,,,0,3.00,2.25,2.25,192.00,0.00,192.00,192.00,N/A
46922_3,EXCISION OF ANAL LESION(S),ProFee,0989,46922,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
46924_3,"DESTRUCTION, ANAL LESION(S)",ProFee,0989,46924,,,,0,3.00,2.25,2.25,263.00,0.00,263.00,263.00,N/A
46930_3,DESTROY INTERNAL HEMORRHOIDS,ProFee,0989,46930,,,,0,3.00,2.25,2.25,213.00,0.00,213.00,213.00,N/A
46934_3,DESTRUCTION OF HEMORRHOIDS,ProFee,0989,46934,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46935_3,DESTRUCTION OF HEMORRHOIDS,ProFee,0989,46935,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46936_3,DESTRUCTION OF HEMORRHOIDS,ProFee,0989,46936,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46937_3,CRYOTHERAPY OF RECTAL LESION,ProFee,0989,46937,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46938_3,CRYOTHERAPY OF RECTAL LESION,ProFee,0989,46938,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46940_3,TREATMENT OF ANAL FISSURE,ProFee,0989,46940,,,,0,3.00,2.25,2.25,210.50,0.00,210.50,210.50,N/A
46942_3,TREATMENT OF ANAL FISSURE,ProFee,0989,46942,,,,0,3.00,2.25,2.25,190.00,0.00,190.00,190.00,N/A
46945_3,LIGATION OF HEMORRHOIDS,ProFee,0989,46945,,,,0,3.00,2.25,2.25,324.50,0.00,324.50,324.50,N/A
46946_3,LIGATION OF HEMORRHOIDS,ProFee,0989,46946,,,,0,3.00,2.25,2.25,325.00,0.00,325.00,325.00,N/A
46947_3,HEMORRHOIDOPEXY BY STAPLING,ProFee,0989,46947,,,,0,3.00,2.25,2.25,552.50,0.00,552.50,552.50,N/A
46948_3,INT HRHC TRANAL DARTLZJ 2+,ProFee,0989,46948,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
46999_3,ANUS SURGERY PROCEDURE,ProFee,0989,46999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47000_3,NEEDLE BIOPSY OF LIVER,ProFee,0989,47000,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
47001_3,"NEEDLE BIOPSY, LIVER ADD-ON",ProFee,0989,47001,,,,0,3.00,2.25,2.25,151.50,0.00,151.50,151.50,N/A
47010_3,"OPEN DRAINAGE, LIVER LESION",ProFee,0989,47010,,,,0,3.00,2.25,2.25,1742.00,0.00,1742.00,1742.00,N/A
47011_3,"PERCUT DRAIN, LIVER LESION",ProFee,0989,47011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
47015_3,INJECT/ASPIRATE LIVER CYST,ProFee,0989,47015,,,,0,3.00,2.25,2.25,1684.00,0.00,1684.00,1684.00,N/A
47100_3,WEDGE BIOPSY OF LIVER,ProFee,0989,47100,,,,0,3.00,2.25,2.25,1221.00,0.00,1221.00,1221.00,N/A
47120_3,PARTIAL REMOVAL OF LIVER,ProFee,0989,47120,,,,0,3.00,2.25,2.25,3372.00,0.00,3372.00,3372.00,N/A
47122_3,EXTENSIVE REMOVAL OF LIVER,ProFee,0989,47122,,,,0,3.00,2.25,2.25,4952.00,0.00,4952.00,4952.00,N/A
47125_3,PARTIAL REMOVAL OF LIVER,ProFee,0989,47125,,,,0,3.00,2.25,2.25,4454.00,0.00,4454.00,4454.00,N/A
47130_3,PARTIAL REMOVAL OF LIVER,ProFee,0989,47130,,,,0,3.00,2.25,2.25,4783.50,0.00,4783.50,4783.50,N/A
47133_3,REMOVAL OF DONOR LIVER,ProFee,0989,47133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47135_3,TRANSPLANTATION OF LIVER,ProFee,0989,47135,,,,0,3.00,2.25,2.25,7749.00,0.00,7749.00,7749.00,N/A
47136_3,TRANSPLANTATION OF LIVER,ProFee,0989,47399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47140_3,"PARTIAL REMOVAL, DONOR LIVER",ProFee,0989,47140,,,,0,3.00,2.25,2.25,5164.50,0.00,5164.50,5164.50,N/A
47141_3,"PARTIAL REMOVAL, DONOR LIVER",ProFee,0989,47141,,,,0,3.00,2.25,2.25,6165.50,0.00,6165.50,6165.50,N/A
47142_3,"PARTIAL REMOVAL, DONOR LIVER",ProFee,0989,47142,,,,0,3.00,2.25,2.25,6792.00,0.00,6792.00,6792.00,N/A
47143_3,"PREP DONOR LIVER, WHOLE",ProFee,0989,47143,,,,0,3.00,2.25,2.25,568.00,0.00,568.00,568.00,N/A
47144_3,"PREP DONOR LIVER, 3-SEGMENT",ProFee,0989,47144,,,,0,3.00,2.25,2.25,649.50,0.00,649.50,649.50,N/A
47145_3,"PREP DONOR LIVER, LOBE SPLIT",ProFee,0989,47145,,,,0,3.00,2.25,2.25,652.50,0.00,652.50,652.50,N/A
47146_3,PREP DONOR LIVER/VENOUS,ProFee,0989,47146,,,,0,3.00,2.25,2.25,479.50,0.00,479.50,479.50,N/A
47147_3,PREP DONOR LIVER/ARTERIAL,ProFee,0989,47147,,,,0,3.00,2.25,2.25,557.00,0.00,557.00,557.00,N/A
47300_3,SURGERY FOR LIVER LESION,ProFee,0989,47300,,,,0,3.00,2.25,2.25,1635.50,0.00,1635.50,1635.50,N/A
47350_3,REPAIR LIVER WOUND,ProFee,0989,47350,,,,0,3.00,2.25,2.25,1982.00,0.00,1982.00,1982.00,N/A
47360_3,REPAIR LIVER WOUND,ProFee,0989,47360,,,,0,3.00,2.25,2.25,2720.00,0.00,2720.00,2720.00,N/A
47361_3,REPAIR LIVER WOUND,ProFee,0989,47361,,,,0,3.00,2.25,2.25,4376.50,0.00,4376.50,4376.50,N/A
47362_3,REPAIR LIVER WOUND,ProFee,0989,47362,,,,0,3.00,2.25,2.25,2100.50,0.00,2100.50,2100.50,N/A
47370_3,LAPARO ABLATE LIVER TUMOR RF,ProFee,0989,47370,,,,0,3.00,2.25,2.25,1806.50,0.00,1806.50,1806.50,N/A
47371_3,LAPARO ABLATE LIVER CRYOSURG,ProFee,0989,47371,,,,0,3.00,2.25,2.25,1820.50,0.00,1820.50,1820.50,N/A
47379_3,"LAPAROSCOPE PROCEDURE, LIVER",ProFee,0989,47379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47380_3,OPEN ABLATE LIVER TUMOR RF,ProFee,0989,47380,,,,0,3.00,2.25,2.25,2084.00,0.00,2084.00,2084.00,N/A
47381_3,OPEN ABLATE LIVER TUMOR CRYO,ProFee,0989,47381,,,,0,3.00,2.25,2.25,2146.00,0.00,2146.00,2146.00,N/A
47382_3,PERCUT ABLATE LIVER RF,ProFee,0989,47382,,,,0,3.00,2.25,2.25,1083.00,0.00,1083.00,1083.00,N/A
47383_3,PERQ ABLTJ LVR CRYOABLATION,ProFee,0989,47383,,,,0,3.00,2.25,2.25,658.00,0.00,658.00,658.00,N/A
47399_3,LIVER SURGERY PROCEDURE,ProFee,0989,47399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47400_3,INCISION OF LIVER DUCT,ProFee,0989,47400,,,,0,3.00,2.25,2.25,3123.50,0.00,3123.50,3123.50,N/A
47420_3,INCISION OF BILE DUCT,ProFee,0989,47420,,,,0,3.00,2.25,2.25,1938.50,0.00,1938.50,1938.50,N/A
47425_3,INCISION OF BILE DUCT,ProFee,0989,47425,,,,0,3.00,2.25,2.25,1981.50,0.00,1981.50,1981.50,N/A
47460_3,INCISE BILE DUCT SPHINCTER,ProFee,0989,47460,,,,0,3.00,2.25,2.25,1837.50,0.00,1837.50,1837.50,N/A
47480_3,INCISION OF GALLBLADDER,ProFee,0989,47480,,,,0,3.00,2.25,2.25,1268.00,0.00,1268.00,1268.00,N/A
47490_3,INCISION OF GALLBLADDER,ProFee,0989,47490,,,,0,3.00,2.25,2.25,476.00,0.00,476.00,476.00,N/A
47500_3,INJECTION FOR LIVER X-RAYS,ProFee,0989,47532,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
47505_3,INJECTION FOR LIVER X-RAYS,ProFee,0989,47531,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
47510_3,"INSERT CATHETER, BILE DUCT",ProFee,0989,47510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
47511_3,INSERT BILE DUCT DRAIN,ProFee,0989,47534,,,,0,3.00,2.25,2.25,541.50,0.00,541.50,541.50,N/A
47525_3,CHANGE BILE DUCT CATHETER,ProFee,0989,47536,,,,0,3.00,2.25,2.25,193.00,0.00,193.00,193.00,N/A
47530_3,REVISE/REINSERT BILE TUBE,ProFee,0989,47530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
47531_3,INJECTION FOR CHOLANGIOGRAM,ProFee,0989,47531,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
47532_3,INJECTION FOR CHOLANGIOGRAM,ProFee,0989,47532,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
47533_3,PLMT BILIARY DRAINAGE CATH,ProFee,0989,47533,,,,0,3.00,2.25,2.25,388.50,0.00,388.50,388.50,N/A
47534_3,PLMT BILIARY DRAINAGE CATH,ProFee,0989,47534,,,,0,3.00,2.25,2.25,541.50,0.00,541.50,541.50,N/A
47535_3,CONVERSION EXT BIL DRG CATH,ProFee,0989,47535,,,,0,3.00,2.25,2.25,288.00,0.00,288.00,288.00,N/A
47536_3,EXCHANGE BILIARY DRG CATH,ProFee,0989,47536,,,,0,3.00,2.25,2.25,193.00,0.00,193.00,193.00,N/A
47537_3,REMOVAL BILIARY DRG CATH,ProFee,0989,47537,,,,0,3.00,2.25,2.25,140.00,0.00,140.00,140.00,N/A
47538_3,PERQ PLMT BILE DUCT STENT,ProFee,0989,47538,,,,0,3.00,2.25,2.25,344.00,0.00,344.00,344.00,N/A
47539_3,PERQ PLMT BILE DUCT STENT,ProFee,0989,47539,,,,0,3.00,2.25,2.25,623.50,0.00,623.50,623.50,N/A
47540_3,PERQ PLMT BILE DUCT STENT,ProFee,0989,47540,,,,0,3.00,2.25,2.25,643.50,0.00,643.50,643.50,N/A
47541_3,PLMT ACCESS BIL TREE SM BWL,ProFee,0989,47541,,,,0,3.00,2.25,2.25,484.50,0.00,484.50,484.50,N/A
47542_3,DILATE BILIARY DUCT/AMPULLA,ProFee,0989,47542,,,,0,3.00,2.25,2.25,197.50,0.00,197.50,197.50,N/A
47543_3,ENDOLUMINAL BX BILIARY TREE,ProFee,0989,47543,,,,0,3.00,2.25,2.25,210.00,0.00,210.00,210.00,N/A
47544_3,REMOVAL DUCT GLBLDR CALCULI,ProFee,0989,47544,,,,0,3.00,2.25,2.25,232.50,0.00,232.50,232.50,N/A
47550_3,BILE DUCT ENDOSCOPY ADD-ON,ProFee,0989,47550,,,,0,3.00,2.25,2.25,240.00,0.00,240.00,240.00,N/A
47552_3,BILIARY ENDOSCOPY THRU SKIN,ProFee,0989,47552,,,,0,3.00,2.25,2.25,447.00,0.00,447.00,447.00,N/A
47553_3,BILIARY ENDOSCOPY THRU SKIN,ProFee,0989,47553,,,,0,3.00,2.25,2.25,440.50,0.00,440.50,440.50,N/A
47554_3,BILIARY ENDOSCOPY THRU SKIN,ProFee,0989,47554,,,,0,3.00,2.25,2.25,749.50,0.00,749.50,749.50,N/A
47555_3,BILIARY ENDOSCOPY THRU SKIN,ProFee,0989,47555,,,,0,3.00,2.25,2.25,471.50,0.00,471.50,471.50,N/A
47556_3,BILIARY ENDOSCOPY THRU SKIN,ProFee,0989,47556,,,,0,3.00,2.25,2.25,534.00,0.00,534.00,534.00,N/A
47560_3,LAPAROSCOPY W/CHOLANGIO,ProFee,0989,47579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47561_3,LAPARO W/CHOLANGIO/BIOPSY,ProFee,0989,47579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47562_3,LAPAROSCOPIC CHOLECYSTECTOMY,ProFee,0989,47562,,,,0,3.00,2.25,2.25,952.00,0.00,952.00,952.00,N/A
47563_3,LAPARO CHOLECYSTECTOMY/GRAPH,ProFee,0989,47563,,,,0,3.00,2.25,2.25,1033.50,0.00,1033.50,1033.50,N/A
47564_3,LAPARO CHOLECYSTECTOMY/EXPLR,ProFee,0989,47564,,,,0,3.00,2.25,2.25,1610.50,0.00,1610.50,1610.50,N/A
47570_3,LAPARO CHOLECYSTOENTEROSTOMY,ProFee,0989,47570,,,,0,3.00,2.25,2.25,1123.00,0.00,1123.00,1123.00,N/A
47579_3,"LAPAROSCOPE PROC, BILIARY",ProFee,0989,47579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
47600_3,REMOVAL OF GALLBLADDER,ProFee,0989,47600,,,,0,3.00,2.25,2.25,1544.50,0.00,1544.50,1544.50,N/A
47605_3,REMOVAL OF GALLBLADDER,ProFee,0989,47605,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
47610_3,REMOVAL OF GALLBLADDER,ProFee,0989,47610,,,,0,3.00,2.25,2.25,1816.00,0.00,1816.00,1816.00,N/A
47612_3,REMOVAL OF GALLBLADDER,ProFee,0989,47612,,,,0,3.00,2.25,2.25,1842.50,0.00,1842.50,1842.50,N/A
47620_3,REMOVAL OF GALLBLADDER,ProFee,0989,47620,,,,0,3.00,2.25,2.25,1998.00,0.00,1998.00,1998.00,N/A
47630_3,REMOVE BILE DUCT STONE,ProFee,0989,47544,,,,0,3.00,2.25,2.25,232.50,0.00,232.50,232.50,N/A
47700_3,EXPLORATION OF BILE DUCTS,ProFee,0989,47700,,,,0,3.00,2.25,2.25,1523.50,0.00,1523.50,1523.50,N/A
47701_3,BILE DUCT REVISION,ProFee,0989,47701,,,,0,3.00,2.25,2.25,2513.50,0.00,2513.50,2513.50,N/A
47711_3,EXCISION OF BILE DUCT TUMOR,ProFee,0989,47711,,,,0,3.00,2.25,2.25,2252.00,0.00,2252.00,2252.00,N/A
47712_3,EXCISION OF BILE DUCT TUMOR,ProFee,0989,47712,,,,0,3.00,2.25,2.25,2899.00,0.00,2899.00,2899.00,N/A
47715_3,EXCISION OF BILE DUCT CYST,ProFee,0989,47715,,,,0,3.00,2.25,2.25,1927.50,0.00,1927.50,1927.50,N/A
47716_3,FUSION OF BILE DUCT CYST,ProFee,0989,47716,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
47720_3,FUSE GALLBLADDER & BOWEL,ProFee,0989,47720,,,,0,3.00,2.25,2.25,1671.50,0.00,1671.50,1671.50,N/A
47721_3,FUSE UPPER GI STRUCTURES,ProFee,0989,47721,,,,0,3.00,2.25,2.25,1962.50,0.00,1962.50,1962.50,N/A
47740_3,FUSE GALLBLADDER & BOWEL,ProFee,0989,47740,,,,0,3.00,2.25,2.25,1902.00,0.00,1902.00,1902.00,N/A
47741_3,FUSE GALLBLADDER & BOWEL,ProFee,0989,47741,,,,0,3.00,2.25,2.25,2139.50,0.00,2139.50,2139.50,N/A
47760_3,FUSE BILE DUCTS AND BOWEL,ProFee,0989,47760,,,,0,3.00,2.25,2.25,3270.00,0.00,3270.00,3270.00,N/A
47765_3,FUSE LIVER DUCTS & BOWEL,ProFee,0989,47765,,,,0,3.00,2.25,2.25,4404.50,0.00,4404.50,4404.50,N/A
47780_3,FUSE BILE DUCTS AND BOWEL,ProFee,0989,47780,,,,0,3.00,2.25,2.25,3584.50,0.00,3584.50,3584.50,N/A
47785_3,FUSE BILE DUCTS AND BOWEL,ProFee,0989,47785,,,,0,3.00,2.25,2.25,4685.00,0.00,4685.00,4685.00,N/A
47800_3,RECONSTRUCTION OF BILE DUCTS,ProFee,0989,47800,,,,0,3.00,2.25,2.25,2284.50,0.00,2284.50,2284.50,N/A
47801_3,"PLACEMENT, BILE DUCT SUPPORT",ProFee,0989,47801,,,,0,3.00,2.25,2.25,1548.50,0.00,1548.50,1548.50,N/A
47802_3,FUSE LIVER DUCT & INTESTINE,ProFee,0989,47802,,,,0,3.00,2.25,2.25,2212.00,0.00,2212.00,2212.00,N/A
47900_3,SUTURE BILE DUCT INJURY,ProFee,0989,47900,,,,0,3.00,2.25,2.25,1991.00,0.00,1991.00,1991.00,N/A
47999_3,BILE TRACT SURGERY PROCEDURE,ProFee,0989,47999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
48000_3,DRAINAGE OF ABDOMEN,ProFee,0989,48000,,,,0,3.00,2.25,2.25,2736.00,0.00,2736.00,2736.00,N/A
48001_3,"PLACEMENT OF DRAIN, PANCREAS",ProFee,0989,48001,,,,0,3.00,2.25,2.25,3348.00,0.00,3348.00,3348.00,N/A
48005_3,RESECT/DEBRIDE PANCREAS,ProFee,0989,48005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
48020_3,REMOVAL OF PANCREATIC STONE,ProFee,0989,48020,,,,0,3.00,2.25,2.25,1706.00,0.00,1706.00,1706.00,N/A
48100_3,"BIOPSY OF PANCREAS, OPEN",ProFee,0989,48100,,,,0,3.00,2.25,2.25,1283.50,0.00,1283.50,1283.50,N/A
48102_3,"NEEDLE BIOPSY, PANCREAS",ProFee,0989,48102,,,,0,3.00,2.25,2.25,348.50,0.00,348.50,348.50,N/A
48105_3,RESECT/DEBRIDE PANCREAS,ProFee,0989,48105,,,,0,3.00,2.25,2.25,4119.00,0.00,4119.00,4119.00,N/A
48120_3,REMOVAL OF PANCREAS LESION,ProFee,0989,48120,,,,0,3.00,2.25,2.25,1597.00,0.00,1597.00,1597.00,N/A
48140_3,PARTIAL REMOVAL OF PANCREAS,ProFee,0989,48140,,,,0,3.00,2.25,2.25,2264.00,0.00,2264.00,2264.00,N/A
48145_3,PARTIAL REMOVAL OF PANCREAS,ProFee,0989,48145,,,,0,3.00,2.25,2.25,2367.50,0.00,2367.50,2367.50,N/A
48146_3,PANCREATECTOMY,ProFee,0989,48146,,,,0,3.00,2.25,2.25,2723.50,0.00,2723.50,2723.50,N/A
48148_3,REMOVAL OF PANCREATIC DUCT,ProFee,0989,48148,,,,0,3.00,2.25,2.25,1810.50,0.00,1810.50,1810.50,N/A
48150_3,PARTIAL REMOVAL OF PANCREAS,ProFee,0989,48150,,,,0,3.00,2.25,2.25,4504.50,0.00,4504.50,4504.50,N/A
48152_3,PANCREATECTOMY,ProFee,0989,48152,,,,0,3.00,2.25,2.25,4183.00,0.00,4183.00,4183.00,N/A
48153_3,PANCREATECTOMY,ProFee,0989,48153,,,,0,3.00,2.25,2.25,4482.50,0.00,4482.50,4482.50,N/A
48154_3,PANCREATECTOMY,ProFee,0989,48154,,,,0,3.00,2.25,2.25,4200.50,0.00,4200.50,4200.50,N/A
48155_3,REMOVAL OF PANCREAS,ProFee,0989,48155,,,,0,3.00,2.25,2.25,2631.50,0.00,2631.50,2631.50,N/A
48160_3,PANCREAS REMOVAL/TRANSPLANT,ProFee,0989,48160,,,,0,3.00,2.25,2.25,4522.00,0.00,4522.00,4522.00,N/A
48180_3,FUSE PANCREAS AND BOWEL,ProFee,0989,48180,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
48400_3,"INJECTION, INTRAOP ADD-ON",ProFee,0989,48400,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
48500_3,SURGERY OF PANCREATIC CYST,ProFee,0989,48500,,,,0,3.00,2.25,2.25,1667.50,0.00,1667.50,1667.50,N/A
48510_3,DRAIN PANCREATIC PSEUDOCYST,ProFee,0989,48510,,,,0,3.00,2.25,2.25,1590.00,0.00,1590.00,1590.00,N/A
48511_3,DRAIN PANCREATIC PSEUDOCYST,ProFee,0989,48511,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
48520_3,FUSE PANCREAS CYST AND BOWEL,ProFee,0989,48520,,,,0,3.00,2.25,2.25,1581.00,0.00,1581.00,1581.00,N/A
48540_3,FUSE PANCREAS CYST AND BOWEL,ProFee,0989,48540,,,,0,3.00,2.25,2.25,1900.50,0.00,1900.50,1900.50,N/A
48545_3,PANCREATORRHAPHY,ProFee,0989,48545,,,,0,3.00,2.25,2.25,1951.00,0.00,1951.00,1951.00,N/A
48547_3,DUODENAL EXCLUSION,ProFee,0989,48547,,,,0,3.00,2.25,2.25,2600.50,0.00,2600.50,2600.50,N/A
48548_3,FUSE PANCREAS AND BOWEL,ProFee,0989,48548,,,,0,3.00,2.25,2.25,2405.00,0.00,2405.00,2405.00,N/A
48550_3,DONOR PANCREATECTOMY,ProFee,0989,48550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
48551_3,PREP DONOR PANCREAS,ProFee,0989,48551,,,,0,3.00,2.25,2.25,357.50,0.00,357.50,357.50,N/A
48552_3,PREP DONOR PANCREAS/VENOUS,ProFee,0989,48552,,,,0,3.00,2.25,2.25,343.00,0.00,343.00,343.00,N/A
48554_3,TRANSPL ALLOGRAFT PANCREAS,ProFee,0989,48554,,,,0,3.00,2.25,2.25,3685.00,0.00,3685.00,3685.00,N/A
48556_3,"REMOVAL, ALLOGRAFT PANCREAS",ProFee,0989,48556,,,,0,3.00,2.25,2.25,1845.50,0.00,1845.50,1845.50,N/A
48999_3,PANCREAS SURGERY PROCEDURE,ProFee,0989,48999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
49000_3,EXPLORATION OF ABDOMEN,ProFee,0989,49000,,,,0,3.00,2.25,2.25,1113.50,0.00,1113.50,1113.50,N/A
49002_3,REOPENING OF ABDOMEN,ProFee,0989,49002,,,,0,3.00,2.25,2.25,1513.50,0.00,1513.50,1513.50,N/A
49010_3,EXPLORATION BEHIND ABDOMEN,ProFee,0989,49010,,,,0,3.00,2.25,2.25,1349.00,0.00,1349.00,1349.00,N/A
49013_3,PRPERTL PEL PACK HEMRRG TRMA,ProFee,0989,49013,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49014_3,REEXPLORATION PELVIC WOUND,ProFee,0989,49014,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49020_3,DRAIN ABDOMINAL ABSCESS,ProFee,0989,49020,,,,0,3.00,2.25,2.25,2301.50,0.00,2301.50,2301.50,N/A
49021_3,DRAIN ABDOMINAL ABSCESS,ProFee,0989,49021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49040_3,"DRAIN, OPEN, ABDOM ABSCESS",ProFee,0989,49040,,,,0,3.00,2.25,2.25,1446.50,0.00,1446.50,1446.50,N/A
49041_3,"DRAIN, PERCUT, ABDOM ABSCESS",ProFee,0989,49041,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49060_3,"DRAIN, OPEN, RETROP ABSCESS",ProFee,0989,49060,,,,0,3.00,2.25,2.25,1591.00,0.00,1591.00,1591.00,N/A
49061_3,"DRAIN, PERCUT, RETROPER ABSC",ProFee,0989,49061,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49062_3,DRAIN TO PERITONEAL CAVITY,ProFee,0989,49062,,,,0,3.00,2.25,2.25,1084.00,0.00,1084.00,1084.00,N/A
49080_3,"PUNCTURE, PERITONEAL CAVITY",ProFee,0989,49080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49081_3,REMOVAL OF ABDOMINAL FLUID,ProFee,0989,49081,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49082_3,ABD PARACENTESIS,ProFee,0989,49082,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
49083_3,ABD PARACENTESIS W/IMAGING,ProFee,0989,49083,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
49085_3,REMOVE ABDOMEN FOREIGN BODY,ProFee,0989,49085,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49180_3,"BIOPSY, ABDOMINAL MASS",ProFee,0989,49180,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
49185_3,SCLEROTX FLUID COLLECTION,ProFee,0989,49185,,,,0,3.00,2.25,2.25,174.00,0.00,174.00,174.00,N/A
49200_3,REMOVAL OF ABDOMINAL LESION,ProFee,0989,49200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49201_3,"REMOVE ABDOM LESION, COMPLEX",ProFee,0989,49201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49203_3,EXC ABD TUM 5 CM OR LESS,ProFee,0989,49203,,,,0,3.00,2.25,2.25,1733.00,0.00,1733.00,1733.00,N/A
49204_3,EXC ABD TUM OVER 5 CM,ProFee,0989,49204,,,,0,3.00,2.25,2.25,2219.00,0.00,2219.00,2219.00,N/A
49205_3,EXC ABD TUM OVER 10 CM,ProFee,0989,49205,,,,0,3.00,2.25,2.25,2547.50,0.00,2547.50,2547.50,N/A
49215_3,EXCISE SACRAL SPINE TUMOR,ProFee,0989,49215,,,,0,3.00,2.25,2.25,3216.50,0.00,3216.50,3216.50,N/A
49220_3,"MULTIPLE SURGERY, ABDOMEN",ProFee,0989,49220,,,,0,3.00,2.25,2.25,1406.50,0.00,1406.50,1406.50,N/A
49250_3,EXCISION OF UMBILICUS,ProFee,0989,49250,,,,0,3.00,2.25,2.25,849.00,0.00,849.00,849.00,N/A
49255_3,REMOVAL OF OMENTUM,ProFee,0989,49255,,,,0,3.00,2.25,2.25,1145.00,0.00,1145.00,1145.00,N/A
49320_3,DIAG LAPARO SEPARATE PROC,ProFee,0989,49320,,,,0,3.00,2.25,2.25,471.50,0.00,471.50,471.50,N/A
49321_3,"LAPAROSCOPY, BIOPSY",ProFee,0989,49321,,,,0,3.00,2.25,2.25,499.00,0.00,499.00,499.00,N/A
49322_3,"LAPAROSCOPY, ASPIRATION",ProFee,0989,49322,,,,0,3.00,2.25,2.25,534.50,0.00,534.50,534.50,N/A
49323_3,LAPARO DRAIN LYMPHOCELE,ProFee,0989,49323,,,,0,3.00,2.25,2.25,920.50,0.00,920.50,920.50,N/A
49324_3,LAP INSERTION PERM IP CATH,ProFee,0989,49324,,,,0,3.00,2.25,2.25,562.50,0.00,562.50,562.50,N/A
49325_3,LAP REVISION PERM IP CATH,ProFee,0989,49325,,,,0,3.00,2.25,2.25,598.00,0.00,598.00,598.00,N/A
49326_3,LAP W/OMENTOPEXY ADD-ON,ProFee,0989,49326,,,,0,3.00,2.25,2.25,274.00,0.00,274.00,274.00,N/A
49327_3,LAP INS DEVICE FOR RT,ProFee,0989,49327,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
49329_3,"LAPARO PROC, ABDM/PER/OMENT",ProFee,0989,49329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
49400_3,AIR INJECTION INTO ABDOMEN,ProFee,0989,49400,,,,0,3.00,2.25,2.25,134.50,0.00,134.50,134.50,N/A
49402_3,"REMOVE FOREIGN BODY, ADBOMEN",ProFee,0989,49402,,,,0,3.00,2.25,2.25,1239.50,0.00,1239.50,1239.50,N/A
49405_3,IMAGE CATH FLUID COLXN VISC,ProFee,0989,49405,,,,0,3.00,2.25,2.25,286.00,0.00,286.00,286.00,N/A
49406_3,IMAGE CATH FLUID PERI/RETRO,ProFee,0989,49406,,,,0,3.00,2.25,2.25,286.00,0.00,286.00,286.00,N/A
49407_3,IMAGE CATH FLUID TRNS/VGNL,ProFee,0989,49407,,,,0,3.00,2.25,2.25,303.50,0.00,303.50,303.50,N/A
49411_3,INS MARK ABD/PEL FOR RT PERQ,ProFee,0989,49411,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
49412_3,INS DEVICE FOR RT GUIDE OPEN,ProFee,0989,49412,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
49418_3,INSERT TUN IP CATH PERC,ProFee,0989,49418,,,,0,3.00,2.25,2.25,295.00,0.00,295.00,295.00,N/A
49419_3,INSRT ABDOM CATH FOR CHEMOTX,ProFee,0989,49419,,,,0,3.00,2.25,2.25,642.50,0.00,642.50,642.50,N/A
49420_3,"INSERT ABDOM DRAIN, TEMP",ProFee,0989,49420,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
49421_3,"INSERT ABDOM DRAIN, PERM",ProFee,0989,49421,,,,0,3.00,2.25,2.25,332.50,0.00,332.50,332.50,N/A
49422_3,REMOVE PERM CANNULA/CATHETER,ProFee,0989,49422,,,,0,3.00,2.25,2.25,549.50,0.00,549.50,549.50,N/A
49423_3,EXCHANGE DRAINAGE CATHETER,ProFee,0989,49423,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
49424_3,"ASSESS CYST, CONTRAST INJECT",ProFee,0989,49424,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
49425_3,INSERT ABDOMEN-VENOUS DRAIN,ProFee,0989,49425,,,,0,3.00,2.25,2.25,1034.00,0.00,1034.00,1034.00,N/A
49426_3,REVISE ABDOMEN-VENOUS SHUNT,ProFee,0989,49426,,,,0,3.00,2.25,2.25,888.00,0.00,888.00,888.00,N/A
49427_3,"INJECTION, ABDOMINAL SHUNT",ProFee,0989,49427,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
49428_3,LIGATION OF SHUNT,ProFee,0989,49428,,,,0,3.00,2.25,2.25,625.50,0.00,625.50,625.50,N/A
49429_3,REMOVAL OF SHUNT,ProFee,0989,49429,,,,0,3.00,2.25,2.25,665.00,0.00,665.00,665.00,N/A
49435_3,INSERT SUBQ EXTEN TO IP CATH,ProFee,0989,49435,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
49436_3,EMBEDDED IP CATH EXIT-SITE,ProFee,0989,49436,,,,0,3.00,2.25,2.25,269.00,0.00,269.00,269.00,N/A
49440_3,PLACE GASTROSTOMY TUBE PERC,ProFee,0989,49440,,,,0,3.00,2.25,2.25,299.00,0.00,299.00,299.00,N/A
49441_3,PLACE DUOD/JEJ TUBE PERC,ProFee,0989,49441,,,,0,3.00,2.25,2.25,350.50,0.00,350.50,350.50,N/A
49442_3,PLACE CECOSTOMY TUBE PERC,ProFee,0989,49442,,,,0,3.00,2.25,2.25,302.00,0.00,302.00,302.00,N/A
49446_3,CHANGE G-TUBE TO G-J PERC,ProFee,0989,49446,,,,0,3.00,2.25,2.25,215.50,0.00,215.50,215.50,N/A
49450_3,REPLACE G/C TUBE PERC,ProFee,0989,49450,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
49451_3,REPLACE DUOD/JEJ TUBE PERC,ProFee,0989,49451,,,,0,3.00,2.25,2.25,131.00,0.00,131.00,131.00,N/A
49452_3,REPLACE G-J TUBE PERC,ProFee,0989,49452,,,,0,3.00,2.25,2.25,201.50,0.00,201.50,201.50,N/A
49460_3,FIX G/COLON TUBE W/DEVICE,ProFee,0989,49460,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
49465_3,FLUORO EXAM OF G/COLON TUBE,ProFee,0989,49465,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
49491_3,RPR HERN PREEMIE REDUC,ProFee,0989,49491,,,,0,3.00,2.25,2.25,1148.00,0.00,1148.00,1148.00,N/A
49492_3,"RPR ING HERN PREMIE, BLOCKED",ProFee,0989,49492,,,,0,3.00,2.25,2.25,1384.50,0.00,1384.50,1384.50,N/A
49495_3,"RPR ING HERNIA BABY, REDUC",ProFee,0989,49495,,,,0,3.00,2.25,2.25,593.00,0.00,593.00,593.00,N/A
49496_3,"RPR ING HERNIA BABY, BLOCKED",ProFee,0989,49496,,,,0,3.00,2.25,2.25,888.50,0.00,888.50,888.50,N/A
49500_3,"RPR ING HERNIA, INIT, REDUCE",ProFee,0989,49500,,,,0,3.00,2.25,2.25,595.50,0.00,595.50,595.50,N/A
49501_3,"RPR ING HERNIA, INIT BLOCKED",ProFee,0989,49501,,,,0,3.00,2.25,2.25,875.50,0.00,875.50,875.50,N/A
49505_3,PRP I/HERN INIT REDUC >5 YR,ProFee,0989,49505,,,,0,3.00,2.25,2.25,751.50,0.00,751.50,751.50,N/A
49507_3,PRP I/HERN INIT BLOCK >5 YR,ProFee,0989,49507,,,,0,3.00,2.25,2.25,847.00,0.00,847.00,847.00,N/A
49520_3,"REREPAIR ING HERNIA, REDUCE",ProFee,0989,49520,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
49521_3,"REREPAIR ING HERNIA, BLOCKED",ProFee,0989,49521,,,,0,3.00,2.25,2.25,1035.50,0.00,1035.50,1035.50,N/A
49525_3,"REPAIR ING HERNIA, SLIDING",ProFee,0989,49525,,,,0,3.00,2.25,2.25,827.00,0.00,827.00,827.00,N/A
49540_3,REPAIR LUMBAR HERNIA,ProFee,0989,49540,,,,0,3.00,2.25,2.25,971.00,0.00,971.00,971.00,N/A
49550_3,"RPR REM HERNIA, INIT, REDUCE",ProFee,0989,49550,,,,0,3.00,2.25,2.25,832.00,0.00,832.00,832.00,N/A
49553_3,"RPR FEM HERNIA, INIT BLOCKED",ProFee,0989,49553,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
49555_3,"REREPAIR FEM HERNIA, REDUCE",ProFee,0989,49555,,,,0,3.00,2.25,2.25,865.00,0.00,865.00,865.00,N/A
49557_3,"REREPAIR FEM HERNIA, BLOCKED",ProFee,0989,49557,,,,0,3.00,2.25,2.25,1046.00,0.00,1046.00,1046.00,N/A
49560_3,"RPR VENTRAL HERN INIT, REDUC",ProFee,0989,49560,,,,0,3.00,2.25,2.25,1066.50,0.00,1066.50,1066.50,N/A
49561_3,"RPR VENTRAL HERN INIT, BLOCK",ProFee,0989,49561,,,,0,3.00,2.25,2.25,1344.50,0.00,1344.50,1344.50,N/A
49565_3,"REREPAIR VENTRL HERN, REDUCE",ProFee,0989,49565,,,,0,3.00,2.25,2.25,1110.00,0.00,1110.00,1110.00,N/A
49566_3,"REREPAIR VENTRL HERN, BLOCK",ProFee,0989,49566,,,,0,3.00,2.25,2.25,1356.50,0.00,1356.50,1356.50,N/A
49568_3,HERNIA REPAIR W/MESH,ProFee,0989,49568,,,,0,3.00,2.25,2.25,388.00,0.00,388.00,388.00,N/A
49570_3,"RPR EPIGASTRIC HERN, REDUCE",ProFee,0989,49570,,,,0,3.00,2.25,2.25,603.50,0.00,603.50,603.50,N/A
49572_3,"RPR EPIGASTRIC HERN, BLOCKED",ProFee,0989,49572,,,,0,3.00,2.25,2.25,744.50,0.00,744.50,744.50,N/A
49580_3,"RPR UMBIL HERN, REDUC < 5 YR",ProFee,0989,49580,,,,0,3.00,2.25,2.25,480.50,0.00,480.50,480.50,N/A
49582_3,"RPR UMBIL HERN, BLOCK < 5 YR",ProFee,0989,49582,,,,0,3.00,2.25,2.25,697.50,0.00,697.50,697.50,N/A
49585_3,"RPR UMBIL HERN, REDUC > 5 YR",ProFee,0989,49585,,,,0,3.00,2.25,2.25,643.00,0.00,643.00,643.00,N/A
49587_3,"RPR UMBIL HERN, BLOCK > 5 YR",ProFee,0989,49587,,,,0,3.00,2.25,2.25,687.00,0.00,687.00,687.00,N/A
49590_3,REPAIR SPIGELIAN HERNIA,ProFee,0989,49590,,,,0,3.00,2.25,2.25,827.00,0.00,827.00,827.00,N/A
49600_3,REPAIR UMBILICAL LESION,ProFee,0989,49600,,,,0,3.00,2.25,2.25,1056.50,0.00,1056.50,1056.50,N/A
49605_3,REPAIR UMBILICAL LESION,ProFee,0989,49605,,,,0,3.00,2.25,2.25,7131.50,0.00,7131.50,7131.50,N/A
49606_3,REPAIR UMBILICAL LESION,ProFee,0989,49606,,,,0,3.00,2.25,2.25,1640.50,0.00,1640.50,1640.50,N/A
49610_3,REPAIR UMBILICAL LESION,ProFee,0989,49610,,,,0,3.00,2.25,2.25,994.00,0.00,994.00,994.00,N/A
49611_3,REPAIR UMBILICAL LESION,ProFee,0989,49611,,,,0,3.00,2.25,2.25,876.00,0.00,876.00,876.00,N/A
49650_3,LAPARO HERNIA REPAIR INITIAL,ProFee,0989,49650,,,,0,3.00,2.25,2.25,619.50,0.00,619.50,619.50,N/A
49651_3,LAPARO HERNIA REPAIR RECUR,ProFee,0989,49651,,,,0,3.00,2.25,2.25,803.00,0.00,803.00,803.00,N/A
49652_3,LAP VENT/ABD HERNIA REPAIR,ProFee,0989,49652,,,,0,3.00,2.25,2.25,1075.50,0.00,1075.50,1075.50,N/A
49653_3,LAP VENT/ABD HERN PROC COMP,ProFee,0989,49653,,,,0,3.00,2.25,2.25,1341.00,0.00,1341.00,1341.00,N/A
49654_3,LAP INC HERNIA REPAIR,ProFee,0989,49654,,,,0,3.00,2.25,2.25,1223.00,0.00,1223.00,1223.00,N/A
49655_3,LAP INC HERN REPAIR COMP,ProFee,0989,49655,,,,0,3.00,2.25,2.25,1492.50,0.00,1492.50,1492.50,N/A
49656_3,LAP INC HERNIA REPAIR RECUR,ProFee,0989,49656,,,,0,3.00,2.25,2.25,1327.00,0.00,1327.00,1327.00,N/A
49657_3,LAP INC HERN RECUR COMP,ProFee,0989,49657,,,,0,3.00,2.25,2.25,1909.00,0.00,1909.00,1909.00,N/A
49659_3,"LAPARO PROC, HERNIA REPAIR",ProFee,0989,49659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
49900_3,REPAIR OF ABDOMINAL WALL,ProFee,0989,49900,,,,0,3.00,2.25,2.25,1178.50,0.00,1178.50,1178.50,N/A
49904_3,"OMENTAL FLAP, EXTRA-ABDOM",ProFee,0989,49904,,,,0,3.00,2.25,2.25,2050.50,0.00,2050.50,2050.50,N/A
49905_3,"OMENTAL FLAP, INTRA-ABDOM",ProFee,0989,49905,,,,0,3.00,2.25,2.25,512.50,0.00,512.50,512.50,N/A
49906_3,"FREE OMENTAL FLAP, MICROVASC",ProFee,0989,49906,,,,0,3.00,2.25,2.25,3067.50,0.00,3067.50,3067.50,N/A
49999_3,ABDOMEN SURGERY PROCEDURE,ProFee,0989,49999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50010_3,EXPLORATION OF KIDNEY,ProFee,0989,50010,,,,0,3.00,2.25,2.25,1060.00,0.00,1060.00,1060.00,N/A
50020_3,"RENAL ABSCESS, OPEN DRAIN",ProFee,0989,50020,,,,0,3.00,2.25,2.25,1466.50,0.00,1466.50,1466.50,N/A
50021_3,"RENAL ABSCESS, PERCUT DRAIN",ProFee,0989,50021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
50040_3,DRAINAGE OF KIDNEY,ProFee,0989,50040,,,,0,3.00,2.25,2.25,1339.00,0.00,1339.00,1339.00,N/A
50045_3,EXPLORATION OF KIDNEY,ProFee,0989,50045,,,,0,3.00,2.25,2.25,1350.50,0.00,1350.50,1350.50,N/A
5005F_3,PT COUNSLD ON EXAM FOR MOLES,ProFee,0989,5005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50060_3,REMOVAL OF KIDNEY STONE,ProFee,0989,50060,,,,0,3.00,2.25,2.25,1652.50,0.00,1652.50,1652.50,N/A
50065_3,INCISION OF KIDNEY,ProFee,0989,50065,,,,0,3.00,2.25,2.25,1753.00,0.00,1753.00,1753.00,N/A
50070_3,INCISION OF KIDNEY,ProFee,0989,50070,,,,0,3.00,2.25,2.25,1718.50,0.00,1718.50,1718.50,N/A
50075_3,REMOVAL OF KIDNEY STONE,ProFee,0989,50075,,,,0,3.00,2.25,2.25,2112.50,0.00,2112.50,2112.50,N/A
50080_3,REMOVAL OF KIDNEY STONE,ProFee,0989,50080,,,,0,3.00,2.25,2.25,1260.00,0.00,1260.00,1260.00,N/A
50081_3,REMOVAL OF KIDNEY STONE,ProFee,0989,50081,,,,0,3.00,2.25,2.25,1850.50,0.00,1850.50,1850.50,N/A
50100_3,REVISE KIDNEY BLOOD VESSELS,ProFee,0989,50100,,,,0,3.00,2.25,2.25,1562.00,0.00,1562.00,1562.00,N/A
5010F_3,MACUL+ FNDNGS TO DR MNG DM,ProFee,0989,5010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50120_3,EXPLORATION OF KIDNEY,ProFee,0989,50120,,,,0,3.00,2.25,2.25,1375.50,0.00,1375.50,1375.50,N/A
50125_3,EXPLORE AND DRAIN KIDNEY,ProFee,0989,50125,,,,0,3.00,2.25,2.25,1423.50,0.00,1423.50,1423.50,N/A
50130_3,REMOVAL OF KIDNEY STONE,ProFee,0989,50130,,,,0,3.00,2.25,2.25,1497.00,0.00,1497.00,1497.00,N/A
50135_3,EXPLORATION OF KIDNEY,ProFee,0989,50135,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
5015F_3,DOC FX & TEST/TXMNT FOR OP,ProFee,0989,5015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50200_3,BIOPSY OF KIDNEY,ProFee,0989,50200,,,,0,3.00,2.25,2.25,186.50,0.00,186.50,186.50,N/A
50205_3,BIOPSY OF KIDNEY,ProFee,0989,50205,,,,0,3.00,2.25,2.25,1092.00,0.00,1092.00,1092.00,N/A
5020F_3,TXMNTS 2 MAIN DR BY 1 MON,ProFee,0989,5020F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50220_3,"REMOVE KIDNEY, OPEN",ProFee,0989,50220,,,,0,3.00,2.25,2.25,1518.00,0.00,1518.00,1518.00,N/A
50225_3,"REMOVAL KIDNEY OPEN, COMPLEX",ProFee,0989,50225,,,,0,3.00,2.25,2.25,1740.00,0.00,1740.00,1740.00,N/A
50230_3,"REMOVAL KIDNEY OPEN, RADICAL",ProFee,0989,50230,,,,0,3.00,2.25,2.25,1857.50,0.00,1857.50,1857.50,N/A
50234_3,REMOVAL OF KIDNEY & URETER,ProFee,0989,50234,,,,0,3.00,2.25,2.25,1885.50,0.00,1885.50,1885.50,N/A
50236_3,REMOVAL OF KIDNEY & URETER,ProFee,0989,50236,,,,0,3.00,2.25,2.25,2129.00,0.00,2129.00,2129.00,N/A
50240_3,PARTIAL REMOVAL OF KIDNEY,ProFee,0989,50240,,,,0,3.00,2.25,2.25,1919.00,0.00,1919.00,1919.00,N/A
50250_3,CRYOABLATE RENAL MASS OPEN,ProFee,0989,50250,,,,0,3.00,2.25,2.25,1763.00,0.00,1763.00,1763.00,N/A
50280_3,REMOVAL OF KIDNEY LESION,ProFee,0989,50280,,,,0,3.00,2.25,2.25,1382.00,0.00,1382.00,1382.00,N/A
50290_3,REMOVAL OF KIDNEY LESION,ProFee,0989,50290,,,,0,3.00,2.25,2.25,1302.50,0.00,1302.50,1302.50,N/A
50300_3,REMOVE CADAVER DONOR KIDNEY,ProFee,0989,50300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50320_3,"REMOVE KIDNEY, LIVING DONOR",ProFee,0989,50320,,,,0,3.00,2.25,2.25,2175.00,0.00,2175.00,2175.00,N/A
50323_3,PREP CADAVER RENAL ALLOGRAFT,ProFee,0989,50323,,,,0,3.00,2.25,2.25,315.00,0.00,315.00,315.00,N/A
50325_3,PREP DONOR RENAL GRAFT,ProFee,0989,50325,,,,0,3.00,2.25,2.25,272.50,0.00,272.50,272.50,N/A
50327_3,PREP RENAL GRAFT/VENOUS,ProFee,0989,50327,,,,0,3.00,2.25,2.25,314.50,0.00,314.50,314.50,N/A
50328_3,PREP RENAL GRAFT/ARTERIAL,ProFee,0989,50328,,,,0,3.00,2.25,2.25,276.00,0.00,276.00,276.00,N/A
50329_3,PREP RENAL GRAFT/URETERAL,ProFee,0989,50329,,,,0,3.00,2.25,2.25,260.50,0.00,260.50,260.50,N/A
50340_3,REMOVAL OF KIDNEY,ProFee,0989,50340,,,,0,3.00,2.25,2.25,1370.00,0.00,1370.00,1370.00,N/A
50360_3,TRANSPLANTATION OF KIDNEY,ProFee,0989,50360,,,,0,3.00,2.25,2.25,3499.00,0.00,3499.00,3499.00,N/A
50365_3,TRANSPLANTATION OF KIDNEY,ProFee,0989,50365,,,,0,3.00,2.25,2.25,4135.50,0.00,4135.50,4135.50,N/A
50370_3,REMOVE TRANSPLANTED KIDNEY,ProFee,0989,50370,,,,0,3.00,2.25,2.25,1744.00,0.00,1744.00,1744.00,N/A
50380_3,REIMPLANTATION OF KIDNEY,ProFee,0989,50380,,,,0,3.00,2.25,2.25,2895.00,0.00,2895.00,2895.00,N/A
50382_3,"CHANGE URETER STENT, PERCUT",ProFee,0989,50382,,,,0,3.00,2.25,2.25,373.50,0.00,373.50,373.50,N/A
50384_3,"REMOVE URETER STENT, PERCUT",ProFee,0989,50384,,,,0,3.00,2.25,2.25,335.50,0.00,335.50,335.50,N/A
50385_3,CHANGE STENT VIA TRANSURETH,ProFee,0989,50385,,,,0,3.00,2.25,2.25,318.00,0.00,318.00,318.00,N/A
50386_3,REMOVE STENT VIA TRANSURETH,ProFee,0989,50386,,,,0,3.00,2.25,2.25,237.50,0.00,237.50,237.50,N/A
50387_3,CHANGE EXT/INT URETER STENT,ProFee,0989,50387,,,,0,3.00,2.25,2.25,122.00,0.00,122.00,122.00,N/A
50389_3,REMOVE RENAL TUBE W/FLUORO,ProFee,0989,50389,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
50390_3,DRAINAGE OF KIDNEY LESION,ProFee,0989,50390,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
50391_3,INSTLL RX AGNT INTO RNAL TUB,ProFee,0989,50391,,,,0,3.00,2.25,2.25,142.00,0.00,142.00,142.00,N/A
50392_3,INSERT KIDNEY DRAIN,ProFee,0989,50432,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
50393_3,INSERT URETERAL TUBE,ProFee,0989,50393,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
50394_3,INJECTION FOR KIDNEY X-RAY,ProFee,0989,50394,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
50395_3,CREATE PASSAGE TO KIDNEY,ProFee,0989,50395,,,,0,3.00,2.25,2.25,258.00,0.00,258.00,258.00,N/A
50396_3,MEASURE KIDNEY PRESSURE,ProFee,0989,50396,,,,0,3.00,2.25,2.25,169.50,0.00,169.50,169.50,N/A
50398_3,CHANGE KIDNEY TUBE,ProFee,0989,50435,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
50400_3,REVISION OF KIDNEY/URETER,ProFee,0989,50400,,,,0,3.00,2.25,2.25,1680.00,0.00,1680.00,1680.00,N/A
50405_3,REVISION OF KIDNEY/URETER,ProFee,0989,50405,,,,0,3.00,2.25,2.25,2023.00,0.00,2023.00,2023.00,N/A
50430_3,NJX PX NFROSGRM &/URTRGRM,ProFee,0989,50430,,,,0,3.00,2.25,2.25,223.50,0.00,223.50,223.50,N/A
50431_3,NJX PX NFROSGRM &/URTRGRM,ProFee,0989,50431,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
50432_3,PLMT NEPHROSTOMY CATHETER,ProFee,0989,50432,,,,0,3.00,2.25,2.25,299.50,0.00,299.50,299.50,N/A
50433_3,PLMT NEPHROURETERAL CATHETER,ProFee,0989,50433,,,,0,3.00,2.25,2.25,374.00,0.00,374.00,374.00,N/A
50434_3,CONVERT NEPHROSTOMY CATHETER,ProFee,0989,50434,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
50435_3,EXCHANGE NEPHROSTOMY CATH,ProFee,0989,50435,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
50436_3,DILAT XST TRC NDURLGC PX,ProFee,0989,50436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50437_3,DILAT XST TRC NEW ACCESS RCS,ProFee,0989,50437,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50500_3,REPAIR OF KIDNEY WOUND,ProFee,0989,50500,,,,0,3.00,2.25,2.25,1862.00,0.00,1862.00,1862.00,N/A
5050F_3,PLAN 2 MAIN DR. BY 1 MONTH,ProFee,0989,5050F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50520_3,CLOSE KIDNEY-SKIN FISTULA,ProFee,0989,50520,,,,0,3.00,2.25,2.25,1675.00,0.00,1675.00,1675.00,N/A
50525_3,REPAIR RENAL-ABDOMEN FISTULA,ProFee,0989,50525,,,,0,3.00,2.25,2.25,2127.00,0.00,2127.00,2127.00,N/A
50526_3,REPAIR RENAL-ABDOMEN FISTULA,ProFee,0989,50526,,,,0,3.00,2.25,2.25,2280.00,0.00,2280.00,2280.00,N/A
50540_3,REVISION OF HORSESHOE KIDNEY,ProFee,0989,50540,,,,0,3.00,2.25,2.25,1664.00,0.00,1664.00,1664.00,N/A
50541_3,LAPARO ABLATE RENAL CYST,ProFee,0989,50541,,,,0,3.00,2.25,2.25,1332.00,0.00,1332.00,1332.00,N/A
50542_3,LAPARO ABLATE RENAL MASS,ProFee,0989,50542,,,,0,3.00,2.25,2.25,1689.50,0.00,1689.50,1689.50,N/A
50543_3,LAPARO PARTIAL NEPHRECTOMY,ProFee,0989,50543,,,,0,3.00,2.25,2.25,2156.50,0.00,2156.50,2156.50,N/A
50544_3,"LAPAROSCOPY, PYELOPLASTY",ProFee,0989,50544,,,,0,3.00,2.25,2.25,1806.00,0.00,1806.00,1806.00,N/A
50545_3,LAPARO RADICAL NEPHRECTOMY,ProFee,0989,50545,,,,0,3.00,2.25,2.25,1942.50,0.00,1942.50,1942.50,N/A
50546_3,LAPAROSCOPIC NEPHRECTOMY,ProFee,0989,50546,,,,0,3.00,2.25,2.25,1744.00,0.00,1744.00,1744.00,N/A
50547_3,LAPARO REMOVAL DONOR KIDNEY,ProFee,0989,50547,,,,0,3.00,2.25,2.25,2330.00,0.00,2330.00,2330.00,N/A
50548_3,LAPARO REMOVE W/URETER,ProFee,0989,50548,,,,0,3.00,2.25,2.25,1952.50,0.00,1952.50,1952.50,N/A
50549_3,"LAPAROSCOPE PROC, RENAL",ProFee,0989,50549,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50551_3,KIDNEY ENDOSCOPY,ProFee,0989,50551,,,,0,3.00,2.25,2.25,427.50,0.00,427.50,427.50,N/A
50553_3,KIDNEY ENDOSCOPY,ProFee,0989,50553,,,,0,3.00,2.25,2.25,457.00,0.00,457.00,457.00,N/A
50555_3,KIDNEY ENDOSCOPY & BIOPSY,ProFee,0989,50555,,,,0,3.00,2.25,2.25,496.00,0.00,496.00,496.00,N/A
50557_3,KIDNEY ENDOSCOPY & TREATMENT,ProFee,0989,50557,,,,0,3.00,2.25,2.25,502.50,0.00,502.50,502.50,N/A
50561_3,KIDNEY ENDOSCOPY & TREATMENT,ProFee,0989,50561,,,,0,3.00,2.25,2.25,572.50,0.00,572.50,572.50,N/A
50562_3,RENAL SCOPE W/TUMOR RESECT,ProFee,0989,50562,,,,0,3.00,2.25,2.25,844.00,0.00,844.00,844.00,N/A
50570_3,KIDNEY ENDOSCOPY,ProFee,0989,50570,,,,0,3.00,2.25,2.25,714.00,0.00,714.00,714.00,N/A
50572_3,KIDNEY ENDOSCOPY,ProFee,0989,50572,,,,0,3.00,2.25,2.25,772.50,0.00,772.50,772.50,N/A
50574_3,KIDNEY ENDOSCOPY & BIOPSY,ProFee,0989,50574,,,,0,3.00,2.25,2.25,821.50,0.00,821.50,821.50,N/A
50575_3,KIDNEY ENDOSCOPY,ProFee,0989,50575,,,,0,3.00,2.25,2.25,1037.00,0.00,1037.00,1037.00,N/A
50576_3,KIDNEY ENDOSCOPY & TREATMENT,ProFee,0989,50576,,,,0,3.00,2.25,2.25,819.50,0.00,819.50,819.50,N/A
50580_3,KIDNEY ENDOSCOPY & TREATMENT,ProFee,0989,50580,,,,0,3.00,2.25,2.25,882.50,0.00,882.50,882.50,N/A
50590_3,FRAGMENTING OF KIDNEY STONE,ProFee,0989,50590,,,,0,3.00,2.25,2.25,823.50,0.00,823.50,823.50,N/A
50592_3,PERC RF ABLATE RENAL TUMOR,ProFee,0989,50592,,,,0,3.00,2.25,2.25,498.00,0.00,498.00,498.00,N/A
50593_3,PERC CRYO ABLATE RENAL TUM,ProFee,0989,50593,,,,0,3.00,2.25,2.25,668.50,0.00,668.50,668.50,N/A
50600_3,EXPLORATION OF URETER,ProFee,0989,50600,,,,0,3.00,2.25,2.25,1360.50,0.00,1360.50,1360.50,N/A
50605_3,INSERT URETERAL SUPPORT,ProFee,0989,50605,,,,0,3.00,2.25,2.25,1431.00,0.00,1431.00,1431.00,N/A
50606_3,ENDOLUMINAL BX URTR RNL PLVS,ProFee,0989,50606,,,,0,3.00,2.25,2.25,223.00,0.00,223.00,223.00,N/A
5060F_3,FNDNGS MAMMO 2PT W/IN 3 DAYS,ProFee,0989,5060F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50610_3,REMOVAL OF URETER STONE,ProFee,0989,50610,,,,0,3.00,2.25,2.25,1370.00,0.00,1370.00,1370.00,N/A
50620_3,REMOVAL OF URETER STONE,ProFee,0989,50620,,,,0,3.00,2.25,2.25,1311.00,0.00,1311.00,1311.00,N/A
5062F_3,DOC F2FMAMMO FNDNG IN 3 DAYS,ProFee,0989,5062F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50630_3,REMOVAL OF URETER STONE,ProFee,0989,50630,,,,0,3.00,2.25,2.25,1294.50,0.00,1294.50,1294.50,N/A
50650_3,REMOVAL OF URETER,ProFee,0989,50650,,,,0,3.00,2.25,2.25,1502.00,0.00,1502.00,1502.00,N/A
50660_3,REMOVAL OF URETER,ProFee,0989,50660,,,,0,3.00,2.25,2.25,1658.00,0.00,1658.00,1658.00,N/A
50684_3,INJECTION FOR URETER X-RAY,ProFee,0989,50684,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
50686_3,MEASURE URETER PRESSURE,ProFee,0989,50686,,,,0,3.00,2.25,2.25,128.50,0.00,128.50,128.50,N/A
50688_3,CHANGE OF URETER TUBE,ProFee,0989,50688,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
50690_3,INJECTION FOR URETER X-RAY,ProFee,0989,50690,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
50693_3,PLMT URETERAL STENT PRQ,ProFee,0989,50693,,,,0,3.00,2.25,2.25,297.00,0.00,297.00,297.00,N/A
50694_3,PLMT URETERAL STENT PRQ,ProFee,0989,50694,,,,0,3.00,2.25,2.25,389.00,0.00,389.00,389.00,N/A
50695_3,PLMT URETERAL STENT PRQ,ProFee,0989,50695,,,,0,3.00,2.25,2.25,498.00,0.00,498.00,498.00,N/A
50700_3,REVISION OF URETER,ProFee,0989,50700,,,,0,3.00,2.25,2.25,1341.00,0.00,1341.00,1341.00,N/A
50705_3,URETERAL EMBOLIZATION/OCCL,ProFee,0989,50705,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
50706_3,BALLOON DILATE URTRL STRIX,ProFee,0989,50706,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
50715_3,RELEASE OF URETER,ProFee,0989,50715,,,,0,3.00,2.25,2.25,1765.00,0.00,1765.00,1765.00,N/A
50722_3,RELEASE OF URETER,ProFee,0989,50722,,,,0,3.00,2.25,2.25,1460.50,0.00,1460.50,1460.50,N/A
50725_3,RELEASE/REVISE URETER,ProFee,0989,50725,,,,0,3.00,2.25,2.25,1598.00,0.00,1598.00,1598.00,N/A
50727_3,REVISE URETER,ProFee,0989,50727,,,,0,3.00,2.25,2.25,737.00,0.00,737.00,737.00,N/A
50728_3,REVISE URETER,ProFee,0989,50728,,,,0,3.00,2.25,2.25,1012.50,0.00,1012.50,1012.50,N/A
50740_3,FUSION OF URETER & KIDNEY,ProFee,0989,50740,,,,0,3.00,2.25,2.25,1771.50,0.00,1771.50,1771.50,N/A
50750_3,FUSION OF URETER & KIDNEY,ProFee,0989,50750,,,,0,3.00,2.25,2.25,1672.50,0.00,1672.50,1672.50,N/A
50760_3,FUSION OF URETERS,ProFee,0989,50760,,,,0,3.00,2.25,2.25,1629.00,0.00,1629.00,1629.00,N/A
50770_3,SPLICING OF URETERS,ProFee,0989,50770,,,,0,3.00,2.25,2.25,1672.50,0.00,1672.50,1672.50,N/A
50780_3,REIMPLANT URETER IN BLADDER,ProFee,0989,50780,,,,0,3.00,2.25,2.25,1605.50,0.00,1605.50,1605.50,N/A
50782_3,REIMPLANT URETER IN BLADDER,ProFee,0989,50782,,,,0,3.00,2.25,2.25,1558.50,0.00,1558.50,1558.50,N/A
50783_3,REIMPLANT URETER IN BLADDER,ProFee,0989,50783,,,,0,3.00,2.25,2.25,1635.00,0.00,1635.00,1635.00,N/A
50785_3,REIMPLANT URETER IN BLADDER,ProFee,0989,50785,,,,0,3.00,2.25,2.25,1758.00,0.00,1758.00,1758.00,N/A
50800_3,IMPLANT URETER IN BOWEL,ProFee,0989,50800,,,,0,3.00,2.25,2.25,1340.00,0.00,1340.00,1340.00,N/A
50810_3,FUSION OF URETER & BOWEL,ProFee,0989,50810,,,,0,3.00,2.25,2.25,2023.00,0.00,2023.00,2023.00,N/A
50815_3,URINE SHUNT TO INTESTINE,ProFee,0989,50815,,,,0,3.00,2.25,2.25,1772.00,0.00,1772.00,1772.00,N/A
50820_3,CONSTRUCT BOWEL BLADDER,ProFee,0989,50820,,,,0,3.00,2.25,2.25,1904.00,0.00,1904.00,1904.00,N/A
50825_3,CONSTRUCT BOWEL BLADDER,ProFee,0989,50825,,,,0,3.00,2.25,2.25,2391.00,0.00,2391.00,2391.00,N/A
50830_3,REVISE URINE FLOW,ProFee,0989,50830,,,,0,3.00,2.25,2.25,2612.50,0.00,2612.50,2612.50,N/A
50840_3,REPLACE URETER BY BOWEL,ProFee,0989,50840,,,,0,3.00,2.25,2.25,1781.50,0.00,1781.50,1781.50,N/A
50845_3,APPENDICO-VESICOSTOMY,ProFee,0989,50845,,,,0,3.00,2.25,2.25,1810.50,0.00,1810.50,1810.50,N/A
50860_3,TRANSPLANT URETER TO SKIN,ProFee,0989,50860,,,,0,3.00,2.25,2.25,1369.50,0.00,1369.50,1369.50,N/A
50900_3,REPAIR OF URETER,ProFee,0989,50900,,,,0,3.00,2.25,2.25,1223.50,0.00,1223.50,1223.50,N/A
50920_3,CLOSURE URETER/SKIN FISTULA,ProFee,0989,50920,,,,0,3.00,2.25,2.25,1277.50,0.00,1277.50,1277.50,N/A
50930_3,CLOSURE URETER/BOWEL FISTULA,ProFee,0989,50930,,,,0,3.00,2.25,2.25,1597.50,0.00,1597.50,1597.50,N/A
50940_3,RELEASE OF URETER,ProFee,0989,50940,,,,0,3.00,2.25,2.25,1286.00,0.00,1286.00,1286.00,N/A
50945_3,LAPAROSCOPY URETEROLITHOTOMY,ProFee,0989,50945,,,,0,3.00,2.25,2.25,1411.00,0.00,1411.00,1411.00,N/A
50947_3,LAPARO NEW URETER/BLADDER,ProFee,0989,50947,,,,0,3.00,2.25,2.25,2008.00,0.00,2008.00,2008.00,N/A
50948_3,LAPARO NEW URETER/BLADDER,ProFee,0989,50948,,,,0,3.00,2.25,2.25,1848.50,0.00,1848.50,1848.50,N/A
50949_3,"LAPAROSCOPE PROC, URETER",ProFee,0989,50949,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
50951_3,ENDOSCOPY OF URETER,ProFee,0989,50951,,,,0,3.00,2.25,2.25,445.00,0.00,445.00,445.00,N/A
50953_3,ENDOSCOPY OF URETER,ProFee,0989,50953,,,,0,3.00,2.25,2.25,476.50,0.00,476.50,476.50,N/A
50955_3,URETER ENDOSCOPY & BIOPSY,ProFee,0989,50955,,,,0,3.00,2.25,2.25,512.00,0.00,512.00,512.00,N/A
50957_3,URETER ENDOSCOPY & TREATMENT,ProFee,0989,50957,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
50961_3,URETER ENDOSCOPY & TREATMENT,ProFee,0989,50961,,,,0,3.00,2.25,2.25,461.00,0.00,461.00,461.00,N/A
50970_3,URETER ENDOSCOPY,ProFee,0989,50970,,,,0,3.00,2.25,2.25,538.50,0.00,538.50,538.50,N/A
50972_3,URETER ENDOSCOPY & CATHETER,ProFee,0989,50972,,,,0,3.00,2.25,2.25,520.50,0.00,520.50,520.50,N/A
50974_3,URETER ENDOSCOPY & BIOPSY,ProFee,0989,50974,,,,0,3.00,2.25,2.25,687.00,0.00,687.00,687.00,N/A
50976_3,URETER ENDOSCOPY & TREATMENT,ProFee,0989,50976,,,,0,3.00,2.25,2.25,677.00,0.00,677.00,677.00,N/A
50980_3,URETER ENDOSCOPY & TREATMENT,ProFee,0989,50980,,,,0,3.00,2.25,2.25,518.00,0.00,518.00,518.00,N/A
51000_3,DRAINAGE OF BLADDER,ProFee,0989,51000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
51005_3,DRAINAGE OF BLADDER,ProFee,0989,51005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
5100F_3,RSK FX REF W/N 24 HRS X-RAY,ProFee,0989,5100F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
51010_3,DRAINAGE OF BLADDER,ProFee,0989,51010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
51020_3,INCISE & TREAT BLADDER,ProFee,0989,51020,,,,0,3.00,2.25,2.25,680.00,0.00,680.00,680.00,N/A
51030_3,INCISE & TREAT BLADDER,ProFee,0989,51030,,,,0,3.00,2.25,2.25,682.00,0.00,682.00,682.00,N/A
51040_3,INCISE & DRAIN BLADDER,ProFee,0989,51040,,,,0,3.00,2.25,2.25,419.50,0.00,419.50,419.50,N/A
51045_3,INCISE BLADDER/DRAIN URETER,ProFee,0989,51045,,,,0,3.00,2.25,2.25,708.00,0.00,708.00,708.00,N/A
51050_3,REMOVAL OF BLADDER STONE,ProFee,0989,51050,,,,0,3.00,2.25,2.25,685.00,0.00,685.00,685.00,N/A
51060_3,REMOVAL OF URETER STONE,ProFee,0989,51060,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
51065_3,REMOVE URETER CALCULUS,ProFee,0989,51065,,,,0,3.00,2.25,2.25,838.50,0.00,838.50,838.50,N/A
51080_3,DRAINAGE OF BLADDER ABSCESS,ProFee,0989,51080,,,,0,3.00,2.25,2.25,592.50,0.00,592.50,592.50,N/A
51101_3,DRAIN BLADDER BY TROCAR/CATH,ProFee,0989,51101,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
51102_3,DRAIN BL W/CATH INSERTION,ProFee,0989,51102,,,,0,3.00,2.25,2.25,209.00,0.00,209.00,209.00,N/A
51500_3,REMOVAL OF BLADDER CYST,ProFee,0989,51500,,,,0,3.00,2.25,2.25,923.00,0.00,923.00,923.00,N/A
51520_3,REMOVAL OF BLADDER LESION,ProFee,0989,51520,,,,0,3.00,2.25,2.25,861.00,0.00,861.00,861.00,N/A
51525_3,REMOVAL OF BLADDER LESION,ProFee,0989,51525,,,,0,3.00,2.25,2.25,1244.00,0.00,1244.00,1244.00,N/A
51530_3,REMOVAL OF BLADDER LESION,ProFee,0989,51530,,,,0,3.00,2.25,2.25,1131.00,0.00,1131.00,1131.00,N/A
51535_3,REPAIR OF URETER LESION,ProFee,0989,51535,,,,0,3.00,2.25,2.25,1130.50,0.00,1130.50,1130.50,N/A
51550_3,PARTIAL REMOVAL OF BLADDER,ProFee,0989,51550,,,,0,3.00,2.25,2.25,1397.50,0.00,1397.50,1397.50,N/A
51555_3,PARTIAL REMOVAL OF BLADDER,ProFee,0989,51555,,,,0,3.00,2.25,2.25,1834.00,0.00,1834.00,1834.00,N/A
51565_3,REVISE BLADDER & URETER(S),ProFee,0989,51565,,,,0,3.00,2.25,2.25,1869.50,0.00,1869.50,1869.50,N/A
51570_3,REMOVAL OF BLADDER,ProFee,0989,51570,,,,0,3.00,2.25,2.25,2139.00,0.00,2139.00,2139.00,N/A
51575_3,REMOVAL OF BLADDER & NODES,ProFee,0989,51575,,,,0,3.00,2.25,2.25,2641.50,0.00,2641.50,2641.50,N/A
51580_3,REMOVE BLADDER/REVISE TRACT,ProFee,0989,51580,,,,0,3.00,2.25,2.25,2748.50,0.00,2748.50,2748.50,N/A
51585_3,REMOVAL OF BLADDER & NODES,ProFee,0989,51585,,,,0,3.00,2.25,2.25,3060.50,0.00,3060.50,3060.50,N/A
51590_3,REMOVE BLADDER/REVISE TRACT,ProFee,0989,51590,,,,0,3.00,2.25,2.25,2806.00,0.00,2806.00,2806.00,N/A
51595_3,REMOVE BLADDER/REVISE TRACT,ProFee,0989,51595,,,,0,3.00,2.25,2.25,3173.00,0.00,3173.00,3173.00,N/A
51596_3,REMOVE BLADDER/CREATE POUCH,ProFee,0989,51596,,,,0,3.00,2.25,2.25,3411.50,0.00,3411.50,3411.50,N/A
51597_3,REMOVAL OF PELVIC STRUCTURES,ProFee,0989,51597,,,,0,3.00,2.25,2.25,3330.00,0.00,3330.00,3330.00,N/A
51600_3,INJECTION FOR BLADDER X-RAY,ProFee,0989,51600,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
51605_3,PREPARATION FOR BLADDER XRAY,ProFee,0989,51605,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
51610_3,INJECTION FOR BLADDER X-RAY,ProFee,0989,51610,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
51700_3,IRRIGATION OF BLADDER,ProFee,0989,51700,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
51702_2,INSERT TEMP BLADDER CATH,ProFee,0989,51702,,,,0,159.00,119.25,37.50,119.25,0.00,37.50,37.50,N/A
51702_3,INSERT TEMP BLADDER CATH,ProFee,0989,51702,,,,0,159.00,119.25,37.50,119.25,0.00,37.50,37.50,N/A
51703_3,"INSERT BLADDER CATH, COMPLEX",ProFee,0989,51703,,,,0,3.00,2.25,2.25,111.50,0.00,111.50,111.50,N/A
51705_3,CHANGE OF BLADDER TUBE,ProFee,0989,51705,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
51710_3,CHANGE OF BLADDER TUBE,ProFee,0989,51710,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
51715_3,ENDOSCOPIC INJECTION/IMPLANT,ProFee,0989,51715,,,,0,3.00,2.25,2.25,290.00,0.00,290.00,290.00,N/A
51720_3,TREATMENT OF BLADDER LESION,ProFee,0989,51720,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
51725_3,SIMPLE CYSTOMETROGRAM,ProFee,0989,51725,,,,0,3.00,2.25,2.25,110.00,0.00,110.00,110.00,N/A
51726_3,COMPLEX CYSTOMETROGRAM,ProFee,0989,51726,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
51727_3,CYSTOMETROGRAM W/UP,ProFee,0989,51727,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
51728_3,CYSTOMETROGRAM W/VP,ProFee,0989,51728,,,,0,3.00,2.25,2.25,151.00,0.00,151.00,151.00,N/A
51729_3,CYSTOMETROGRAM W/VP&UP,ProFee,0989,51729,,,,0,3.00,2.25,2.25,182.00,0.00,182.00,182.00,N/A
51736_3,URINE FLOW MEASUREMENT,ProFee,0989,51736,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
51741_3,"ELECTRO-UROFLOWMETRY, FIRST",ProFee,0989,51741,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
51772_3,URETHRA PRESSURE PROFILE,ProFee,0989,51772,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
51784_3,ANAL/URINARY MUSCLE STUDY,ProFee,0989,51784,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
51785_3,ANAL/URINARY MUSCLE STUDY,ProFee,0989,51785,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
51792_3,URINARY REFLEX STUDY,ProFee,0989,51792,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
51795_3,URINE VOIDING PRESSURE STUDY,ProFee,0989,51795,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
51797_3,INTRAABDOMINAL PRESSURE TEST,ProFee,0989,51797,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
51798_3,US URINE CAPACITY MEASURE,ProFee,0989,51798,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
51800_3,REVISION OF BLADDER/URETHRA,ProFee,0989,51800,,,,0,3.00,2.25,2.25,1507.50,0.00,1507.50,1507.50,N/A
51820_3,REVISION OF URINARY TRACT,ProFee,0989,51820,,,,0,3.00,2.25,2.25,1570.00,0.00,1570.00,1570.00,N/A
51840_3,ATTACH BLADDER/URETHRA,ProFee,0989,51840,,,,0,3.00,2.25,2.25,947.50,0.00,947.50,947.50,N/A
51841_3,ATTACH BLADDER/URETHRA,ProFee,0989,51841,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
51845_3,REPAIR BLADDER NECK,ProFee,0989,51845,,,,0,3.00,2.25,2.25,845.50,0.00,845.50,845.50,N/A
51860_3,REPAIR OF BLADDER WOUND,ProFee,0989,51860,,,,0,3.00,2.25,2.25,1079.00,0.00,1079.00,1079.00,N/A
51865_3,REPAIR OF BLADDER WOUND,ProFee,0989,51865,,,,0,3.00,2.25,2.25,1295.50,0.00,1295.50,1295.50,N/A
51880_3,REPAIR OF BLADDER OPENING,ProFee,0989,51880,,,,0,3.00,2.25,2.25,676.00,0.00,676.00,676.00,N/A
51900_3,REPAIR BLADDER/VAGINA LESION,ProFee,0989,51900,,,,0,3.00,2.25,2.25,1195.00,0.00,1195.00,1195.00,N/A
51920_3,CLOSE BLADDER-UTERUS FISTULA,ProFee,0989,51920,,,,0,3.00,2.25,2.25,1106.50,0.00,1106.50,1106.50,N/A
51925_3,HYSTERECTOMY/BLADDER REPAIR,ProFee,0989,51925,,,,0,3.00,2.25,2.25,1452.00,0.00,1452.00,1452.00,N/A
51940_3,CORRECTION OF BLADDER DEFECT,ProFee,0989,51940,,,,0,3.00,2.25,2.25,2379.50,0.00,2379.50,2379.50,N/A
51960_3,REVISION OF BLADDER & BOWEL,ProFee,0989,51960,,,,0,3.00,2.25,2.25,2008.50,0.00,2008.50,2008.50,N/A
51980_3,CONSTRUCT BLADDER OPENING,ProFee,0989,51980,,,,0,3.00,2.25,2.25,1034.00,0.00,1034.00,1034.00,N/A
51990_3,LAPARO URETHRAL SUSPENSION,ProFee,0989,51990,,,,0,3.00,2.25,2.25,1085.50,0.00,1085.50,1085.50,N/A
51992_3,LAPARO SLING OPERATION,ProFee,0989,51992,,,,0,3.00,2.25,2.25,1206.00,0.00,1206.00,1206.00,N/A
51999_3,"LAPAROSCOPE PROC, BLADDER",ProFee,0989,51999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
52000_3,CYSTOSCOPY,ProFee,0989,52000,,,,0,3.00,2.25,2.25,119.00,0.00,119.00,119.00,N/A
52001_3,"CYSTOSCOPY, REMOVAL OF CLOTS",ProFee,0989,52001,,,,0,3.00,2.25,2.25,417.00,0.00,417.00,417.00,N/A
52005_3,CYSTOSCOPY & URETER CATHETER,ProFee,0989,52005,,,,0,3.00,2.25,2.25,193.00,0.00,193.00,193.00,N/A
52007_3,CYSTOSCOPY AND BIOPSY,ProFee,0989,52007,,,,0,3.00,2.25,2.25,240.00,0.00,240.00,240.00,N/A
5200F_3,EVAL APPROS SURG THXPY EPI,ProFee,0989,5200F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
52010_3,CYSTOSCOPY & DUCT CATHETER,ProFee,0989,52010,,,,0,3.00,2.25,2.25,240.50,0.00,240.50,240.50,N/A
52204_3,CYSTOSCOPY,ProFee,0989,52204,,,,0,3.00,2.25,2.25,205.50,0.00,205.50,205.50,N/A
52214_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52214,,,,0,3.00,2.25,2.25,255.50,0.00,255.50,255.50,N/A
52224_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52224,,,,0,3.00,2.25,2.25,296.00,0.00,296.00,296.00,N/A
52234_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52234,,,,0,3.00,2.25,2.25,357.50,0.00,357.50,357.50,N/A
52235_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52235,,,,0,3.00,2.25,2.25,419.00,0.00,419.00,419.00,N/A
52240_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52240,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
52250_3,CYSTOSCOPY AND RADIOTRACER,ProFee,0989,52250,,,,0,3.00,2.25,2.25,348.00,0.00,348.00,348.00,N/A
52260_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52260,,,,0,3.00,2.25,2.25,305.50,0.00,305.50,305.50,N/A
52265_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52265,,,,0,3.00,2.25,2.25,234.50,0.00,234.50,234.50,N/A
52270_3,CYSTOSCOPY & REVISE URETHRA,ProFee,0989,52270,,,,0,3.00,2.25,2.25,264.00,0.00,264.00,264.00,N/A
52275_3,CYSTOSCOPY & REVISE URETHRA,ProFee,0989,52275,,,,0,3.00,2.25,2.25,361.00,0.00,361.00,361.00,N/A
52276_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52276,,,,0,3.00,2.25,2.25,384.00,0.00,384.00,384.00,N/A
52277_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52277,,,,0,3.00,2.25,2.25,469.50,0.00,469.50,469.50,N/A
52281_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52281,,,,0,3.00,2.25,2.25,220.50,0.00,220.50,220.50,N/A
52282_3,"CYSTOSCOPY, IMPLANT STENT",ProFee,0989,52282,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
52283_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52283,,,,0,3.00,2.25,2.25,292.50,0.00,292.50,292.50,N/A
52285_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52285,,,,0,3.00,2.25,2.25,284.00,0.00,284.00,284.00,N/A
52287_3,CYSTOSCOPY CHEMODENERVATION,ProFee,0989,52287,,,,0,3.00,2.25,2.25,245.00,0.00,245.00,245.00,N/A
52290_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52290,,,,0,3.00,2.25,2.25,355.00,0.00,355.00,355.00,N/A
52300_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52300,,,,0,3.00,2.25,2.25,407.50,0.00,407.50,407.50,N/A
52301_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52301,,,,0,3.00,2.25,2.25,421.50,0.00,421.50,421.50,N/A
52305_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52305,,,,0,3.00,2.25,2.25,404.00,0.00,404.00,404.00,N/A
52310_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52310,,,,0,3.00,2.25,2.25,219.50,0.00,219.50,219.50,N/A
52315_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52315,,,,0,3.00,2.25,2.25,398.50,0.00,398.50,398.50,N/A
52317_3,REMOVE BLADDER STONE,ProFee,0989,52317,,,,0,3.00,2.25,2.25,504.50,0.00,504.50,504.50,N/A
52318_3,REMOVE BLADDER STONE,ProFee,0989,52318,,,,0,3.00,2.25,2.25,687.50,0.00,687.50,687.50,N/A
52320_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52320,,,,0,3.00,2.25,2.25,358.50,0.00,358.50,358.50,N/A
52325_3,"CYSTOSCOPY, STONE REMOVAL",ProFee,0989,52325,,,,0,3.00,2.25,2.25,466.00,0.00,466.00,466.00,N/A
52327_3,"CYSTOSCOPY, INJECT MATERIAL",ProFee,0989,52327,,,,0,3.00,2.25,2.25,381.00,0.00,381.00,381.00,N/A
52330_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52330,,,,0,3.00,2.25,2.25,383.50,0.00,383.50,383.50,N/A
52332_3,CYSTOSCOPY AND TREATMENT,ProFee,0989,52332,,,,0,3.00,2.25,2.25,226.00,0.00,226.00,226.00,N/A
52334_3,CREATE PASSAGE TO KIDNEY,ProFee,0989,52334,,,,0,3.00,2.25,2.25,372.00,0.00,372.00,372.00,N/A
52341_3,CYSTO W/URETER STRICTURE TX,ProFee,0989,52341,,,,0,3.00,2.25,2.25,412.50,0.00,412.50,412.50,N/A
52342_3,CYSTO W/UP STRICTURE TX,ProFee,0989,52342,,,,0,3.00,2.25,2.25,448.50,0.00,448.50,448.50,N/A
52343_3,CYSTO W/RENAL STRICTURE TX,ProFee,0989,52343,,,,0,3.00,2.25,2.25,500.00,0.00,500.00,500.00,N/A
52344_3,"CYSTO/URETERO, STRICTURE TX",ProFee,0989,52344,,,,0,3.00,2.25,2.25,537.00,0.00,537.00,537.00,N/A
52345_3,CYSTO/URETERO W/UP STRICTURE,ProFee,0989,52345,,,,0,3.00,2.25,2.25,572.50,0.00,572.50,572.50,N/A
52346_3,CYSTOURETERO W/RENAL STRICT,ProFee,0989,52346,,,,0,3.00,2.25,2.25,648.50,0.00,648.50,648.50,N/A
52351_3,CYSTOURETERO & OR PYELOSCOPE,ProFee,0989,52351,,,,0,3.00,2.25,2.25,440.00,0.00,440.00,440.00,N/A
52352_3,CYSTOURETERO W/STONE REMOVE,ProFee,0989,52352,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
52353_3,CYSTOURETERO W/LITHOTRIPSY,ProFee,0989,52353,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
52354_3,CYSTOURETERO W/BIOPSY,ProFee,0989,52354,,,,0,3.00,2.25,2.25,606.00,0.00,606.00,606.00,N/A
52355_3,CYSTOURETERO W/EXCISE TUMOR,ProFee,0989,52355,,,,0,3.00,2.25,2.25,679.00,0.00,679.00,679.00,N/A
52356_3,CYSTO/URETERO W/LITHOTRIPSY,ProFee,0989,52356,,,,0,3.00,2.25,2.25,604.00,0.00,604.00,604.00,N/A
52400_3,CYSTOURETERO W/CONGEN REPR,ProFee,0989,52400,,,,0,3.00,2.25,2.25,693.00,0.00,693.00,693.00,N/A
52402_3,CYSTOURETHRO CUT EJACUL DUCT,ProFee,0989,52402,,,,0,3.00,2.25,2.25,387.50,0.00,387.50,387.50,N/A
52441_3,CYSTOURETHRO W/IMPLANT,ProFee,0989,52441,,,,0,3.00,2.25,2.25,329.00,0.00,329.00,329.00,N/A
52442_3,CYSTOURETHRO W/ADDL IMPLANT,ProFee,0989,52442,,,,0,3.00,2.25,2.25,87.50,0.00,87.50,87.50,N/A
52450_3,INCISION OF PROSTATE,ProFee,0989,52450,,,,0,3.00,2.25,2.25,681.00,0.00,681.00,681.00,N/A
52500_3,REVISION OF BLADDER NECK,ProFee,0989,52500,,,,0,3.00,2.25,2.25,707.00,0.00,707.00,707.00,N/A
5250F_3,ASTHMA DISCHARGE PLAN PRESNT,ProFee,0989,5250F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
52510_3,DILATION PROSTATIC URETHRA,ProFee,0989,52510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
52601_3,PROSTATECTOMY (TURP),ProFee,0989,52601,,,,0,3.00,2.25,2.25,1057.50,0.00,1057.50,1057.50,N/A
52606_3,CONTROL POSTOP BLEEDING,ProFee,0989,52606,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
52612_3,"PROSTATECTOMY, FIRST STAGE",ProFee,0989,52612,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
52614_3,"PROSTATECTOMY, SECOND STAGE",ProFee,0989,52614,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
52620_3,REMOVE RESIDUAL PROSTATE,ProFee,0989,52620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
52630_3,REMOVE PROSTATE REGROWTH,ProFee,0989,52630,,,,0,3.00,2.25,2.25,580.00,0.00,580.00,580.00,N/A
52640_3,RELIEVE BLADDER CONTRACTURE,ProFee,0989,52640,,,,0,3.00,2.25,2.25,457.50,0.00,457.50,457.50,N/A
52647_3,LASER SURGERY OF PROSTATE,ProFee,0989,52647,,,,0,3.00,2.25,2.25,938.50,0.00,938.50,938.50,N/A
52648_3,LASER SURGERY OF PROSTATE,ProFee,0989,52648,,,,0,3.00,2.25,2.25,1000.50,0.00,1000.50,1000.50,N/A
52649_3,PROSTATE LASER ENUCLEATION,ProFee,0989,52649,,,,0,3.00,2.25,2.25,1193.00,0.00,1193.00,1193.00,N/A
52700_3,DRAINAGE OF PROSTATE ABSCESS,ProFee,0989,52700,,,,0,3.00,2.25,2.25,639.00,0.00,639.00,639.00,N/A
53000_3,INCISION OF URETHRA,ProFee,0989,53000,,,,0,3.00,2.25,2.25,215.00,0.00,215.00,215.00,N/A
53010_3,INCISION OF URETHRA,ProFee,0989,53010,,,,0,3.00,2.25,2.25,427.00,0.00,427.00,427.00,N/A
53020_3,INCISION OF URETHRA,ProFee,0989,53020,,,,0,3.00,2.25,2.25,141.00,0.00,141.00,141.00,N/A
53025_3,INCISION OF URETHRA,ProFee,0989,53025,,,,0,3.00,2.25,2.25,99.50,0.00,99.50,99.50,N/A
53040_3,DRAINAGE OF URETHRA ABSCESS,ProFee,0989,53040,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
53060_3,DRAINAGE OF URETHRA ABSCESS,ProFee,0989,53060,,,,0,3.00,2.25,2.25,235.00,0.00,235.00,235.00,N/A
53080_3,DRAINAGE OF URINARY LEAKAGE,ProFee,0989,53080,,,,0,3.00,2.25,2.25,609.00,0.00,609.00,609.00,N/A
53085_3,DRAINAGE OF URINARY LEAKAGE,ProFee,0989,53085,,,,0,3.00,2.25,2.25,940.50,0.00,940.50,940.50,N/A
53200_3,BIOPSY OF URETHRA,ProFee,0989,53200,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
53210_3,REMOVAL OF URETHRA,ProFee,0989,53210,,,,0,3.00,2.25,2.25,1116.00,0.00,1116.00,1116.00,N/A
53215_3,REMOVAL OF URETHRA,ProFee,0989,53215,,,,0,3.00,2.25,2.25,1344.50,0.00,1344.50,1344.50,N/A
53220_3,TREATMENT OF URETHRA LESION,ProFee,0989,53220,,,,0,3.00,2.25,2.25,654.50,0.00,654.50,654.50,N/A
53230_3,REMOVAL OF URETHRA LESION,ProFee,0989,53230,,,,0,3.00,2.25,2.25,876.50,0.00,876.50,876.50,N/A
53235_3,REMOVAL OF URETHRA LESION,ProFee,0989,53235,,,,0,3.00,2.25,2.25,917.50,0.00,917.50,917.50,N/A
53240_3,SURGERY FOR URETHRA POUCH,ProFee,0989,53240,,,,0,3.00,2.25,2.25,616.00,0.00,616.00,616.00,N/A
53250_3,REMOVAL OF URETHRA GLAND,ProFee,0989,53250,,,,0,3.00,2.25,2.25,573.50,0.00,573.50,573.50,N/A
53260_3,TREATMENT OF URETHRA LESION,ProFee,0989,53260,,,,0,3.00,2.25,2.25,260.00,0.00,260.00,260.00,N/A
53265_3,TREATMENT OF URETHRA LESION,ProFee,0989,53265,,,,0,3.00,2.25,2.25,269.00,0.00,269.00,269.00,N/A
53270_3,REMOVAL OF URETHRA GLAND,ProFee,0989,53270,,,,0,3.00,2.25,2.25,266.00,0.00,266.00,266.00,N/A
53275_3,REPAIR OF URETHRA DEFECT,ProFee,0989,53275,,,,0,3.00,2.25,2.25,380.50,0.00,380.50,380.50,N/A
53400_3,"REVISE URETHRA, STAGE 1",ProFee,0989,53400,,,,0,3.00,2.25,2.25,1159.00,0.00,1159.00,1159.00,N/A
53405_3,"REVISE URETHRA, STAGE 2",ProFee,0989,53405,,,,0,3.00,2.25,2.25,1266.00,0.00,1266.00,1266.00,N/A
53410_3,RECONSTRUCTION OF URETHRA,ProFee,0989,53410,,,,0,3.00,2.25,2.25,1417.50,0.00,1417.50,1417.50,N/A
53415_3,RECONSTRUCTION OF URETHRA,ProFee,0989,53415,,,,0,3.00,2.25,2.25,1640.00,0.00,1640.00,1640.00,N/A
53420_3,"RECONSTRUCT URETHRA, STAGE 1",ProFee,0989,53420,,,,0,3.00,2.25,2.25,1219.50,0.00,1219.50,1219.50,N/A
53425_3,"RECONSTRUCT URETHRA, STAGE 2",ProFee,0989,53425,,,,0,3.00,2.25,2.25,1357.00,0.00,1357.00,1357.00,N/A
53430_3,RECONSTRUCTION OF URETHRA,ProFee,0989,53430,,,,0,3.00,2.25,2.25,1403.00,0.00,1403.00,1403.00,N/A
53431_3,RECONSTRUCT URETHRA/BLADDER,ProFee,0989,53431,,,,0,3.00,2.25,2.25,1673.50,0.00,1673.50,1673.50,N/A
53440_3,MALE SLING PROCEDURE,ProFee,0989,53440,,,,0,3.00,2.25,2.25,1091.50,0.00,1091.50,1091.50,N/A
53442_3,REMOVE/REVISE MALE SLING,ProFee,0989,53442,,,,0,3.00,2.25,2.25,1135.00,0.00,1135.00,1135.00,N/A
53444_3,INSERT TANDEM CUFF,ProFee,0989,53444,,,,0,3.00,2.25,2.25,1149.50,0.00,1149.50,1149.50,N/A
53445_3,INSERT URO/VES NCK SPHINCTER,ProFee,0989,53445,,,,0,3.00,2.25,2.25,1092.00,0.00,1092.00,1092.00,N/A
53446_3,REMOVE URO SPHINCTER,ProFee,0989,53446,,,,0,3.00,2.25,2.25,930.50,0.00,930.50,930.50,N/A
53447_3,REMOVE/REPLACE UR SPHINCTER,ProFee,0989,53447,,,,0,3.00,2.25,2.25,1172.00,0.00,1172.00,1172.00,N/A
53448_3,REMOV/REPLC UR SPHINCTR COMP,ProFee,0989,53448,,,,0,3.00,2.25,2.25,1856.00,0.00,1856.00,1856.00,N/A
53449_3,REPAIR URO SPHINCTER,ProFee,0989,53449,,,,0,3.00,2.25,2.25,886.00,0.00,886.00,886.00,N/A
53450_3,REVISION OF URETHRA,ProFee,0989,53450,,,,0,3.00,2.25,2.25,592.50,0.00,592.50,592.50,N/A
53460_3,REVISION OF URETHRA,ProFee,0989,53460,,,,0,3.00,2.25,2.25,664.50,0.00,664.50,664.50,N/A
53500_3,"URETHRLYS, TRANSVAG W/ SCOPE",ProFee,0989,53500,,,,0,3.00,2.25,2.25,1081.00,0.00,1081.00,1081.00,N/A
53502_3,REPAIR OF URETHRA INJURY,ProFee,0989,53502,,,,0,3.00,2.25,2.25,704.50,0.00,704.50,704.50,N/A
53505_3,REPAIR OF URETHRA INJURY,ProFee,0989,53505,,,,0,3.00,2.25,2.25,704.00,0.00,704.00,704.00,N/A
53510_3,REPAIR OF URETHRA INJURY,ProFee,0989,53510,,,,0,3.00,2.25,2.25,915.50,0.00,915.50,915.50,N/A
53515_3,REPAIR OF URETHRA INJURY,ProFee,0989,53515,,,,0,3.00,2.25,2.25,1153.00,0.00,1153.00,1153.00,N/A
53520_3,REPAIR OF URETHRA DEFECT,ProFee,0989,53520,,,,0,3.00,2.25,2.25,806.50,0.00,806.50,806.50,N/A
53600_3,DILATE URETHRA STRICTURE,ProFee,0989,53600,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
53601_3,DILATE URETHRA STRICTURE,ProFee,0989,53601,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
53605_3,DILATE URETHRA STRICTURE,ProFee,0989,53605,,,,0,3.00,2.25,2.25,94.00,0.00,94.00,94.00,N/A
53620_3,DILATE URETHRA STRICTURE,ProFee,0989,53620,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
53621_3,DILATE URETHRA STRICTURE,ProFee,0989,53621,,,,0,3.00,2.25,2.25,105.00,0.00,105.00,105.00,N/A
53660_3,DILATION OF URETHRA,ProFee,0989,53660,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
53661_3,DILATION OF URETHRA,ProFee,0989,53661,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
53665_3,DILATION OF URETHRA,ProFee,0989,53665,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
53850_3,PROSTATIC MICROWAVE THERMOTX,ProFee,0989,53850,,,,0,3.00,2.25,2.25,879.50,0.00,879.50,879.50,N/A
53852_3,PROSTATIC RF THERMOTX,ProFee,0989,53852,,,,0,3.00,2.25,2.25,903.00,0.00,903.00,903.00,N/A
53853_3,PROSTATIC WATER THERMOTHER,ProFee,0989,53853,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
53854_3,TRURL DSTRJ PRST8 TISS RF WV,ProFee,0989,53854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
53855_3,INSERT PROST URETHRAL STENT,ProFee,0989,53855,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
53860_3,TRANSURETHRAL RF TREATMENT,ProFee,0989,53860,,,,0,3.00,2.25,2.25,326.00,0.00,326.00,326.00,N/A
53899_3,UROLOGY SURGERY PROCEDURE,ProFee,0989,53899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
54000_3,SLITTING OF PREPUCE,ProFee,0989,54000,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
54001_3,SLITTING OF PREPUCE,ProFee,0989,54001,,,,0,3.00,2.25,2.25,201.00,0.00,201.00,201.00,N/A
54015_3,DRAIN PENIS LESION,ProFee,0989,54015,,,,0,3.00,2.25,2.25,445.00,0.00,445.00,445.00,N/A
54050_3,"DESTRUCTION, PENIS LESION(S)",ProFee,0989,54050,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
54055_3,"DESTRUCTION, PENIS LESION(S)",ProFee,0989,54055,,,,0,3.00,2.25,2.25,134.00,0.00,134.00,134.00,N/A
54056_3,"CRYOSURGERY, PENIS LESION(S)",ProFee,0989,54056,,,,0,3.00,2.25,2.25,160.00,0.00,160.00,160.00,N/A
54057_3,"LASER SURG, PENIS LESION(S)",ProFee,0989,54057,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
54060_3,EXCISION OF PENIS LESION(S),ProFee,0989,54060,,,,0,3.00,2.25,2.25,189.00,0.00,189.00,189.00,N/A
54065_3,"DESTRUCTION, PENIS LESION(S)",ProFee,0989,54065,,,,0,3.00,2.25,2.25,248.50,0.00,248.50,248.50,N/A
54100_3,BIOPSY OF PENIS,ProFee,0989,54100,,,,0,3.00,2.25,2.25,182.00,0.00,182.00,182.00,N/A
54105_3,BIOPSY OF PENIS,ProFee,0989,54105,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
54110_3,TREATMENT OF PENIS LESION,ProFee,0989,54110,,,,0,3.00,2.25,2.25,905.00,0.00,905.00,905.00,N/A
54111_3,"TREAT PENIS LESION, GRAFT",ProFee,0989,54111,,,,0,3.00,2.25,2.25,1160.50,0.00,1160.50,1160.50,N/A
54112_3,"TREAT PENIS LESION, GRAFT",ProFee,0989,54112,,,,0,3.00,2.25,2.25,1358.50,0.00,1358.50,1358.50,N/A
54115_3,TREATMENT OF PENIS LESION,ProFee,0989,54115,,,,0,3.00,2.25,2.25,615.50,0.00,615.50,615.50,N/A
54120_3,PARTIAL REMOVAL OF PENIS,ProFee,0989,54120,,,,0,3.00,2.25,2.25,917.00,0.00,917.00,917.00,N/A
54125_3,REMOVAL OF PENIS,ProFee,0989,54125,,,,0,3.00,2.25,2.25,1178.50,0.00,1178.50,1178.50,N/A
54130_3,REMOVE PENIS & NODES,ProFee,0989,54130,,,,0,3.00,2.25,2.25,1729.50,0.00,1729.50,1729.50,N/A
54135_3,REMOVE PENIS & NODES,ProFee,0989,54135,,,,0,3.00,2.25,2.25,2192.00,0.00,2192.00,2192.00,N/A
54152_3,CIRCUMCISION,ProFee,0989,54152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
54161_3,CIRCUMCISION,ProFee,0989,54161,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
54162_3,LYSIS PENIL CIRCUMIC LESION,ProFee,0989,54162,,,,0,3.00,2.25,2.25,289.00,0.00,289.00,289.00,N/A
54163_3,REPAIR OF CIRCUMCISION,ProFee,0989,54163,,,,0,3.00,2.25,2.25,317.00,0.00,317.00,317.00,N/A
54164_3,FRENULOTOMY OF PENIS,ProFee,0989,54164,,,,0,3.00,2.25,2.25,280.50,0.00,280.50,280.50,N/A
54200_3,TREATMENT OF PENIS LESION,ProFee,0989,54200,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
54205_3,TREATMENT OF PENIS LESION,ProFee,0989,54205,,,,0,3.00,2.25,2.25,771.50,0.00,771.50,771.50,N/A
54220_3,TREATMENT OF PENIS LESION,ProFee,0989,54220,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
54230_3,PREPARE PENIS STUDY,ProFee,0989,54230,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
54231_3,DYNAMIC CAVERNOSOMETRY,ProFee,0989,54231,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
54235_3,PENILE INJECTION,ProFee,0989,54235,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
54240_3,PENIS STUDY,ProFee,0989,54240,,,,0,3.00,2.25,2.25,100.00,0.00,100.00,100.00,N/A
54250_3,PENIS STUDY,ProFee,0989,54250,,,,0,3.00,2.25,2.25,158.50,0.00,158.50,158.50,N/A
54300_3,REVISION OF PENIS,ProFee,0989,54300,,,,0,3.00,2.25,2.25,931.00,0.00,931.00,931.00,N/A
54304_3,REVISION OF PENIS,ProFee,0989,54304,,,,0,3.00,2.25,2.25,1088.00,0.00,1088.00,1088.00,N/A
54308_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54308,,,,0,3.00,2.25,2.25,1037.00,0.00,1037.00,1037.00,N/A
54312_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54312,,,,0,3.00,2.25,2.25,1186.00,0.00,1186.00,1186.00,N/A
54316_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54316,,,,0,3.00,2.25,2.25,1447.00,0.00,1447.00,1447.00,N/A
54318_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54318,,,,0,3.00,2.25,2.25,1031.00,0.00,1031.00,1031.00,N/A
54322_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54322,,,,0,3.00,2.25,2.25,1131.50,0.00,1131.50,1131.50,N/A
54324_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54324,,,,0,3.00,2.25,2.25,1403.50,0.00,1403.50,1403.50,N/A
54326_3,RECONSTRUCTION OF URETHRA,ProFee,0989,54326,,,,0,3.00,2.25,2.25,1370.50,0.00,1370.50,1370.50,N/A
54328_3,REVISE PENIS/URETHRA,ProFee,0989,54328,,,,0,3.00,2.25,2.25,1361.50,0.00,1361.50,1361.50,N/A
54332_3,REVISE PENIS/URETHRA,ProFee,0989,54332,,,,0,3.00,2.25,2.25,1470.50,0.00,1470.50,1470.50,N/A
54336_3,REVISE PENIS/URETHRA,ProFee,0989,54336,,,,0,3.00,2.25,2.25,1724.50,0.00,1724.50,1724.50,N/A
54340_3,SECONDARY URETHRAL SURGERY,ProFee,0989,54340,,,,0,3.00,2.25,2.25,826.50,0.00,826.50,826.50,N/A
54344_3,SECONDARY URETHRAL SURGERY,ProFee,0989,54344,,,,0,3.00,2.25,2.25,1373.50,0.00,1373.50,1373.50,N/A
54348_3,SECONDARY URETHRAL SURGERY,ProFee,0989,54348,,,,0,3.00,2.25,2.25,1470.50,0.00,1470.50,1470.50,N/A
54352_3,RECONSTRUCT URETHRA/PENIS,ProFee,0989,54352,,,,0,3.00,2.25,2.25,2052.50,0.00,2052.50,2052.50,N/A
54360_3,PENIS PLASTIC SURGERY,ProFee,0989,54360,,,,0,3.00,2.25,2.25,1044.50,0.00,1044.50,1044.50,N/A
54380_3,REPAIR PENIS,ProFee,0989,54380,,,,0,3.00,2.25,2.25,1158.50,0.00,1158.50,1158.50,N/A
54385_3,REPAIR PENIS,ProFee,0989,54385,,,,0,3.00,2.25,2.25,1345.00,0.00,1345.00,1345.00,N/A
54390_3,REPAIR PENIS AND BLADDER,ProFee,0989,54390,,,,0,3.00,2.25,2.25,1798.00,0.00,1798.00,1798.00,N/A
54400_3,INSERT SEMI-RIGID PROSTHESIS,ProFee,0989,54400,,,,0,3.00,2.25,2.25,767.50,0.00,767.50,767.50,N/A
54401_3,INSERT SELF-CONTD PROSTHESIS,ProFee,0989,54401,,,,0,3.00,2.25,2.25,950.50,0.00,950.50,950.50,N/A
54405_3,INSERT MULTI-COMP PENIS PROS,ProFee,0989,54405,,,,0,3.00,2.25,2.25,1171.50,0.00,1171.50,1171.50,N/A
54406_3,REMOVE MUTI-COMP PENIS PROS,ProFee,0989,54406,,,,0,3.00,2.25,2.25,1059.50,0.00,1059.50,1059.50,N/A
54408_3,REPAIR MULTI-COMP PENIS PROS,ProFee,0989,54408,,,,0,3.00,2.25,2.25,1145.00,0.00,1145.00,1145.00,N/A
54410_3,REMOVE/REPLACE PENIS PROSTH,ProFee,0989,54410,,,,0,3.00,2.25,2.25,1245.50,0.00,1245.50,1245.50,N/A
54411_3,"REMOV/REPLC PENIS PROS, COMP",ProFee,0989,54411,,,,0,3.00,2.25,2.25,1486.50,0.00,1486.50,1486.50,N/A
54415_3,REMOVE SELF-CONTD PENIS PROS,ProFee,0989,54415,,,,0,3.00,2.25,2.25,766.00,0.00,766.00,766.00,N/A
54416_3,REMV/REPL PENIS CONTAIN PROS,ProFee,0989,54416,,,,0,3.00,2.25,2.25,1029.50,0.00,1029.50,1029.50,N/A
54417_3,"REMV/REPLC PENIS PROS, COMPL",ProFee,0989,54417,,,,0,3.00,2.25,2.25,1303.00,0.00,1303.00,1303.00,N/A
54420_3,REVISION OF PENIS,ProFee,0989,54420,,,,0,3.00,2.25,2.25,1022.00,0.00,1022.00,1022.00,N/A
54430_3,REVISION OF PENIS,ProFee,0989,54430,,,,0,3.00,2.25,2.25,928.50,0.00,928.50,928.50,N/A
54435_3,REVISION OF PENIS,ProFee,0989,54435,,,,0,3.00,2.25,2.25,604.50,0.00,604.50,604.50,N/A
54437_3,REPAIR CORPOREAL TEAR,ProFee,0989,54437,,,,0,3.00,2.25,2.25,977.00,0.00,977.00,977.00,N/A
54438_3,REPLANTATION OF PENIS,ProFee,0989,54438,,,,0,3.00,2.25,2.25,1938.50,0.00,1938.50,1938.50,N/A
54440_3,REPAIR OF PENIS,ProFee,0989,54440,,,,0,3.00,2.25,2.25,812.50,0.00,812.50,812.50,N/A
54450_3,PREPUTIAL STRETCHING,ProFee,0989,54450,,,,0,3.00,2.25,2.25,84.00,0.00,84.00,84.00,N/A
54500_3,BIOPSY OF TESTIS,ProFee,0989,54500,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
54505_3,BIOPSY OF TESTIS,ProFee,0989,54505,,,,0,3.00,2.25,2.25,304.00,0.00,304.00,304.00,N/A
54512_3,EXCISE LESION TESTIS,ProFee,0989,54512,,,,0,3.00,2.25,2.25,783.50,0.00,783.50,783.50,N/A
54520_3,REMOVAL OF TESTIS,ProFee,0989,54520,,,,0,3.00,2.25,2.25,473.50,0.00,473.50,473.50,N/A
54522_3,"ORCHIECTOMY, PARTIAL",ProFee,0989,54522,,,,0,3.00,2.25,2.25,856.00,0.00,856.00,856.00,N/A
54530_3,REMOVAL OF TESTIS,ProFee,0989,54530,,,,0,3.00,2.25,2.25,732.50,0.00,732.50,732.50,N/A
54535_3,EXTENSIVE TESTIS SURGERY,ProFee,0989,54535,,,,0,3.00,2.25,2.25,1079.00,0.00,1079.00,1079.00,N/A
54550_3,EXPLORATION FOR TESTIS,ProFee,0989,54550,,,,0,3.00,2.25,2.25,713.00,0.00,713.00,713.00,N/A
54560_3,EXPLORATION FOR TESTIS,ProFee,0989,54560,,,,0,3.00,2.25,2.25,995.50,0.00,995.50,995.50,N/A
54600_3,REDUCE TESTIS TORSION,ProFee,0989,54600,,,,0,3.00,2.25,2.25,658.00,0.00,658.00,658.00,N/A
54620_3,SUSPENSION OF TESTIS,ProFee,0989,54620,,,,0,3.00,2.25,2.25,434.50,0.00,434.50,434.50,N/A
54640_3,SUSPENSION OF TESTIS,ProFee,0989,54640,,,,0,3.00,2.25,2.25,694.00,0.00,694.00,694.00,N/A
54650_3,ORCHIOPEXY (FOWLER-STEPHENS),ProFee,0989,54650,,,,0,3.00,2.25,2.25,1032.00,0.00,1032.00,1032.00,N/A
54660_3,REVISION OF TESTIS,ProFee,0989,54660,,,,0,3.00,2.25,2.25,518.00,0.00,518.00,518.00,N/A
54670_3,REPAIR TESTIS INJURY,ProFee,0989,54670,,,,0,3.00,2.25,2.25,588.00,0.00,588.00,588.00,N/A
54680_3,RELOCATION OF TESTIS(ES),ProFee,0989,54680,,,,0,3.00,2.25,2.25,1141.00,0.00,1141.00,1141.00,N/A
54690_3,"LAPAROSCOPY, ORCHIECTOMY",ProFee,0989,54690,,,,0,3.00,2.25,2.25,954.00,0.00,954.00,954.00,N/A
54692_3,"LAPAROSCOPY, ORCHIOPEXY",ProFee,0989,54692,,,,0,3.00,2.25,2.25,1100.50,0.00,1100.50,1100.50,N/A
54699_3,"LAPAROSCOPE PROC, TESTIS",ProFee,0989,54699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
54700_3,DRAINAGE OF SCROTUM,ProFee,0989,54700,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
54800_3,BIOPSY OF EPIDIDYMIS,ProFee,0989,54800,,,,0,3.00,2.25,2.25,183.00,0.00,183.00,183.00,N/A
54820_3,EXPLORATION OF EPIDIDYMIS,ProFee,0989,54820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
54830_3,REMOVE EPIDIDYMIS LESION,ProFee,0989,54830,,,,0,3.00,2.25,2.25,540.50,0.00,540.50,540.50,N/A
54840_3,REMOVE EPIDIDYMIS LESION,ProFee,0989,54840,,,,0,3.00,2.25,2.25,466.00,0.00,466.00,466.00,N/A
54860_3,REMOVAL OF EPIDIDYMIS,ProFee,0989,54860,,,,0,3.00,2.25,2.25,608.00,0.00,608.00,608.00,N/A
54861_3,REMOVAL OF EPIDIDYMIS,ProFee,0989,54861,,,,0,3.00,2.25,2.25,821.00,0.00,821.00,821.00,N/A
54865_3,EXPLORE EPIDIDYMIS,ProFee,0989,54865,,,,0,3.00,2.25,2.25,520.50,0.00,520.50,520.50,N/A
54900_3,FUSION OF SPERMATIC DUCTS,ProFee,0989,54900,,,,0,3.00,2.25,2.25,1160.50,0.00,1160.50,1160.50,N/A
54901_3,FUSION OF SPERMATIC DUCTS,ProFee,0989,54901,,,,0,3.00,2.25,2.25,1531.00,0.00,1531.00,1531.00,N/A
55040_3,REMOVAL OF HYDROCELE,ProFee,0989,55040,,,,0,3.00,2.25,2.25,490.00,0.00,490.00,490.00,N/A
55041_3,REMOVAL OF HYDROCELES,ProFee,0989,55041,,,,0,3.00,2.25,2.25,739.00,0.00,739.00,739.00,N/A
55060_3,REPAIR OF HYDROCELE,ProFee,0989,55060,,,,0,3.00,2.25,2.25,552.00,0.00,552.00,552.00,N/A
55100_3,DRAINAGE OF SCROTUM ABSCESS,ProFee,0989,55100,,,,0,3.00,2.25,2.25,240.50,0.00,240.50,240.50,N/A
55110_3,EXPLORE SCROTUM,ProFee,0989,55110,,,,0,3.00,2.25,2.25,562.00,0.00,562.00,562.00,N/A
55120_3,REMOVAL OF SCROTUM LESION,ProFee,0989,55120,,,,0,3.00,2.25,2.25,513.00,0.00,513.00,513.00,N/A
55150_3,REMOVAL OF SCROTUM,ProFee,0989,55150,,,,0,3.00,2.25,2.25,712.00,0.00,712.00,712.00,N/A
55175_3,REVISION OF SCROTUM,ProFee,0989,55175,,,,0,3.00,2.25,2.25,526.50,0.00,526.50,526.50,N/A
55180_3,REVISION OF SCROTUM,ProFee,0989,55180,,,,0,3.00,2.25,2.25,993.00,0.00,993.00,993.00,N/A
55200_3,INCISION OF SPERM DUCT,ProFee,0989,55200,,,,0,3.00,2.25,2.25,404.00,0.00,404.00,404.00,N/A
55300_3,"PREPARE, SPERM DUCT X-RAY",ProFee,0989,55300,,,,0,3.00,2.25,2.25,271.50,0.00,271.50,271.50,N/A
55400_3,REPAIR OF SPERM DUCT,ProFee,0989,55400,,,,0,3.00,2.25,2.25,722.50,0.00,722.50,722.50,N/A
55450_3,LIGATION OF SPERM DUCT,ProFee,0989,55250,,,,0,3.00,2.25,2.25,329.50,0.00,329.50,329.50,N/A
55500_3,REMOVAL OF HYDROCELE,ProFee,0989,55500,,,,0,3.00,2.25,2.25,572.50,0.00,572.50,572.50,N/A
55520_3,REMOVAL OF SPERM CORD LESION,ProFee,0989,55520,,,,0,3.00,2.25,2.25,654.50,0.00,654.50,654.50,N/A
55530_3,REVISE SPERMATIC CORD VEINS,ProFee,0989,55530,,,,0,3.00,2.25,2.25,510.00,0.00,510.00,510.00,N/A
55535_3,REVISE SPERMATIC CORD VEINS,ProFee,0989,55535,,,,0,3.00,2.25,2.25,624.00,0.00,624.00,624.00,N/A
55540_3,REVISE HERNIA & SPERM VEINS,ProFee,0989,55540,,,,0,3.00,2.25,2.25,798.50,0.00,798.50,798.50,N/A
55550_3,LAPARO LIGATE SPERMATIC VEIN,ProFee,0989,55550,,,,0,3.00,2.25,2.25,621.50,0.00,621.50,621.50,N/A
55559_3,"LAPARO PROC, SPERMATIC CORD",ProFee,0989,55559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
55600_3,INCISE SPERM DUCT POUCH,ProFee,0989,55600,,,,0,3.00,2.25,2.25,611.50,0.00,611.50,611.50,N/A
55605_3,INCISE SPERM DUCT POUCH,ProFee,0989,55605,,,,0,3.00,2.25,2.25,755.50,0.00,755.50,755.50,N/A
55650_3,REMOVE SPERM DUCT POUCH,ProFee,0989,55650,,,,0,3.00,2.25,2.25,1040.00,0.00,1040.00,1040.00,N/A
55680_3,REMOVE SPERM POUCH LESION,ProFee,0989,55680,,,,0,3.00,2.25,2.25,502.00,0.00,502.00,502.00,N/A
55700_3,BIOPSY OF PROSTATE,ProFee,0989,55700,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
55705_3,BIOPSY OF PROSTATE,ProFee,0989,55705,,,,0,3.00,2.25,2.25,385.50,0.00,385.50,385.50,N/A
55706_3,PROSTATE SATURATION SAMPLING,ProFee,0989,55706,,,,0,3.00,2.25,2.25,539.50,0.00,539.50,539.50,N/A
55720_3,DRAINAGE OF PROSTATE ABSCESS,ProFee,0989,55720,,,,0,3.00,2.25,2.25,656.00,0.00,656.00,656.00,N/A
55725_3,DRAINAGE OF PROSTATE ABSCESS,ProFee,0989,55725,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
55801_3,REMOVAL OF PROSTATE,ProFee,0989,55801,,,,0,3.00,2.25,2.25,1585.50,0.00,1585.50,1585.50,N/A
55810_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55810,,,,0,3.00,2.25,2.25,1900.50,0.00,1900.50,1900.50,N/A
55812_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55812,,,,0,3.00,2.25,2.25,2333.00,0.00,2333.00,2333.00,N/A
55815_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55815,,,,0,3.00,2.25,2.25,2556.00,0.00,2556.00,2556.00,N/A
55821_3,REMOVAL OF PROSTATE,ProFee,0989,55821,,,,0,3.00,2.25,2.25,1266.00,0.00,1266.00,1266.00,N/A
55831_3,REMOVAL OF PROSTATE,ProFee,0989,55831,,,,0,3.00,2.25,2.25,1369.50,0.00,1369.50,1369.50,N/A
55840_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55840,,,,0,3.00,2.25,2.25,1699.00,0.00,1699.00,1699.00,N/A
55842_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55842,,,,0,3.00,2.25,2.25,1699.50,0.00,1699.50,1699.50,N/A
55845_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55845,,,,0,3.00,2.25,2.25,1977.00,0.00,1977.00,1977.00,N/A
55859_3,"PERCUT/NEEDLE INSERT, PROS",ProFee,0989,55859,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
55860_3,"SURGICAL EXPOSURE, PROSTATE",ProFee,0989,55860,,,,0,3.00,2.25,2.25,1268.50,0.00,1268.50,1268.50,N/A
55862_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55862,,,,0,3.00,2.25,2.25,1590.00,0.00,1590.00,1590.00,N/A
55865_3,EXTENSIVE PROSTATE SURGERY,ProFee,0989,55865,,,,0,3.00,2.25,2.25,1934.00,0.00,1934.00,1934.00,N/A
55866_3,LAPARO RADICAL PROSTATECTOMY,ProFee,0989,55866,,,,0,3.00,2.25,2.25,2093.50,0.00,2093.50,2093.50,N/A
55870_3,ELECTROEJACULATION,ProFee,0989,55870,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
55873_3,CRYOABLATE PROSTATE,ProFee,0989,55873,,,,0,3.00,2.25,2.25,1107.50,0.00,1107.50,1107.50,N/A
55874_3,TPRNL PLMT BIODEGRDABL MATRL,ProFee,0989,55874,,,,0,3.00,2.25,2.25,240.50,0.00,240.50,240.50,N/A
55875_3,"TRANSPERI NEEDLE PLACE, PROS",ProFee,0989,55875,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
55876_3,"PLACE RT DEVICE/MARKER, PROS",ProFee,0989,55876,,,,0,3.00,2.25,2.25,146.00,0.00,146.00,146.00,N/A
55899_3,GENITAL SURGERY PROCEDURE,ProFee,0989,55899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
55920_3,PLACE NEEDLES PELVIC FOR RT,ProFee,0989,55920,,,,0,3.00,2.25,2.25,648.50,0.00,648.50,648.50,N/A
55970_3,"SEX TRANSFORMATION, M TO F",ProFee,0989,55970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
55980_3,"SEX TRANSFORMATION, F TO M",ProFee,0989,55980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
56405_3,I & D OF VULVA/PERINEUM,ProFee,0989,56405,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
56420_3,DRAINAGE OF GLAND ABSCESS,ProFee,0989,56420,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
56440_3,SURGERY FOR VULVA LESION,ProFee,0989,56440,,,,0,3.00,2.25,2.25,258.00,0.00,258.00,258.00,N/A
56442_3,HYMENOTOMY,ProFee,0989,56442,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
56501_3,"DESTROY, VULVA LESIONS, SIM",ProFee,0989,56501,,,,0,3.00,2.25,2.25,163.50,0.00,163.50,163.50,N/A
56515_3,DESTROY VULVA LESION/S COMPL,ProFee,0989,56515,,,,0,3.00,2.25,2.25,286.50,0.00,286.50,286.50,N/A
56605_3,BIOPSY OF VULVA/PERINEUM,ProFee,0989,56605,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
56606_3,BIOPSY OF VULVA/PERINEUM,ProFee,0989,56606,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
56620_3,PARTIAL REMOVAL OF VULVA,ProFee,0989,56620,,,,0,3.00,2.25,2.25,748.00,0.00,748.00,748.00,N/A
56625_3,COMPLETE REMOVAL OF VULVA,ProFee,0989,56625,,,,0,3.00,2.25,2.25,906.00,0.00,906.00,906.00,N/A
56630_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56630,,,,0,3.00,2.25,2.25,1340.00,0.00,1340.00,1340.00,N/A
56631_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56631,,,,0,3.00,2.25,2.25,1712.00,0.00,1712.00,1712.00,N/A
56632_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56632,,,,0,3.00,2.25,2.25,1992.50,0.00,1992.50,1992.50,N/A
56633_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56633,,,,0,3.00,2.25,2.25,1746.50,0.00,1746.50,1746.50,N/A
56634_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56634,,,,0,3.00,2.25,2.25,1893.00,0.00,1893.00,1893.00,N/A
56637_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56637,,,,0,3.00,2.25,2.25,2215.00,0.00,2215.00,2215.00,N/A
56640_3,EXTENSIVE VULVA SURGERY,ProFee,0989,56640,,,,0,3.00,2.25,2.25,2216.00,0.00,2216.00,2216.00,N/A
56700_3,PARTIAL REMOVAL OF HYMEN,ProFee,0989,56700,,,,0,3.00,2.25,2.25,263.50,0.00,263.50,263.50,N/A
56720_3,INCISION OF HYMEN,ProFee,0989,56720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
56740_3,REMOVE VAGINA GLAND LESION,ProFee,0989,56740,,,,0,3.00,2.25,2.25,426.50,0.00,426.50,426.50,N/A
56800_3,REPAIR OF VAGINA,ProFee,0989,56800,,,,0,3.00,2.25,2.25,341.00,0.00,341.00,341.00,N/A
56805_3,REPAIR CLITORIS,ProFee,0989,56805,,,,0,3.00,2.25,2.25,1610.50,0.00,1610.50,1610.50,N/A
56810_3,REPAIR OF PERINEUM,ProFee,0989,56810,,,,0,3.00,2.25,2.25,368.50,0.00,368.50,368.50,N/A
56820_3,EXAM OF VULVA W/SCOPE,ProFee,0989,56820,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
56821_3,EXAM/BIOPSY OF VULVA W/SCOPE,ProFee,0989,56821,,,,0,3.00,2.25,2.25,164.50,0.00,164.50,164.50,N/A
57000_3,EXPLORATION OF VAGINA,ProFee,0989,57000,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
57010_3,DRAINAGE OF PELVIC ABSCESS,ProFee,0989,57010,,,,0,3.00,2.25,2.25,611.00,0.00,611.00,611.00,N/A
57020_3,DRAINAGE OF PELVIC FLUID,ProFee,0989,57020,,,,0,3.00,2.25,2.25,115.00,0.00,115.00,115.00,N/A
57022_3,"I & D VAGINAL HEMATOMA, PP",ProFee,0989,57022,,,,0,3.00,2.25,2.25,236.50,0.00,236.50,236.50,N/A
57023_3,"I & D VAG HEMATOMA, NON-OB",ProFee,0989,57023,,,,0,3.00,2.25,2.25,437.00,0.00,437.00,437.00,N/A
57061_3,"DESTROY VAG LESIONS, SIMPLE",ProFee,0989,57061,,,,0,3.00,2.25,2.25,139.50,0.00,139.50,139.50,N/A
57065_3,"DESTROY VAG LESIONS, COMPLEX",ProFee,0989,57065,,,,0,3.00,2.25,2.25,248.00,0.00,248.00,248.00,N/A
57100_3,BIOPSY OF VAGINA,ProFee,0989,57100,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
57105_3,BIOPSY OF VAGINA,ProFee,0989,57105,,,,0,3.00,2.25,2.25,180.50,0.00,180.50,180.50,N/A
57106_3,"REMOVE VAGINA WALL, PARTIAL",ProFee,0989,57106,,,,0,3.00,2.25,2.25,706.00,0.00,706.00,706.00,N/A
57107_3,"REMOVE VAGINA TISSUE, PART",ProFee,0989,57107,,,,0,3.00,2.25,2.25,2073.00,0.00,2073.00,2073.00,N/A
57109_3,VAGINECTOMY PARTIAL W/NODES,ProFee,0989,57109,,,,0,3.00,2.25,2.25,2534.00,0.00,2534.00,2534.00,N/A
57110_3,"REMOVE VAGINA WALL, COMPLETE",ProFee,0989,57110,,,,0,3.00,2.25,2.25,1261.50,0.00,1261.50,1261.50,N/A
57111_3,"REMOVE VAGINA TISSUE, COMPL",ProFee,0989,57111,,,,0,3.00,2.25,2.25,2534.00,0.00,2534.00,2534.00,N/A
57112_3,"VAGINECTOMY W/NODES, COMPL",ProFee,0989,57112,,,,0,3.00,2.25,2.25,2713.50,0.00,2713.50,2713.50,N/A
57120_3,CLOSURE OF VAGINA,ProFee,0989,57120,,,,0,3.00,2.25,2.25,719.00,0.00,719.00,719.00,N/A
57130_3,REMOVE VAGINA LESION,ProFee,0989,57130,,,,0,3.00,2.25,2.25,224.50,0.00,224.50,224.50,N/A
57135_3,REMOVE VAGINA LESION,ProFee,0989,57135,,,,0,3.00,2.25,2.25,246.00,0.00,246.00,246.00,N/A
57150_3,TREAT VAGINA INFECTION,ProFee,0989,57150,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
57155_3,INSERT UTERI TANDEMS/OVOIDS,ProFee,0989,57155,,,,0,3.00,2.25,2.25,402.00,0.00,402.00,402.00,N/A
57156_3,INS VAG BRACHYTX DEVICE,ProFee,0989,57156,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
57170_3,FITTING OF DIAPHRAGM/CAP,ProFee,0989,57170,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
57180_3,TREAT VAGINAL BLEEDING,ProFee,0989,57180,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
57200_3,REPAIR OF VAGINA,ProFee,0989,57200,,,,0,3.00,2.25,2.25,429.50,0.00,429.50,429.50,N/A
57210_3,REPAIR VAGINA/PERINEUM,ProFee,0989,57210,,,,0,3.00,2.25,2.25,521.00,0.00,521.00,521.00,N/A
57220_3,REVISION OF URETHRA,ProFee,0989,57220,,,,0,3.00,2.25,2.25,451.00,0.00,451.00,451.00,N/A
57230_3,REPAIR OF URETHRAL LESION,ProFee,0989,57230,,,,0,3.00,2.25,2.25,556.00,0.00,556.00,556.00,N/A
57240_3,REPAIR BLADDER & VAGINA,ProFee,0989,57240,,,,0,3.00,2.25,2.25,838.50,0.00,838.50,838.50,N/A
57250_3,REPAIR RECTUM & VAGINA,ProFee,0989,57250,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
57260_3,REPAIR OF VAGINA,ProFee,0989,57260,,,,0,3.00,2.25,2.25,1079.00,0.00,1079.00,1079.00,N/A
57265_3,EXTENSIVE REPAIR OF VAGINA,ProFee,0989,57265,,,,0,3.00,2.25,2.25,1212.00,0.00,1212.00,1212.00,N/A
57267_3,INSERT MESH/PELVIC FLR ADDON,ProFee,0989,57267,,,,0,3.00,2.25,2.25,364.50,0.00,364.50,364.50,N/A
57268_3,REPAIR OF BOWEL BULGE,ProFee,0989,57268,,,,0,3.00,2.25,2.25,685.50,0.00,685.50,685.50,N/A
57270_3,REPAIR OF BOWEL POUCH,ProFee,0989,57270,,,,0,3.00,2.25,2.25,1141.00,0.00,1141.00,1141.00,N/A
57280_3,SUSPENSION OF VAGINA,ProFee,0989,57280,,,,0,3.00,2.25,2.25,1353.00,0.00,1353.00,1353.00,N/A
57282_3,"COLPOPEXY, EXTRAPERITONEAL",ProFee,0989,57282,,,,0,3.00,2.25,2.25,709.50,0.00,709.50,709.50,N/A
57283_3,"COLPOPEXY, INTRAPERITONEAL",ProFee,0989,57283,,,,0,3.00,2.25,2.25,973.00,0.00,973.00,973.00,N/A
57284_3,REPAIR PARAVAGINAL DEFECT,ProFee,0989,57284,,,,0,3.00,2.25,2.25,1157.00,0.00,1157.00,1157.00,N/A
57285_3,"REPAIR PARAVAG DEFECT, VAG",ProFee,0989,57285,,,,0,3.00,2.25,2.25,954.00,0.00,954.00,954.00,N/A
57287_3,REVISE/REMOVE SLING REPAIR,ProFee,0989,57287,,,,0,3.00,2.25,2.25,971.50,0.00,971.50,971.50,N/A
57288_3,REPAIR BLADDER DEFECT,ProFee,0989,57288,,,,0,3.00,2.25,2.25,1020.00,0.00,1020.00,1020.00,N/A
57289_3,REPAIR BLADDER & VAGINA,ProFee,0989,57289,,,,0,3.00,2.25,2.25,1073.00,0.00,1073.00,1073.00,N/A
57291_3,CONSTRUCTION OF VAGINA,ProFee,0989,57291,,,,0,3.00,2.25,2.25,745.50,0.00,745.50,745.50,N/A
57292_3,CONSTRUCT VAGINA WITH GRAFT,ProFee,0989,57292,,,,0,3.00,2.25,2.25,1149.00,0.00,1149.00,1149.00,N/A
57295_3,CHANGE VAGINAL GRAFT,ProFee,0989,57295,,,,0,3.00,2.25,2.25,677.50,0.00,677.50,677.50,N/A
57296_3,"REVISE VAG GRAFT, OPEN ABD",ProFee,0989,57296,,,,0,3.00,2.25,2.25,1332.50,0.00,1332.50,1332.50,N/A
57300_3,REPAIR RECTUM-VAGINA FISTULA,ProFee,0989,57300,,,,0,3.00,2.25,2.25,803.50,0.00,803.50,803.50,N/A
57305_3,REPAIR RECTUM-VAGINA FISTULA,ProFee,0989,57305,,,,0,3.00,2.25,2.25,1339.00,0.00,1339.00,1339.00,N/A
57307_3,FISTULA REPAIR & COLOSTOMY,ProFee,0989,57307,,,,0,3.00,2.25,2.25,1468.50,0.00,1468.50,1468.50,N/A
57308_3,"FISTULA REPAIR, TRANSPERINE",ProFee,0989,57308,,,,0,3.00,2.25,2.25,949.50,0.00,949.50,949.50,N/A
57310_3,REPAIR URETHROVAGINAL LESION,ProFee,0989,57310,,,,0,3.00,2.25,2.25,668.00,0.00,668.00,668.00,N/A
57311_3,REPAIR URETHROVAGINAL LESION,ProFee,0989,57311,,,,0,3.00,2.25,2.25,759.50,0.00,759.50,759.50,N/A
57320_3,REPAIR BLADDER-VAGINA LESION,ProFee,0989,57320,,,,0,3.00,2.25,2.25,763.00,0.00,763.00,763.00,N/A
57330_3,REPAIR BLADDER-VAGINA LESION,ProFee,0989,57330,,,,0,3.00,2.25,2.25,1071.50,0.00,1071.50,1071.50,N/A
57335_3,REPAIR VAGINA,ProFee,0989,57335,,,,0,3.00,2.25,2.25,1626.50,0.00,1626.50,1626.50,N/A
57400_3,DILATION OF VAGINA,ProFee,0989,57400,,,,0,3.00,2.25,2.25,189.00,0.00,189.00,189.00,N/A
57410_3,PELVIC EXAMINATION,ProFee,0989,57410,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
57415_3,REMOVE VAGINAL FOREIGN BODY,ProFee,0989,57415,,,,0,3.00,2.25,2.25,228.00,0.00,228.00,228.00,N/A
57420_3,EXAM OF VAGINA W/SCOPE,ProFee,0989,57420,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
57421_3,EXAM/BIOPSY OF VAG W/SCOPE,ProFee,0989,57421,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
57423_3,"REPAIR PARAVAG DEFECT, LAP",ProFee,0989,57423,,,,0,3.00,2.25,2.25,1292.50,0.00,1292.50,1292.50,N/A
57425_3,"LAPAROSCOPY, SURG, COLPOPEXY",ProFee,0989,57425,,,,0,3.00,2.25,2.25,1375.00,0.00,1375.00,1375.00,N/A
57426_3,REVISE PROSTH VAG GRAFT LAP,ProFee,0989,57426,,,,0,3.00,2.25,2.25,1188.50,0.00,1188.50,1188.50,N/A
57455_3,BIOPSY OF CERVIX W/SCOPE,ProFee,0989,57455,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
57456_3,ENDOCERV CURETTAGE W/SCOPE,ProFee,0989,57456,,,,0,3.00,2.25,2.25,146.00,0.00,146.00,146.00,N/A
57460_3,"BX OF CERVIX W/SCOPE, LEEP",ProFee,0989,57460,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
57461_3,"CONZ OF CERVIX W/SCOPE, LEEP",ProFee,0989,57461,,,,0,3.00,2.25,2.25,266.00,0.00,266.00,266.00,N/A
57500_3,BIOPSY OF CERVIX,ProFee,0989,57500,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
57505_3,ENDOCERVICAL CURETTAGE,ProFee,0989,57505,,,,0,3.00,2.25,2.25,131.00,0.00,131.00,131.00,N/A
57510_3,CAUTERIZATION OF CERVIX,ProFee,0989,57510,,,,0,3.00,2.25,2.25,163.50,0.00,163.50,163.50,N/A
57511_2,CRYOCAUTERY OF CERVIX,Ambulatory Surgical,0521,57511,,,,0,383.00,287.25,287.25,363.85,344.70,363.85,0.00,344.70
57511_2,CRYOCAUTERY OF CERVIX,Inpatient,0521,57511,,,,0,383.00,287.25,287.25,363.85,344.70,363.85,363.85,344.70
57511_3,CRYOCAUTERY OF CERVIX,Ambulatory Surgical,0521,57511,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,0.00,337.50
57511_3,CRYOCAUTERY OF CERVIX,Inpatient,0521,57511,,,,0,375.00,281.25,281.25,356.25,337.50,356.25,356.25,337.50
57513_3,LASER SURGERY OF CERVIX,ProFee,0989,57513,,,,0,3.00,2.25,2.25,191.50,0.00,191.50,191.50,N/A
57520_3,CONIZATION OF CERVIX,ProFee,0989,57520,,,,0,3.00,2.25,2.25,392.00,0.00,392.00,392.00,N/A
57522_3,CONIZATION OF CERVIX,ProFee,0989,57522,,,,0,3.00,2.25,2.25,345.00,0.00,345.00,345.00,N/A
57530_3,REMOVAL OF CERVIX,ProFee,0989,57530,,,,0,3.00,2.25,2.25,491.00,0.00,491.00,491.00,N/A
57531_3,"REMOVAL OF CERVIX, RADICAL",ProFee,0989,57531,,,,0,3.00,2.25,2.25,2381.00,0.00,2381.00,2381.00,N/A
57540_3,REMOVAL OF RESIDUAL CERVIX,ProFee,0989,57540,,,,0,3.00,2.25,2.25,1095.50,0.00,1095.50,1095.50,N/A
57545_3,REMOVE CERVIX/REPAIR PELVIS,ProFee,0989,57545,,,,0,3.00,2.25,2.25,1156.00,0.00,1156.00,1156.00,N/A
57550_3,REMOVAL OF RESIDUAL CERVIX,ProFee,0989,57550,,,,0,3.00,2.25,2.25,573.50,0.00,573.50,573.50,N/A
57555_3,REMOVE CERVIX/REPAIR VAGINA,ProFee,0989,57555,,,,0,3.00,2.25,2.25,845.50,0.00,845.50,845.50,N/A
57556_3,"REMOVE CERVIX, REPAIR BOWEL",ProFee,0989,57556,,,,0,3.00,2.25,2.25,800.00,0.00,800.00,800.00,N/A
57558_3,D&C OF CERVICAL STUMP,ProFee,0989,57558,,,,0,3.00,2.25,2.25,160.00,0.00,160.00,160.00,N/A
57700_3,REVISION OF CERVIX,ProFee,0989,57700,,,,0,3.00,2.25,2.25,437.50,0.00,437.50,437.50,N/A
57720_3,REVISION OF CERVIX,ProFee,0989,57720,,,,0,3.00,2.25,2.25,432.50,0.00,432.50,432.50,N/A
57800_3,DILATION OF CERVICAL CANAL,ProFee,0989,57800,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
57820_3,D & C OF RESIDUAL CERVIX,ProFee,0989,57820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
58100_2,BIOPSY OF UTERUS LINING,Ambulatory Surgical,0521,58100,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,256.50
58100_2,BIOPSY OF UTERUS LINING,Inpatient,0521,58100,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
58100_3,BIOPSY OF UTERUS LINING,Ambulatory Surgical,0521,58100,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,252.00
58100_3,BIOPSY OF UTERUS LINING,Inpatient,0521,58100,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
58110_3,BX DONE W/COLPOSCOPY ADD-ON,ProFee,0989,58110,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
58120_3,DILATION AND CURETTAGE,ProFee,0989,58120,,,,0,3.00,2.25,2.25,311.00,0.00,311.00,311.00,N/A
58140_3,MYOMECTOMY ABDOM METHOD,ProFee,0989,58140,,,,0,3.00,2.25,2.25,1298.50,0.00,1298.50,1298.50,N/A
58145_3,MYOMECTOMY VAG METHOD,ProFee,0989,58145,,,,0,3.00,2.25,2.25,779.00,0.00,779.00,779.00,N/A
58146_3,MYOMECTOMY ABDOM COMPLEX,ProFee,0989,58146,,,,0,3.00,2.25,2.25,1621.00,0.00,1621.00,1621.00,N/A
58150_3,TOTAL HYSTERECTOMY,ProFee,0989,58150,,,,0,3.00,2.25,2.25,1447.50,0.00,1447.50,1447.50,N/A
58152_3,TOTAL HYSTERECTOMY,ProFee,0989,58152,,,,0,3.00,2.25,2.25,1770.00,0.00,1770.00,1770.00,N/A
58180_3,PARTIAL HYSTERECTOMY,ProFee,0989,58180,,,,0,3.00,2.25,2.25,1365.50,0.00,1365.50,1365.50,N/A
58200_3,EXTENSIVE HYSTERECTOMY,ProFee,0989,58200,,,,0,3.00,2.25,2.25,1977.00,0.00,1977.00,1977.00,N/A
58210_3,EXTENSIVE HYSTERECTOMY,ProFee,0989,58210,,,,0,3.00,2.25,2.25,2663.00,0.00,2663.00,2663.00,N/A
58240_3,REMOVAL OF PELVIS CONTENTS,ProFee,0989,58240,,,,0,3.00,2.25,2.25,4189.50,0.00,4189.50,4189.50,N/A
58260_3,VAGINAL HYSTERECTOMY,ProFee,0989,58260,,,,0,3.00,2.25,2.25,1165.50,0.00,1165.50,1165.50,N/A
58262_3,VAG HYST INCLUDING T/O,ProFee,0989,58262,,,,0,3.00,2.25,2.25,1298.50,0.00,1298.50,1298.50,N/A
58263_3,VAG HYST W/T/O & VAG REPAIR,ProFee,0989,58263,,,,0,3.00,2.25,2.25,1395.00,0.00,1395.00,1395.00,N/A
58267_3,VAG HYST W/URINARY REPAIR,ProFee,0989,58267,,,,0,3.00,2.25,2.25,1482.00,0.00,1482.00,1482.00,N/A
58270_3,VAG HYST W/ENTEROCELE REPAIR,ProFee,0989,58270,,,,0,3.00,2.25,2.25,1244.50,0.00,1244.50,1244.50,N/A
58275_3,HYSTERECTOMY/REVISE VAGINA,ProFee,0989,58275,,,,0,3.00,2.25,2.25,1390.00,0.00,1390.00,1390.00,N/A
58280_3,HYSTERECTOMY/REVISE VAGINA,ProFee,0989,58280,,,,0,3.00,2.25,2.25,1478.00,0.00,1478.00,1478.00,N/A
58285_3,EXTENSIVE HYSTERECTOMY,ProFee,0989,58285,,,,0,3.00,2.25,2.25,2070.50,0.00,2070.50,2070.50,N/A
58290_3,VAG HYST COMPLEX,ProFee,0989,58290,,,,0,3.00,2.25,2.25,1619.00,0.00,1619.00,1619.00,N/A
58291_3,"VAG HYST INCL T/O, COMPLEX",ProFee,0989,58291,,,,0,3.00,2.25,2.25,1757.00,0.00,1757.00,1757.00,N/A
58292_3,"VAG HYST T/O & REPAIR, COMPL",ProFee,0989,58292,,,,0,3.00,2.25,2.25,1846.50,0.00,1846.50,1846.50,N/A
58293_3,"VAG HYST W/URO REPAIR, COMPL",ProFee,0989,58293,,,,0,3.00,2.25,2.25,1920.00,0.00,1920.00,1920.00,N/A
58294_3,"VAG HYST W/ENTEROCELE, COMPL",ProFee,0989,58294,,,,0,3.00,2.25,2.25,1711.00,0.00,1711.00,1711.00,N/A
58300_3,INSERT INTRAUTERINE DEVICE,ProFee,0989,58300,,,,0,3.00,2.25,2.25,77.00,0.00,77.00,77.00,N/A
58301_2,REMOVE INTRAUTERINE DEVICE,Inpatient,0521,58301,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
58301_2,REMOVE INTRAUTERINE DEVICE,Outpatient,0521,58301,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,0.00,147.60
58301_3,REMOVE INTRAUTERINE DEVICE,Outpatient,0521,58301,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,0.00,146.70
58301_3,REMOVE INTRAUTERINE DEVICE,Inpatient,0521,58301,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
58321_3,ARTIFICIAL INSEMINATION,ProFee,0989,58321,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
58322_3,ARTIFICIAL INSEMINATION,ProFee,0989,58322,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
58323_3,SPERM WASHING,ProFee,0989,58323,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
58340_3,CATHETER FOR HYSTEROGRAPHY,ProFee,0989,58340,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
58345_3,REOPEN FALLOPIAN TUBE,ProFee,0989,58345,,,,0,3.00,2.25,2.25,392.00,0.00,392.00,392.00,N/A
58346_3,INSERT HEYMAN UTERI CAPSULE,ProFee,0989,58346,,,,0,3.00,2.25,2.25,645.00,0.00,645.00,645.00,N/A
58350_3,REOPEN FALLOPIAN TUBE,ProFee,0989,58350,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
58353_3,"ENDOMETR ABLATE, THERMAL",ProFee,0989,58353,,,,0,3.00,2.25,2.25,308.50,0.00,308.50,308.50,N/A
58356_3,ENDOMETRIAL CRYOABLATION,ProFee,0989,58356,,,,0,3.00,2.25,2.25,486.50,0.00,486.50,486.50,N/A
58400_3,SUSPENSION OF UTERUS,ProFee,0989,58400,,,,0,3.00,2.25,2.25,624.50,0.00,624.50,624.50,N/A
58410_3,SUSPENSION OF UTERUS,ProFee,0989,58410,,,,0,3.00,2.25,2.25,1130.50,0.00,1130.50,1130.50,N/A
58520_3,REPAIR OF RUPTURED UTERUS,ProFee,0989,58520,,,,0,3.00,2.25,2.25,1106.50,0.00,1106.50,1106.50,N/A
58540_3,REVISION OF UTERUS,ProFee,0989,58540,,,,0,3.00,2.25,2.25,1276.50,0.00,1276.50,1276.50,N/A
58541_3,"LSH, UTERUS 250 G OR LESS",ProFee,0989,58541,,,,0,3.00,2.25,2.25,1012.00,0.00,1012.00,1012.00,N/A
58542_3,LSH W/T/O UT 250 G OR LESS,ProFee,0989,58542,,,,0,3.00,2.25,2.25,1154.50,0.00,1154.50,1154.50,N/A
58543_3,LSH UTERUS ABOVE 250 G,ProFee,0989,58543,,,,0,3.00,2.25,2.25,1168.50,0.00,1168.50,1168.50,N/A
58544_3,LSH W/T/O UTERUS ABOVE 250 G,ProFee,0989,58544,,,,0,3.00,2.25,2.25,1271.50,0.00,1271.50,1271.50,N/A
58545_3,LAPAROSCOPIC MYOMECTOMY,ProFee,0989,58545,,,,0,3.00,2.25,2.25,1278.50,0.00,1278.50,1278.50,N/A
58546_3,"LAPARO-MYOMECTOMY, COMPLEX",ProFee,0989,58546,,,,0,3.00,2.25,2.25,1581.50,0.00,1581.50,1581.50,N/A
58548_3,LAP RADICAL HYST,ProFee,0989,58548,,,,0,3.00,2.25,2.25,2736.50,0.00,2736.50,2736.50,N/A
58550_3,LAPARO-ASST VAG HYSTERECTOMY,ProFee,0989,58550,,,,0,3.00,2.25,2.25,1244.50,0.00,1244.50,1244.50,N/A
58552_3,LAPARO-VAG HYST INCL T/O,ProFee,0989,58552,,,,0,3.00,2.25,2.25,1400.00,0.00,1400.00,1400.00,N/A
58553_3,"LAPARO-VAG HYST, COMPLEX",ProFee,0989,58553,,,,0,3.00,2.25,2.25,1590.50,0.00,1590.50,1590.50,N/A
58554_3,"LAPARO-VAG HYST W/T/O, COMPL",ProFee,0989,58554,,,,0,3.00,2.25,2.25,1881.00,0.00,1881.00,1881.00,N/A
58555_3,"HYSTEROSCOPY, DX, SEP PROC",ProFee,0989,58555,,,,0,3.00,2.25,2.25,218.50,0.00,218.50,218.50,N/A
58558_3,"HYSTEROSCOPY, BIOPSY",ProFee,0989,58558,,,,0,3.00,2.25,2.25,333.50,0.00,333.50,333.50,N/A
58559_3,"HYSTEROSCOPY, LYSIS",ProFee,0989,58559,,,,0,3.00,2.25,2.25,413.00,0.00,413.00,413.00,N/A
58560_3,"HYSTEROSCOPY, RESECT SEPTUM",ProFee,0989,58560,,,,0,3.00,2.25,2.25,450.00,0.00,450.00,450.00,N/A
58561_3,"HYSTEROSCOPY, REMOVE MYOMA",ProFee,0989,58561,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
58562_3,"HYSTEROSCOPY, REMOVE FB",ProFee,0989,58562,,,,0,3.00,2.25,2.25,320.00,0.00,320.00,320.00,N/A
58563_3,"HYSTEROSCOPY, ABLATION",ProFee,0989,58563,,,,0,3.00,2.25,2.25,354.50,0.00,354.50,354.50,N/A
58565_3,"HYSTEROSCOPY, STERILIZATION",ProFee,0989,58565,,,,0,3.00,2.25,2.25,609.50,0.00,609.50,609.50,N/A
58570_3,"TLH, UTERUS 250 G OR LESS",ProFee,0989,58570,,,,0,3.00,2.25,2.25,1106.50,0.00,1106.50,1106.50,N/A
58571_3,TLH W/T/O 250 G OR LESS,ProFee,0989,58571,,,,0,3.00,2.25,2.25,1278.00,0.00,1278.00,1278.00,N/A
58572_3,"TLH, UTERUS OVER 250 G",ProFee,0989,58572,,,,0,3.00,2.25,2.25,1455.50,0.00,1455.50,1455.50,N/A
58573_3,TLH W/T/O UTERUS OVER 250 G,ProFee,0989,58573,,,,0,3.00,2.25,2.25,1735.00,0.00,1735.00,1735.00,N/A
58575_3,LAPS TOT HYST RESJ MAL,ProFee,0989,58575,,,,0,3.00,2.25,2.25,2681.00,0.00,2681.00,2681.00,N/A
58578_3,"LAPARO PROC, UTERUS",ProFee,0989,58578,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
58579_3,HYSTEROSCOPE PROCEDURE,ProFee,0989,58579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
58600_3,DIVISION OF FALLOPIAN TUBE,ProFee,0989,58600,,,,0,3.00,2.25,2.25,512.50,0.00,512.50,512.50,N/A
58605_3,DIVISION OF FALLOPIAN TUBE,ProFee,0989,58605,,,,0,3.00,2.25,2.25,463.50,0.00,463.50,463.50,N/A
58611_3,LIGATE OVIDUCT(S) ADD-ON,ProFee,0989,58611,,,,0,3.00,2.25,2.25,109.00,0.00,109.00,109.00,N/A
58615_3,OCCLUDE FALLOPIAN TUBE(S),ProFee,0989,58615,,,,0,3.00,2.25,2.25,343.00,0.00,343.00,343.00,N/A
58660_3,"LAPAROSCOPY, LYSIS",ProFee,0989,58660,,,,0,3.00,2.25,2.25,954.50,0.00,954.50,954.50,N/A
58661_3,"LAPAROSCOPY, REMOVE ADNEXA",ProFee,0989,58661,,,,0,3.00,2.25,2.25,922.50,0.00,922.50,922.50,N/A
58662_3,"LAPAROSCOPY, EXCISE LESIONS",ProFee,0989,58662,,,,0,3.00,2.25,2.25,1007.50,0.00,1007.50,1007.50,N/A
58670_3,"LAPAROSCOPY, TUBAL CAUTERY",ProFee,0989,58670,,,,0,3.00,2.25,2.25,514.00,0.00,514.00,514.00,N/A
58671_3,"LAPAROSCOPY, TUBAL BLOCK",ProFee,0989,58671,,,,0,3.00,2.25,2.25,513.00,0.00,513.00,513.00,N/A
58672_3,"LAPAROSCOPY, FIMBRIOPLASTY",ProFee,0989,58672,,,,0,3.00,2.25,2.25,1033.50,0.00,1033.50,1033.50,N/A
58673_3,"LAPAROSCOPY, SALPINGOSTOMY",ProFee,0989,58673,,,,0,3.00,2.25,2.25,1123.50,0.00,1123.50,1123.50,N/A
58674_3,LAPS ABLTJ UTERINE FIBROIDS,ProFee,0989,58674,,,,0,3.00,2.25,2.25,1148.50,0.00,1148.50,1148.50,N/A
58679_3,"LAPARO PROC, OVIDUCT-OVARY",ProFee,0989,58679,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
58700_3,REMOVAL OF FALLOPIAN TUBE,ProFee,0989,58700,,,,0,3.00,2.25,2.25,1106.50,0.00,1106.50,1106.50,N/A
58720_3,REMOVAL OF OVARY/TUBE(S),ProFee,0989,58720,,,,0,3.00,2.25,2.25,1050.50,0.00,1050.50,1050.50,N/A
58740_3,REVISE FALLOPIAN TUBE(S),ProFee,0989,58740,,,,0,3.00,2.25,2.25,1262.00,0.00,1262.00,1262.00,N/A
58750_3,REPAIR OVIDUCT,ProFee,0989,58750,,,,0,3.00,2.25,2.25,1266.50,0.00,1266.50,1266.50,N/A
58752_3,REVISE OVARIAN TUBE(S),ProFee,0989,58752,,,,0,3.00,2.25,2.25,1263.00,0.00,1263.00,1263.00,N/A
58760_3,REMOVE TUBAL OBSTRUCTION,ProFee,0989,58760,,,,0,3.00,2.25,2.25,1138.00,0.00,1138.00,1138.00,N/A
58770_3,CREATE NEW TUBAL OPENING,ProFee,0989,58770,,,,0,3.00,2.25,2.25,1198.00,0.00,1198.00,1198.00,N/A
58800_3,DRAINAGE OF OVARIAN CYST(S),ProFee,0989,58800,,,,0,3.00,2.25,2.25,420.50,0.00,420.50,420.50,N/A
58805_3,DRAINAGE OF OVARIAN CYST(S),ProFee,0989,58805,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
58820_3,"DRAIN OVARY ABSCESS, OPEN",ProFee,0989,58820,,,,0,3.00,2.25,2.25,439.00,0.00,439.00,439.00,N/A
58822_3,"DRAIN OVARY ABSCESS, PERCUT",ProFee,0989,58822,,,,0,3.00,2.25,2.25,984.00,0.00,984.00,984.00,N/A
58823_3,"DRAIN PELVIC ABSCESS, PERCUT",ProFee,0989,58823,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
58825_3,"TRANSPOSITION, OVARY(S)",ProFee,0989,58825,,,,0,3.00,2.25,2.25,977.00,0.00,977.00,977.00,N/A
58900_3,BIOPSY OF OVARY(S),ProFee,0989,58900,,,,0,3.00,2.25,2.25,582.00,0.00,582.00,582.00,N/A
58920_3,PARTIAL REMOVAL OF OVARY(S),ProFee,0989,58920,,,,0,3.00,2.25,2.25,984.50,0.00,984.50,984.50,N/A
58925_3,REMOVAL OF OVARIAN CYST(S),ProFee,0989,58925,,,,0,3.00,2.25,2.25,1061.00,0.00,1061.00,1061.00,N/A
58940_3,REMOVAL OF OVARY(S),ProFee,0989,58940,,,,0,3.00,2.25,2.25,751.50,0.00,751.50,751.50,N/A
58943_3,REMOVAL OF OVARY(S),ProFee,0989,58943,,,,0,3.00,2.25,2.25,1690.00,0.00,1690.00,1690.00,N/A
58950_3,RESECT OVARIAN MALIGNANCY,ProFee,0989,58950,,,,0,3.00,2.25,2.25,1630.00,0.00,1630.00,1630.00,N/A
58951_3,RESECT OVARIAN MALIGNANCY,ProFee,0989,58951,,,,0,3.00,2.25,2.25,2096.50,0.00,2096.50,2096.50,N/A
58952_3,RESECT OVARIAN MALIGNANCY,ProFee,0989,58952,,,,0,3.00,2.25,2.25,2368.50,0.00,2368.50,2368.50,N/A
58953_3,"TAH, RAD DISSECT FOR DEBULK",ProFee,0989,58953,,,,0,3.00,2.25,2.25,2936.00,0.00,2936.00,2936.00,N/A
58954_3,TAH RAD DEBULK/LYMPH REMOVE,ProFee,0989,58954,,,,0,3.00,2.25,2.25,3193.00,0.00,3193.00,3193.00,N/A
58956_3,"BSO, OMENTECTOMY W/TAH",ProFee,0989,58956,,,,0,3.00,2.25,2.25,1992.00,0.00,1992.00,1992.00,N/A
58957_3,RESECT RECURRENT GYN MAL,ProFee,0989,58957,,,,0,3.00,2.25,2.25,2290.00,0.00,2290.00,2290.00,N/A
58958_3,RESECT RECUR GYN MAL W/LYM,ProFee,0989,58958,,,,0,3.00,2.25,2.25,2390.00,0.00,2390.00,2390.00,N/A
58960_3,EXPLORATION OF ABDOMEN,ProFee,0989,58960,,,,0,3.00,2.25,2.25,1402.00,0.00,1402.00,1402.00,N/A
58970_3,RETRIEVAL OF OOCYTE,ProFee,0989,58970,,,,0,3.00,2.25,2.25,282.50,0.00,282.50,282.50,N/A
58974_3,TRANSFER OF EMBRYO,ProFee,0989,58974,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
58976_3,TRANSFER OF EMBRYO,ProFee,0989,58976,,,,0,3.00,2.25,2.25,305.50,0.00,305.50,305.50,N/A
58999_3,GENITAL SURGERY PROCEDURE,ProFee,0989,58999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
59000_3,"AMNIOCENTESIS, DIAGNOSTIC",ProFee,0989,59000,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
59001_3,"AMNIOCENTESIS, THERAPEUTIC",ProFee,0989,59001,,,,0,3.00,2.25,2.25,259.00,0.00,259.00,259.00,N/A
59012_3,"FETAL CORD PUNCTURE,PRENATAL",ProFee,0989,59012,,,,0,3.00,2.25,2.25,292.00,0.00,292.00,292.00,N/A
59015_3,CHORION BIOPSY,ProFee,0989,59015,,,,0,3.00,2.25,2.25,190.50,0.00,190.50,190.50,N/A
59020_3,FETAL CONTRACT STRESS TEST,ProFee,0989,59020,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
59025_3,FETAL NON-STRESS TEST,ProFee,0989,59025,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
59030_3,FETAL SCALP BLOOD SAMPLE,ProFee,0989,59030,,,,0,3.00,2.25,2.25,163.00,0.00,163.00,163.00,N/A
59050_3,FETAL MONITOR W/REPORT,ProFee,0989,59050,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
59051_3,FETAL MONITOR/INTERPRET ONLY,ProFee,0989,59051,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
59070_3,TRANSABDOM AMNIOINFUS W/US,ProFee,0989,59070,,,,0,3.00,2.25,2.25,448.00,0.00,448.00,448.00,N/A
59072_3,UMBILICAL CORD OCCLUD W/US,ProFee,0989,59072,,,,0,3.00,2.25,2.25,756.00,0.00,756.00,756.00,N/A
59074_3,FETAL FLUID DRAINAGE W/US,ProFee,0989,59074,,,,0,3.00,2.25,2.25,448.00,0.00,448.00,448.00,N/A
59076_3,"FETAL SHUNT PLACEMENT, W/US",ProFee,0989,59076,,,,0,3.00,2.25,2.25,756.00,0.00,756.00,756.00,N/A
59100_3,REMOVE UTERUS LESION,ProFee,0989,59100,,,,0,3.00,2.25,2.25,1199.00,0.00,1199.00,1199.00,N/A
59120_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59120,,,,0,3.00,2.25,2.25,1141.50,0.00,1141.50,1141.50,N/A
59121_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59121,,,,0,3.00,2.25,2.25,1143.00,0.00,1143.00,1143.00,N/A
59130_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59130,,,,0,3.00,2.25,2.25,1335.00,0.00,1335.00,1335.00,N/A
59135_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59135,,,,0,3.00,2.25,2.25,1319.00,0.00,1319.00,1319.00,N/A
59136_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59136,,,,0,3.00,2.25,2.25,1263.50,0.00,1263.50,1263.50,N/A
59140_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59140,,,,0,3.00,2.25,2.25,575.50,0.00,575.50,575.50,N/A
59150_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59150,,,,0,3.00,2.25,2.25,1107.00,0.00,1107.00,1107.00,N/A
59151_3,TREAT ECTOPIC PREGNANCY,ProFee,0989,59151,,,,0,3.00,2.25,2.25,1073.50,0.00,1073.50,1073.50,N/A
59160_3,D & C AFTER DELIVERY,ProFee,0989,59160,,,,0,3.00,2.25,2.25,249.50,0.00,249.50,249.50,N/A
59200_3,INSERT CERVICAL DILATOR,ProFee,0989,59200,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
59300_3,EPISIOTOMY OR VAGINAL REPAIR,ProFee,0989,59300,,,,0,3.00,2.25,2.25,214.50,0.00,214.50,214.50,N/A
59320_3,REVISION OF CERVIX,ProFee,0989,59320,,,,0,3.00,2.25,2.25,220.00,0.00,220.00,220.00,N/A
59325_3,REVISION OF CERVIX,ProFee,0989,59325,,,,0,3.00,2.25,2.25,350.00,0.00,350.00,350.00,N/A
59350_3,REPAIR OF UTERUS,ProFee,0989,59350,,,,0,3.00,2.25,2.25,406.00,0.00,406.00,406.00,N/A
59400_3,OBSTETRICAL CARE,ProFee,0989,59400,,,,0,3.00,2.25,2.25,2996.00,0.00,2996.00,2996.00,N/A
59409_3,OBSTETRICAL CARE,ProFee,0989,59409,,,,0,3.00,2.25,2.25,1172.00,0.00,1172.00,1172.00,N/A
59410_3,OBSTETRICAL CARE,ProFee,0989,59410,,,,0,3.00,2.25,2.25,1497.00,0.00,1497.00,1497.00,N/A
59412_3,ANTEPARTUM MANIPULATION,ProFee,0989,59412,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
59414_3,DELIVER PLACENTA,ProFee,0989,59414,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
59425_3,ANTEPARTUM CARE ONLY,ProFee,0989,59425,,,,0,3.00,2.25,2.25,513.00,0.00,513.00,513.00,N/A
59426_3,ANTEPARTUM CARE ONLY,ProFee,0989,59426,,,,0,3.00,2.25,2.25,901.50,0.00,901.50,901.50,N/A
59430_3,CARE AFTER DELIVERY,ProFee,0989,59430,,,,0,3.00,2.25,2.25,199.00,0.00,199.00,199.00,N/A
59510_3,CESAREAN DELIVERY,ProFee,0989,59510,,,,0,3.00,2.25,2.25,3323.00,0.00,3323.00,3323.00,N/A
59514_3,CESAREAN DELIVERY ONLY,ProFee,0989,59514,,,,0,3.00,2.25,2.25,1319.50,0.00,1319.50,1319.50,N/A
59515_3,CESAREAN DELIVERY,ProFee,0989,59515,,,,0,3.00,2.25,2.25,1818.50,0.00,1818.50,1818.50,N/A
59525_3,REMOVE UTERUS AFTER CESAREAN,ProFee,0989,59525,,,,0,3.00,2.25,2.25,700.50,0.00,700.50,700.50,N/A
59610_3,VBAC DELIVERY,ProFee,0989,59610,,,,0,3.00,2.25,2.25,3154.00,0.00,3154.00,3154.00,N/A
59612_3,VBAC DELIVERY ONLY,ProFee,0989,59612,,,,0,3.00,2.25,2.25,1320.50,0.00,1320.50,1320.50,N/A
59614_3,VBAC CARE AFTER DELIVERY,ProFee,0989,59614,,,,0,3.00,2.25,2.25,1642.00,0.00,1642.00,1642.00,N/A
59618_3,ATTEMPTED VBAC DELIVERY,ProFee,0989,59618,,,,0,3.00,2.25,2.25,3366.00,0.00,3366.00,3366.00,N/A
59620_3,ATTEMPTED VBAC DELIVERY ONLY,ProFee,0989,59620,,,,0,3.00,2.25,2.25,1367.50,0.00,1367.50,1367.50,N/A
59622_3,ATTEMPTED VBAC AFTER CARE,ProFee,0989,59622,,,,0,3.00,2.25,2.25,1864.50,0.00,1864.50,1864.50,N/A
59812_3,TREATMENT OF MISCARRIAGE,ProFee,0989,59812,,,,0,3.00,2.25,2.25,424.50,0.00,424.50,424.50,N/A
59820_3,CARE OF MISCARRIAGE,ProFee,0989,59820,,,,0,3.00,2.25,2.25,511.00,0.00,511.00,511.00,N/A
59821_3,TREATMENT OF MISCARRIAGE,ProFee,0989,59821,,,,0,3.00,2.25,2.25,513.00,0.00,513.00,513.00,N/A
59830_3,TREAT UTERUS INFECTION,ProFee,0989,59830,,,,0,3.00,2.25,2.25,626.50,0.00,626.50,626.50,N/A
59840_3,ABORTION,ProFee,0989,59840,,,,0,3.00,2.25,2.25,298.50,0.00,298.50,298.50,N/A
59841_3,ABORTION,ProFee,0989,59841,,,,0,3.00,2.25,2.25,517.50,0.00,517.50,517.50,N/A
59850_3,ABORTION,ProFee,0989,59850,,,,0,3.00,2.25,2.25,545.50,0.00,545.50,545.50,N/A
59851_3,ABORTION,ProFee,0989,59851,,,,0,3.00,2.25,2.25,572.00,0.00,572.00,572.00,N/A
59852_3,ABORTION,ProFee,0989,59852,,,,0,3.00,2.25,2.25,727.50,0.00,727.50,727.50,N/A
59855_3,ABORTION,ProFee,0989,59855,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
59856_3,ABORTION,ProFee,0989,59856,,,,0,3.00,2.25,2.25,701.00,0.00,701.00,701.00,N/A
59857_3,ABORTION,ProFee,0989,59857,,,,0,3.00,2.25,2.25,746.50,0.00,746.50,746.50,N/A
59866_3,ABORTION (MPR),ProFee,0989,59866,,,,0,3.00,2.25,2.25,312.50,0.00,312.50,312.50,N/A
59870_3,EVACUATE MOLE OF UTERUS,ProFee,0989,59870,,,,0,3.00,2.25,2.25,677.00,0.00,677.00,677.00,N/A
59871_3,REMOVE CERCLAGE SUTURE,ProFee,0989,59871,,,,0,3.00,2.25,2.25,192.50,0.00,192.50,192.50,N/A
59897_3,FETAL INVAS PX W/US,ProFee,0989,59897,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
59898_3,"LAPARO PROC, OB CARE/DELIVER",ProFee,0989,59898,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
59899_3,MATERNITY CARE PROCEDURE,ProFee,0989,59899,,,,0,3.00,2.25,2.25,706.50,0.00,706.50,706.50,N/A
60000_3,DRAIN THYROID/TONGUE CYST,ProFee,0989,60000,,,,0,3.00,2.25,2.25,216.00,0.00,216.00,216.00,N/A
60001_3,ASPIRATE/INJECT THYRIOD CYST,ProFee,0989,60001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
6005F_3,CARE LEVEL RATIONALE DOC,ProFee,0989,6005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
60100_3,BIOPSY OF THYROID,ProFee,0989,60100,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
6010F_3,DYSPHAG TEST DONE B/4 EATING,ProFee,0989,6010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6015F_3,DYSPHAG TEST DONE B/4 EATING,ProFee,0989,6015F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
60200_3,REMOVE THYROID LESION,ProFee,0989,60200,,,,0,3.00,2.25,2.25,943.50,0.00,943.50,943.50,N/A
6020F_3,NPO (NOTHING-MOUTH) ORDERED,ProFee,0989,6020F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
60210_3,PARTIAL THYROID EXCISION,ProFee,0989,60210,,,,0,3.00,2.25,2.25,1013.00,0.00,1013.00,1013.00,N/A
60212_3,PARTIAL THYROID EXCISION,ProFee,0989,60212,,,,0,3.00,2.25,2.25,1485.50,0.00,1485.50,1485.50,N/A
60220_3,PARTIAL REMOVAL OF THYROID,ProFee,0989,60220,,,,0,3.00,2.25,2.25,1009.00,0.00,1009.00,1009.00,N/A
60225_3,PARTIAL REMOVAL OF THYROID,ProFee,0989,60225,,,,0,3.00,2.25,2.25,1332.00,0.00,1332.00,1332.00,N/A
60240_3,REMOVAL OF THYROID,ProFee,0989,60240,,,,0,3.00,2.25,2.25,1316.50,0.00,1316.50,1316.50,N/A
60252_3,REMOVAL OF THYROID,ProFee,0989,60252,,,,0,3.00,2.25,2.25,1892.50,0.00,1892.50,1892.50,N/A
60254_3,EXTENSIVE THYROID SURGERY,ProFee,0989,60254,,,,0,3.00,2.25,2.25,2387.50,0.00,2387.50,2387.50,N/A
60260_3,REPEAT THYROID SURGERY,ProFee,0989,60260,,,,0,3.00,2.25,2.25,1564.50,0.00,1564.50,1564.50,N/A
60270_3,REMOVAL OF THYROID,ProFee,0989,60270,,,,0,3.00,2.25,2.25,1963.00,0.00,1963.00,1963.00,N/A
60271_3,REMOVAL OF THYROID,ProFee,0989,60271,,,,0,3.00,2.25,2.25,1513.50,0.00,1513.50,1513.50,N/A
60280_3,REMOVE THYROID DUCT LESION,ProFee,0989,60280,,,,0,3.00,2.25,2.25,627.00,0.00,627.00,627.00,N/A
60281_3,REMOVE THYROID DUCT LESION,ProFee,0989,60281,,,,0,3.00,2.25,2.25,831.50,0.00,831.50,831.50,N/A
60300_3,ASPIR/INJ THYROID CYST,ProFee,0989,60300,,,,0,3.00,2.25,2.25,72.00,0.00,72.00,72.00,N/A
6030F_3,MAX STERILE BARRIERS FOLLW'D,ProFee,0989,6030F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6040F_3,APPRO RAD DS DVCS TECHS DOCD,ProFee,0989,6040F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6045F_3,RADXPS IN END RPRT4FLURO PXD,ProFee,0989,6045F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
60500_3,EXPLORE PARATHYROID GLANDS,ProFee,0989,60500,,,,0,3.00,2.25,2.25,1386.50,0.00,1386.50,1386.50,N/A
60502_3,RE-EXPLORE PARATHYROIDS,ProFee,0989,60502,,,,0,3.00,2.25,2.25,1852.50,0.00,1852.50,1852.50,N/A
60505_3,EXPLORE PARATHYROID GLANDS,ProFee,0989,60505,,,,0,3.00,2.25,2.25,1988.00,0.00,1988.00,1988.00,N/A
60512_3,AUTOTRANSPLANT PARATHYROID,ProFee,0989,60512,,,,0,3.00,2.25,2.25,350.50,0.00,350.50,350.50,N/A
60520_3,REMOVAL OF THYMUS GLAND,ProFee,0989,60520,,,,0,3.00,2.25,2.25,1510.00,0.00,1510.00,1510.00,N/A
60521_3,REMOVAL OF THYMUS GLAND,ProFee,0989,60521,,,,0,3.00,2.25,2.25,1617.00,0.00,1617.00,1617.00,N/A
60522_3,REMOVAL OF THYMUS GLAND,ProFee,0989,60522,,,,0,3.00,2.25,2.25,1970.00,0.00,1970.00,1970.00,N/A
60540_3,EXPLORE ADRENAL GLAND,ProFee,0989,60540,,,,0,3.00,2.25,2.25,1534.50,0.00,1534.50,1534.50,N/A
60545_3,EXPLORE ADRENAL GLAND,ProFee,0989,60545,,,,0,3.00,2.25,2.25,1757.00,0.00,1757.00,1757.00,N/A
60600_3,REMOVE CAROTID BODY LESION,ProFee,0989,60600,,,,0,3.00,2.25,2.25,1992.00,0.00,1992.00,1992.00,N/A
60605_3,REMOVE CAROTID BODY LESION,ProFee,0989,60605,,,,0,3.00,2.25,2.25,2414.00,0.00,2414.00,2414.00,N/A
60650_3,LAPAROSCOPY ADRENALECTOMY,ProFee,0989,60650,,,,0,3.00,2.25,2.25,1724.50,0.00,1724.50,1724.50,N/A
60659_3,"LAPARO PROC, ENDOCRINE",ProFee,0989,60659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
60699_3,ENDOCRINE SURGERY PROCEDURE,ProFee,0989,60699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6070F_3,PT ASKED/CNSLD AED EFFECTS,ProFee,0989,6070F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6080F_3,PT/CAREGIVER QUERIED FALLS,ProFee,0989,6080F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6090F_3,PT/CAREGIVER COUNSEL SAFETY,ProFee,0989,6090F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
61000_3,REMOVE CRANIAL CAVITY FLUID,ProFee,0989,61000,,,,0,3.00,2.25,2.25,167.00,0.00,167.00,167.00,N/A
61001_3,REMOVE CRANIAL CAVITY FLUID,ProFee,0989,61001,,,,0,3.00,2.25,2.25,158.50,0.00,158.50,158.50,N/A
6100F_3,VERIFY PT SITE PXD DOCD,ProFee,0989,6100F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
6101F_3,SAFETY COUNSELING DEMENTIA,ProFee,0989,6101F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
61020_3,REMOVE BRAIN CAVITY FLUID,ProFee,0989,61020,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
61026_3,INJECTION INTO BRAIN CANAL,ProFee,0989,61026,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
6102F_3,SAFETY COUNSELING DEM ORDER,ProFee,0989,6102F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
61050_3,REMOVE BRAIN CANAL FLUID,ProFee,0989,61050,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
61055_3,INJECTION INTO BRAIN CANAL,ProFee,0989,61055,,,,0,3.00,2.25,2.25,179.00,0.00,179.00,179.00,N/A
61070_3,BRAIN CANAL SHUNT PROCEDURE,ProFee,0989,61070,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
61105_3,TWIST DRILL HOLE,ProFee,0989,61105,,,,0,3.00,2.25,2.25,677.50,0.00,677.50,677.50,N/A
61107_3,DRILL SKULL FOR IMPLANTATION,ProFee,0989,61107,,,,0,3.00,2.25,2.25,460.50,0.00,460.50,460.50,N/A
61108_3,DRILL SKULL FOR DRAINAGE,ProFee,0989,61108,,,,0,3.00,2.25,2.25,1308.00,0.00,1308.00,1308.00,N/A
6110F_3,COUNSEL PROV DRIVING RISKS,ProFee,0989,6110F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
61120_3,BURR HOLE FOR PUNCTURE,ProFee,0989,61120,,,,0,3.00,2.25,2.25,1093.50,0.00,1093.50,1093.50,N/A
61140_3,PIERCE SKULL FOR BIOPSY,ProFee,0989,61140,,,,0,3.00,2.25,2.25,1844.50,0.00,1844.50,1844.50,N/A
61150_3,PIERCE SKULL FOR DRAINAGE,ProFee,0989,61150,,,,0,3.00,2.25,2.25,1988.00,0.00,1988.00,1988.00,N/A
61151_3,PIERCE SKULL FOR DRAINAGE,ProFee,0989,61151,,,,0,3.00,2.25,2.25,1457.50,0.00,1457.50,1457.50,N/A
61154_3,PIERCE SKULL & REMOVE CLOT,ProFee,0989,61154,,,,0,3.00,2.25,2.25,1854.50,0.00,1854.50,1854.50,N/A
61156_3,PIERCE SKULL FOR DRAINAGE,ProFee,0989,61156,,,,0,3.00,2.25,2.25,1828.50,0.00,1828.50,1828.50,N/A
61210_3,"PIERCE SKULL, IMPLANT DEVICE",ProFee,0989,61210,,,,0,3.00,2.25,2.25,543.00,0.00,543.00,543.00,N/A
61215_3,INSERT BRAIN-FLUID DEVICE,ProFee,0989,61215,,,,0,3.00,2.25,2.25,739.50,0.00,739.50,739.50,N/A
61250_3,PIERCE SKULL & EXPLORE,ProFee,0989,61250,,,,0,3.00,2.25,2.25,1270.50,0.00,1270.50,1270.50,N/A
61253_3,PIERCE SKULL & EXPLORE,ProFee,0989,61253,,,,0,3.00,2.25,2.25,1457.50,0.00,1457.50,1457.50,N/A
61304_3,OPEN SKULL FOR EXPLORATION,ProFee,0989,61304,,,,0,3.00,2.25,2.25,2391.00,0.00,2391.00,2391.00,N/A
61305_3,OPEN SKULL FOR EXPLORATION,ProFee,0989,61305,,,,0,3.00,2.25,2.25,2948.00,0.00,2948.00,2948.00,N/A
61312_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61312,,,,0,3.00,2.25,2.25,3037.00,0.00,3037.00,3037.00,N/A
61313_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61313,,,,0,3.00,2.25,2.25,2895.00,0.00,2895.00,2895.00,N/A
61314_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61314,,,,0,3.00,2.25,2.25,2671.50,0.00,2671.50,2671.50,N/A
61315_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61315,,,,0,3.00,2.25,2.25,3019.50,0.00,3019.50,3019.50,N/A
61316_3,IMPLT CRAN BONE FLAP TO ABDO,ProFee,0989,61316,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
61320_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61320,,,,0,3.00,2.25,2.25,2777.00,0.00,2777.00,2777.00,N/A
61321_3,OPEN SKULL FOR DRAINAGE,ProFee,0989,61321,,,,0,3.00,2.25,2.25,3124.00,0.00,3124.00,3124.00,N/A
61322_3,DECOMPRESSIVE CRANIOTOMY,ProFee,0989,61322,,,,0,3.00,2.25,2.25,3468.00,0.00,3468.00,3468.00,N/A
61323_3,DECOMPRESSIVE LOBECTOMY,ProFee,0989,61323,,,,0,3.00,2.25,2.25,3510.00,0.00,3510.00,3510.00,N/A
61330_3,DECOMPRESS EYE SOCKET,ProFee,0989,61330,,,,0,3.00,2.25,2.25,2634.00,0.00,2634.00,2634.00,N/A
61332_3,EXPLORE/BIOPSY EYE SOCKET,ProFee,0989,61332,,,,0,3.00,2.25,2.25,2912.50,0.00,2912.50,2912.50,N/A
61333_3,EXPLORE ORBIT/REMOVE LESION,ProFee,0989,61333,,,,0,3.00,2.25,2.25,2976.00,0.00,2976.00,2976.00,N/A
61334_3,EXPLORE ORBIT/REMOVE OBJECT,ProFee,0989,61334,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61340_3,SUBTEMPORAL DECOMPRESSION,ProFee,0989,61340,,,,0,3.00,2.25,2.25,2121.00,0.00,2121.00,2121.00,N/A
61343_3,INCISE SKULL (PRESS RELIEF),ProFee,0989,61343,,,,0,3.00,2.25,2.25,3205.00,0.00,3205.00,3205.00,N/A
61345_3,RELIEVE CRANIAL PRESSURE,ProFee,0989,61345,,,,0,3.00,2.25,2.25,2993.50,0.00,2993.50,2993.50,N/A
61440_3,INCISE SKULL FOR SURGERY,ProFee,0989,61440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61450_3,INCISE SKULL FOR SURGERY,ProFee,0989,61450,,,,0,3.00,2.25,2.25,2822.50,0.00,2822.50,2822.50,N/A
61458_3,INCISE SKULL FOR BRAIN WOUND,ProFee,0989,61458,,,,0,3.00,2.25,2.25,2935.50,0.00,2935.50,2935.50,N/A
61460_3,INCISE SKULL FOR SURGERY,ProFee,0989,61460,,,,0,3.00,2.25,2.25,3087.50,0.00,3087.50,3087.50,N/A
61470_3,INCISE SKULL FOR SURGERY,ProFee,0989,61470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61480_3,INCISE SKULL FOR SURGERY,ProFee,0989,61480,,,,0,3.00,2.25,2.25,2848.50,0.00,2848.50,2848.50,N/A
61490_3,INCISE SKULL FOR SURGERY,ProFee,0989,61490,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61500_3,REMOVAL OF SKULL LESION,ProFee,0989,61500,,,,0,3.00,2.25,2.25,1914.00,0.00,1914.00,1914.00,N/A
61501_3,REMOVE INFECTED SKULL BONE,ProFee,0989,61501,,,,0,3.00,2.25,2.25,1650.50,0.00,1650.50,1650.50,N/A
6150F_3,PT NOTRCVNG1ST ANTITNF TXMNT,ProFee,0989,6150F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
61510_3,REMOVAL OF BRAIN LESION,ProFee,0989,61510,,,,0,3.00,2.25,2.25,3188.50,0.00,3188.50,3188.50,N/A
61512_3,REMOVE BRAIN LINING LESION,ProFee,0989,61512,,,,0,3.00,2.25,2.25,3718.50,0.00,3718.50,3718.50,N/A
61514_3,REMOVAL OF BRAIN ABSCESS,ProFee,0989,61514,,,,0,3.00,2.25,2.25,2775.00,0.00,2775.00,2775.00,N/A
61516_3,REMOVAL OF BRAIN LESION,ProFee,0989,61516,,,,0,3.00,2.25,2.25,2721.00,0.00,2721.00,2721.00,N/A
61517_3,IMPLT BRAIN CHEMOTX ADD-ON,ProFee,0989,61517,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
61518_3,REMOVAL OF BRAIN LESION,ProFee,0989,61518,,,,0,3.00,2.25,2.25,4018.00,0.00,4018.00,4018.00,N/A
61519_3,REMOVE BRAIN LINING LESION,ProFee,0989,61519,,,,0,3.00,2.25,2.25,4284.00,0.00,4284.00,4284.00,N/A
61520_3,REMOVAL OF BRAIN LESION,ProFee,0989,61520,,,,0,3.00,2.25,2.25,5442.00,0.00,5442.00,5442.00,N/A
61521_3,REMOVAL OF BRAIN LESION,ProFee,0989,61521,,,,0,3.00,2.25,2.25,4659.50,0.00,4659.50,4659.50,N/A
61522_3,REMOVAL OF BRAIN ABSCESS,ProFee,0989,61522,,,,0,3.00,2.25,2.25,3208.50,0.00,3208.50,3208.50,N/A
61524_3,REMOVAL OF BRAIN LESION,ProFee,0989,61524,,,,0,3.00,2.25,2.25,3054.50,0.00,3054.50,3054.50,N/A
61526_3,REMOVAL OF BRAIN LESION,ProFee,0989,61526,,,,0,3.00,2.25,2.25,5180.00,0.00,5180.00,5180.00,N/A
61530_3,REMOVAL OF BRAIN LESION,ProFee,0989,61530,,,,0,3.00,2.25,2.25,4504.50,0.00,4504.50,4504.50,N/A
61531_3,IMPLANT BRAIN ELECTRODES,ProFee,0989,61531,,,,0,3.00,2.25,2.25,1790.50,0.00,1790.50,1790.50,N/A
61533_3,IMPLANT BRAIN ELECTRODES,ProFee,0989,61533,,,,0,3.00,2.25,2.25,2227.50,0.00,2227.50,2227.50,N/A
61534_3,REMOVAL OF BRAIN LESION,ProFee,0989,61534,,,,0,3.00,2.25,2.25,2413.00,0.00,2413.00,2413.00,N/A
61535_3,REMOVE BRAIN ELECTRODES,ProFee,0989,61535,,,,0,3.00,2.25,2.25,1465.50,0.00,1465.50,1465.50,N/A
61536_3,REMOVAL OF BRAIN LESION,ProFee,0989,61536,,,,0,3.00,2.25,2.25,3781.50,0.00,3781.50,3781.50,N/A
61537_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61537,,,,0,3.00,2.25,2.25,3602.00,0.00,3602.00,3602.00,N/A
61538_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61538,,,,0,3.00,2.25,2.25,3913.50,0.00,3913.50,3913.50,N/A
61539_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61539,,,,0,3.00,2.25,2.25,3462.50,0.00,3462.50,3462.50,N/A
61540_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61540,,,,0,3.00,2.25,2.25,3202.00,0.00,3202.00,3202.00,N/A
61541_3,INCISION OF BRAIN TISSUE,ProFee,0989,61541,,,,0,3.00,2.25,2.25,3152.00,0.00,3152.00,3152.00,N/A
61542_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61542,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61543_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61543,,,,0,3.00,2.25,2.25,3186.50,0.00,3186.50,3186.50,N/A
61544_3,REMOVE & TREAT BRAIN LESION,ProFee,0989,61544,,,,0,3.00,2.25,2.25,2792.00,0.00,2792.00,2792.00,N/A
61545_3,EXCISION OF BRAIN TUMOR,ProFee,0989,61545,,,,0,3.00,2.25,2.25,4657.50,0.00,4657.50,4657.50,N/A
61546_3,REMOVAL OF PITUITARY GLAND,ProFee,0989,61546,,,,0,3.00,2.25,2.25,3384.50,0.00,3384.50,3384.50,N/A
61548_3,REMOVAL OF PITUITARY GLAND,ProFee,0989,61548,,,,0,3.00,2.25,2.25,2290.00,0.00,2290.00,2290.00,N/A
61550_3,RELEASE OF SKULL SEAMS,ProFee,0989,61550,,,,0,3.00,2.25,2.25,1736.00,0.00,1736.00,1736.00,N/A
61552_3,RELEASE OF SKULL SEAMS,ProFee,0989,61552,,,,0,3.00,2.25,2.25,2170.00,0.00,2170.00,2170.00,N/A
61556_3,INCISE SKULL/SUTURES,ProFee,0989,61556,,,,0,3.00,2.25,2.25,2499.50,0.00,2499.50,2499.50,N/A
61557_3,INCISE SKULL/SUTURES,ProFee,0989,61557,,,,0,3.00,2.25,2.25,2464.00,0.00,2464.00,2464.00,N/A
61558_3,EXCISION OF SKULL/SUTURES,ProFee,0989,61558,,,,0,3.00,2.25,2.25,2754.50,0.00,2754.50,2754.50,N/A
61559_3,EXCISION OF SKULL/SUTURES,ProFee,0989,61559,,,,0,3.00,2.25,2.25,3505.00,0.00,3505.00,3505.00,N/A
61563_3,EXCISION OF SKULL TUMOR,ProFee,0989,61563,,,,0,3.00,2.25,2.25,2905.00,0.00,2905.00,2905.00,N/A
61564_3,EXCISION OF SKULL TUMOR,ProFee,0989,61564,,,,0,3.00,2.25,2.25,3529.00,0.00,3529.00,3529.00,N/A
61566_3,REMOVAL OF BRAIN TISSUE,ProFee,0989,61566,,,,0,3.00,2.25,2.25,3297.50,0.00,3297.50,3297.50,N/A
61567_3,INCISION OF BRAIN TISSUE,ProFee,0989,61567,,,,0,3.00,2.25,2.25,3755.00,0.00,3755.00,3755.00,N/A
61570_3,"REMOVE FOREIGN BODY, BRAIN",ProFee,0989,61570,,,,0,3.00,2.25,2.25,2739.50,0.00,2739.50,2739.50,N/A
61571_3,INCISE SKULL FOR BRAIN WOUND,ProFee,0989,61571,,,,0,3.00,2.25,2.25,2917.50,0.00,2917.50,2917.50,N/A
61575_3,SKULL BASE/BRAINSTEM SURGERY,ProFee,0989,61575,,,,0,3.00,2.25,2.25,3673.50,0.00,3673.50,3673.50,N/A
61576_3,SKULL BASE/BRAINSTEM SURGERY,ProFee,0989,61576,,,,0,3.00,2.25,2.25,6116.50,0.00,6116.50,6116.50,N/A
61580_3,"CRANIOFACIAL APPROACH, SKULL",ProFee,0989,61580,,,,0,3.00,2.25,2.25,3511.50,0.00,3511.50,3511.50,N/A
61581_3,"CRANIOFACIAL APPROACH, SKULL",ProFee,0989,61581,,,,0,3.00,2.25,2.25,3744.50,0.00,3744.50,3744.50,N/A
61582_3,"CRANIOFACIAL APPROACH, SKULL",ProFee,0989,61582,,,,0,3.00,2.25,2.25,4386.00,0.00,4386.00,4386.00,N/A
61583_3,"CRANIOFACIAL APPROACH, SKULL",ProFee,0989,61583,,,,0,3.00,2.25,2.25,4170.50,0.00,4170.50,4170.50,N/A
61584_3,ORBITOCRANIAL APPROACH/SKULL,ProFee,0989,61584,,,,0,3.00,2.25,2.25,4140.00,0.00,4140.00,4140.00,N/A
61585_3,ORBITOCRANIAL APPROACH/SKULL,ProFee,0989,61585,,,,0,3.00,2.25,2.25,4692.50,0.00,4692.50,4692.50,N/A
61586_3,"RESECT NASOPHARYNX, SKULL",ProFee,0989,61586,,,,0,3.00,2.25,2.25,3523.50,0.00,3523.50,3523.50,N/A
61590_3,INFRATEMPORAL APPROACH/SKULL,ProFee,0989,61590,,,,0,3.00,2.25,2.25,4383.50,0.00,4383.50,4383.50,N/A
61591_3,INFRATEMPORAL APPROACH/SKULL,ProFee,0989,61591,,,,0,3.00,2.25,2.25,4416.50,0.00,4416.50,4416.50,N/A
61592_3,ORBITOCRANIAL APPROACH/SKULL,ProFee,0989,61592,,,,0,3.00,2.25,2.25,4585.00,0.00,4585.00,4585.00,N/A
61595_3,TRANSTEMPORAL APPROACH/SKULL,ProFee,0989,61595,,,,0,3.00,2.25,2.25,3351.50,0.00,3351.50,3351.50,N/A
61596_3,TRANSCOCHLEAR APPROACH/SKULL,ProFee,0989,61596,,,,0,3.00,2.25,2.25,3471.00,0.00,3471.00,3471.00,N/A
61597_3,TRANSCONDYLAR APPROACH/SKULL,ProFee,0989,61597,,,,0,3.00,2.25,2.25,4337.00,0.00,4337.00,4337.00,N/A
61598_3,TRANSPETROSAL APPROACH/SKULL,ProFee,0989,61598,,,,0,3.00,2.25,2.25,4142.50,0.00,4142.50,4142.50,N/A
61600_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61600,,,,0,3.00,2.25,2.25,3058.50,0.00,3058.50,3058.50,N/A
61601_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61601,,,,0,3.00,2.25,2.25,3470.50,0.00,3470.50,3470.50,N/A
61605_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61605,,,,0,3.00,2.25,2.25,3078.50,0.00,3078.50,3078.50,N/A
61606_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61606,,,,0,3.00,2.25,2.25,4260.50,0.00,4260.50,4260.50,N/A
61607_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61607,,,,0,3.00,2.25,2.25,4178.50,0.00,4178.50,4178.50,N/A
61608_3,RESECT/EXCISE CRANIAL LESION,ProFee,0989,61608,,,,0,3.00,2.25,2.25,4716.00,0.00,4716.00,4716.00,N/A
61609_3,"TRANSECT ARTERY, SINUS",ProFee,0989,61609,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61610_3,"TRANSECT ARTERY, SINUS",ProFee,0989,61610,,,,0,3.00,2.25,2.25,2770.50,0.00,2770.50,2770.50,N/A
61611_3,"TRANSECT ARTERY, SINUS",ProFee,0989,61611,,,,0,3.00,2.25,2.25,693.50,0.00,693.50,693.50,N/A
61612_3,"TRANSECT ARTERY, SINUS",ProFee,0989,61612,,,,0,3.00,2.25,2.25,2603.00,0.00,2603.00,2603.00,N/A
61613_3,"REMOVE ANEURYSM, SINUS",ProFee,0989,61613,,,,0,3.00,2.25,2.25,4794.50,0.00,4794.50,4794.50,N/A
61615_3,"RESECT/EXCISE LESION, SKULL",ProFee,0989,61615,,,,0,3.00,2.25,2.25,4085.50,0.00,4085.50,4085.50,N/A
61616_3,"RESECT/EXCISE LESION, SKULL",ProFee,0989,61616,,,,0,3.00,2.25,2.25,4818.50,0.00,4818.50,4818.50,N/A
61618_3,REPAIR DURA,ProFee,0989,61618,,,,0,3.00,2.25,2.25,1875.50,0.00,1875.50,1875.50,N/A
61619_3,REPAIR DURA,ProFee,0989,61619,,,,0,3.00,2.25,2.25,2076.00,0.00,2076.00,2076.00,N/A
61623_3,ENDOVASC TEMPORY VESSEL OCCL,ProFee,0989,61623,,,,0,3.00,2.25,2.25,840.00,0.00,840.00,840.00,N/A
61624_3,"TRANSCATH OCCLUSION, CNS",ProFee,0989,61624,,,,0,3.00,2.25,2.25,1679.00,0.00,1679.00,1679.00,N/A
61626_3,"TRANSCATH OCCLUSION, NON-CNS",ProFee,0989,61626,,,,0,3.00,2.25,2.25,1259.50,0.00,1259.50,1259.50,N/A
61630_3,INTRACRANIAL ANGIOPLASTY,ProFee,0989,61630,,,,0,3.00,2.25,2.25,1990.50,0.00,1990.50,1990.50,N/A
61635_3,INTRACRAN ANGIOPLSTY W/STENT,ProFee,0989,61635,,,,0,3.00,2.25,2.25,2121.00,0.00,2121.00,2121.00,N/A
61640_3,"DILATE IC VASOSPASM, INIT",ProFee,0989,61640,,,,0,3.00,2.25,2.25,700.50,0.00,700.50,700.50,N/A
61641_3,DILATE IC VASOSPASM ADD-ON,ProFee,0989,61641,,,,0,3.00,2.25,2.25,246.00,0.00,246.00,246.00,N/A
61642_3,DILATE IC VASOSPASM ADD-ON,ProFee,0989,61642,,,,0,3.00,2.25,2.25,492.00,0.00,492.00,492.00,N/A
61645_3,PERQ ART M-THROMBECT &/NFS,ProFee,0989,61645,,,,0,3.00,2.25,2.25,1202.00,0.00,1202.00,1202.00,N/A
61650_3,EVASC PRLNG ADMN RX AGNT 1ST,ProFee,0989,61650,,,,0,3.00,2.25,2.25,783.00,0.00,783.00,783.00,N/A
61651_3,EVASC PRLNG ADMN RX AGNT ADD,ProFee,0989,61651,,,,0,3.00,2.25,2.25,332.50,0.00,332.50,332.50,N/A
61680_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61680,,,,0,3.00,2.25,2.25,3274.00,0.00,3274.00,3274.00,N/A
61682_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61682,,,,0,3.00,2.25,2.25,6062.00,0.00,6062.00,6062.00,N/A
61684_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61684,,,,0,3.00,2.25,2.25,4165.50,0.00,4165.50,4165.50,N/A
61686_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61686,,,,0,3.00,2.25,2.25,6476.50,0.00,6476.50,6476.50,N/A
61690_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61690,,,,0,3.00,2.25,2.25,3206.50,0.00,3206.50,3206.50,N/A
61692_3,INTRACRANIAL VESSEL SURGERY,ProFee,0989,61692,,,,0,3.00,2.25,2.25,5344.50,0.00,5344.50,5344.50,N/A
61697_3,"BRAIN ANEURYSM REPR, COMPLX",ProFee,0989,61697,,,,0,3.00,2.25,2.25,6125.00,0.00,6125.00,6125.00,N/A
61698_3,"BRAIN ANEURYSM REPR, COMPLX",ProFee,0989,61698,,,,0,3.00,2.25,2.25,6640.50,0.00,6640.50,6640.50,N/A
61700_3,"BRAIN ANEURYSM REPR, SIMPLE",ProFee,0989,61700,,,,0,3.00,2.25,2.25,4966.00,0.00,4966.00,4966.00,N/A
61702_3,INNER SKULL VESSEL SURGERY,ProFee,0989,61702,,,,0,3.00,2.25,2.25,5861.50,0.00,5861.50,5861.50,N/A
61703_3,CLAMP NECK ARTERY,ProFee,0989,61703,,,,0,3.00,2.25,2.25,1992.50,0.00,1992.50,1992.50,N/A
61705_3,REVISE CIRCULATION TO HEAD,ProFee,0989,61705,,,,0,3.00,2.25,2.25,3816.50,0.00,3816.50,3816.50,N/A
61708_3,REVISE CIRCULATION TO HEAD,ProFee,0989,61708,,,,0,3.00,2.25,2.25,3733.00,0.00,3733.00,3733.00,N/A
61710_3,REVISE CIRCULATION TO HEAD,ProFee,0989,61710,,,,0,3.00,2.25,2.25,3141.00,0.00,3141.00,3141.00,N/A
61711_3,FUSION OF SKULL ARTERIES,ProFee,0989,61711,,,,0,3.00,2.25,2.25,3813.00,0.00,3813.00,3813.00,N/A
61720_3,INCISE SKULL/BRAIN SURGERY,ProFee,0989,61720,,,,0,3.00,2.25,2.25,1863.00,0.00,1863.00,1863.00,N/A
61735_3,INCISE SKULL/BRAIN SURGERY,ProFee,0989,61735,,,,0,3.00,2.25,2.25,2331.00,0.00,2331.00,2331.00,N/A
61750_3,INCISE SKULL/BRAIN BIOPSY,ProFee,0989,61750,,,,0,3.00,2.25,2.25,2067.00,0.00,2067.00,2067.00,N/A
61751_3,BRAIN BIOPSY W/CT/MR GUIDE,ProFee,0989,61751,,,,0,3.00,2.25,2.25,2019.50,0.00,2019.50,2019.50,N/A
61760_3,IMPLANT BRAIN ELECTRODES,ProFee,0989,61760,,,,0,3.00,2.25,2.25,2311.50,0.00,2311.50,2311.50,N/A
61770_3,INCISE SKULL FOR TREATMENT,ProFee,0989,61770,,,,0,3.00,2.25,2.25,2383.00,0.00,2383.00,2383.00,N/A
61781_3,SCAN PROC CRANIAL INTRA,ProFee,0989,61781,,,,0,3.00,2.25,2.25,347.50,0.00,347.50,347.50,N/A
61782_3,SCAN PROC CRANIAL EXTRA,ProFee,0989,61782,,,,0,3.00,2.25,2.25,250.50,0.00,250.50,250.50,N/A
61783_3,SCAN PROC SPINAL,ProFee,0989,61783,,,,0,3.00,2.25,2.25,340.50,0.00,340.50,340.50,N/A
61790_3,TREAT TRIGEMINAL NERVE,ProFee,0989,61790,,,,0,3.00,2.25,2.25,1285.50,0.00,1285.50,1285.50,N/A
61791_3,TREAT TRIGEMINAL TRACT,ProFee,0989,61791,,,,0,3.00,2.25,2.25,1648.50,0.00,1648.50,1648.50,N/A
61793_3,FOCUS RADIATION BEAM,ProFee,0989,61793,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61795_3,BRAIN SURGERY USING COMPUTER,ProFee,0989,61795,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61796_3,"SRS, CRANIAL LESION SIMPLE",ProFee,0989,61796,,,,0,3.00,2.25,2.25,1484.50,0.00,1484.50,1484.50,N/A
61797_3,"SRS, CRAN LES SIMPLE, ADDL",ProFee,0989,61797,,,,0,3.00,2.25,2.25,326.00,0.00,326.00,326.00,N/A
61798_3,"SRS, CRANIAL LESION COMPLEX",ProFee,0989,61798,,,,0,3.00,2.25,2.25,2022.50,0.00,2022.50,2022.50,N/A
61799_3,"SRS, CRAN LES COMPLEX, ADDL",ProFee,0989,61799,,,,0,3.00,2.25,2.25,448.00,0.00,448.00,448.00,N/A
61800_3,APPLY SRS HEADFRAME ADD-ON,ProFee,0989,61800,,,,0,3.00,2.25,2.25,226.50,0.00,226.50,226.50,N/A
61850_3,IMPLANT NEUROELECTRODES,ProFee,0989,61850,,,,0,3.00,2.25,2.25,1439.50,0.00,1439.50,1439.50,N/A
61860_3,IMPLANT NEUROELECTRODES,ProFee,0989,61860,,,,0,3.00,2.25,2.25,2295.50,0.00,2295.50,2295.50,N/A
61863_3,IMPLANT NEUROELECTRODE,ProFee,0989,61863,,,,0,3.00,2.25,2.25,2194.50,0.00,2194.50,2194.50,N/A
61864_3,"IMPLANT NEUROELECTRDE, ADD'L",ProFee,0989,61864,,,,0,3.00,2.25,2.25,418.50,0.00,418.50,418.50,N/A
61867_3,IMPLANT NEUROELECTRODE,ProFee,0989,61867,,,,0,3.00,2.25,2.25,3334.50,0.00,3334.50,3334.50,N/A
61868_3,"IMPLANT NEUROELECTRDE, ADD'L",ProFee,0989,61868,,,,0,3.00,2.25,2.25,736.50,0.00,736.50,736.50,N/A
61870_3,IMPLANT NEUROELECTRODES,ProFee,0989,61870,,,,0,3.00,2.25,2.25,1735.00,0.00,1735.00,1735.00,N/A
61875_3,IMPLANT NEUROELECTRODES,ProFee,0989,61875,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
61880_3,REVISE/REMOVE NEUROELECTRODE,ProFee,0989,61880,,,,0,3.00,2.25,2.25,827.50,0.00,827.50,827.50,N/A
61885_3,INSRT/REDO NEUROSTIM 1 ARRAY,ProFee,0989,61885,,,,0,3.00,2.25,2.25,747.00,0.00,747.00,747.00,N/A
61886_3,IMPLANT NEUROSTIM ARRAYS,ProFee,0989,61886,,,,0,3.00,2.25,2.25,1229.00,0.00,1229.00,1229.00,N/A
61888_3,REVISE/REMOVE NEURORECEIVER,ProFee,0989,61888,,,,0,3.00,2.25,2.25,579.00,0.00,579.00,579.00,N/A
62000_3,TREAT SKULL FRACTURE,ProFee,0989,62000,,,,0,3.00,2.25,2.25,1509.50,0.00,1509.50,1509.50,N/A
62005_3,TREAT SKULL FRACTURE,ProFee,0989,62005,,,,0,3.00,2.25,2.25,1863.50,0.00,1863.50,1863.50,N/A
62010_3,TREATMENT OF HEAD INJURY,ProFee,0989,62010,,,,0,3.00,2.25,2.25,2247.00,0.00,2247.00,2247.00,N/A
62100_3,REPAIR BRAIN FLUID LEAKAGE,ProFee,0989,62100,,,,0,3.00,2.25,2.25,2304.00,0.00,2304.00,2304.00,N/A
62115_3,REDUCTION OF SKULL DEFECT,ProFee,0989,62115,,,,0,3.00,2.25,2.25,2450.50,0.00,2450.50,2450.50,N/A
62116_3,REDUCTION OF SKULL DEFECT,ProFee,0989,62116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
62117_3,REDUCTION OF SKULL DEFECT,ProFee,0989,62117,,,,0,3.00,2.25,2.25,2880.00,0.00,2880.00,2880.00,N/A
62120_3,REPAIR SKULL CAVITY LESION,ProFee,0989,62120,,,,0,3.00,2.25,2.25,3111.50,0.00,3111.50,3111.50,N/A
62121_3,INCISE SKULL REPAIR,ProFee,0989,62121,,,,0,3.00,2.25,2.25,2472.50,0.00,2472.50,2472.50,N/A
62140_3,REPAIR OF SKULL DEFECT,ProFee,0989,62140,,,,0,3.00,2.25,2.25,1493.00,0.00,1493.00,1493.00,N/A
62141_3,REPAIR OF SKULL DEFECT,ProFee,0989,62141,,,,0,3.00,2.25,2.25,1654.00,0.00,1654.00,1654.00,N/A
62142_3,REMOVE SKULL PLATE/FLAP,ProFee,0989,62142,,,,0,3.00,2.25,2.25,1291.00,0.00,1291.00,1291.00,N/A
62143_3,REPLACE SKULL PLATE/FLAP,ProFee,0989,62143,,,,0,3.00,2.25,2.25,1514.50,0.00,1514.50,1514.50,N/A
62145_3,REPAIR OF SKULL & BRAIN,ProFee,0989,62145,,,,0,3.00,2.25,2.25,2057.50,0.00,2057.50,2057.50,N/A
62146_3,REPAIR OF SKULL WITH GRAFT,ProFee,0989,62146,,,,0,3.00,2.25,2.25,1800.00,0.00,1800.00,1800.00,N/A
62147_3,REPAIR OF SKULL WITH GRAFT,ProFee,0989,62147,,,,0,3.00,2.25,2.25,2140.00,0.00,2140.00,2140.00,N/A
62148_3,RETR BONE FLAP TO FIX SKULL,ProFee,0989,62148,,,,0,3.00,2.25,2.25,187.00,0.00,187.00,187.00,N/A
62160_3,NEUROENDOSCOPY ADD-ON,ProFee,0989,62160,,,,0,3.00,2.25,2.25,280.50,0.00,280.50,280.50,N/A
62161_3,DISSECT BRAIN W/SCOPE,ProFee,0989,62161,,,,0,3.00,2.25,2.25,2223.00,0.00,2223.00,2223.00,N/A
62162_3,REMOVE COLLOID CYST W/SCOPE,ProFee,0989,62162,,,,0,3.00,2.25,2.25,2772.50,0.00,2772.50,2772.50,N/A
62163_3,NEUROENDOSCOPY W/FB REMOVAL,ProFee,0989,62163,,,,0,3.00,2.25,2.25,1793.50,0.00,1793.50,1793.50,N/A
62164_3,REMOVE BRAIN TUMOR W/SCOPE,ProFee,0989,62164,,,,0,3.00,2.25,2.25,3064.00,0.00,3064.00,3064.00,N/A
62165_3,REMOVE PITUIT TUMOR W/SCOPE,ProFee,0989,62165,,,,0,3.00,2.25,2.25,2223.00,0.00,2223.00,2223.00,N/A
62180_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62180,,,,0,3.00,2.25,2.25,2348.00,0.00,2348.00,2348.00,N/A
62190_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62190,,,,0,3.00,2.25,2.25,1353.00,0.00,1353.00,1353.00,N/A
62192_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62192,,,,0,3.00,2.25,2.25,1427.00,0.00,1427.00,1427.00,N/A
62194_3,REPLACE/IRRIGATE CATHETER,ProFee,0989,62194,,,,0,3.00,2.25,2.25,710.50,0.00,710.50,710.50,N/A
62200_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62200,,,,0,3.00,2.25,2.25,2019.50,0.00,2019.50,2019.50,N/A
62201_3,BRAIN CAVITY SHUNT W/SCOPE,ProFee,0989,62201,,,,0,3.00,2.25,2.25,1760.00,0.00,1760.00,1760.00,N/A
62220_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62220,,,,0,3.00,2.25,2.25,1475.50,0.00,1475.50,1475.50,N/A
62223_3,ESTABLISH BRAIN CAVITY SHUNT,ProFee,0989,62223,,,,0,3.00,2.25,2.25,1519.50,0.00,1519.50,1519.50,N/A
62225_3,REPLACE/IRRIGATE CATHETER,ProFee,0989,62225,,,,0,3.00,2.25,2.25,759.50,0.00,759.50,759.50,N/A
62230_3,REPLACE/REVISE BRAIN SHUNT,ProFee,0989,62230,,,,0,3.00,2.25,2.25,1225.50,0.00,1225.50,1225.50,N/A
62252_3,CSF SHUNT REPROGRAM,ProFee,0989,62252,,,,0,3.00,2.25,2.25,67.50,0.00,67.50,67.50,N/A
62256_3,REMOVE BRAIN CAVITY SHUNT,ProFee,0989,62256,,,,0,3.00,2.25,2.25,872.50,0.00,872.50,872.50,N/A
62258_3,REPLACE BRAIN CAVITY SHUNT,ProFee,0989,62258,,,,0,3.00,2.25,2.25,1627.50,0.00,1627.50,1627.50,N/A
62263_3,EPIDURAL LYSIS MULT SESSIONS,ProFee,0989,62263,,,,0,3.00,2.25,2.25,457.50,0.00,457.50,457.50,N/A
62264_3,EPIDURAL LYSIS ON SINGLE DAY,ProFee,0989,62264,,,,0,3.00,2.25,2.25,341.50,0.00,341.50,341.50,N/A
62267_3,"INTERDISCAL PERQ ASPIR, DX",ProFee,0989,62267,,,,0,3.00,2.25,2.25,227.50,0.00,227.50,227.50,N/A
62268_3,DRAIN SPINAL CORD CYST,ProFee,0989,62268,,,,0,3.00,2.25,2.25,372.00,0.00,372.00,372.00,N/A
62269_3,"NEEDLE BIOPSY, SPINAL CORD",ProFee,0989,62269,,,,0,3.00,2.25,2.25,377.00,0.00,377.00,377.00,N/A
62270_3,"SPINAL FLUID TAP, DIAGNOSTIC",ProFee,0989,62270,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
62272_3,DRAIN CEREBRO SPINAL FLUID,ProFee,0989,62272,,,,0,3.00,2.25,2.25,120.50,0.00,120.50,120.50,N/A
62273_3,INJECT EPIDURAL PATCH,ProFee,0989,62273,,,,0,3.00,2.25,2.25,163.00,0.00,163.00,163.00,N/A
62280_3,TREAT SPINAL CORD LESION,ProFee,0989,62280,,,,0,3.00,2.25,2.25,238.00,0.00,238.00,238.00,N/A
62281_3,TREAT SPINAL CORD LESION,ProFee,0989,62281,,,,0,3.00,2.25,2.25,225.00,0.00,225.00,225.00,N/A
62282_3,TREAT SPINAL CANAL LESION,ProFee,0989,62282,,,,0,3.00,2.25,2.25,207.50,0.00,207.50,207.50,N/A
62284_3,INJECTION FOR MYELOGRAM,ProFee,0989,62284,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
62287_3,PERCUTANEOUS DISKECTOMY,ProFee,0989,62287,,,,0,3.00,2.25,2.25,827.00,0.00,827.00,827.00,N/A
62290_3,INJECT FOR SPINE DISK X-RAY,ProFee,0989,62290,,,,0,3.00,2.25,2.25,243.50,0.00,243.50,243.50,N/A
62291_3,INJECT FOR SPINE DISK X-RAY,ProFee,0989,62291,,,,0,3.00,2.25,2.25,241.00,0.00,241.00,241.00,N/A
62292_3,INJECTION INTO DISK LESION,ProFee,0989,62292,,,,0,3.00,2.25,2.25,825.50,0.00,825.50,825.50,N/A
62294_3,INJECTION INTO SPINAL ARTERY,ProFee,0989,62294,,,,0,3.00,2.25,2.25,1391.50,0.00,1391.50,1391.50,N/A
62302_3,MYELOGRAPHY LUMBAR INJECTION,ProFee,0989,62302,,,,0,3.00,2.25,2.25,176.50,0.00,176.50,176.50,N/A
62303_3,MYELOGRAPHY LUMBAR INJECTION,ProFee,0989,62303,,,,0,3.00,2.25,2.25,176.50,0.00,176.50,176.50,N/A
62304_3,MYELOGRAPHY LUMBAR INJECTION,ProFee,0989,62304,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
62305_3,MYELOGRAPHY LUMBAR INJECTION,ProFee,0989,62305,,,,0,3.00,2.25,2.25,180.50,0.00,180.50,180.50,N/A
62310_3,INJECT SPINE C/T,ProFee,0989,62320,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
62311_3,INJECT SPINE L/S (CD),ProFee,0989,62322,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
62318_3,"INJECT SPINE W/CATH, C/T",ProFee,0989,62324,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
62319_3,INJECT SPINE W/CATH L/S (CD),ProFee,0989,62326,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
62320_3,NJX INTERLAMINAR CRV/THRC,ProFee,0989,62320,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
62321_3,NJX INTERLAMINAR CRV/THRC,ProFee,0989,62321,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
62322_3,NJX INTERLAMINAR LMBR/SAC,ProFee,0989,62322,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
62323_3,NJX INTERLAMINAR LMBR/SAC,ProFee,0989,62323,,,,0,3.00,2.25,2.25,142.50,0.00,142.50,142.50,N/A
62324_3,NJX INTERLAMINAR CRV/THRC,ProFee,0989,62324,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
62325_3,NJX INTERLAMINAR CRV/THRC,ProFee,0989,62325,,,,0,3.00,2.25,2.25,150.00,0.00,150.00,150.00,N/A
62326_3,NJX INTERLAMINAR LMBR/SAC,ProFee,0989,62326,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
62327_3,NJX INTERLAMINAR LMBR/SAC,ProFee,0989,62327,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
62328_3,DX LMBR SPI PNXR W/FLUOR/CT,ProFee,0989,62328,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
62329_3,THER SPI PNXR CSF FLUOR/CT,ProFee,0989,62329,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
62350_3,IMPLANT SPINAL CANAL CATH,ProFee,0989,62350,,,,0,3.00,2.25,2.25,575.50,0.00,575.50,575.50,N/A
62351_3,IMPLANT SPINAL CANAL CATH,ProFee,0989,62351,,,,0,3.00,2.25,2.25,1243.00,0.00,1243.00,1243.00,N/A
62355_3,REMOVE SPINAL CANAL CATHETER,ProFee,0989,62355,,,,0,3.00,2.25,2.25,386.50,0.00,386.50,386.50,N/A
62360_3,INSERT SPINE INFUSION DEVICE,ProFee,0989,62360,,,,0,3.00,2.25,2.25,449.50,0.00,449.50,449.50,N/A
62361_3,IMPLANT SPINE INFUSION PUMP,ProFee,0989,62361,,,,0,3.00,2.25,2.25,623.00,0.00,623.00,623.00,N/A
62362_3,IMPLANT SPINE INFUSION PUMP,ProFee,0989,62362,,,,0,3.00,2.25,2.25,553.50,0.00,553.50,553.50,N/A
62365_3,REMOVE SPINE INFUSION DEVICE,ProFee,0989,62365,,,,0,3.00,2.25,2.25,427.50,0.00,427.50,427.50,N/A
62367_3,ANALYZE SPINE INFUSION PUMP,ProFee,0989,62367,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
62368_3,ANALYZE SPINE INFUSION PUMP,ProFee,0989,62368,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
62369_3,ANAL SP INF PMP W/REPRG&FILL,ProFee,0989,62369,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
62370_3,ANL SP INF PMP W/MDREPRG&FIL,ProFee,0989,62370,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
62380_3,NDSC DCMPRN 1 NTRSPC LUMBAR,ProFee,0989,62380,,,,0,3.00,2.25,2.25,1190.50,0.00,1190.50,1190.50,N/A
63001_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63001,,,,0,3.00,2.25,2.25,1804.00,0.00,1804.00,1804.00,N/A
63003_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63003,,,,0,3.00,2.25,2.25,1808.00,0.00,1808.00,1808.00,N/A
63005_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63005,,,,0,3.00,2.25,2.25,1719.00,0.00,1719.00,1719.00,N/A
63011_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63011,,,,0,3.00,2.25,2.25,1582.50,0.00,1582.50,1582.50,N/A
63012_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63012,,,,0,3.00,2.25,2.25,1732.00,0.00,1732.00,1732.00,N/A
63015_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63015,,,,0,3.00,2.25,2.25,2158.00,0.00,2158.00,2158.00,N/A
63016_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63016,,,,0,3.00,2.25,2.25,2226.00,0.00,2226.00,2226.00,N/A
63017_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63017,,,,0,3.00,2.25,2.25,1828.50,0.00,1828.50,1828.50,N/A
63020_3,NECK SPINE DISK SURGERY,ProFee,0989,63020,,,,0,3.00,2.25,2.25,1683.50,0.00,1683.50,1683.50,N/A
63030_3,LOW BACK DISK SURGERY,ProFee,0989,63030,,,,0,3.00,2.25,2.25,1409.50,0.00,1409.50,1409.50,N/A
63035_3,SPINAL DISK SURGERY ADD-ON,ProFee,0989,63035,,,,0,3.00,2.25,2.25,279.00,0.00,279.00,279.00,N/A
63040_3,"LAMINOTOMY, SINGLE CERVICAL",ProFee,0989,63040,,,,0,3.00,2.25,2.25,2033.50,0.00,2033.50,2033.50,N/A
63042_3,"LAMINOTOMY, SINGLE LUMBAR",ProFee,0989,63042,,,,0,3.00,2.25,2.25,1883.00,0.00,1883.00,1883.00,N/A
63043_3,"LAMINOTOMY, ADD'L CERVICAL",ProFee,0989,63043,,,,0,3.00,2.25,2.25,881.00,0.00,881.00,881.00,N/A
63044_3,"LAMINOTOMY, ADD'L LUMBAR",ProFee,0989,63044,,,,0,3.00,2.25,2.25,837.50,0.00,837.50,837.50,N/A
63045_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63045,,,,0,3.00,2.25,2.25,1869.00,0.00,1869.00,1869.00,N/A
63046_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63046,,,,0,3.00,2.25,2.25,1779.00,0.00,1779.00,1779.00,N/A
63047_3,REMOVAL OF SPINAL LAMINA,ProFee,0989,63047,,,,0,3.00,2.25,2.25,1600.00,0.00,1600.00,1600.00,N/A
63048_3,REMOVE SPINAL LAMINA ADD-ON,ProFee,0989,63048,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
63050_3,CERVICAL LAMINOPLASTY,ProFee,0989,63050,,,,0,3.00,2.25,2.25,2301.00,0.00,2301.00,2301.00,N/A
63051_3,C-LAMINOPLASTY W/GRAFT/PLATE,ProFee,0989,63051,,,,0,3.00,2.25,2.25,2482.00,0.00,2482.00,2482.00,N/A
63055_3,DECOMPRESS SPINAL CORD,ProFee,0989,63055,,,,0,3.00,2.25,2.25,2367.50,0.00,2367.50,2367.50,N/A
63056_3,DECOMPRESS SPINAL CORD,ProFee,0989,63056,,,,0,3.00,2.25,2.25,2161.50,0.00,2161.50,2161.50,N/A
63057_3,DECOMPRESS SPINE CORD ADD-ON,ProFee,0989,63057,,,,0,3.00,2.25,2.25,467.50,0.00,467.50,467.50,N/A
63064_3,DECOMPRESS SPINAL CORD,ProFee,0989,63064,,,,0,3.00,2.25,2.25,2591.50,0.00,2591.50,2591.50,N/A
63066_3,DECOMPRESS SPINE CORD ADD-ON,ProFee,0989,63066,,,,0,3.00,2.25,2.25,305.50,0.00,305.50,305.50,N/A
63075_3,NECK SPINE DISK SURGERY,ProFee,0989,63075,,,,0,3.00,2.25,2.25,1963.00,0.00,1963.00,1963.00,N/A
63076_3,NECK SPINE DISK SURGERY,ProFee,0989,63076,,,,0,3.00,2.25,2.25,360.50,0.00,360.50,360.50,N/A
63077_3,"SPINE DISK SURGERY, THORAX",ProFee,0989,63077,,,,0,3.00,2.25,2.25,2163.50,0.00,2163.50,2163.50,N/A
63078_3,"SPINE DISK SURGERY, THORAX",ProFee,0989,63078,,,,0,3.00,2.25,2.25,307.00,0.00,307.00,307.00,N/A
63081_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63081,,,,0,3.00,2.25,2.25,2556.50,0.00,2556.50,2556.50,N/A
63082_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63082,,,,0,3.00,2.25,2.25,389.50,0.00,389.50,389.50,N/A
63085_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63085,,,,0,3.00,2.25,2.25,2778.50,0.00,2778.50,2778.50,N/A
63086_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63086,,,,0,3.00,2.25,2.25,278.50,0.00,278.50,278.50,N/A
63087_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63087,,,,0,3.00,2.25,2.25,3512.50,0.00,3512.50,3512.50,N/A
63088_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63088,,,,0,3.00,2.25,2.25,360.50,0.00,360.50,360.50,N/A
63090_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63090,,,,0,3.00,2.25,2.25,2849.50,0.00,2849.50,2849.50,N/A
63091_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63091,,,,0,3.00,2.25,2.25,259.50,0.00,259.50,259.50,N/A
63101_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63101,,,,0,3.00,2.25,2.25,3380.50,0.00,3380.50,3380.50,N/A
63102_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63102,,,,0,3.00,2.25,2.25,3295.00,0.00,3295.00,3295.00,N/A
63103_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63103,,,,0,3.00,2.25,2.25,429.50,0.00,429.50,429.50,N/A
63170_3,INCISE SPINAL CORD TRACT(S),ProFee,0989,63170,,,,0,3.00,2.25,2.25,2335.00,0.00,2335.00,2335.00,N/A
63172_3,DRAINAGE OF SPINAL CYST,ProFee,0989,63172,,,,0,3.00,2.25,2.25,2070.00,0.00,2070.00,2070.00,N/A
63173_3,DRAINAGE OF SPINAL CYST,ProFee,0989,63173,,,,0,3.00,2.25,2.25,2531.50,0.00,2531.50,2531.50,N/A
63180_3,REVISE SPINAL CORD LIGAMENTS,ProFee,0989,63180,,,,0,3.00,2.25,2.25,2179.50,0.00,2179.50,2179.50,N/A
63182_3,REVISE SPINAL CORD LIGAMENTS,ProFee,0989,63182,,,,0,3.00,2.25,2.25,2393.00,0.00,2393.00,2393.00,N/A
63185_3,INCISE SPINAL COLUMN/NERVES,ProFee,0989,63185,,,,0,3.00,2.25,2.25,1646.00,0.00,1646.00,1646.00,N/A
63190_3,INCISE SPINAL COLUMN/NERVES,ProFee,0989,63190,,,,0,3.00,2.25,2.25,1807.00,0.00,1807.00,1807.00,N/A
63191_3,INCISE SPINAL COLUMN/NERVES,ProFee,0989,63191,,,,0,3.00,2.25,2.25,2020.50,0.00,2020.50,2020.50,N/A
63194_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63194,,,,0,3.00,2.25,2.25,2342.50,0.00,2342.50,2342.50,N/A
63195_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63195,,,,0,3.00,2.25,2.25,2256.00,0.00,2256.00,2256.00,N/A
63196_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63196,,,,0,3.00,2.25,2.25,2614.00,0.00,2614.00,2614.00,N/A
63197_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63197,,,,0,3.00,2.25,2.25,2510.00,0.00,2510.00,2510.00,N/A
63198_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63198,,,,0,3.00,2.25,2.25,3068.50,0.00,3068.50,3068.50,N/A
63199_3,INCISE SPINAL COLUMN & CORD,ProFee,0989,63199,,,,0,3.00,2.25,2.25,3215.00,0.00,3215.00,3215.00,N/A
63200_3,RELEASE OF SPINAL CORD,ProFee,0989,63200,,,,0,3.00,2.25,2.25,2236.00,0.00,2236.00,2236.00,N/A
63250_3,REVISE SPINAL CORD VESSELS,ProFee,0989,63250,,,,0,3.00,2.25,2.25,4347.00,0.00,4347.00,4347.00,N/A
63251_3,REVISE SPINAL CORD VESSELS,ProFee,0989,63251,,,,0,3.00,2.25,2.25,4441.50,0.00,4441.50,4441.50,N/A
63252_3,REVISE SPINAL CORD VESSELS,ProFee,0989,63252,,,,0,3.00,2.25,2.25,4441.00,0.00,4441.00,4441.00,N/A
63265_3,EXCISE INTRASPINAL LESION,ProFee,0989,63265,,,,0,3.00,2.25,2.25,2434.50,0.00,2434.50,2434.50,N/A
63266_3,EXCISE INTRASPINAL LESION,ProFee,0989,63266,,,,0,3.00,2.25,2.25,2505.00,0.00,2505.00,2505.00,N/A
63267_3,EXCISE INTRASPINAL LESION,ProFee,0989,63267,,,,0,3.00,2.25,2.25,1990.00,0.00,1990.00,1990.00,N/A
63268_3,EXCISE INTRASPINAL LESION,ProFee,0989,63268,,,,0,3.00,2.25,2.25,2112.00,0.00,2112.00,2112.00,N/A
63270_3,EXCISE INTRASPINAL LESION,ProFee,0989,63270,,,,0,3.00,2.25,2.25,3047.00,0.00,3047.00,3047.00,N/A
63271_3,EXCISE INTRASPINAL LESION,ProFee,0989,63271,,,,0,3.00,2.25,2.25,3014.50,0.00,3014.50,3014.50,N/A
63272_3,EXCISE INTRASPINAL LESION,ProFee,0989,63272,,,,0,3.00,2.25,2.25,2763.50,0.00,2763.50,2763.50,N/A
63273_3,EXCISE INTRASPINAL LESION,ProFee,0989,63273,,,,0,3.00,2.25,2.25,2735.50,0.00,2735.50,2735.50,N/A
63275_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63275,,,,0,3.00,2.25,2.25,2624.00,0.00,2624.00,2624.00,N/A
63276_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63276,,,,0,3.00,2.25,2.25,2600.00,0.00,2600.00,2600.00,N/A
63277_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63277,,,,0,3.00,2.25,2.25,2260.50,0.00,2260.50,2260.50,N/A
63278_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63278,,,,0,3.00,2.25,2.25,2330.00,0.00,2330.00,2330.00,N/A
63280_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63280,,,,0,3.00,2.25,2.25,3083.50,0.00,3083.50,3083.50,N/A
63281_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63281,,,,0,3.00,2.25,2.25,3053.50,0.00,3053.50,3053.50,N/A
63282_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63282,,,,0,3.00,2.25,2.25,2871.00,0.00,2871.00,2871.00,N/A
63283_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63283,,,,0,3.00,2.25,2.25,2786.50,0.00,2786.50,2786.50,N/A
63285_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63285,,,,0,3.00,2.25,2.25,3834.00,0.00,3834.00,3834.00,N/A
63286_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63286,,,,0,3.00,2.25,2.25,3787.00,0.00,3787.00,3787.00,N/A
63287_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63287,,,,0,3.00,2.25,2.25,4022.00,0.00,4022.00,4022.00,N/A
63290_3,BIOPSY/EXCISE SPINAL TUMOR,ProFee,0989,63290,,,,0,3.00,2.25,2.25,4089.50,0.00,4089.50,4089.50,N/A
63295_3,REPAIR OF LAMINECTOMY DEFECT,ProFee,0989,63295,,,,0,3.00,2.25,2.25,491.50,0.00,491.50,491.50,N/A
63300_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63300,,,,0,3.00,2.25,2.25,2667.50,0.00,2667.50,2667.50,N/A
63301_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63301,,,,0,3.00,2.25,2.25,3235.00,0.00,3235.00,3235.00,N/A
63302_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63302,,,,0,3.00,2.25,2.25,3194.50,0.00,3194.50,3194.50,N/A
63303_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63303,,,,0,3.00,2.25,2.25,3394.50,0.00,3394.50,3394.50,N/A
63304_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63304,,,,0,3.00,2.25,2.25,3446.00,0.00,3446.00,3446.00,N/A
63305_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63305,,,,0,3.00,2.25,2.25,3667.00,0.00,3667.00,3667.00,N/A
63306_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63306,,,,0,3.00,2.25,2.25,3603.50,0.00,3603.50,3603.50,N/A
63307_3,REMOVAL OF VERTEBRAL BODY,ProFee,0989,63307,,,,0,3.00,2.25,2.25,3529.50,0.00,3529.50,3529.50,N/A
63308_3,REMOVE VERTEBRAL BODY ADD-ON,ProFee,0989,63308,,,,0,3.00,2.25,2.25,469.50,0.00,469.50,469.50,N/A
63600_3,REMOVE SPINAL CORD LESION,ProFee,0989,63600,,,,0,3.00,2.25,2.25,1520.50,0.00,1520.50,1520.50,N/A
63610_3,STIMULATION OF SPINAL CORD,ProFee,0989,63610,,,,0,3.00,2.25,2.25,858.50,0.00,858.50,858.50,N/A
63615_3,REMOVE LESION OF SPINAL CORD,ProFee,0989,63615,,,,0,3.00,2.25,2.25,1815.50,0.00,1815.50,1815.50,N/A
63620_3,"SRS, SPINAL LESION",ProFee,0989,63620,,,,0,3.00,2.25,2.25,1640.50,0.00,1640.50,1640.50,N/A
63621_3,"SRS, SPINAL LESION, ADDL",ProFee,0989,63621,,,,0,3.00,2.25,2.25,375.00,0.00,375.00,375.00,N/A
63650_3,IMPLANT NEUROELECTRODES,ProFee,0989,63650,,,,0,3.00,2.25,2.25,591.50,0.00,591.50,591.50,N/A
63655_3,IMPLANT NEUROELECTRODES,ProFee,0989,63655,,,,0,3.00,2.25,2.25,1203.50,0.00,1203.50,1203.50,N/A
63660_3,REVISE/REMOVE NEUROELECTRODE,ProFee,0989,63660,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
63661_3,REMOVE SPINE ELTRD PERQ ARAY,ProFee,0989,63661,,,,0,3.00,2.25,2.25,466.50,0.00,466.50,466.50,N/A
63662_3,REMOVE SPINE ELTRD PLATE,ProFee,0989,63662,,,,0,3.00,2.25,2.25,1216.50,0.00,1216.50,1216.50,N/A
63663_3,REVISE SPINE ELTRD PERQ ARAY,ProFee,0989,63663,,,,0,3.00,2.25,2.25,649.00,0.00,649.00,649.00,N/A
63664_3,REVISE SPINE ELTRD PLATE,ProFee,0989,63664,,,,0,3.00,2.25,2.25,1266.50,0.00,1266.50,1266.50,N/A
63685_3,INSRT/REDO SPINE N GENERATOR,ProFee,0989,63685,,,,0,3.00,2.25,2.25,523.50,0.00,523.50,523.50,N/A
63688_3,REVISE/REMOVE NEURORECEIVER,ProFee,0989,63688,,,,0,3.00,2.25,2.25,538.00,0.00,538.00,538.00,N/A
63700_3,REPAIR OF SPINAL HERNIATION,ProFee,0989,63700,,,,0,3.00,2.25,2.25,1902.50,0.00,1902.50,1902.50,N/A
63702_3,REPAIR OF SPINAL HERNIATION,ProFee,0989,63702,,,,0,3.00,2.25,2.25,2084.00,0.00,2084.00,2084.00,N/A
63704_3,REPAIR OF SPINAL HERNIATION,ProFee,0989,63704,,,,0,3.00,2.25,2.25,2415.50,0.00,2415.50,2415.50,N/A
63706_3,REPAIR OF SPINAL HERNIATION,ProFee,0989,63706,,,,0,3.00,2.25,2.25,2689.50,0.00,2689.50,2689.50,N/A
63707_3,REPAIR SPINAL FLUID LEAKAGE,ProFee,0989,63707,,,,0,3.00,2.25,2.25,1340.50,0.00,1340.50,1340.50,N/A
63709_3,REPAIR SPINAL FLUID LEAKAGE,ProFee,0989,63709,,,,0,3.00,2.25,2.25,1597.00,0.00,1597.00,1597.00,N/A
63710_3,GRAFT REPAIR OF SPINE DEFECT,ProFee,0989,63710,,,,0,3.00,2.25,2.25,1571.50,0.00,1571.50,1571.50,N/A
63740_3,INSTALL SPINAL SHUNT,ProFee,0989,63740,,,,0,3.00,2.25,2.25,1423.50,0.00,1423.50,1423.50,N/A
63741_3,INSTALL SPINAL SHUNT,ProFee,0989,63741,,,,0,3.00,2.25,2.25,987.00,0.00,987.00,987.00,N/A
63744_3,REVISION OF SPINAL SHUNT,ProFee,0989,63744,,,,0,3.00,2.25,2.25,956.50,0.00,956.50,956.50,N/A
63746_3,REMOVAL OF SPINAL SHUNT,ProFee,0989,63746,,,,0,3.00,2.25,2.25,877.00,0.00,877.00,877.00,N/A
64400_3,"N BLOCK INJ, TRIGEMINAL",ProFee,0989,64400,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
64405_3,"N BLOCK INJ, OCCIPITAL",ProFee,0989,64405,,,,0,3.00,2.25,2.25,91.50,0.00,91.50,91.50,N/A
64408_3,"N BLOCK INJ, VAGUS",ProFee,0989,64408,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
64412_3,"N BLOCK INJ, SPINAL ACCESSOR",ProFee,0989,64999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
64415_3,"N BLOCK INJ, BRACHIAL PLEXUS",ProFee,0989,64415,,,,0,3.00,2.25,2.25,93.50,0.00,93.50,93.50,N/A
64416_3,"N BLOCK CONT INFUSE, B PLEX",ProFee,0989,64416,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
64417_3,"N BLOCK INJ, AXILLARY",ProFee,0989,64417,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
64418_3,"N BLOCK INJ, SUPRASCAPULAR",ProFee,0989,64418,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
64421_3,"N BLOCK INJ, INTERCOST, MLT",ProFee,0989,64421,,,,0,3.00,2.25,2.25,132.00,0.00,132.00,132.00,N/A
64425_3,"N BLOCK INJ, ILIO-ING/HYPOGI",ProFee,0989,64425,,,,0,3.00,2.25,2.25,134.50,0.00,134.50,134.50,N/A
64430_3,"N BLOCK INJ, PUDENDAL",ProFee,0989,64430,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
64435_3,"N BLOCK INJ, PARACERVICAL",ProFee,0989,64435,,,,0,3.00,2.25,2.25,117.50,0.00,117.50,117.50,N/A
64445_3,"N BLOCK INJ, SCIATIC, SNG",ProFee,0989,64445,,,,0,3.00,2.25,2.25,104.50,0.00,104.50,104.50,N/A
64446_3,"N BLK INJ, SCIATIC, CONT INF",ProFee,0989,64446,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
64447_3,"N BLOCK INJ FEM, SINGLE",ProFee,0989,64447,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
64448_3,"N BLOCK INJ FEM, CONT INF",ProFee,0989,64448,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
64449_3,"N BLOCK INJ, LUMBAR PLEXUS",ProFee,0989,64449,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
64450_3,"N BLOCK, OTHER PERIPHERAL",ProFee,0989,64450,,,,0,3.00,2.25,2.25,65.00,0.00,65.00,65.00,N/A
64451_3,NJX AA&/STRD NRV NRVTG SI JT,ProFee,0989,64451,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64454_3,NJX AA&/STRD GNCLR NRV BRNCH,ProFee,0989,64454,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64455_3,"N BLOCK INJ,  PLANTAR DIGIT",ProFee,0989,64455,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
64461_3,PVB THORACIC SINGLE INJ SITE,ProFee,0989,64461,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
64462_3,PVB THORACIC 2ND+ INJ SITE,ProFee,0989,64462,,,,0,3.00,2.25,2.25,77.00,0.00,77.00,77.00,N/A
64463_3,PVB THORACIC CONT INFUSION,ProFee,0989,64463,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
64470_3,INJ PARAVERTEBRAL C/T,ProFee,0989,64470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64472_3,INJ PARAVERTEBRAL C/T ADD-ON,ProFee,0989,64472,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64475_3,INJ PARAVERTEBRAL L/S,ProFee,0989,64475,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64476_3,INJ PARAVERTEBRAL L/S ADD-ON,ProFee,0989,64476,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64479_3,INJ FORAMEN EPIDURAL C/T,ProFee,0989,64479,,,,0,3.00,2.25,2.25,189.00,0.00,189.00,189.00,N/A
64480_3,INJ FORAMEN EPIDURAL ADD-ON,ProFee,0989,64480,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
64483_3,INJ FORAMEN EPIDURAL L/S,ProFee,0989,64483,,,,0,3.00,2.25,2.25,161.00,0.00,161.00,161.00,N/A
64484_3,INJ FORAMEN EPIDURAL ADD-ON,ProFee,0989,64484,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
64486_3,TAP BLOCK UNIL BY INJECTION,ProFee,0989,64486,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
64487_3,TAP BLOCK UNI BY INFUSION,ProFee,0989,64487,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
64488_3,TAP BLOCK BI INJECTION,ProFee,0989,64488,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
64489_3,TAP BLOCK BI BY INFUSION,ProFee,0989,64489,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
64490_3,INJ PARAVERT F JNT C/T 1 LEV,ProFee,0989,64490,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
64491_3,INJ PARAVERT F JNT C/T 2 LEV,ProFee,0989,64491,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
64492_3,INJ PARAVERT F JNT C/T 3 LEV,ProFee,0989,64492,,,,0,3.00,2.25,2.25,87.50,0.00,87.50,87.50,N/A
64493_3,INJ PARAVERT F JNT L/S 1 LEV,ProFee,0989,64493,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
64494_3,INJ PARAVERT F JNT L/S 2 LEV,ProFee,0989,64494,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
64495_3,INJ PARAVERT F JNT L/S 3 LEV,ProFee,0989,64495,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
64505_3,"N BLOCK, SPENOPALATINE GANGL",ProFee,0989,64505,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
64508_3,"N BLOCK, CAROTID SINUS S/P",ProFee,0989,64508,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
64510_3,"N BLOCK, STELLATE GANGLION",ProFee,0989,64510,,,,0,3.00,2.25,2.25,105.50,0.00,105.50,105.50,N/A
64517_3,"N BLOCK INJ, HYPOGAS PLXS",ProFee,0989,64517,,,,0,3.00,2.25,2.25,180.50,0.00,180.50,180.50,N/A
64520_3,"N BLOCK, LUMBAR/THORACIC",ProFee,0989,64520,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
64530_3,"N BLOCK INJ, CELIAC PELUS",ProFee,0989,64530,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
64550_3,APPLY NEUROSTIMULATOR,ProFee,0989,64550,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
64553_3,IMPLANT NEUROELECTRODES,ProFee,0989,64553,,,,0,3.00,2.25,2.25,546.50,0.00,546.50,546.50,N/A
64555_3,IMPLANT NEUROELECTRODES,ProFee,0989,64555,,,,0,3.00,2.25,2.25,487.00,0.00,487.00,487.00,N/A
64560_3,IMPLANT NEUROELECTRODES,ProFee,0989,64560,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64561_3,IMPLANT NEUROELECTRODES,ProFee,0989,64561,,,,0,3.00,2.25,2.25,438.00,0.00,438.00,438.00,N/A
64565_3,IMPLANT NEUROELECTRODES,ProFee,0989,64565,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64566_3,NEUROELTRD STIM POST TIBIAL,ProFee,0989,64566,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
64568_3,INC FOR VAGUS N ELECT IMPL,ProFee,0989,64568,,,,0,3.00,2.25,2.25,926.00,0.00,926.00,926.00,N/A
64569_3,REVISE/REPL VAGUS N ELTRD,ProFee,0989,64569,,,,0,3.00,2.25,2.25,1117.00,0.00,1117.00,1117.00,N/A
64570_3,REMOVE VAGUS N ELTRD,ProFee,0989,64570,,,,0,3.00,2.25,2.25,1074.00,0.00,1074.00,1074.00,N/A
64573_3,IMPLANT NEUROELECTRODES,ProFee,0989,64573,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64575_3,IMPLANT NEUROELECTRODES,ProFee,0989,64575,,,,0,3.00,2.25,2.25,464.00,0.00,464.00,464.00,N/A
64577_3,IMPLANT NEUROELECTRODES,ProFee,0989,64577,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64580_3,IMPLANT NEUROELECTRODES,ProFee,0989,64580,,,,0,3.00,2.25,2.25,440.50,0.00,440.50,440.50,N/A
64581_3,IMPLANT NEUROELECTRODES,ProFee,0989,64581,,,,0,3.00,2.25,2.25,959.00,0.00,959.00,959.00,N/A
64585_3,REVISE/REMOVE NEUROELECTRODE,ProFee,0989,64585,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
64590_3,INSRT/REDO PERPH N GENERATOR,ProFee,0989,64590,,,,0,3.00,2.25,2.25,232.50,0.00,232.50,232.50,N/A
64595_3,REVISE/REMOVE NEURORECEIVER,ProFee,0989,64595,,,,0,3.00,2.25,2.25,182.50,0.00,182.50,182.50,N/A
64600_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64600,,,,0,3.00,2.25,2.25,325.00,0.00,325.00,325.00,N/A
64605_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64605,,,,0,3.00,2.25,2.25,487.50,0.00,487.50,487.50,N/A
64610_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64610,,,,0,3.00,2.25,2.25,707.50,0.00,707.50,707.50,N/A
64611_3,CHEMODENERV SALIV GLANDS,ProFee,0989,64611,,,,0,3.00,2.25,2.25,148.50,0.00,148.50,148.50,N/A
64612_3,"DESTROY NERVE, FACE MUSCLE",ProFee,0989,64612,,,,0,3.00,2.25,2.25,168.50,0.00,168.50,168.50,N/A
64613_3,"DESTROY NERVE, SPINE MUSCLE",ProFee,0989,64613,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64614_3,"DESTROY NERVE, EXTREM MUSC",ProFee,0989,64614,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64615_3,CHEMODENERV MUSC MIGRAINE,ProFee,0989,64615,,,,0,3.00,2.25,2.25,180.00,0.00,180.00,180.00,N/A
64616_3,CHEMODENERV MUSC NECK DYSTON,ProFee,0989,64616,,,,0,3.00,2.25,2.25,159.50,0.00,159.50,159.50,N/A
64617_3,CHEMODENER MUSCLE LARYNX EMG,ProFee,0989,64617,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
64620_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64620,,,,0,3.00,2.25,2.25,247.00,0.00,247.00,247.00,N/A
64622_3,DESTR PARAVERTEBRL NERVE L/S,ProFee,0989,64622,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64623_3,DESTR PARAVERTEBRAL N ADD-ON,ProFee,0989,64623,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64624_3,DSTRJ NULYT AGT GNCLR NRV,ProFee,0989,64624,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64625_3,RF ABLTJ NRV NRVTG SI JT,ProFee,0989,64625,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64626_3,DESTR PARAVERTEBRL NERVE C/T,ProFee,0989,64626,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64627_3,DESTR PARAVERTEBRAL N ADD-ON,ProFee,0989,64627,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64630_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64630,,,,0,3.00,2.25,2.25,274.50,0.00,274.50,274.50,N/A
64632_3,"N BLOCK INJ, COMMON DIGIT",ProFee,0989,64632,,,,0,3.00,2.25,2.25,99.00,0.00,99.00,99.00,N/A
64633_3,DESTROY CERV/THOR FACET JNT,ProFee,0989,64633,,,,0,3.00,2.25,2.25,323.00,0.00,323.00,323.00,N/A
64634_3,DESTROY C/TH FACET JNT ADDL,ProFee,0989,64634,,,,0,3.00,2.25,2.25,98.00,0.00,98.00,98.00,N/A
64635_3,DESTROY LUMB/SAC FACET JNT,ProFee,0989,64635,,,,0,3.00,2.25,2.25,318.50,0.00,318.50,318.50,N/A
64636_3,DESTROY L/S FACET JNT ADDL,ProFee,0989,64636,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
64640_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64640,,,,0,3.00,2.25,2.25,133.50,0.00,133.50,133.50,N/A
64642_3,CHEMODENERV 1 EXTREMITY 1-4,ProFee,0989,64642,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
64643_3,CHEMODENERV 1 EXTREM 1-4 EA,ProFee,0989,64643,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
64644_3,CHEMODENERV 1 EXTREM 5/> MUS,ProFee,0989,64644,,,,0,3.00,2.25,2.25,171.00,0.00,171.00,171.00,N/A
64645_3,CHEMODENERV 1 EXTREM 5/> EA,ProFee,0989,64645,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
64646_3,CHEMODENERV TRUNK MUSC 1-5,ProFee,0989,64646,,,,0,3.00,2.25,2.25,168.00,0.00,168.00,168.00,N/A
64647_3,CHEMODENERV TRUNK MUSC 6/>,ProFee,0989,64647,,,,0,3.00,2.25,2.25,200.00,0.00,200.00,200.00,N/A
64650_3,CHEMODENERV ECCRINE GLANDS,ProFee,0989,64650,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
64653_3,CHEMODENERV ECCRINE GLANDS,ProFee,0989,64653,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
64680_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64680,,,,0,3.00,2.25,2.25,234.50,0.00,234.50,234.50,N/A
64681_3,INJECTION TREATMENT OF NERVE,ProFee,0989,64681,,,,0,3.00,2.25,2.25,350.50,0.00,350.50,350.50,N/A
64702_3,REVISE FINGER/TOE NERVE,ProFee,0989,64702,,,,0,3.00,2.25,2.25,719.50,0.00,719.50,719.50,N/A
64704_3,REVISE HAND/FOOT NERVE,ProFee,0989,64704,,,,0,3.00,2.25,2.25,458.50,0.00,458.50,458.50,N/A
64708_3,REVISE ARM/LEG NERVE,ProFee,0989,64708,,,,0,3.00,2.25,2.25,717.50,0.00,717.50,717.50,N/A
64712_3,REVISION OF SCIATIC NERVE,ProFee,0989,64712,,,,0,3.00,2.25,2.25,831.50,0.00,831.50,831.50,N/A
64713_3,REVISION OF ARM NERVE(S),ProFee,0989,64713,,,,0,3.00,2.25,2.25,1106.50,0.00,1106.50,1106.50,N/A
64714_3,REVISE LOW BACK NERVE(S),ProFee,0989,64714,,,,0,3.00,2.25,2.25,1023.00,0.00,1023.00,1023.00,N/A
64716_3,REVISION OF CRANIAL NERVE,ProFee,0989,64716,,,,0,3.00,2.25,2.25,759.00,0.00,759.00,759.00,N/A
64718_3,REVISE ULNAR NERVE AT ELBOW,ProFee,0989,64718,,,,0,3.00,2.25,2.25,852.00,0.00,852.00,852.00,N/A
64719_3,REVISE ULNAR NERVE AT WRIST,ProFee,0989,64719,,,,0,3.00,2.25,2.25,575.50,0.00,575.50,575.50,N/A
64721_3,CARPAL TUNNEL SURGERY,ProFee,0989,64721,,,,0,3.00,2.25,2.25,613.50,0.00,613.50,613.50,N/A
64722_3,RELIEVE PRESSURE ON NERVE(S),ProFee,0989,64722,,,,0,3.00,2.25,2.25,515.00,0.00,515.00,515.00,N/A
64726_3,RELEASE FOOT/TOE NERVE,ProFee,0989,64726,,,,0,3.00,2.25,2.25,389.50,0.00,389.50,389.50,N/A
64727_3,INTERNAL NERVE REVISION,ProFee,0989,64727,,,,0,3.00,2.25,2.25,266.50,0.00,266.50,266.50,N/A
64732_3,INCISION OF BROW NERVE,ProFee,0989,64732,,,,0,3.00,2.25,2.25,641.00,0.00,641.00,641.00,N/A
64734_3,INCISION OF CHEEK NERVE,ProFee,0989,64734,,,,0,3.00,2.25,2.25,726.00,0.00,726.00,726.00,N/A
64736_3,INCISION OF CHIN NERVE,ProFee,0989,64736,,,,0,3.00,2.25,2.25,557.00,0.00,557.00,557.00,N/A
64738_3,INCISION OF JAW NERVE,ProFee,0989,64738,,,,0,3.00,2.25,2.25,667.00,0.00,667.00,667.00,N/A
64740_3,INCISION OF TONGUE NERVE,ProFee,0989,64740,,,,0,3.00,2.25,2.25,709.00,0.00,709.00,709.00,N/A
64742_3,INCISION OF FACIAL NERVE,ProFee,0989,64742,,,,0,3.00,2.25,2.25,707.00,0.00,707.00,707.00,N/A
64744_3,"INCISE NERVE, BACK OF HEAD",ProFee,0989,64744,,,,0,3.00,2.25,2.25,718.50,0.00,718.50,718.50,N/A
64746_3,INCISE DIAPHRAGM NERVE,ProFee,0989,64746,,,,0,3.00,2.25,2.25,619.50,0.00,619.50,619.50,N/A
64752_3,INCISION OF VAGUS NERVE,ProFee,0989,64752,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64755_3,INCISION OF STOMACH NERVES,ProFee,0989,64755,,,,0,3.00,2.25,2.25,1330.00,0.00,1330.00,1330.00,N/A
64760_3,INCISION OF VAGUS NERVE,ProFee,0989,64760,,,,0,3.00,2.25,2.25,742.50,0.00,742.50,742.50,N/A
64761_3,INCISION OF PELVIS NERVE,ProFee,0989,64761,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64763_3,INCISE HIP/THIGH NERVE,ProFee,0989,64763,,,,0,3.00,2.25,2.25,735.00,0.00,735.00,735.00,N/A
64766_3,INCISE HIP/THIGH NERVE,ProFee,0989,64766,,,,0,3.00,2.25,2.25,905.50,0.00,905.50,905.50,N/A
64771_3,SEVER CRANIAL NERVE,ProFee,0989,64771,,,,0,3.00,2.25,2.25,854.50,0.00,854.50,854.50,N/A
64772_3,INCISION OF SPINAL NERVE,ProFee,0989,64772,,,,0,3.00,2.25,2.25,813.50,0.00,813.50,813.50,N/A
64774_3,REMOVE SKIN NERVE LESION,ProFee,0989,64774,,,,0,3.00,2.25,2.25,592.50,0.00,592.50,592.50,N/A
64776_3,REMOVE DIGIT NERVE LESION,ProFee,0989,64776,,,,0,3.00,2.25,2.25,562.00,0.00,562.00,562.00,N/A
64778_3,DIGIT NERVE SURGERY ADD-ON,ProFee,0989,64778,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
64782_3,REMOVE LIMB NERVE LESION,ProFee,0989,64782,,,,0,3.00,2.25,2.25,655.50,0.00,655.50,655.50,N/A
64783_3,LIMB NERVE SURGERY ADD-ON,ProFee,0989,64783,,,,0,3.00,2.25,2.25,317.50,0.00,317.50,317.50,N/A
64784_3,REMOVE NERVE LESION,ProFee,0989,64784,,,,0,3.00,2.25,2.25,1046.00,0.00,1046.00,1046.00,N/A
64786_3,REMOVE SCIATIC NERVE LESION,ProFee,0989,64786,,,,0,3.00,2.25,2.25,1446.00,0.00,1446.00,1446.00,N/A
64787_3,IMPLANT NERVE END,ProFee,0989,64787,,,,0,3.00,2.25,2.25,349.00,0.00,349.00,349.00,N/A
64788_3,REMOVE SKIN NERVE LESION,ProFee,0989,64788,,,,0,3.00,2.25,2.25,569.00,0.00,569.00,569.00,N/A
64790_3,REMOVAL OF NERVE LESION,ProFee,0989,64790,,,,0,3.00,2.25,2.25,1212.50,0.00,1212.50,1212.50,N/A
64792_3,REMOVAL OF NERVE LESION,ProFee,0989,64792,,,,0,3.00,2.25,2.25,1740.50,0.00,1740.50,1740.50,N/A
64795_3,BIOPSY OF NERVE,ProFee,0989,64795,,,,0,3.00,2.25,2.25,282.00,0.00,282.00,282.00,N/A
64802_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64802,,,,0,3.00,2.25,2.25,1212.50,0.00,1212.50,1212.50,N/A
64804_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64804,,,,0,3.00,2.25,2.25,1730.00,0.00,1730.00,1730.00,N/A
64809_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64809,,,,0,3.00,2.25,2.25,1590.50,0.00,1590.50,1590.50,N/A
64818_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64818,,,,0,3.00,2.25,2.25,909.00,0.00,909.00,909.00,N/A
64820_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64820,,,,0,3.00,2.25,2.25,1025.00,0.00,1025.00,1025.00,N/A
64821_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64821,,,,0,3.00,2.25,2.25,998.00,0.00,998.00,998.00,N/A
64822_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64822,,,,0,3.00,2.25,2.25,998.00,0.00,998.00,998.00,N/A
64823_3,REMOVE SYMPATHETIC NERVES,ProFee,0989,64823,,,,0,3.00,2.25,2.25,1136.50,0.00,1136.50,1136.50,N/A
64831_3,REPAIR OF DIGIT NERVE,ProFee,0989,64831,,,,0,3.00,2.25,2.25,988.50,0.00,988.50,988.50,N/A
64832_3,REPAIR NERVE ADD-ON,ProFee,0989,64832,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
64834_3,REPAIR OF HAND OR FOOT NERVE,ProFee,0989,64834,,,,0,3.00,2.25,2.25,1066.00,0.00,1066.00,1066.00,N/A
64835_3,REPAIR OF HAND OR FOOT NERVE,ProFee,0989,64835,,,,0,3.00,2.25,2.25,1176.00,0.00,1176.00,1176.00,N/A
64836_3,REPAIR OF HAND OR FOOT NERVE,ProFee,0989,64836,,,,0,3.00,2.25,2.25,1176.00,0.00,1176.00,1176.00,N/A
64837_3,REPAIR NERVE ADD-ON,ProFee,0989,64837,,,,0,3.00,2.25,2.25,535.00,0.00,535.00,535.00,N/A
64840_3,REPAIR OF LEG NERVE,ProFee,0989,64840,,,,0,3.00,2.25,2.25,1389.00,0.00,1389.00,1389.00,N/A
64856_3,REPAIR/TRANSPOSE NERVE,ProFee,0989,64856,,,,0,3.00,2.25,2.25,1461.50,0.00,1461.50,1461.50,N/A
64857_3,REPAIR ARM/LEG NERVE,ProFee,0989,64857,,,,0,3.00,2.25,2.25,1527.50,0.00,1527.50,1527.50,N/A
64858_3,REPAIR SCIATIC NERVE,ProFee,0989,64858,,,,0,3.00,2.25,2.25,1703.00,0.00,1703.00,1703.00,N/A
64859_3,NERVE SURGERY,ProFee,0989,64859,,,,0,3.00,2.25,2.25,363.50,0.00,363.50,363.50,N/A
64861_3,REPAIR OF ARM NERVES,ProFee,0989,64861,,,,0,3.00,2.25,2.25,2218.50,0.00,2218.50,2218.50,N/A
64862_3,REPAIR OF LOW BACK NERVES,ProFee,0989,64862,,,,0,3.00,2.25,2.25,1994.50,0.00,1994.50,1994.50,N/A
64864_3,REPAIR OF FACIAL NERVE,ProFee,0989,64864,,,,0,3.00,2.25,2.25,1256.50,0.00,1256.50,1256.50,N/A
64865_3,REPAIR OF FACIAL NERVE,ProFee,0989,64865,,,,0,3.00,2.25,2.25,1569.00,0.00,1569.00,1569.00,N/A
64866_3,FUSION OF FACIAL/OTHER NERVE,ProFee,0989,64866,,,,0,3.00,2.25,2.25,1854.50,0.00,1854.50,1854.50,N/A
64868_3,FUSION OF FACIAL/OTHER NERVE,ProFee,0989,64868,,,,0,3.00,2.25,2.25,1436.50,0.00,1436.50,1436.50,N/A
64870_3,FUSION OF FACIAL/OTHER NERVE,ProFee,0989,64870,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
64872_3,SUBSEQUENT REPAIR OF NERVE,ProFee,0989,64872,,,,0,3.00,2.25,2.25,169.50,0.00,169.50,169.50,N/A
64874_3,REPAIR & REVISE NERVE ADD-ON,ProFee,0989,64874,,,,0,3.00,2.25,2.25,255.00,0.00,255.00,255.00,N/A
64876_3,REPAIR NERVE/SHORTEN BONE,ProFee,0989,64876,,,,0,3.00,2.25,2.25,288.50,0.00,288.50,288.50,N/A
64885_3,"NERVE GRAFT, HEAD OR NECK",ProFee,0989,64885,,,,0,3.00,2.25,2.25,1611.50,0.00,1611.50,1611.50,N/A
64886_3,"NERVE GRAFT, HEAD OR NECK",ProFee,0989,64886,,,,0,3.00,2.25,2.25,1848.50,0.00,1848.50,1848.50,N/A
64890_3,"NERVE GRAFT, HAND OR FOOT",ProFee,0989,64890,,,,0,3.00,2.25,2.25,1562.50,0.00,1562.50,1562.50,N/A
64891_3,"NERVE GRAFT, HAND OR FOOT",ProFee,0989,64891,,,,0,3.00,2.25,2.25,1662.00,0.00,1662.00,1662.00,N/A
64892_3,"NERVE GRAFT, ARM OR LEG",ProFee,0989,64892,,,,0,3.00,2.25,2.25,1519.00,0.00,1519.00,1519.00,N/A
64893_3,"NERVE GRAFT, ARM OR LEG",ProFee,0989,64893,,,,0,3.00,2.25,2.25,1621.50,0.00,1621.50,1621.50,N/A
64895_3,"NERVE GRAFT, HAND OR FOOT",ProFee,0989,64895,,,,0,3.00,2.25,2.25,1922.50,0.00,1922.50,1922.50,N/A
64896_3,"NERVE GRAFT, HAND OR FOOT",ProFee,0989,64896,,,,0,3.00,2.25,2.25,2073.50,0.00,2073.50,2073.50,N/A
64897_3,"NERVE GRAFT, ARM OR LEG",ProFee,0989,64897,,,,0,3.00,2.25,2.25,1836.00,0.00,1836.00,1836.00,N/A
64898_3,"NERVE GRAFT, ARM OR LEG",ProFee,0989,64898,,,,0,3.00,2.25,2.25,1990.50,0.00,1990.50,1990.50,N/A
64901_3,NERVE GRAFT ADD-ON,ProFee,0989,64901,,,,0,3.00,2.25,2.25,872.00,0.00,872.00,872.00,N/A
64902_3,NERVE GRAFT ADD-ON,ProFee,0989,64902,,,,0,3.00,2.25,2.25,1009.50,0.00,1009.50,1009.50,N/A
64905_3,NERVE PEDICLE TRANSFER,ProFee,0989,64905,,,,0,3.00,2.25,2.25,1465.00,0.00,1465.00,1465.00,N/A
64907_3,NERVE PEDICLE TRANSFER,ProFee,0989,64907,,,,0,3.00,2.25,2.25,1885.50,0.00,1885.50,1885.50,N/A
64910_3,NERVE REPAIR W/ALLOGRAFT,ProFee,0989,64910,,,,0,3.00,2.25,2.25,1154.50,0.00,1154.50,1154.50,N/A
64911_3,NEURORRAPHY W/VEIN AUTOGRAFT,ProFee,0989,64911,,,,0,3.00,2.25,2.25,1481.00,0.00,1481.00,1481.00,N/A
64912_3,NRV RPR W/NRV ALGRFT 1ST,ProFee,0989,64912,,,,0,3.00,2.25,2.25,1119.50,0.00,1119.50,1119.50,N/A
64913_3,NRV RPR W/NRV ALGRFT EA ADDL,ProFee,0989,64913,,,,0,3.00,2.25,2.25,227.00,0.00,227.00,227.00,N/A
64999_3,NERVOUS SYSTEM SURGERY,ProFee,0989,64999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
65091_3,REVISE EYE,ProFee,0989,65091,,,,0,3.00,2.25,2.25,904.50,0.00,904.50,904.50,N/A
65093_3,REVISE EYE WITH IMPLANT,ProFee,0989,65093,,,,0,3.00,2.25,2.25,894.50,0.00,894.50,894.50,N/A
65101_3,REMOVAL OF EYE,ProFee,0989,65101,,,,0,3.00,2.25,2.25,1051.00,0.00,1051.00,1051.00,N/A
65103_3,REMOVE EYE/INSERT IMPLANT,ProFee,0989,65103,,,,0,3.00,2.25,2.25,1097.00,0.00,1097.00,1097.00,N/A
65105_3,REMOVE EYE/ATTACH IMPLANT,ProFee,0989,65105,,,,0,3.00,2.25,2.25,1209.00,0.00,1209.00,1209.00,N/A
65110_3,REMOVAL OF EYE,ProFee,0989,65110,,,,0,3.00,2.25,2.25,1738.50,0.00,1738.50,1738.50,N/A
65112_3,REMOVE EYE/REVISE SOCKET,ProFee,0989,65112,,,,0,3.00,2.25,2.25,2016.50,0.00,2016.50,2016.50,N/A
65114_3,REMOVE EYE/REVISE SOCKET,ProFee,0989,65114,,,,0,3.00,2.25,2.25,2114.50,0.00,2114.50,2114.50,N/A
65125_3,REVISE OCULAR IMPLANT,ProFee,0989,65125,,,,0,3.00,2.25,2.25,417.50,0.00,417.50,417.50,N/A
65130_3,INSERT OCULAR IMPLANT,ProFee,0989,65130,,,,0,3.00,2.25,2.25,1042.50,0.00,1042.50,1042.50,N/A
65135_3,INSERT OCULAR IMPLANT,ProFee,0989,65135,,,,0,3.00,2.25,2.25,1057.50,0.00,1057.50,1057.50,N/A
65140_3,ATTACH OCULAR IMPLANT,ProFee,0989,65140,,,,0,3.00,2.25,2.25,1149.50,0.00,1149.50,1149.50,N/A
65150_3,REVISE OCULAR IMPLANT,ProFee,0989,65150,,,,0,3.00,2.25,2.25,823.00,0.00,823.00,823.00,N/A
65155_3,REINSERT OCULAR IMPLANT,ProFee,0989,65155,,,,0,3.00,2.25,2.25,1204.50,0.00,1204.50,1204.50,N/A
65175_3,REMOVAL OF OCULAR IMPLANT,ProFee,0989,65175,,,,0,3.00,2.25,2.25,935.50,0.00,935.50,935.50,N/A
65205_2,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65205,,,,0,342.00,256.50,256.50,324.90,307.80,324.90,324.90,307.80
65205_2,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65205,,,,0,342.00,256.50,256.50,324.90,307.80,324.90,0.00,307.80
65205_3,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65205,,,,0,336.00,252.00,252.00,319.20,302.40,319.20,0.00,302.40
65205_3,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65205,,,,0,336.00,252.00,252.00,319.20,302.40,319.20,319.20,302.40
65210_2,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65210,,,,0,366.00,274.50,274.50,347.70,329.40,347.70,347.70,329.40
65210_2,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65210,,,,0,366.00,274.50,274.50,347.70,329.40,347.70,0.00,329.40
65210_3,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65210,,,,0,359.00,269.25,269.25,341.05,323.10,341.05,0.00,323.10
65210_3,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65210,,,,0,359.00,269.25,269.25,341.05,323.10,341.05,341.05,323.10
65220_2,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65220,,,,0,431.00,323.25,323.25,409.45,387.90,409.45,409.45,387.90
65220_2,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65220,,,,0,431.00,323.25,323.25,409.45,387.90,409.45,0.00,387.90
65220_3,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65220,,,,0,422.00,316.50,316.50,400.90,379.80,400.90,400.90,379.80
65220_3,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65220,,,,0,422.00,316.50,316.50,400.90,379.80,400.90,0.00,379.80
65222_2,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65222,,,,0,374.00,280.50,280.50,355.30,336.60,355.30,0.00,336.60
65222_2,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65222,,,,0,374.00,280.50,280.50,355.30,336.60,355.30,355.30,336.60
65222_3,REMOVE FOREIGN BODY FROM EYE,Inpatient,0521,65222,,,,0,367.00,275.25,275.25,348.65,330.30,348.65,348.65,330.30
65222_3,REMOVE FOREIGN BODY FROM EYE,Outpatient,0521,65222,,,,0,367.00,275.25,275.25,348.65,330.30,348.65,0.00,330.30
65235_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65235,,,,0,3.00,2.25,2.25,1012.00,0.00,1012.00,1012.00,N/A
65260_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65260,,,,0,3.00,2.25,2.25,1368.50,0.00,1368.50,1368.50,N/A
65265_3,REMOVE FOREIGN BODY FROM EYE,ProFee,0989,65265,,,,0,3.00,2.25,2.25,1535.50,0.00,1535.50,1535.50,N/A
65270_3,REPAIR OF EYE WOUND,ProFee,0989,65270,,,,0,3.00,2.25,2.25,201.50,0.00,201.50,201.50,N/A
65272_3,REPAIR OF EYE WOUND,ProFee,0989,65272,,,,0,3.00,2.25,2.25,500.00,0.00,500.00,500.00,N/A
65273_3,REPAIR OF EYE WOUND,ProFee,0989,65273,,,,0,3.00,2.25,2.25,542.50,0.00,542.50,542.50,N/A
65275_3,REPAIR OF EYE WOUND,ProFee,0989,65275,,,,0,3.00,2.25,2.25,659.00,0.00,659.00,659.00,N/A
65280_3,REPAIR OF EYE WOUND,ProFee,0989,65280,,,,0,3.00,2.25,2.25,957.50,0.00,957.50,957.50,N/A
65285_3,REPAIR OF EYE WOUND,ProFee,0989,65285,,,,0,3.00,2.25,2.25,1580.00,0.00,1580.00,1580.00,N/A
65286_3,REPAIR OF EYE WOUND,ProFee,0989,65286,,,,0,3.00,2.25,2.25,707.00,0.00,707.00,707.00,N/A
65290_3,REPAIR OF EYE SOCKET WOUND,ProFee,0989,65290,,,,0,3.00,2.25,2.25,699.50,0.00,699.50,699.50,N/A
65400_3,REMOVAL OF EYE LESION,ProFee,0989,65400,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
65410_3,BIOPSY OF CORNEA,ProFee,0989,65410,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
65420_3,REMOVAL OF EYE LESION,ProFee,0989,65420,,,,0,3.00,2.25,2.25,538.50,0.00,538.50,538.50,N/A
65426_3,REMOVAL OF EYE LESION,ProFee,0989,65426,,,,0,3.00,2.25,2.25,683.00,0.00,683.00,683.00,N/A
65430_3,CORNEAL SMEAR,ProFee,0989,65430,,,,0,3.00,2.25,2.25,147.50,0.00,147.50,147.50,N/A
65435_3,CURETTE/TREAT CORNEA,ProFee,0989,65435,,,,0,3.00,2.25,2.25,99.50,0.00,99.50,99.50,N/A
65436_3,CURETTE/TREAT CORNEA,ProFee,0989,65436,,,,0,3.00,2.25,2.25,529.50,0.00,529.50,529.50,N/A
65450_3,TREATMENT OF CORNEAL LESION,ProFee,0989,65450,,,,0,3.00,2.25,2.25,459.50,0.00,459.50,459.50,N/A
65600_3,REVISION OF CORNEA,ProFee,0989,65600,,,,0,3.00,2.25,2.25,490.00,0.00,490.00,490.00,N/A
65710_3,CORNEAL TRANSPLANT,ProFee,0989,65710,,,,0,3.00,2.25,2.25,1574.50,0.00,1574.50,1574.50,N/A
65730_3,CORNEAL TRANSPLANT,ProFee,0989,65730,,,,0,3.00,2.25,2.25,1748.50,0.00,1748.50,1748.50,N/A
65750_3,CORNEAL TRANSPLANT,ProFee,0989,65750,,,,0,3.00,2.25,2.25,1756.50,0.00,1756.50,1756.50,N/A
65755_3,CORNEAL TRANSPLANT,ProFee,0989,65755,,,,0,3.00,2.25,2.25,1748.00,0.00,1748.00,1748.00,N/A
65756_3,"CORNEAL TRNSPL, ENDOTHELIAL",ProFee,0989,65756,,,,0,3.00,2.25,2.25,1687.50,0.00,1687.50,1687.50,N/A
65757_3,PREP CORNEAL ENDO ALLOGRAFT,ProFee,0989,65757,,,,0,3.00,2.25,2.25,198.00,0.00,198.00,198.00,N/A
65760_3,REVISION OF CORNEA,ProFee,0989,65760,,,,0,3.00,2.25,2.25,1662.50,0.00,1662.50,1662.50,N/A
65765_3,REVISION OF CORNEA,ProFee,0989,65765,,,,0,3.00,2.25,2.25,2410.00,0.00,2410.00,2410.00,N/A
65767_3,CORNEAL TISSUE TRANSPLANT,ProFee,0989,65767,,,,0,3.00,2.25,2.25,2244.50,0.00,2244.50,2244.50,N/A
65770_3,REVISE CORNEA WITH IMPLANT,ProFee,0989,65770,,,,0,3.00,2.25,2.25,1996.00,0.00,1996.00,1996.00,N/A
65771_3,RADIAL KERATOTOMY,ProFee,0989,65771,,,,0,3.00,2.25,2.25,915.00,0.00,915.00,915.00,N/A
65772_3,CORRECTION OF ASTIGMATISM,ProFee,0989,65772,,,,0,3.00,2.25,2.25,579.50,0.00,579.50,579.50,N/A
65775_3,CORRECTION OF ASTIGMATISM,ProFee,0989,65775,,,,0,3.00,2.25,2.25,786.00,0.00,786.00,786.00,N/A
65778_3,COVER EYE W/MEMBRANE,ProFee,0989,65778,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
65779_3,COVER EYE W/MEMBRANE STENT,ProFee,0989,65779,,,,0,3.00,2.25,2.25,217.50,0.00,217.50,217.50,N/A
65780_3,"OCULAR RECONST, TRANSPLANT",ProFee,0989,65780,,,,0,3.00,2.25,2.25,950.00,0.00,950.00,950.00,N/A
65781_3,"OCULAR RECONST, TRANSPLANT",ProFee,0989,65781,,,,0,3.00,2.25,2.25,1900.50,0.00,1900.50,1900.50,N/A
65782_3,"OCULAR RECONST, TRANSPLANT",ProFee,0989,65782,,,,0,3.00,2.25,2.25,1640.00,0.00,1640.00,1640.00,N/A
65785_3,IMPLTJ NTRSTRML CRNL RNG SEG,ProFee,0989,65785,,,,0,3.00,2.25,2.25,631.00,0.00,631.00,631.00,N/A
65800_3,DRAINAGE OF EYE,ProFee,0989,65800,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
65805_3,DRAINAGE OF EYE,ProFee,0989,65805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
65810_3,DRAINAGE OF EYE,ProFee,0989,65810,,,,0,3.00,2.25,2.25,663.50,0.00,663.50,663.50,N/A
65815_3,DRAINAGE OF EYE,ProFee,0989,65815,,,,0,3.00,2.25,2.25,681.50,0.00,681.50,681.50,N/A
65820_3,RELIEVE INNER EYE PRESSURE,ProFee,0989,65820,,,,0,3.00,2.25,2.25,1067.50,0.00,1067.50,1067.50,N/A
65850_3,INCISION OF EYE,ProFee,0989,65850,,,,0,3.00,2.25,2.25,1196.00,0.00,1196.00,1196.00,N/A
65855_3,LASER SURGERY OF EYE,ProFee,0989,65855,,,,0,3.00,2.25,2.25,296.50,0.00,296.50,296.50,N/A
65860_3,INCISE INNER EYE ADHESIONS,ProFee,0989,65860,,,,0,3.00,2.25,2.25,361.50,0.00,361.50,361.50,N/A
65865_3,INCISE INNER EYE ADHESIONS,ProFee,0989,65865,,,,0,3.00,2.25,2.25,674.00,0.00,674.00,674.00,N/A
65870_3,INCISE INNER EYE ADHESIONS,ProFee,0989,65870,,,,0,3.00,2.25,2.25,842.00,0.00,842.00,842.00,N/A
65875_3,INCISE INNER EYE ADHESIONS,ProFee,0989,65875,,,,0,3.00,2.25,2.25,898.50,0.00,898.50,898.50,N/A
65880_3,INCISE INNER EYE ADHESIONS,ProFee,0989,65880,,,,0,3.00,2.25,2.25,945.50,0.00,945.50,945.50,N/A
65900_3,REMOVE EYE LESION,ProFee,0989,65900,,,,0,3.00,2.25,2.25,1373.00,0.00,1373.00,1373.00,N/A
65920_3,REMOVE IMPLANT OF EYE,ProFee,0989,65920,,,,0,3.00,2.25,2.25,1123.00,0.00,1123.00,1123.00,N/A
65930_3,REMOVE BLOOD CLOT FROM EYE,ProFee,0989,65930,,,,0,3.00,2.25,2.25,908.00,0.00,908.00,908.00,N/A
66020_3,INJECTION TREATMENT OF EYE,ProFee,0989,66020,,,,0,3.00,2.25,2.25,187.50,0.00,187.50,187.50,N/A
66030_3,INJECTION TREATMENT OF EYE,ProFee,0989,66030,,,,0,3.00,2.25,2.25,159.00,0.00,159.00,159.00,N/A
66130_3,REMOVE EYE LESION,ProFee,0989,66130,,,,0,3.00,2.25,2.25,810.50,0.00,810.50,810.50,N/A
66150_3,GLAUCOMA SURGERY,ProFee,0989,66150,,,,0,3.00,2.25,2.25,1249.50,0.00,1249.50,1249.50,N/A
66155_3,GLAUCOMA SURGERY,ProFee,0989,66155,,,,0,3.00,2.25,2.25,1248.50,0.00,1248.50,1248.50,N/A
66160_3,GLAUCOMA SURGERY,ProFee,0989,66160,,,,0,3.00,2.25,2.25,1407.50,0.00,1407.50,1407.50,N/A
66165_3,GLAUCOMA SURGERY,ProFee,0989,66165,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
66170_3,GLAUCOMA SURGERY,ProFee,0989,66170,,,,0,3.00,2.25,2.25,1559.00,0.00,1559.00,1559.00,N/A
66172_3,INCISION OF EYE,ProFee,0989,66172,,,,0,3.00,2.25,2.25,1698.00,0.00,1698.00,1698.00,N/A
66174_3,TRANSLUM DIL EYE CANAL,ProFee,0989,66174,,,,0,3.00,2.25,2.25,1350.50,0.00,1350.50,1350.50,N/A
66175_3,TRNSLUM DIL EYE CANAL W/STNT,ProFee,0989,66175,,,,0,3.00,2.25,2.25,1414.00,0.00,1414.00,1414.00,N/A
66179_3,AQUEOUS SHUNT EYE W/O GRAFT,ProFee,0989,66179,,,,0,3.00,2.25,2.25,1536.00,0.00,1536.00,1536.00,N/A
66180_3,IMPLANT EYE SHUNT,ProFee,0989,66180,,,,0,3.00,2.25,2.25,1620.50,0.00,1620.50,1620.50,N/A
66183_3,INSERT ANT DRAINAGE DEVICE,ProFee,0989,66183,,,,0,3.00,2.25,2.25,1468.00,0.00,1468.00,1468.00,N/A
66184_3,REVISION OF AQUEOUS SHUNT,ProFee,0989,66184,,,,0,3.00,2.25,2.25,1119.00,0.00,1119.00,1119.00,N/A
66185_3,REVISE EYE SHUNT,ProFee,0989,66185,,,,0,3.00,2.25,2.25,1203.50,0.00,1203.50,1203.50,N/A
66220_3,REPAIR EYE LESION,ProFee,0989,66220,,,,0,3.00,2.25,2.25,1064.50,0.00,1064.50,1064.50,N/A
66225_3,REPAIR/GRAFT EYE LESION,ProFee,0989,66225,,,,0,3.00,2.25,2.25,1328.00,0.00,1328.00,1328.00,N/A
66250_3,FOLLOW-UP SURGERY OF EYE,ProFee,0989,66250,,,,0,3.00,2.25,2.25,794.50,0.00,794.50,794.50,N/A
66500_3,INCISION OF IRIS,ProFee,0989,66500,,,,0,3.00,2.25,2.25,504.00,0.00,504.00,504.00,N/A
66505_3,INCISION OF IRIS,ProFee,0989,66505,,,,0,3.00,2.25,2.25,553.00,0.00,553.00,553.00,N/A
66600_3,REMOVE IRIS AND LESION,ProFee,0989,66600,,,,0,3.00,2.25,2.25,1187.00,0.00,1187.00,1187.00,N/A
66605_3,REMOVAL OF IRIS,ProFee,0989,66605,,,,0,3.00,2.25,2.25,1504.50,0.00,1504.50,1504.50,N/A
66625_3,REMOVAL OF IRIS,ProFee,0989,66625,,,,0,3.00,2.25,2.25,612.00,0.00,612.00,612.00,N/A
66630_3,REMOVAL OF IRIS,ProFee,0989,66630,,,,0,3.00,2.25,2.25,811.50,0.00,811.50,811.50,N/A
66635_3,REMOVAL OF IRIS,ProFee,0989,66635,,,,0,3.00,2.25,2.25,819.50,0.00,819.50,819.50,N/A
66680_3,REPAIR IRIS & CILIARY BODY,ProFee,0989,66680,,,,0,3.00,2.25,2.25,737.50,0.00,737.50,737.50,N/A
66682_3,REPAIR IRIS & CILIARY BODY,ProFee,0989,66682,,,,0,3.00,2.25,2.25,909.50,0.00,909.50,909.50,N/A
66700_3,"DESTRUCTION, CILIARY BODY",ProFee,0989,66700,,,,0,3.00,2.25,2.25,561.00,0.00,561.00,561.00,N/A
66710_3,CILIARY TRANSSLERAL THERAPY,ProFee,0989,66710,,,,0,3.00,2.25,2.25,560.50,0.00,560.50,560.50,N/A
66711_3,CILIARY ENDOSCOPIC ABLATION,ProFee,0989,66711,,,,0,3.00,2.25,2.25,916.50,0.00,916.50,916.50,N/A
66720_3,"DESTRUCTION, CILIARY BODY",ProFee,0989,66720,,,,0,3.00,2.25,2.25,583.50,0.00,583.50,583.50,N/A
66740_3,"DESTRUCTION, CILIARY BODY",ProFee,0989,66740,,,,0,3.00,2.25,2.25,561.00,0.00,561.00,561.00,N/A
66761_3,REVISION OF IRIS,ProFee,0989,66761,,,,0,3.00,2.25,2.25,336.50,0.00,336.50,336.50,N/A
66762_3,REVISION OF IRIS,ProFee,0989,66762,,,,0,3.00,2.25,2.25,607.50,0.00,607.50,607.50,N/A
66770_3,REMOVAL OF INNER EYE LESION,ProFee,0989,66770,,,,0,3.00,2.25,2.25,688.50,0.00,688.50,688.50,N/A
66820_3,"INCISION, SECONDARY CATARACT",ProFee,0989,66820,,,,0,3.00,2.25,2.25,563.00,0.00,563.00,563.00,N/A
66821_3,AFTER CATARACT LASER SURGERY,ProFee,0989,66821,,,,0,3.00,2.25,2.25,443.50,0.00,443.50,443.50,N/A
66825_3,REPOSITION INTRAOCULAR LENS,ProFee,0989,66825,,,,0,3.00,2.25,2.25,1082.50,0.00,1082.50,1082.50,N/A
66830_3,REMOVAL OF LENS LESION,ProFee,0989,66830,,,,0,3.00,2.25,2.25,1014.50,0.00,1014.50,1014.50,N/A
66840_3,REMOVAL OF LENS MATERIAL,ProFee,0989,66840,,,,0,3.00,2.25,2.25,993.00,0.00,993.00,993.00,N/A
66850_3,REMOVAL OF LENS MATERIAL,ProFee,0989,66850,,,,0,3.00,2.25,2.25,1130.00,0.00,1130.00,1130.00,N/A
66852_3,REMOVAL OF LENS MATERIAL,ProFee,0989,66852,,,,0,3.00,2.25,2.25,1203.50,0.00,1203.50,1203.50,N/A
66920_3,EXTRACTION OF LENS,ProFee,0989,66920,,,,0,3.00,2.25,2.25,1074.50,0.00,1074.50,1074.50,N/A
66930_3,EXTRACTION OF LENS,ProFee,0989,66930,,,,0,3.00,2.25,2.25,1220.50,0.00,1220.50,1220.50,N/A
66940_3,EXTRACTION OF LENS,ProFee,0989,66940,,,,0,3.00,2.25,2.25,1115.00,0.00,1115.00,1115.00,N/A
66982_3,"CATARACT SURGERY, COMPLEX",ProFee,0989,66982,,,,0,3.00,2.25,2.25,1132.50,0.00,1132.50,1132.50,N/A
66983_3,"CATARACT SURG W/IOL, 1 STAGE",ProFee,0989,66983,,,,0,3.00,2.25,2.25,1062.00,0.00,1062.00,1062.00,N/A
66984_3,"CATARACT SURG W/IOL, 1 STAGE",ProFee,0989,66984,,,,0,3.00,2.25,2.25,911.50,0.00,911.50,911.50,N/A
66985_3,INSERT LENS PROSTHESIS,ProFee,0989,66985,,,,0,3.00,2.25,2.25,1098.00,0.00,1098.00,1098.00,N/A
66986_3,EXCHANGE LENS PROSTHESIS,ProFee,0989,66986,,,,0,3.00,2.25,2.25,1295.00,0.00,1295.00,1295.00,N/A
66987_3,XCAPSL CTRC RMVL CPLX W/ECP,ProFee,0989,66987,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
66988_3,XCAPSL CTRC RMVL W/ECP,ProFee,0989,66988,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
66990_3,OPHTHALMIC ENDOSCOPE ADD-ON,ProFee,0989,66990,,,,0,3.00,2.25,2.25,128.50,0.00,128.50,128.50,N/A
66999_3,EYE SURGERY PROCEDURE,ProFee,0989,66999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
67005_3,PARTIAL REMOVAL OF EYE FLUID,ProFee,0989,67005,,,,0,3.00,2.25,2.25,673.50,0.00,673.50,673.50,N/A
67010_3,PARTIAL REMOVAL OF EYE FLUID,ProFee,0989,67010,,,,0,3.00,2.25,2.25,773.50,0.00,773.50,773.50,N/A
67015_3,RELEASE OF EYE FLUID,ProFee,0989,67015,,,,0,3.00,2.25,2.25,827.00,0.00,827.00,827.00,N/A
67025_3,REPLACE EYE FLUID,ProFee,0989,67025,,,,0,3.00,2.25,2.25,902.50,0.00,902.50,902.50,N/A
67027_3,IMPLANT EYE DRUG SYSTEM,ProFee,0989,67027,,,,0,3.00,2.25,2.25,1214.50,0.00,1214.50,1214.50,N/A
67028_3,INJECTION EYE DRUG,ProFee,0989,67028,,,,0,3.00,2.25,2.25,143.00,0.00,143.00,143.00,N/A
67030_3,INCISE INNER EYE STRANDS,ProFee,0989,67030,,,,0,3.00,2.25,2.25,759.50,0.00,759.50,759.50,N/A
67031_3,"LASER SURGERY, EYE STRANDS",ProFee,0989,67031,,,,0,3.00,2.25,2.25,508.00,0.00,508.00,508.00,N/A
67036_3,REMOVAL OF INNER EYE FLUID,ProFee,0989,67036,,,,0,3.00,2.25,2.25,1284.50,0.00,1284.50,1284.50,N/A
67038_3,STRIP RETINAL MEMBRANE,ProFee,0989,67038,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
67039_3,LASER TREATMENT OF RETINA,ProFee,0989,67039,,,,0,3.00,2.25,2.25,1375.50,0.00,1375.50,1375.50,N/A
67040_3,LASER TREATMENT OF RETINA,ProFee,0989,67040,,,,0,3.00,2.25,2.25,1486.50,0.00,1486.50,1486.50,N/A
67041_3,VIT FOR MACULAR PUCKER,ProFee,0989,67041,,,,0,3.00,2.25,2.25,1642.50,0.00,1642.50,1642.50,N/A
67042_3,VIT FOR MACULAR HOLE,ProFee,0989,67042,,,,0,3.00,2.25,2.25,1642.50,0.00,1642.50,1642.50,N/A
67043_3,VIT FOR MEMBRANE DISSECT,ProFee,0989,67043,,,,0,3.00,2.25,2.25,1735.50,0.00,1735.50,1735.50,N/A
67101_3,REPAIR DETACHED RETINA,ProFee,0989,67101,,,,0,3.00,2.25,2.25,406.50,0.00,406.50,406.50,N/A
67105_3,REPAIR DETACHED RETINA,ProFee,0989,67105,,,,0,3.00,2.25,2.25,392.50,0.00,392.50,392.50,N/A
67107_3,REPAIR DETACHED RETINA,ProFee,0989,67107,,,,0,3.00,2.25,2.25,1613.50,0.00,1613.50,1613.50,N/A
67108_3,REPAIR DETACHED RETINA,ProFee,0989,67108,,,,0,3.00,2.25,2.25,1711.00,0.00,1711.00,1711.00,N/A
67110_3,REPAIR DETACHED RETINA,ProFee,0989,67110,,,,0,3.00,2.25,2.25,1159.50,0.00,1159.50,1159.50,N/A
67112_3,REREPAIR DETACHED RETINA,ProFee,0989,67112,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
67113_3,"REPAIR RETINAL DETACH, CPLX",ProFee,0989,67113,,,,0,3.00,2.25,2.25,1909.50,0.00,1909.50,1909.50,N/A
67115_3,RELEASE ENCIRCLING MATERIAL,ProFee,0989,67115,,,,0,3.00,2.25,2.25,712.50,0.00,712.50,712.50,N/A
67120_3,REMOVE EYE IMPLANT MATERIAL,ProFee,0989,67120,,,,0,3.00,2.25,2.25,794.00,0.00,794.00,794.00,N/A
67121_3,REMOVE EYE IMPLANT MATERIAL,ProFee,0989,67121,,,,0,3.00,2.25,2.25,1294.50,0.00,1294.50,1294.50,N/A
67141_3,TREATMENT OF RETINA,ProFee,0989,67141,,,,0,3.00,2.25,2.25,696.00,0.00,696.00,696.00,N/A
67145_3,TREATMENT OF RETINA,ProFee,0989,67145,,,,0,3.00,2.25,2.25,710.50,0.00,710.50,710.50,N/A
67208_3,TREATMENT OF RETINAL LESION,ProFee,0989,67208,,,,0,3.00,2.25,2.25,824.00,0.00,824.00,824.00,N/A
67210_3,TREATMENT OF RETINAL LESION,ProFee,0989,67210,,,,0,3.00,2.25,2.25,714.00,0.00,714.00,714.00,N/A
67218_3,TREATMENT OF RETINAL LESION,ProFee,0989,67218,,,,0,3.00,2.25,2.25,1970.50,0.00,1970.50,1970.50,N/A
67220_3,TREATMENT OF CHOROID LESION,ProFee,0989,67220,,,,0,3.00,2.25,2.25,714.00,0.00,714.00,714.00,N/A
67221_3,OCULAR PHOTODYNAMIC THER,ProFee,0989,67221,,,,0,3.00,2.25,2.25,304.50,0.00,304.50,304.50,N/A
67225_3,EYE PHOTODYNAMIC THER ADD-ON,ProFee,0989,67225,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
67227_3,TREATMENT OF RETINAL LESION,ProFee,0989,67227,,,,0,3.00,2.25,2.25,366.50,0.00,366.50,366.50,N/A
67228_3,TREATMENT OF RETINAL LESION,ProFee,0989,67228,,,,0,3.00,2.25,2.25,437.50,0.00,437.50,437.50,N/A
67229_3,TR RETINAL LES PRETERM INF,ProFee,0989,67229,,,,0,3.00,2.25,2.25,1661.50,0.00,1661.50,1661.50,N/A
67250_3,REINFORCE EYE WALL,ProFee,0989,67250,,,,0,3.00,2.25,2.25,1112.50,0.00,1112.50,1112.50,N/A
67255_3,REINFORCE/GRAFT EYE WALL,ProFee,0989,67255,,,,0,3.00,2.25,2.25,974.50,0.00,974.50,974.50,N/A
67299_3,EYE SURGERY PROCEDURE,ProFee,0989,67299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
67311_3,REVISE EYE MUSCLE,ProFee,0989,67311,,,,0,3.00,2.25,2.25,851.50,0.00,851.50,851.50,N/A
67312_3,REVISE TWO EYE MUSCLES,ProFee,0989,67312,,,,0,3.00,2.25,2.25,1013.50,0.00,1013.50,1013.50,N/A
67314_3,REVISE EYE MUSCLE,ProFee,0989,67314,,,,0,3.00,2.25,2.25,958.00,0.00,958.00,958.00,N/A
67316_3,REVISE TWO EYE MUSCLES,ProFee,0989,67316,,,,0,3.00,2.25,2.25,1143.00,0.00,1143.00,1143.00,N/A
67318_3,REVISE EYE MUSCLE(S),ProFee,0989,67318,,,,0,3.00,2.25,2.25,1006.50,0.00,1006.50,1006.50,N/A
67320_3,REVISE EYE MUSCLE(S) ADD-ON,ProFee,0989,67320,,,,0,3.00,2.25,2.25,460.50,0.00,460.50,460.50,N/A
67331_3,EYE SURGERY FOLLOW-UP ADD-ON,ProFee,0989,67331,,,,0,3.00,2.25,2.25,436.50,0.00,436.50,436.50,N/A
67332_3,REREVISE EYE MUSCLES ADD-ON,ProFee,0989,67332,,,,0,3.00,2.25,2.25,473.50,0.00,473.50,473.50,N/A
67334_3,REVISE EYE MUSCLE W/SUTURE,ProFee,0989,67334,,,,0,3.00,2.25,2.25,430.50,0.00,430.50,430.50,N/A
67335_3,EYE SUTURE DURING SURGERY,ProFee,0989,67335,,,,0,3.00,2.25,2.25,211.50,0.00,211.50,211.50,N/A
67340_3,REVISE EYE MUSCLE ADD-ON,ProFee,0989,67340,,,,0,3.00,2.25,2.25,512.00,0.00,512.00,512.00,N/A
67343_3,RELEASE EYE TISSUE,ProFee,0989,67343,,,,0,3.00,2.25,2.25,928.50,0.00,928.50,928.50,N/A
67345_3,DESTROY NERVE OF EYE MUSCLE,ProFee,0989,67345,,,,0,3.00,2.25,2.25,313.00,0.00,313.00,313.00,N/A
67346_3,"BIOPSY, EYE MUSCLE",ProFee,0989,67346,,,,0,3.00,2.25,2.25,277.00,0.00,277.00,277.00,N/A
67350_3,BIOPSY EYE MUSCLE,ProFee,0989,67350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
67399_3,EYE MUSCLE SURGERY PROCEDURE,ProFee,0989,67399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
67400_3,EXPLORE/BIOPSY EYE SOCKET,ProFee,0989,67400,,,,0,3.00,2.25,2.25,1325.00,0.00,1325.00,1325.00,N/A
67405_3,EXPLORE/DRAIN EYE SOCKET,ProFee,0989,67405,,,,0,3.00,2.25,2.25,1126.00,0.00,1126.00,1126.00,N/A
67412_3,EXPLORE/TREAT EYE SOCKET,ProFee,0989,67412,,,,0,3.00,2.25,2.25,1213.00,0.00,1213.00,1213.00,N/A
67413_3,EXPLORE/TREAT EYE SOCKET,ProFee,0989,67413,,,,0,3.00,2.25,2.25,1217.50,0.00,1217.50,1217.50,N/A
67414_3,EXPLR/DECOMPRESS EYE SOCKET,ProFee,0989,67414,,,,0,3.00,2.25,2.25,1886.50,0.00,1886.50,1886.50,N/A
67415_3,"ASPIRATION, ORBITAL CONTENTS",ProFee,0989,67415,,,,0,3.00,2.25,2.25,149.50,0.00,149.50,149.50,N/A
67420_3,EXPLORE/TREAT EYE SOCKET,ProFee,0989,67420,,,,0,3.00,2.25,2.25,2302.50,0.00,2302.50,2302.50,N/A
67430_3,EXPLORE/TREAT EYE SOCKET,ProFee,0989,67430,,,,0,3.00,2.25,2.25,1776.00,0.00,1776.00,1776.00,N/A
67440_3,EXPLORE/DRAIN EYE SOCKET,ProFee,0989,67440,,,,0,3.00,2.25,2.25,1718.00,0.00,1718.00,1718.00,N/A
67445_3,EXPLR/DECOMPRESS EYE SOCKET,ProFee,0989,67445,,,,0,3.00,2.25,2.25,1995.00,0.00,1995.00,1995.00,N/A
67450_3,EXPLORE/BIOPSY EYE SOCKET,ProFee,0989,67450,,,,0,3.00,2.25,2.25,1786.50,0.00,1786.50,1786.50,N/A
67500_3,INJECT/TREAT EYE SOCKET,ProFee,0989,67500,,,,0,3.00,2.25,2.25,105.00,0.00,105.00,105.00,N/A
67505_3,INJECT/TREAT EYE SOCKET,ProFee,0989,67505,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
67515_3,INJECT/TREAT EYE SOCKET,ProFee,0989,67515,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
67550_3,INSERT EYE SOCKET IMPLANT,ProFee,0989,67550,,,,0,3.00,2.25,2.25,1374.00,0.00,1374.00,1374.00,N/A
67560_3,REVISE EYE SOCKET IMPLANT,ProFee,0989,67560,,,,0,3.00,2.25,2.25,1409.00,0.00,1409.00,1409.00,N/A
67570_3,DECOMPRESS OPTIC NERVE,ProFee,0989,67570,,,,0,3.00,2.25,2.25,1656.50,0.00,1656.50,1656.50,N/A
67599_3,ORBIT SURGERY PROCEDURE,ProFee,0989,67599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
67700_3,DRAINAGE OF EYELID ABSCESS,ProFee,0989,67700,,,,0,3.00,2.25,2.25,166.50,0.00,166.50,166.50,N/A
67710_3,INCISION OF EYELID,ProFee,0989,67710,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
67715_3,INCISION OF EYELID FOLD,ProFee,0989,67715,,,,0,3.00,2.25,2.25,154.50,0.00,154.50,154.50,N/A
67800_3,REMOVE EYELID LESION,ProFee,0989,67800,,,,0,3.00,2.25,2.25,147.50,0.00,147.50,147.50,N/A
67801_3,REMOVE EYELID LESIONS,ProFee,0989,67801,,,,0,3.00,2.25,2.25,190.50,0.00,190.50,190.50,N/A
67805_3,REMOVE EYELID LESIONS,ProFee,0989,67805,,,,0,3.00,2.25,2.25,234.50,0.00,234.50,234.50,N/A
67808_3,REMOVE EYELID LESION(S),ProFee,0989,67808,,,,0,3.00,2.25,2.25,525.50,0.00,525.50,525.50,N/A
67810_3,BIOPSY OF EYELID,ProFee,0989,67810,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
67820_3,REVISE EYELASHES,ProFee,0989,67820,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
67825_3,REVISE EYELASHES,ProFee,0989,67825,,,,0,3.00,2.25,2.25,173.50,0.00,173.50,173.50,N/A
67830_3,REVISE EYELASHES,ProFee,0989,67830,,,,0,3.00,2.25,2.25,197.50,0.00,197.50,197.50,N/A
67835_3,REVISE EYELASHES,ProFee,0989,67835,,,,0,3.00,2.25,2.25,625.50,0.00,625.50,625.50,N/A
67840_3,REMOVE EYELID LESION,ProFee,0989,67840,,,,0,3.00,2.25,2.25,225.50,0.00,225.50,225.50,N/A
67850_3,TREAT EYELID LESION,ProFee,0989,67850,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
67875_3,CLOSURE OF EYELID BY SUTURE,ProFee,0989,67875,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
67880_3,REVISION OF EYELID,ProFee,0989,67880,,,,0,3.00,2.25,2.25,525.00,0.00,525.00,525.00,N/A
67882_3,REVISION OF EYELID,ProFee,0989,67882,,,,0,3.00,2.25,2.25,674.50,0.00,674.50,674.50,N/A
67900_3,REPAIR BROW DEFECT,ProFee,0989,67900,,,,0,3.00,2.25,2.25,726.00,0.00,726.00,726.00,N/A
67901_3,REPAIR EYELID DEFECT,ProFee,0989,67901,,,,0,3.00,2.25,2.25,822.00,0.00,822.00,822.00,N/A
67902_3,REPAIR EYELID DEFECT,ProFee,0989,67902,,,,0,3.00,2.25,2.25,1030.50,0.00,1030.50,1030.50,N/A
67903_3,REPAIR EYELID DEFECT,ProFee,0989,67903,,,,0,3.00,2.25,2.25,689.50,0.00,689.50,689.50,N/A
67904_3,REPAIR EYELID DEFECT,ProFee,0989,67904,,,,0,3.00,2.25,2.25,852.50,0.00,852.50,852.50,N/A
67906_3,REPAIR EYELID DEFECT,ProFee,0989,67906,,,,0,3.00,2.25,2.25,724.50,0.00,724.50,724.50,N/A
67908_3,REPAIR EYELID DEFECT,ProFee,0989,67908,,,,0,3.00,2.25,2.25,605.50,0.00,605.50,605.50,N/A
67909_3,REVISE EYELID DEFECT,ProFee,0989,67909,,,,0,3.00,2.25,2.25,626.00,0.00,626.00,626.00,N/A
67911_3,REVISE EYELID DEFECT,ProFee,0989,67911,,,,0,3.00,2.25,2.25,801.50,0.00,801.50,801.50,N/A
67912_3,CORRECTION EYELID W/IMPLANT,ProFee,0989,67912,,,,0,3.00,2.25,2.25,696.00,0.00,696.00,696.00,N/A
67914_3,REPAIR EYELID DEFECT,ProFee,0989,67914,,,,0,3.00,2.25,2.25,467.00,0.00,467.00,467.00,N/A
67915_3,REPAIR EYELID DEFECT,ProFee,0989,67915,,,,0,3.00,2.25,2.25,283.00,0.00,283.00,283.00,N/A
67916_3,REPAIR EYELID DEFECT,ProFee,0989,67916,,,,0,3.00,2.25,2.25,615.00,0.00,615.00,615.00,N/A
67917_3,REPAIR EYELID DEFECT,ProFee,0989,67917,,,,0,3.00,2.25,2.25,653.50,0.00,653.50,653.50,N/A
67921_3,REPAIR EYELID DEFECT,ProFee,0989,67921,,,,0,3.00,2.25,2.25,443.00,0.00,443.00,443.00,N/A
67922_3,REPAIR EYELID DEFECT,ProFee,0989,67922,,,,0,3.00,2.25,2.25,282.00,0.00,282.00,282.00,N/A
67923_3,REPAIR EYELID DEFECT,ProFee,0989,67923,,,,0,3.00,2.25,2.25,614.50,0.00,614.50,614.50,N/A
67924_3,REPAIR EYELID DEFECT,ProFee,0989,67924,,,,0,3.00,2.25,2.25,654.00,0.00,654.00,654.00,N/A
67930_3,REPAIR EYELID WOUND,ProFee,0989,67930,,,,0,3.00,2.25,2.25,343.00,0.00,343.00,343.00,N/A
67935_3,REPAIR EYELID WOUND,ProFee,0989,67935,,,,0,3.00,2.25,2.25,630.50,0.00,630.50,630.50,N/A
67938_2,REMOVE EYELID FOREIGN BODY,Ambulatory Surgical,0521,67938,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,0.00,501.30
67938_2,REMOVE EYELID FOREIGN BODY,Inpatient,0521,67938,,,,0,557.00,417.75,417.75,529.15,501.30,529.15,529.15,501.30
67938_3,REMOVE EYELID FOREIGN BODY,Ambulatory Surgical,0521,67938,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,0.00,489.60
67938_3,REMOVE EYELID FOREIGN BODY,Inpatient,0521,67938,,,,0,544.00,408.00,408.00,516.80,489.60,516.80,516.80,489.60
67950_3,REVISION OF EYELID,ProFee,0989,67950,,,,0,3.00,2.25,2.25,661.00,0.00,661.00,661.00,N/A
67961_3,REVISION OF EYELID,ProFee,0989,67961,,,,0,3.00,2.25,2.25,649.50,0.00,649.50,649.50,N/A
67966_3,REVISION OF EYELID,ProFee,0989,67966,,,,0,3.00,2.25,2.25,937.50,0.00,937.50,937.50,N/A
67971_3,RECONSTRUCTION OF EYELID,ProFee,0989,67971,,,,0,3.00,2.25,2.25,1031.50,0.00,1031.50,1031.50,N/A
67973_3,RECONSTRUCTION OF EYELID,ProFee,0989,67973,,,,0,3.00,2.25,2.25,1327.00,0.00,1327.00,1327.00,N/A
67974_3,RECONSTRUCTION OF EYELID,ProFee,0989,67974,,,,0,3.00,2.25,2.25,1323.50,0.00,1323.50,1323.50,N/A
67975_3,RECONSTRUCTION OF EYELID,ProFee,0989,67975,,,,0,3.00,2.25,2.25,976.00,0.00,976.00,976.00,N/A
67999_3,REVISION OF EYELID,ProFee,0989,67999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
68020_3,INCISE/DRAIN EYELID LINING,ProFee,0989,68020,,,,0,3.00,2.25,2.25,157.50,0.00,157.50,157.50,N/A
68040_3,TREATMENT OF EYELID LESIONS,ProFee,0989,68040,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
68100_3,BIOPSY OF EYELID LINING,ProFee,0989,68100,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
68110_3,REMOVE EYELID LINING LESION,ProFee,0989,68110,,,,0,3.00,2.25,2.25,212.00,0.00,212.00,212.00,N/A
68115_3,REMOVE EYELID LINING LESION,ProFee,0989,68115,,,,0,3.00,2.25,2.25,262.50,0.00,262.50,262.50,N/A
68130_3,REMOVE EYELID LINING LESION,ProFee,0989,68130,,,,0,3.00,2.25,2.25,588.00,0.00,588.00,588.00,N/A
68135_3,REMOVE EYELID LINING LESION,ProFee,0989,68135,,,,0,3.00,2.25,2.25,215.50,0.00,215.50,215.50,N/A
68200_3,TREAT EYELID BY INJECTION,ProFee,0989,68200,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
68320_3,REVISE/GRAFT EYELID LINING,ProFee,0989,68320,,,,0,3.00,2.25,2.25,769.50,0.00,769.50,769.50,N/A
68325_3,REVISE/GRAFT EYELID LINING,ProFee,0989,68325,,,,0,3.00,2.25,2.25,938.00,0.00,938.00,938.00,N/A
68326_3,REVISE/GRAFT EYELID LINING,ProFee,0989,68326,,,,0,3.00,2.25,2.25,921.00,0.00,921.00,921.00,N/A
68328_3,REVISE/GRAFT EYELID LINING,ProFee,0989,68328,,,,0,3.00,2.25,2.25,1010.50,0.00,1010.50,1010.50,N/A
68330_3,REVISE EYELID LINING,ProFee,0989,68330,,,,0,3.00,2.25,2.25,658.00,0.00,658.00,658.00,N/A
68335_3,REVISE/GRAFT EYELID LINING,ProFee,0989,68335,,,,0,3.00,2.25,2.25,925.00,0.00,925.00,925.00,N/A
68340_3,SEPARATE EYELID ADHESIONS,ProFee,0989,68340,,,,0,3.00,2.25,2.25,569.50,0.00,569.50,569.50,N/A
68360_3,REVISE EYELID LINING,ProFee,0989,68360,,,,0,3.00,2.25,2.25,587.00,0.00,587.00,587.00,N/A
68362_3,REVISE EYELID LINING,ProFee,0989,68362,,,,0,3.00,2.25,2.25,936.00,0.00,936.00,936.00,N/A
68371_3,"HARVEST EYE TISSUE, ALOGRAFT",ProFee,0989,68371,,,,0,3.00,2.25,2.25,588.50,0.00,588.50,588.50,N/A
68399_3,EYELID LINING SURGERY,ProFee,0989,68399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
68400_3,INCISE/DRAIN TEAR GLAND,ProFee,0989,68400,,,,0,3.00,2.25,2.25,188.50,0.00,188.50,188.50,N/A
68420_3,INCISE/DRAIN TEAR SAC,ProFee,0989,68420,,,,0,3.00,2.25,2.25,240.50,0.00,240.50,240.50,N/A
68440_3,INCISE TEAR DUCT OPENING,ProFee,0989,68440,,,,0,3.00,2.25,2.25,141.50,0.00,141.50,141.50,N/A
68500_3,REMOVAL OF TEAR GLAND,ProFee,0989,68500,,,,0,3.00,2.25,2.25,1390.00,0.00,1390.00,1390.00,N/A
68505_3,"PARTIAL REMOVAL, TEAR GLAND",ProFee,0989,68505,,,,0,3.00,2.25,2.25,1383.00,0.00,1383.00,1383.00,N/A
68510_3,BIOPSY OF TEAR GLAND,ProFee,0989,68510,,,,0,3.00,2.25,2.25,416.00,0.00,416.00,416.00,N/A
68520_3,REMOVAL OF TEAR SAC,ProFee,0989,68520,,,,0,3.00,2.25,2.25,979.50,0.00,979.50,979.50,N/A
68525_3,BIOPSY OF TEAR SAC,ProFee,0989,68525,,,,0,3.00,2.25,2.25,376.50,0.00,376.50,376.50,N/A
68530_3,CLEARANCE OF TEAR DUCT,ProFee,0989,68530,,,,0,3.00,2.25,2.25,367.00,0.00,367.00,367.00,N/A
68540_3,REMOVE TEAR GLAND LESION,ProFee,0989,68540,,,,0,3.00,2.25,2.25,1323.50,0.00,1323.50,1323.50,N/A
68550_3,REMOVE TEAR GLAND LESION,ProFee,0989,68550,,,,0,3.00,2.25,2.25,1622.50,0.00,1622.50,1622.50,N/A
68700_3,REPAIR TEAR DUCTS,ProFee,0989,68700,,,,0,3.00,2.25,2.25,861.50,0.00,861.50,861.50,N/A
68705_3,REVISE TEAR DUCT OPENING,ProFee,0989,68705,,,,0,3.00,2.25,2.25,237.00,0.00,237.00,237.00,N/A
68720_3,CREATE TEAR SAC DRAIN,ProFee,0989,68720,,,,0,3.00,2.25,2.25,1078.50,0.00,1078.50,1078.50,N/A
68745_3,CREATE TEAR DUCT DRAIN,ProFee,0989,68745,,,,0,3.00,2.25,2.25,1083.50,0.00,1083.50,1083.50,N/A
68750_3,CREATE TEAR DUCT DRAIN,ProFee,0989,68750,,,,0,3.00,2.25,2.25,1121.00,0.00,1121.00,1121.00,N/A
68760_3,CLOSE TEAR DUCT OPENING,ProFee,0989,68760,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
68761_3,CLOSE TEAR DUCT OPENING,ProFee,0989,68761,,,,0,3.00,2.25,2.25,170.00,0.00,170.00,170.00,N/A
68770_3,CLOSE TEAR SYSTEM FISTULA,ProFee,0989,68770,,,,0,3.00,2.25,2.25,897.00,0.00,897.00,897.00,N/A
68801_3,DILATE TEAR DUCT OPENING,ProFee,0989,68801,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
68810_3,PROBE NASOLACRIMAL DUCT,ProFee,0989,68810,,,,0,3.00,2.25,2.25,183.00,0.00,183.00,183.00,N/A
68811_3,PROBE NASOLACRIMAL DUCT,ProFee,0989,68811,,,,0,3.00,2.25,2.25,194.50,0.00,194.50,194.50,N/A
68815_3,PROBE NASOLACRIMAL DUCT,ProFee,0989,68815,,,,0,3.00,2.25,2.25,316.50,0.00,316.50,316.50,N/A
68816_3,PROBE NL DUCT W/BALLOON,ProFee,0989,68816,,,,0,3.00,2.25,2.25,225.00,0.00,225.00,225.00,N/A
68840_3,EXPLORE/IRRIGATE TEAR DUCTS,ProFee,0989,68840,,,,0,3.00,2.25,2.25,166.00,0.00,166.00,166.00,N/A
68850_3,INJECTION FOR TEAR SAC X-RAY,ProFee,0989,68850,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
68899_3,TEAR DUCT SYSTEM SURGERY,ProFee,0989,68899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69000_3,DRAIN EXTERNAL EAR LESION,ProFee,0989,69000,,,,0,3.00,2.25,2.25,169.50,0.00,169.50,169.50,N/A
69005_3,DRAIN EXTERNAL EAR LESION,ProFee,0989,69005,,,,0,3.00,2.25,2.25,222.00,0.00,222.00,222.00,N/A
69020_3,DRAIN OUTER EAR CANAL LESION,ProFee,0989,69020,,,,0,3.00,2.25,2.25,200.50,0.00,200.50,200.50,N/A
69090_3,PIERCE EARLOBES,ProFee,0989,69090,,,,0,3.00,2.25,2.25,43.50,0.00,43.50,43.50,N/A
69100_3,BIOPSY OF EXTERNAL EAR,ProFee,0989,69100,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
69105_3,BIOPSY OF EXTERNAL EAR CANAL,ProFee,0989,69105,,,,0,3.00,2.25,2.25,90.00,0.00,90.00,90.00,N/A
69110_3,"REMOVE EXTERNAL EAR, PARTIAL",ProFee,0989,69110,,,,0,3.00,2.25,2.25,461.00,0.00,461.00,461.00,N/A
69120_3,REMOVAL OF EXTERNAL EAR,ProFee,0989,69120,,,,0,3.00,2.25,2.25,574.00,0.00,574.00,574.00,N/A
69140_3,REMOVE EAR CANAL LESION(S),ProFee,0989,69140,,,,0,3.00,2.25,2.25,1236.50,0.00,1236.50,1236.50,N/A
69145_3,REMOVE EAR CANAL LESION(S),ProFee,0989,69145,,,,0,3.00,2.25,2.25,351.00,0.00,351.00,351.00,N/A
69150_3,EXTENSIVE EAR CANAL SURGERY,ProFee,0989,69150,,,,0,3.00,2.25,2.25,1478.00,0.00,1478.00,1478.00,N/A
69155_3,EXTENSIVE EAR/NECK SURGERY,ProFee,0989,69155,,,,0,3.00,2.25,2.25,2348.00,0.00,2348.00,2348.00,N/A
69200_2,CLEAR OUTER EAR CANAL,Outpatient,0521,69200,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,0.00,187.20
69200_2,CLEAR OUTER EAR CANAL,Inpatient,0521,69200,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
69200_3,CLEAR OUTER EAR CANAL,Inpatient,0521,69200,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
69200_3,CLEAR OUTER EAR CANAL,Outpatient,0521,69200,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,0.00,184.50
69205_3,CLEAR OUTER EAR CANAL,ProFee,0989,69205,,,,0,3.00,2.25,2.25,142.50,0.00,142.50,142.50,N/A
69209_2,removal of impacted cerumen using irrigation/lavag,ProFee,0989,69209,,,,0,121.00,90.75,20.00,90.75,0.00,20.00,20.00,N/A
69209_3,removal of impacted cerumen using irrigation/lavag,ProFee,0989,69209,,,,0,121.00,90.75,20.00,90.75,0.00,20.00,20.00,N/A
69210_2,REMOVE IMPACTED EAR WAX,Outpatient,0521,69210,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,0.00,108.90
69210_2,REMOVE IMPACTED EAR WAX,Inpatient,0521,69210,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
69210_3,REMOVE IMPACTED EAR WAX,Inpatient,0521,69210,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,114.95,108.90
69210_3,REMOVE IMPACTED EAR WAX,Outpatient,0521,69210,,,,0,121.00,90.75,90.75,114.95,108.90,114.95,0.00,108.90
69220_3,CLEAN OUT MASTOID CAVITY,ProFee,0989,69220,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
69222_3,CLEAN OUT MASTOID CAVITY,ProFee,0989,69222,,,,0,3.00,2.25,2.25,192.50,0.00,192.50,192.50,N/A
69300_3,REVISE EXTERNAL EAR,ProFee,0989,69300,,,,0,3.00,2.25,2.25,691.00,0.00,691.00,691.00,N/A
69310_3,REBUILD OUTER EAR CANAL,ProFee,0989,69310,,,,0,3.00,2.25,2.25,1537.00,0.00,1537.00,1537.00,N/A
69320_3,REBUILD OUTER EAR CANAL,ProFee,0989,69320,,,,0,3.00,2.25,2.25,2155.00,0.00,2155.00,2155.00,N/A
69399_3,OUTER EAR SURGERY PROCEDURE,ProFee,0989,69399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69400_3,INFLATE MIDDLE EAR CANAL,ProFee,0989,69400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69401_3,INFLATE MIDDLE EAR CANAL,ProFee,0989,69401,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69405_3,CATHETERIZE MIDDLE EAR CANAL,ProFee,0989,69405,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69420_3,INCISION OF EARDRUM,ProFee,0989,69420,,,,0,3.00,2.25,2.25,170.00,0.00,170.00,170.00,N/A
69421_3,INCISION OF EARDRUM,ProFee,0989,69421,,,,0,3.00,2.25,2.25,210.00,0.00,210.00,210.00,N/A
69424_3,REMOVE VENTILATING TUBE,ProFee,0989,69424,,,,0,3.00,2.25,2.25,87.50,0.00,87.50,87.50,N/A
69433_3,CREATE EARDRUM OPENING,ProFee,0989,69433,,,,0,3.00,2.25,2.25,187.00,0.00,187.00,187.00,N/A
69436_3,CREATE EARDRUM OPENING,ProFee,0989,69436,,,,0,3.00,2.25,2.25,226.00,0.00,226.00,226.00,N/A
69440_3,EXPLORATION OF MIDDLE EAR,ProFee,0989,69440,,,,0,3.00,2.25,2.25,970.00,0.00,970.00,970.00,N/A
69450_3,EARDRUM REVISION,ProFee,0989,69450,,,,0,3.00,2.25,2.25,770.50,0.00,770.50,770.50,N/A
69501_3,MASTOIDECTOMY,ProFee,0989,69501,,,,0,3.00,2.25,2.25,1033.00,0.00,1033.00,1033.00,N/A
69502_3,MASTOIDECTOMY,ProFee,0989,69502,,,,0,3.00,2.25,2.25,1372.50,0.00,1372.50,1372.50,N/A
69505_3,REMOVE MASTOID STRUCTURES,ProFee,0989,69505,,,,0,3.00,2.25,2.25,1696.50,0.00,1696.50,1696.50,N/A
69511_3,EXTENSIVE MASTOID SURGERY,ProFee,0989,69511,,,,0,3.00,2.25,2.25,1738.00,0.00,1738.00,1738.00,N/A
69530_3,EXTENSIVE MASTOID SURGERY,ProFee,0989,69530,,,,0,3.00,2.25,2.25,2332.00,0.00,2332.00,2332.00,N/A
69535_3,REMOVE PART OF TEMPORAL BONE,ProFee,0989,69535,,,,0,3.00,2.25,2.25,3820.00,0.00,3820.00,3820.00,N/A
69540_3,REMOVE EAR LESION,ProFee,0989,69540,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
69550_3,REMOVE EAR LESION,ProFee,0989,69550,,,,0,3.00,2.25,2.25,1467.50,0.00,1467.50,1467.50,N/A
69552_3,REMOVE EAR LESION,ProFee,0989,69552,,,,0,3.00,2.25,2.25,2216.00,0.00,2216.00,2216.00,N/A
69554_3,REMOVE EAR LESION,ProFee,0989,69554,,,,0,3.00,2.25,2.25,3562.50,0.00,3562.50,3562.50,N/A
69601_3,MASTOID SURGERY REVISION,ProFee,0989,69601,,,,0,3.00,2.25,2.25,1476.00,0.00,1476.00,1476.00,N/A
69602_3,MASTOID SURGERY REVISION,ProFee,0989,69602,,,,0,3.00,2.25,2.25,1535.00,0.00,1535.00,1535.00,N/A
69603_3,MASTOID SURGERY REVISION,ProFee,0989,69603,,,,0,3.00,2.25,2.25,1777.50,0.00,1777.50,1777.50,N/A
69604_3,MASTOID SURGERY REVISION,ProFee,0989,69604,,,,0,3.00,2.25,2.25,1569.50,0.00,1569.50,1569.50,N/A
69605_3,MASTOID SURGERY REVISION,ProFee,0989,69605,,,,0,3.00,2.25,2.25,2200.50,0.00,2200.50,2200.50,N/A
69610_3,REPAIR OF EARDRUM,ProFee,0989,69610,,,,0,3.00,2.25,2.25,412.00,0.00,412.00,412.00,N/A
69620_3,REPAIR OF EARDRUM,ProFee,0989,69620,,,,0,3.00,2.25,2.25,689.50,0.00,689.50,689.50,N/A
69631_3,REPAIR EARDRUM STRUCTURES,ProFee,0989,69631,,,,0,3.00,2.25,2.25,1247.00,0.00,1247.00,1247.00,N/A
69632_3,REBUILD EARDRUM STRUCTURES,ProFee,0989,69632,,,,0,3.00,2.25,2.25,1519.50,0.00,1519.50,1519.50,N/A
69633_3,REBUILD EARDRUM STRUCTURES,ProFee,0989,69633,,,,0,3.00,2.25,2.25,1474.00,0.00,1474.00,1474.00,N/A
69635_3,REPAIR EARDRUM STRUCTURES,ProFee,0989,69635,,,,0,3.00,2.25,2.25,1747.00,0.00,1747.00,1747.00,N/A
69636_3,REBUILD EARDRUM STRUCTURES,ProFee,0989,69636,,,,0,3.00,2.25,2.25,1946.50,0.00,1946.50,1946.50,N/A
69637_3,REBUILD EARDRUM STRUCTURES,ProFee,0989,69637,,,,0,3.00,2.25,2.25,1964.50,0.00,1964.50,1964.50,N/A
69641_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69641,,,,0,3.00,2.25,2.25,1469.00,0.00,1469.00,1469.00,N/A
69642_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69642,,,,0,3.00,2.25,2.25,1885.50,0.00,1885.50,1885.50,N/A
69643_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69643,,,,0,3.00,2.25,2.25,1727.00,0.00,1727.00,1727.00,N/A
69644_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69644,,,,0,3.00,2.25,2.25,2085.50,0.00,2085.50,2085.50,N/A
69645_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69645,,,,0,3.00,2.25,2.25,2045.00,0.00,2045.00,2045.00,N/A
69646_3,REVISE MIDDLE EAR & MASTOID,ProFee,0989,69646,,,,0,3.00,2.25,2.25,2182.00,0.00,2182.00,2182.00,N/A
69650_3,RELEASE MIDDLE EAR BONE,ProFee,0989,69650,,,,0,3.00,2.25,2.25,1134.00,0.00,1134.00,1134.00,N/A
69660_3,REVISE MIDDLE EAR BONE,ProFee,0989,69660,,,,0,3.00,2.25,2.25,1308.50,0.00,1308.50,1308.50,N/A
69661_3,REVISE MIDDLE EAR BONE,ProFee,0989,69661,,,,0,3.00,2.25,2.25,1705.50,0.00,1705.50,1705.50,N/A
69662_3,REVISE MIDDLE EAR BONE,ProFee,0989,69662,,,,0,3.00,2.25,2.25,1636.50,0.00,1636.50,1636.50,N/A
69666_3,REPAIR MIDDLE EAR STRUCTURES,ProFee,0989,69666,,,,0,3.00,2.25,2.25,1145.50,0.00,1145.50,1145.50,N/A
69667_3,REPAIR MIDDLE EAR STRUCTURES,ProFee,0989,69667,,,,0,3.00,2.25,2.25,1147.00,0.00,1147.00,1147.00,N/A
69670_3,REMOVE MASTOID AIR CELLS,ProFee,0989,69670,,,,0,3.00,2.25,2.25,1339.00,0.00,1339.00,1339.00,N/A
69676_3,REMOVE MIDDLE EAR NERVE,ProFee,0989,69676,,,,0,3.00,2.25,2.25,1172.00,0.00,1172.00,1172.00,N/A
69700_3,CLOSE MASTOID FISTULA,ProFee,0989,69700,,,,0,3.00,2.25,2.25,967.00,0.00,967.00,967.00,N/A
69710_3,IMPLANT/REPLACE HEARING AID,ProFee,0989,69710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69711_3,REMOVE/REPAIR HEARING AID,ProFee,0989,69711,,,,0,3.00,2.25,2.25,1216.00,0.00,1216.00,1216.00,N/A
69714_3,IMPLANT TEMPLE BONE W/STIMUL,ProFee,0989,69714,,,,0,3.00,2.25,2.25,1523.00,0.00,1523.00,1523.00,N/A
69715_3,TEMPLE BNE IMPLNT W/STIMULAT,ProFee,0989,69715,,,,0,3.00,2.25,2.25,1877.50,0.00,1877.50,1877.50,N/A
69717_3,TEMPLE BONE IMPLANT REVISION,ProFee,0989,69717,,,,0,3.00,2.25,2.25,1595.50,0.00,1595.50,1595.50,N/A
69718_3,REVISE TEMPLE BONE IMPLANT,ProFee,0989,69718,,,,0,3.00,2.25,2.25,1897.50,0.00,1897.50,1897.50,N/A
69720_3,RELEASE FACIAL NERVE,ProFee,0989,69720,,,,0,3.00,2.25,2.25,1724.00,0.00,1724.00,1724.00,N/A
69725_3,RELEASE FACIAL NERVE,ProFee,0989,69725,,,,0,3.00,2.25,2.25,2658.50,0.00,2658.50,2658.50,N/A
69740_3,REPAIR FACIAL NERVE,ProFee,0989,69740,,,,0,3.00,2.25,2.25,1649.50,0.00,1649.50,1649.50,N/A
69745_3,REPAIR FACIAL NERVE,ProFee,0989,69745,,,,0,3.00,2.25,2.25,1754.50,0.00,1754.50,1754.50,N/A
69799_3,MIDDLE EAR SURGERY PROCEDURE,ProFee,0989,69799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69801_3,INCISE INNER EAR,ProFee,0989,69801,,,,0,3.00,2.25,2.25,178.00,0.00,178.00,178.00,N/A
69802_3,INCISE INNER EAR,ProFee,0989,69802,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69805_3,EXPLORE INNER EAR,ProFee,0989,69805,,,,0,3.00,2.25,2.25,1490.00,0.00,1490.00,1490.00,N/A
69806_3,EXPLORE INNER EAR,ProFee,0989,69806,,,,0,3.00,2.25,2.25,1333.50,0.00,1333.50,1333.50,N/A
69820_3,ESTABLISH INNER EAR WINDOW,ProFee,0989,69820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69840_3,REVISE INNER EAR WINDOW,ProFee,0989,69840,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
69905_3,REMOVE INNER EAR,ProFee,0989,69905,,,,0,3.00,2.25,2.25,1294.50,0.00,1294.50,1294.50,N/A
69910_3,REMOVE INNER EAR & MASTOID,ProFee,0989,69910,,,,0,3.00,2.25,2.25,1437.00,0.00,1437.00,1437.00,N/A
69915_3,INCISE INNER EAR NERVE,ProFee,0989,69915,,,,0,3.00,2.25,2.25,2176.50,0.00,2176.50,2176.50,N/A
69930_3,IMPLANT COCHLEAR DEVICE,ProFee,0989,69930,,,,0,3.00,2.25,2.25,1730.50,0.00,1730.50,1730.50,N/A
69949_3,INNER EAR SURGERY PROCEDURE,ProFee,0989,69949,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69950_3,INCISE INNER EAR NERVE,ProFee,0989,69950,,,,0,3.00,2.25,2.25,2522.50,0.00,2522.50,2522.50,N/A
69955_3,RELEASE FACIAL NERVE,ProFee,0989,69955,,,,0,3.00,2.25,2.25,2799.00,0.00,2799.00,2799.00,N/A
69960_3,RELEASE INNER EAR CANAL,ProFee,0989,69960,,,,0,3.00,2.25,2.25,2724.00,0.00,2724.00,2724.00,N/A
69970_3,REMOVE INNER EAR LESION,ProFee,0989,69970,,,,0,3.00,2.25,2.25,3031.50,0.00,3031.50,3031.50,N/A
69979_3,TEMPORAL BONE SURGERY,ProFee,0989,69979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
69990_3,MICROSURGERY ADD-ON,ProFee,0989,69990,,,,0,3.00,2.25,2.25,321.00,0.00,321.00,321.00,N/A
70010_3,CONTRAST X-RAY OF BRAIN,ProFee,0989,70010,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
70015_3,CONTRAST X-RAY OF BRAIN,ProFee,0989,70015,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
70030_3,X-RAY EYE FOR FOREIGN BODY,ProFee,0989,70030,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
70100_3,X-RAY EXAM OF JAW,ProFee,0989,70100,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
7010F_3,PT INFO INTO RECALL SYSTEM,ProFee,0989,7010F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
70110_3,X-RAY EXAM OF JAW,ProFee,0989,70110,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
70120_3,X-RAY EXAM OF MASTOIDS,ProFee,0989,70120,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
70130_3,X-RAY EXAM OF MASTOIDS,ProFee,0989,70130,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
70134_3,X-RAY EXAM OF MIDDLE EAR,ProFee,0989,70134,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
70140_3,X-RAY EXAM OF FACIAL BONES,ProFee,0989,70140,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
70150_3,X-RAY EXAM OF FACIAL BONES,ProFee,0989,70150,,,,0,3.00,2.25,2.25,19.00,0.00,19.00,19.00,N/A
70160_3,X-RAY EXAM OF NASAL BONES,ProFee,0989,70160,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
70170_3,X-RAY EXAM OF TEAR DUCT,ProFee,0989,70170,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
70190_3,X-RAY EXAM OF EYE SOCKETS,ProFee,0989,70190,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
70200_3,X-RAY EXAM OF EYE SOCKETS,ProFee,0989,70200,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
7020F_3,BRST IMAG-RPT/DATACAT DOCD,ProFee,0989,7020F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
70210_3,X-RAY EXAM OF SINUSES,ProFee,0989,70210,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
70220_3,X-RAY EXAM OF SINUSES,ProFee,0989,70220,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
70240_3,"X-RAY EXAM, PITUITARY SADDLE",ProFee,0989,70240,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
70250_3,X-RAY EXAM OF SKULL,ProFee,0989,70250,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
7025F_3,PT INFOSYS ALARM 4 NXT MAMMO,ProFee,0989,7025F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
70260_3,X-RAY EXAM OF SKULL,ProFee,0989,70260,,,,0,3.00,2.25,2.25,25.00,0.00,25.00,25.00,N/A
70300_3,X-RAY EXAM OF TEETH,ProFee,0989,70300,,,,0,3.00,2.25,2.25,8.50,0.00,8.50,8.50,N/A
70310_3,X-RAY EXAM OF TEETH,ProFee,0989,70310,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
70320_3,FULL MOUTH X-RAY OF TEETH,ProFee,0989,70320,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
70328_3,X-RAY EXAM OF JAW JOINT,ProFee,0989,70328,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
70330_3,X-RAY EXAM OF JAW JOINTS,ProFee,0989,70330,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
70332_3,X-RAY EXAM OF JAW JOINT,ProFee,0989,70332,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
70336_3,"MAGNETIC IMAGE, JAW JOINT",ProFee,0989,70336,,,,0,3.00,2.25,2.25,104.50,0.00,104.50,104.50,N/A
70350_3,X-RAY HEAD FOR ORTHODONTIA,ProFee,0989,70350,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
70355_3,PANORAMIC X-RAY OF JAWS,ProFee,0989,70355,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
70360_3,X-RAY EXAM OF NECK,ProFee,0989,70360,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
70370_3,THROAT X-RAY & FLUOROSCOPY,ProFee,0989,70370,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
70371_3,"SPEECH EVALUATION, COMPLEX",ProFee,0989,70371,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
70373_3,CONTRAST X-RAY OF LARYNX,ProFee,0989,76499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
70380_3,X-RAY EXAM OF SALIVARY GLAND,ProFee,0989,70380,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
70390_3,X-RAY EXAM OF SALIVARY DUCT,ProFee,0989,70390,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
70450_3,CT HEAD/BRAIN W/O DYE,ProFee,0989,70450,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
70460_3,CT HEAD/BRAIN W/DYE,ProFee,0989,70460,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
70470_3,CT HEAD/BRAIN W/O & W/DYE,ProFee,0989,70470,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
70480_3,CT ORBIT/EAR/FOSSA W/O DYE,ProFee,0989,70480,,,,0,3.00,2.25,2.25,91.00,0.00,91.00,91.00,N/A
70481_3,CT ORBIT/EAR/FOSSA W/DYE,ProFee,0989,70481,,,,0,3.00,2.25,2.25,98.50,0.00,98.50,98.50,N/A
70482_3,CT ORBIT/EAR/FOSSA W/O&W/DYE,ProFee,0989,70482,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
70486_3,CT MAXILLOFACIAL W/O DYE,ProFee,0989,70486,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
70487_3,CT MAXILLOFACIAL W/DYE,ProFee,0989,70487,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
70488_3,CT MAXILLOFACIAL W/O & W/DYE,ProFee,0989,70488,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
70490_3,CT SOFT TISSUE NECK W/O DYE,ProFee,0989,70490,,,,0,3.00,2.25,2.25,91.50,0.00,91.50,91.50,N/A
70491_3,CT SOFT TISSUE NECK W/DYE,ProFee,0989,70491,,,,0,3.00,2.25,2.25,98.50,0.00,98.50,98.50,N/A
70492_3,CT SFT TSUE NCK W/O & W/DYE,ProFee,0989,70492,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
70496_3,"CT ANGIOGRAPHY, HEAD",ProFee,0989,70496,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
70498_3,"CT ANGIOGRAPHY, NECK",ProFee,0989,70498,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
70540_3,MRI ORBIT/FACE/NECK W/O DYE,ProFee,0989,70540,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
70542_3,MRI ORBIT/FACE/NECK W/DYE,ProFee,0989,70542,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
70543_3,MRI ORBT/FAC/NCK W/O & W/DYE,ProFee,0989,70543,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
70544_3,MR ANGIOGRAPHY HEAD W/O DYE,ProFee,0989,70544,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
70545_3,MR ANGIOGRAPHY HEAD W/DYE,ProFee,0989,70545,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
70546_3,MR ANGIOGRAPH HEAD W/O&W/DYE,ProFee,0989,70546,,,,0,3.00,2.25,2.25,105.00,0.00,105.00,105.00,N/A
70547_3,MR ANGIOGRAPHY NECK W/O DYE,ProFee,0989,70547,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
70548_3,MR ANGIOGRAPHY NECK W/DYE,ProFee,0989,70548,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
70549_3,MR ANGIOGRAPH NECK W/O&W/DYE,ProFee,0989,70549,,,,0,3.00,2.25,2.25,128.00,0.00,128.00,128.00,N/A
70551_3,MRI BRAIN W/O DYE,ProFee,0989,70551,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
70552_3,MRI BRAIN W/DYE,ProFee,0989,70552,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
70553_3,MRI BRAIN W/O & W/DYE,ProFee,0989,70553,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
70554_3,FMRI BRAIN BY TECH,ProFee,0989,70554,,,,0,3.00,2.25,2.25,150.50,0.00,150.50,150.50,N/A
70555_3,FMRI BRAIN BY PHYS/PSYCH,ProFee,0989,70555,,,,0,3.00,2.25,2.25,178.00,0.00,178.00,178.00,N/A
70557_3,MRI BRAIN W/O DYE,ProFee,0989,70557,,,,0,3.00,2.25,2.25,223.00,0.00,223.00,223.00,N/A
70558_3,MRI BRAIN W/DYE,ProFee,0989,70558,,,,0,3.00,2.25,2.25,245.50,0.00,245.50,245.50,N/A
70559_3,MRI BRAIN W/O & W/DYE,ProFee,0989,70559,,,,0,3.00,2.25,2.25,231.50,0.00,231.50,231.50,N/A
71010_3,CHEST X-RAY,ProFee,0989,71045,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
71015_3,CHEST X-RAY,ProFee,0989,71045,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
71020_3,CHEST X-RAY,ProFee,0989,71046,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
71021_3,CHEST X-RAY,ProFee,0989,71047,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
71022_3,CHEST X-RAY,ProFee,0989,71022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71023_3,CHEST X-RAY AND FLUOROSCOPY,ProFee,0989,71023,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71030_3,CHEST X-RAY,ProFee,0989,71048,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
71034_3,CHEST X-RAY AND FLUOROSCOPY,ProFee,0989,71034,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71035_3,CHEST X-RAY,ProFee,0989,71035,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71040_3,CONTRAST X-RAY OF BRONCHI,ProFee,0989,71040,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71045_2,X-RAY EXAM CHEST 1 VIEW,Inpatient,0521,71045,,,,0,433.00,324.75,324.75,411.35,389.70,411.35,411.35,389.70
71045_2,X-RAY EXAM CHEST 1 VIEW,Outpatient,0521,71045,,,,0,433.00,324.75,324.75,411.35,389.70,411.35,0.00,389.70
71045_3,X-RAY EXAM CHEST 1 VIEW,Outpatient,0521,71045,,,,0,433.00,324.75,324.75,411.35,389.70,411.35,0.00,389.70
71045_3,X-RAY EXAM CHEST 1 VIEW,Inpatient,0521,71045,,,,0,433.00,324.75,324.75,411.35,389.70,411.35,411.35,389.70
71046_3,X-RAY EXAM CHEST 2 VIEWS,ProFee,0989,71046,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
71047_3,X-RAY EXAM CHEST 3 VIEWS,ProFee,0989,71047,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
71048_3,X-RAY EXAM CHEST 4+ VIEWS,ProFee,0989,71048,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
71060_3,CONTRAST X-RAY OF BRONCHI,ProFee,0989,71060,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71090_3,X-RAY & PACEMAKER INSERTION,ProFee,0989,71090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
71100_3,X-RAY EXAM OF RIBS,ProFee,0989,71100,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
71101_3,X-RAY EXAM OF RIBS/CHEST,ProFee,0989,71101,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
71110_3,X-RAY EXAM OF RIBS,ProFee,0989,71110,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
71111_3,X-RAY EXAM OF RIBS/CHEST,ProFee,0989,71111,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
71120_3,X-RAY EXAM OF BREASTBONE,ProFee,0989,71120,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
71130_3,X-RAY EXAM OF BREASTBONE,ProFee,0989,71130,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
71250_3,CT THORAX W/O DYE,ProFee,0989,71250,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
71260_3,CT THORAX W/DYE,ProFee,0989,71260,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
71270_3,CT THORAX W/O & W/DYE,ProFee,0989,71270,,,,0,3.00,2.25,2.25,98.50,0.00,98.50,98.50,N/A
71275_3,"CT ANGIOGRAPHY, CHEST",ProFee,0989,71275,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
71550_3,MRI CHEST W/O DYE,ProFee,0989,71550,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
71551_3,MRI CHEST W/DYE,ProFee,0989,71551,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
71552_3,MRI CHEST W/O & W/DYE,ProFee,0989,71552,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
71555_3,MRI ANGIO CHEST W OR W/O DYE,ProFee,0989,71555,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
72010_3,X-RAY EXAM OF SPINE,ProFee,0989,72010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
72020_3,X-RAY EXAM OF SPINE,ProFee,0989,72020,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
72040_3,X-RAY EXAM OF NECK SPINE,ProFee,0989,72040,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
72050_3,X-RAY EXAM OF NECK SPINE,ProFee,0989,72050,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
72052_3,X-RAY EXAM OF NECK SPINE,ProFee,0989,72052,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
72069_3,X-RAY EXAM OF TRUNK SPINE,ProFee,0989,72069,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
72070_3,X-RAY EXAM OF THORACIC SPINE,ProFee,0989,72070,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
72072_3,X-RAY EXAM OF THORACIC SPINE,ProFee,0989,72072,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
72074_3,X-RAY EXAM OF THORACIC SPINE,ProFee,0989,72074,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
72080_3,X-RAY EXAM OF TRUNK SPINE,ProFee,0989,72080,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
72081_3,X-RAY EXAM ENTIRE SPI 1 VW,ProFee,0989,72081,,,,0,3.00,2.25,2.25,19.00,0.00,19.00,19.00,N/A
72082_3,X-RAY EXAM ENTIRE SPI 2/3 VW,ProFee,0989,72082,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
72083_3,X-RAY EXAM ENTIRE SPI 4/5 VW,ProFee,0989,72083,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
72084_3,X-RAY EXAM ENTIRE SPI 6/> VW,ProFee,0989,72084,,,,0,3.00,2.25,2.25,30.50,0.00,30.50,30.50,N/A
72090_3,X-RAY EXAM OF TRUNK SPINE,ProFee,0989,72090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
72100_3,X-RAY EXAM OF LOWER SPINE,ProFee,0989,72100,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
72110_3,X-RAY EXAM OF LOWER SPINE,ProFee,0989,72110,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
72114_3,X-RAY EXAM OF LOWER SPINE,ProFee,0989,72114,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
72120_3,X-RAY EXAM OF LOWER SPINE,ProFee,0989,72120,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
72125_3,CT NECK SPINE W/O DYE,ProFee,0989,72125,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
72126_3,CT NECK SPINE W/DYE,ProFee,0989,72126,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
72127_3,CT NECK SPINE W/O & W/DYE,ProFee,0989,72127,,,,0,3.00,2.25,2.25,90.00,0.00,90.00,90.00,N/A
72128_3,CT CHEST SPINE W/O DYE,ProFee,0989,72128,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
72129_3,CT CHEST SPINE W/DYE,ProFee,0989,72129,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
72130_3,CT CHEST SPINE W/O & W/DYE,ProFee,0989,72130,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
72131_3,CT LUMBAR SPINE W/O DYE,ProFee,0989,72131,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
72132_3,CT LUMBAR SPINE W/DYE,ProFee,0989,72132,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
72133_3,CT LUMBAR SPINE W/O & W/DYE,ProFee,0989,72133,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
72141_3,MRI NECK SPINE W/O DYE,ProFee,0989,72141,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
72142_3,MRI NECK SPINE W/DYE,ProFee,0989,72142,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
72146_3,MRI CHEST SPINE W/O DYE,ProFee,0989,72146,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
72147_3,MRI CHEST SPINE W/DYE,ProFee,0989,72147,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
72148_3,MRI LUMBAR SPINE W/O DYE,ProFee,0989,72148,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
72149_3,MRI LUMBAR SPINE W/DYE,ProFee,0989,72149,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
72156_3,MRI NECK SPINE W/O & W/DYE,ProFee,0989,72156,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
72157_3,MRI CHEST SPINE W/O & W/DYE,ProFee,0989,72157,,,,0,3.00,2.25,2.25,162.50,0.00,162.50,162.50,N/A
72158_3,MRI LUMBAR SPINE W/O & W/DYE,ProFee,0989,72158,,,,0,3.00,2.25,2.25,163.00,0.00,163.00,163.00,N/A
72159_3,MR ANGIO SPINE W/O&W/DYE,ProFee,0989,72159,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
72170_3,X-RAY EXAM OF PELVIS,ProFee,0989,72170,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
72190_3,X-RAY EXAM OF PELVIS,ProFee,0989,72190,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
72191_3,CT ANGIOGRAPH PELV W/O&W/DYE,ProFee,0989,72191,,,,0,3.00,2.25,2.25,128.00,0.00,128.00,128.00,N/A
72192_3,CT PELVIS W/O DYE,ProFee,0989,72192,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
72193_3,CT PELVIS W/DYE,ProFee,0989,72193,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
72194_3,CT PELVIS W/O & W/DYE,ProFee,0989,72194,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
72195_3,MRI PELVIS W/O DYE,ProFee,0989,72195,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
72196_3,MRI PELVIS W/DYE,ProFee,0989,72196,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
72197_3,MRI PELVIS W/O & W/DYE,ProFee,0989,72197,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
72198_3,MR ANGIO PELVIS W/O & W/DYE,ProFee,0989,72198,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
72200_3,X-RAY EXAM SACROILIAC JOINTS,ProFee,0989,72200,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
72202_3,X-RAY EXAM SACROILIAC JOINTS,ProFee,0989,72202,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
72220_3,X-RAY EXAM OF TAILBONE,ProFee,0989,72220,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
72240_3,CONTRAST X-RAY OF NECK SPINE,ProFee,0989,72240,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
72255_3,"CONTRAST X-RAY, THORAX SPINE",ProFee,0989,72255,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
72265_3,"CONTRAST X-RAY, LOWER SPINE",ProFee,0989,72265,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
72270_3,"CONTRAST X-RAY, SPINE",ProFee,0989,72270,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
72275_3,EPIDUROGRAPHY,ProFee,0989,72275,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
72285_3,X-RAY C/T SPINE DISK,ProFee,0989,72285,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
72291_3,"PERQ VERTEBROPLASTY, FLUOR",ProFee,0989,72291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
72292_3,"PERQ VERTEBROPLASTY, CT",ProFee,0989,72292,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
72295_3,X-RAY OF LOWER SPINE DISK,ProFee,0989,72295,,,,0,3.00,2.25,2.25,61.50,0.00,61.50,61.50,N/A
73000_3,X-RAY EXAM OF COLLAR BONE,ProFee,0989,73000,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73010_3,X-RAY EXAM OF SHOULDER BLADE,ProFee,0989,73010,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
73020_3,X-RAY EXAM OF SHOULDER,ProFee,0989,73020,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
73030_3,X-RAY EXAM OF SHOULDER,ProFee,0989,73030,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
73040_3,CONTRAST X-RAY OF SHOULDER,ProFee,0989,73040,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
73050_3,X-RAY EXAM OF SHOULDERS,ProFee,0989,73050,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
73060_3,X-RAY EXAM OF HUMERUS,ProFee,0989,73060,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73070_3,X-RAY EXAM OF ELBOW,ProFee,0989,73070,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
73080_3,X-RAY EXAM OF ELBOW,ProFee,0989,73080,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73085_3,CONTRAST X-RAY OF ELBOW,ProFee,0989,73085,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
73090_3,X-RAY EXAM OF FOREARM,ProFee,0989,73090,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73092_3,"X-RAY EXAM OF ARM, INFANT",ProFee,0989,73092,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
73100_3,X-RAY EXAM OF WRIST,ProFee,0989,73100,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73110_3,X-RAY EXAM OF WRIST,ProFee,0989,73110,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73115_3,CONTRAST X-RAY OF WRIST,ProFee,0989,73115,,,,0,3.00,2.25,2.25,40.50,0.00,40.50,40.50,N/A
73120_3,X-RAY EXAM OF HAND,ProFee,0989,73120,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73130_3,X-RAY EXAM OF HAND,ProFee,0989,73130,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73140_3,X-RAY EXAM OF FINGER(S),ProFee,0989,73140,,,,0,3.00,2.25,2.25,10.00,0.00,10.00,10.00,N/A
73200_3,CT UPPER EXTREMITY W/O DYE,ProFee,0989,73200,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
73201_3,CT UPPER EXTREMITY W/DYE,ProFee,0989,73201,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
73202_3,CT UPPR EXTREMITY W/O&W/DYE,ProFee,0989,73202,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
73206_3,CT ANGIO UPR EXTRM W/O&W/DYE,ProFee,0989,73206,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
73218_3,MRI UPPER EXTREMITY W/O DYE,ProFee,0989,73218,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
73219_3,MRI UPPER EXTREMITY W/DYE,ProFee,0989,73219,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
73220_3,MRI UPPR EXTREMITY W/O&W/DYE,ProFee,0989,73220,,,,0,3.00,2.25,2.25,153.00,0.00,153.00,153.00,N/A
73221_3,MRI JOINT UPR EXTREM W/O DYE,ProFee,0989,73221,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
73222_3,MRI JOINT UPR EXTREM W/DYE,ProFee,0989,73222,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
73223_3,MRI JOINT UPR EXTR W/O&W/DYE,ProFee,0989,73223,,,,0,3.00,2.25,2.25,153.00,0.00,153.00,153.00,N/A
73225_3,MR ANGIO UPR EXTR W/O&W/DYE,ProFee,0989,73225,,,,0,3.00,2.25,2.25,122.00,0.00,122.00,122.00,N/A
73500_3,X-RAY EXAM OF HIP,ProFee,0989,73501,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
73501_3,X-RAY EXAM HIP UNI 1 VIEW,ProFee,0989,73501,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
73502_3,X-RAY EXAM HIP UNI 2-3 VIEWS,ProFee,0989,73502,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
73503_3,X-RAY EXAM HIP UNI 4/> VIEWS,ProFee,0989,73503,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
73510_3,X-RAY EXAM OF HIP,ProFee,0989,73510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73520_3,X-RAY EXAM OF HIPS,ProFee,0989,73520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73521_3,X-RAY EXAM HIPS BI 2 VIEWS,ProFee,0989,73521,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
73522_3,X-RAY EXAM HIPS BI 3-4 VIEWS,ProFee,0989,73522,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
73523_3,X-RAY EXAM HIPS BI 5/> VIEWS,ProFee,0989,73523,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
73525_3,CONTRAST X-RAY OF HIP,ProFee,0989,73525,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
73530_3,X-RAY EXAM OF HIP,ProFee,0989,73530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73540_3,X-RAY EXAM OF PELVIS & HIPS,ProFee,0989,73540,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73542_3,"X-RAY EXAM, SACROILIAC JOINT",ProFee,0989,73542,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73550_3,X-RAY EXAM OF THIGH,ProFee,0989,73550,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
73551_3,X-RAY EXAM OF FEMUR 1,ProFee,0989,73551,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73552_3,X-RAY EXAM OF FEMUR 2/>,ProFee,0989,73552,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
73560_3,"X-RAY EXAM OF KNEE, 1 OR 2",ProFee,0989,73560,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73562_3,"X-RAY EXAM OF KNEE, 3",ProFee,0989,73562,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
73564_3,"X-RAY EXAM, KNEE, 4 OR MORE",ProFee,0989,73564,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
73565_3,X-RAY EXAM OF KNEES,ProFee,0989,73565,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73580_3,CONTRAST X-RAY OF KNEE JOINT,ProFee,0989,73580,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
73590_3,X-RAY EXAM OF LOWER LEG,ProFee,0989,73590,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73592_3,"X-RAY EXAM OF LEG, INFANT",ProFee,0989,73592,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
73600_3,X-RAY EXAM OF ANKLE,ProFee,0989,73600,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73610_3,X-RAY EXAM OF ANKLE,ProFee,0989,73610,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
73615_3,CONTRAST X-RAY OF ANKLE,ProFee,0989,73615,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
73620_3,X-RAY EXAM OF FOOT,ProFee,0989,73620,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
73630_3,X-RAY EXAM OF FOOT,ProFee,0989,73630,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
73650_3,X-RAY EXAM OF HEEL,ProFee,0989,73650,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
73660_3,X-RAY EXAM OF TOE(S),ProFee,0989,73660,,,,0,3.00,2.25,2.25,9.50,0.00,9.50,9.50,N/A
73700_3,CT LOWER EXTREMITY W/O DYE,ProFee,0989,73700,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
73701_3,CT LOWER EXTREMITY W/DYE,ProFee,0989,73701,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
73702_3,CT LWR EXTREMITY W/O&W/DYE,ProFee,0989,73702,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
73706_3,CT ANGIO LWR EXTR W/O&W/DYE,ProFee,0989,73706,,,,0,3.00,2.25,2.25,134.50,0.00,134.50,134.50,N/A
73718_3,MRI LOWER EXTREMITY W/O DYE,ProFee,0989,73718,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
73719_3,MRI LOWER EXTREMITY W/DYE,ProFee,0989,73719,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
73720_3,MRI LWR EXTREMITY W/O&W/DYE,ProFee,0989,73720,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
73721_3,MRI JNT OF LWR EXTRE W/O DYE,ProFee,0989,73721,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
73722_3,MRI JOINT OF LWR EXTR W/DYE,ProFee,0989,73722,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
73723_3,MRI JOINT LWR EXTR W/O&W/DYE,ProFee,0989,73723,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
73725_3,MR ANG LWR EXT W OR W/O DYE,ProFee,0989,73725,,,,0,3.00,2.25,2.25,128.00,0.00,128.00,128.00,N/A
74000_3,X-RAY EXAM OF ABDOMEN,ProFee,0989,74018,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
74010_3,X-RAY EXAM OF ABDOMEN,ProFee,0989,74010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74018_3,X-RAY EXAM ABDOMEN 1 VIEW,ProFee,0989,74018,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
74019_3,X-RAY EXAM ABDOMEN 2 VIEWS,ProFee,0989,74019,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
74020_3,X-RAY EXAM OF ABDOMEN,ProFee,0989,74020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74021_3,X-RAY EXAM ABDOMEN 3+ VIEWS,ProFee,0989,74021,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
74022_3,"X-RAY EXAM SERIES, ABDOMEN",ProFee,0989,74022,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
74150_3,CT ABDOMEN W/O DYE,ProFee,0989,74150,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
74160_3,CT ABDOMEN W/DYE,ProFee,0989,74160,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
74170_3,CT ABDOMEN W/O & W/DYE,ProFee,0989,74170,,,,0,3.00,2.25,2.25,100.00,0.00,100.00,100.00,N/A
74174_3,CT ANGIO ABD&PELV W/O&W/DYE,ProFee,0989,74174,,,,0,3.00,2.25,2.25,155.00,0.00,155.00,155.00,N/A
74175_3,CT ANGIO ABDOM W/O & W/DYE,ProFee,0989,74175,,,,0,3.00,2.25,2.25,128.50,0.00,128.50,128.50,N/A
74176_3,CT ABD & PELVIS W/O CONTRAST,ProFee,0989,74176,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
74177_3,CT ABDOMEN&PELVIS W/CONTRAST,ProFee,0989,74177,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
74178_3,CT ABD&PELV 1+ SECTION/REGNS,ProFee,0989,74178,,,,0,3.00,2.25,2.25,142.50,0.00,142.50,142.50,N/A
74181_3,MRI ABDOMEN W/O DYE,ProFee,0989,74181,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
74182_3,MRI ABDOMEN W/DYE,ProFee,0989,74182,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
74183_3,MRI ABDOMEN W/O & W/DYE,ProFee,0989,74183,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
74185_3,"MRI ANGIO, ABDOM W ORW/O DYE",ProFee,0989,74185,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
74190_3,X-RAY EXAM OF PERITONEUM,ProFee,0989,74190,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
74210_3,CONTRST X-RAY EXAM OF THROAT,ProFee,0989,74210,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
74220_3,"CONTRAST X-RAY, ESOPHAGUS",ProFee,0989,74220,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
74221_3,X-RAY XM ESOPHAGUS 2CNTRST,ProFee,0989,74221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74230_3,"CINE/VID X-RAY, THROAT/ESOPH",ProFee,0989,74230,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
74235_3,REMOVE ESOPHAGUS OBSTRUCTION,ProFee,0989,74235,,,,0,3.00,2.25,2.25,88.00,0.00,88.00,88.00,N/A
74240_3,"X-RAY EXAM, UPPER GI TRACT",ProFee,0989,74240,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
74246_3,CONTRST X-RAY UPPR GI TRACT,ProFee,0989,74246,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
74248_3,X-RAY SM INT F-THRU STD,ProFee,0989,74248,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74250_3,X-RAY EXAM OF SMALL BOWEL,ProFee,0989,74250,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
74251_3,X-RAY EXAM OF SMALL BOWEL,ProFee,0989,74251,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
74261_3,"CT COLONOGRAPHY, W/O DYE",ProFee,0989,74261,,,,0,3.00,2.25,2.25,171.00,0.00,171.00,171.00,N/A
74262_3,"CT COLONOGRAPHY, W/DYE",ProFee,0989,74262,,,,0,3.00,2.25,2.25,178.00,0.00,178.00,178.00,N/A
74263_3,"CT COLONOGRAPHY, SCREEN",ProFee,0989,74263,,,,0,3.00,2.25,2.25,161.50,0.00,161.50,161.50,N/A
74270_3,CONTRAST X-RAY EXAM OF COLON,ProFee,0989,74270,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
74280_3,CONTRAST X-RAY EXAM OF COLON,ProFee,0989,74280,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
74283_3,CONTRAST X-RAY EXAM OF COLON,ProFee,0989,74283,,,,0,3.00,2.25,2.25,146.50,0.00,146.50,146.50,N/A
74290_3,"CONTRAST X-RAY, GALLBLADDER",ProFee,0989,74290,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
74291_3,"CONTRAST X-RAYS, GALLBLADDER",ProFee,0989,74291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74300_3,X-RAY BILE DUCTS/PANCREAS,ProFee,0989,74300,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
74301_3,X-RAYS AT SURGERY ADD-ON,ProFee,0989,74301,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
74305_3,X-RAY BILE DUCTS/PANCREAS,ProFee,0989,47531,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
74320_3,CONTRAST X-RAY OF BILE DUCTS,ProFee,0989,47532,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
74327_3,X-RAY BILE STONE REMOVAL,ProFee,0989,47544,,,,0,3.00,2.25,2.25,232.50,0.00,232.50,232.50,N/A
74328_3,X-RAY BILE DUCT ENDOSCOPY,ProFee,0989,74328,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
74329_3,X-RAY FOR PANCREAS ENDOSCOPY,ProFee,0989,74329,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
74330_3,X-RAY BILE/PANC ENDOSCOPY,ProFee,0989,74330,,,,0,3.00,2.25,2.25,65.00,0.00,65.00,65.00,N/A
74340_3,X-RAY GUIDE FOR GI TUBE,ProFee,0989,74340,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
74350_3,"X-RAY GUIDE, STOMACH TUBE",ProFee,0989,74350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74355_3,"X-RAY GUIDE, INTESTINAL TUBE",ProFee,0989,74355,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
74360_3,"X-RAY GUIDE, GI DILATION",ProFee,0989,74360,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
74363_3,"X-RAY, BILE DUCT DILATION",ProFee,0989,74363,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
74400_3,"CONTRST X-RAY, URINARY TRACT",ProFee,0989,74400,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
74410_3,"CONTRST X-RAY, URINARY TRACT",ProFee,0989,74410,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
74415_3,"CONTRST X-RAY, URINARY TRACT",ProFee,0989,74415,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
74420_3,"CONTRST X-RAY, URINARY TRACT",ProFee,0989,74420,,,,0,3.00,2.25,2.25,25.00,0.00,25.00,25.00,N/A
74425_3,"CONTRST X-RAY, URINARY TRACT",ProFee,0989,74425,,,,0,3.00,2.25,2.25,25.00,0.00,25.00,25.00,N/A
74430_3,"CONTRAST X-RAY, BLADDER",ProFee,0989,74430,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
74440_3,"X-RAY, MALE GENITAL TRACT",ProFee,0989,74440,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
74445_3,X-RAY EXAM OF PENIS,ProFee,0989,74445,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
74450_3,"X-RAY, URETHRA/BLADDER",ProFee,0989,74450,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
74455_3,"X-RAY, URETHRA/BLADDER",ProFee,0989,74455,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
74470_3,X-RAY EXAM OF KIDNEY LESION,ProFee,0989,74470,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
74475_3,"X-RAY CONTROL, CATH INSERT",ProFee,0989,74475,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74480_3,"X-RAY CONTROL, CATH INSERT",ProFee,0989,74480,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
74485_3,"X-RAY GUIDE, GU DILATION",ProFee,0989,74485,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
74710_3,X-RAY MEASUREMENT OF PELVIS,ProFee,0989,74710,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
74712_3,MRI FETAL SNGL/1ST GESTATION,ProFee,0989,74712,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
74713_3,MRI FETAL EA ADDL GESTATION,ProFee,0989,74713,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
74740_3,"X-RAY, FEMALE GENITAL TRACT",ProFee,0989,74740,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
74742_3,"X-RAY, FALLOPIAN TUBE",ProFee,0989,74742,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
74775_3,X-RAY EXAM OF PERINEUM,ProFee,0989,74775,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
75552_3,HEART MRI FOR MORPH W/O DYE,ProFee,0989,75552,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75553_3,HEART MRI FOR MORPH W/DYE,ProFee,0989,75553,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75554_3,CARDIAC MRI/FUNCTION,ProFee,0989,75554,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75555_3,CARDIAC MRI/LIMITED STUDY,ProFee,0989,75555,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75556_3,CARDIAC MRI/FLOW MAPPING,ProFee,0989,75556,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75557_3,CARDIAC MRI FOR MORPH,ProFee,0989,75557,,,,0,3.00,2.25,2.25,164.50,0.00,164.50,164.50,N/A
75558_3,CARDIAC MRI FLOW/VELOCITY,ProFee,0989,75558,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75559_3,CARDIAC MRI W/STRESS IMG,ProFee,0989,75559,,,,0,3.00,2.25,2.25,203.00,0.00,203.00,203.00,N/A
75560_3,CARDIAC MRI FLOW/VEL/STRESS,ProFee,0989,75560,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75561_3,CARDIAC MRI FOR MORPH W/DYE,ProFee,0989,75561,,,,0,3.00,2.25,2.25,181.50,0.00,181.50,181.50,N/A
75562_3,CARD MRI FLOW/VEL W/DYE,ProFee,0989,75562,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75563_3,CARD MRI W/STRESS IMG & DYE,ProFee,0989,75563,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
75564_3,HT MRI W/FLO/VEL/STRS & DYE,ProFee,0989,75564,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75565_3,CARD MRI VEL FLW MAP ADD-ON,ProFee,0989,75565,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
75571_3,CT HRT W/O DYE W/CA TEST,ProFee,0989,75571,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
75572_3,CT HRT W/3D IMAGE,ProFee,0989,75572,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
75573_3,"CT HRT W/3D IMAGE, CONGEN",ProFee,0989,75573,,,,0,3.00,2.25,2.25,179.00,0.00,179.00,179.00,N/A
75574_3,CT ANGIO HRT W/3D IMAGE,ProFee,0989,75574,,,,0,3.00,2.25,2.25,168.00,0.00,168.00,168.00,N/A
75600_3,CONTRAST X-RAY EXAM OF AORTA,ProFee,0989,75600,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
75605_3,CONTRAST X-RAY EXAM OF AORTA,ProFee,0989,75605,,,,0,3.00,2.25,2.25,79.00,0.00,79.00,79.00,N/A
75625_3,CONTRAST X-RAY EXAM OF AORTA,ProFee,0989,75625,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
75630_3,"X-RAY AORTA, LEG ARTERIES",ProFee,0989,75630,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
75635_3,CT ANGIO ABDOMINAL ARTERIES,ProFee,0989,75635,,,,0,3.00,2.25,2.25,168.50,0.00,168.50,168.50,N/A
75650_3,"ARTERY X-RAYS, HEAD & NECK",ProFee,0989,75650,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75658_3,"ARTERY X-RAYS, ARM",ProFee,0989,75710,,,,0,3.00,2.25,2.25,122.50,0.00,122.50,122.50,N/A
75660_3,"ARTERY X-RAYS, HEAD & NECK",ProFee,0989,75660,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75662_3,"ARTERY X-RAYS, HEAD & NECK",ProFee,0989,75662,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75665_3,"ARTERY X-RAYS, HEAD & NECK",ProFee,0989,75665,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75671_3,"ARTERY X-RAYS, HEAD & NECK",ProFee,0989,75671,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75676_3,"ARTERY X-RAYS, NECK",ProFee,0989,75676,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75680_3,"ARTERY X-RAYS, NECK",ProFee,0989,75680,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75685_3,"ARTERY X-RAYS, SPINE",ProFee,0989,75685,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75705_3,"ARTERY X-RAYS, SPINE",ProFee,0989,75705,,,,0,3.00,2.25,2.25,164.00,0.00,164.00,164.00,N/A
75710_3,"ARTERY X-RAYS, ARM/LEG",ProFee,0989,75710,,,,0,3.00,2.25,2.25,122.50,0.00,122.50,122.50,N/A
75716_3,"ARTERY X-RAYS, ARMS/LEGS",ProFee,0989,75716,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
75722_3,"ARTERY X-RAYS, KIDNEY",ProFee,0989,75722,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75724_3,"ARTERY X-RAYS, KIDNEYS",ProFee,0989,75724,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75726_3,"ARTERY X-RAYS, ABDOMEN",ProFee,0989,75726,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
75731_3,"ARTERY X-RAYS, ADRENAL GLAND",ProFee,0989,75731,,,,0,3.00,2.25,2.25,81.50,0.00,81.50,81.50,N/A
75733_3,"ARTERY X-RAYS, ADRENALS",ProFee,0989,75733,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
75736_3,"ARTERY X-RAYS, PELVIS",ProFee,0989,75736,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
75741_3,"ARTERY X-RAYS, LUNG",ProFee,0989,75741,,,,0,3.00,2.25,2.25,89.50,0.00,89.50,89.50,N/A
75743_3,"ARTERY X-RAYS, LUNGS",ProFee,0989,75743,,,,0,3.00,2.25,2.25,114.50,0.00,114.50,114.50,N/A
75746_3,"ARTERY X-RAYS, LUNG",ProFee,0989,75746,,,,0,3.00,2.25,2.25,79.00,0.00,79.00,79.00,N/A
75756_3,"ARTERY X-RAYS, CHEST",ProFee,0989,75756,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
75774_3,"ARTERY X-RAY, EACH VESSEL",ProFee,0989,75774,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
75790_3,VISUALIZE A-V SHUNT,ProFee,0989,75790,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75791_3,AV DIALYSIS SHUNT IMAGING,ProFee,0989,75791,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75801_3,"LYMPH VESSEL X-RAY, ARM/LEG",ProFee,0989,75801,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
75803_3,"LYMPH VESSEL X-RAY,ARMS/LEGS",ProFee,0989,75803,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
75805_3,"LYMPH VESSEL X-RAY, TRUNK",ProFee,0989,75805,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
75807_3,"LYMPH VESSEL X-RAY, TRUNK",ProFee,0989,75807,,,,0,3.00,2.25,2.25,80.50,0.00,80.50,80.50,N/A
75809_3,"NONVASCULAR SHUNT, X-RAY",ProFee,0989,75809,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
75810_3,"VEIN X-RAY, SPLEEN/LIVER",ProFee,0989,75810,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
75820_3,"VEIN X-RAY, ARM/LEG",ProFee,0989,75820,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
75822_3,"VEIN X-RAY, ARMS/LEGS",ProFee,0989,75822,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
75825_3,"VEIN X-RAY, TRUNK",ProFee,0989,75825,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
75827_3,"VEIN X-RAY, CHEST",ProFee,0989,75827,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
75831_3,"VEIN X-RAY, KIDNEY",ProFee,0989,75831,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
75833_3,"VEIN X-RAY, KIDNEYS",ProFee,0989,75833,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
75840_3,"VEIN X-RAY, ADRENAL GLAND",ProFee,0989,75840,,,,0,3.00,2.25,2.25,81.50,0.00,81.50,81.50,N/A
75842_3,"VEIN X-RAY, ADRENAL GLANDS",ProFee,0989,75842,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
75860_3,"VEIN X-RAY, NECK",ProFee,0989,75860,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
75870_3,"VEIN X-RAY, SKULL",ProFee,0989,75870,,,,0,3.00,2.25,2.25,81.50,0.00,81.50,81.50,N/A
75872_3,"VEIN X-RAY, SKULL",ProFee,0989,75872,,,,0,3.00,2.25,2.25,81.50,0.00,81.50,81.50,N/A
75880_3,"VEIN X-RAY, EYE SOCKET",ProFee,0989,75880,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
75885_3,"VEIN X-RAY, LIVER",ProFee,0989,75885,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
75887_3,"VEIN X-RAY, LIVER",ProFee,0989,75887,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
75889_3,"VEIN X-RAY, LIVER",ProFee,0989,75889,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
75891_3,"VEIN X-RAY, LIVER",ProFee,0989,75891,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
75893_3,VENOUS SAMPLING BY CATHETER,ProFee,0989,75893,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
75894_3,"X-RAYS, TRANSCATH THERAPY",ProFee,0989,75894,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
75896_3,"X-RAYS, TRANSCATH THERAPY",ProFee,0989,75896,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75898_3,FOLLOW-UP ANGIOGRAPHY,ProFee,0989,75898,,,,0,3.00,2.25,2.25,128.00,0.00,128.00,128.00,N/A
75900_3,ARTERIAL CATHETER EXCHANGE,ProFee,0989,75900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75901_3,REMOVE CVA DEVICE OBSTRUCT,ProFee,0989,75901,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
75902_3,REMOVE CVA LUMEN OBSTRUCT,ProFee,0989,75902,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
75940_3,"X-RAY PLACEMENT, VEIN FILTER",ProFee,0989,75940,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75945_3,INTRAVASCULAR US,ProFee,0989,37252,,,,0,3.00,2.25,2.25,133.00,0.00,133.00,133.00,N/A
75946_3,INTRAVASCULAR US ADD-ON,ProFee,0989,37253,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
75952_3,ENDOVASC REPAIR ABDOM AORTA,ProFee,0989,75952,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75953_3,ABDOM ANEURYSM ENDOVAS RPR,ProFee,0989,75953,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75954_3,ILIAC ANEURYSM ENDOVAS RPR,ProFee,0989,75954,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75956_3,"XRAY, ENDOVASC THOR AO REPR",ProFee,0989,75956,,,,0,3.00,2.25,2.25,493.50,0.00,493.50,493.50,N/A
75957_3,"XRAY, ENDOVASC THOR AO REPR",ProFee,0989,75957,,,,0,3.00,2.25,2.25,423.00,0.00,423.00,423.00,N/A
75958_3,"XRAY, PLACE PROX EXT THOR AO",ProFee,0989,75958,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
75959_3,"XRAY, PLACE DIST EXT THOR AO",ProFee,0989,75959,,,,0,3.00,2.25,2.25,247.00,0.00,247.00,247.00,N/A
75960_3,TRANSCATH IV STENT RS&I,ProFee,0989,75960,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75961_3,"RETRIEVAL, BROKEN CATHETER",ProFee,0989,75961,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75962_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,75962,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75964_3,"REPAIR ARTERY BLOCKAGE, EACH",ProFee,0989,75964,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75966_3,REPAIR ARTERIAL BLOCKAGE,ProFee,0989,75966,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75968_3,"REPAIR ARTERY BLOCKAGE, EACH",ProFee,0989,75968,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75970_3,VASCULAR BIOPSY,ProFee,0989,75970,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
75978_3,REPAIR VENOUS BLOCKAGE,ProFee,0989,75978,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75980_3,CONTRAST XRAY EXAM BILE DUCT,ProFee,0989,75980,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75982_3,CONTRAST XRAY EXAM BILE DUCT,ProFee,0989,75982,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75984_3,XRAY CONTROL CATHETER CHANGE,ProFee,0989,75984,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
75989_3,ABSCESS DRAINAGE UNDER X-RAY,ProFee,0989,75989,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
75992_3,"ATHERECTOMY, X-RAY EXAM",ProFee,0989,75992,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75993_3,"ATHERECTOMY, X-RAY EXAM",ProFee,0989,75993,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75994_3,"ATHERECTOMY, X-RAY EXAM",ProFee,0989,75994,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75995_3,"ATHERECTOMY, X-RAY EXAM",ProFee,0989,75995,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75996_3,"ATHERECTOMY, X-RAY EXAM",ProFee,0989,75996,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
75998_3,FLUOROGUIDE FOR VEIN DEVICE,ProFee,0989,75998,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76000_3,FLUOROSCOPE EXAMINATION,ProFee,0989,76000,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
76001_3,"FLUOROSCOPE EXAM, EXTENSIVE",ProFee,0989,76001,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
76003_3,NEEDLE LOCALIZATION BY X-RAY,ProFee,0989,76003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76005_3,FLUOROGUIDE FOR SPINE INJECT,ProFee,0989,76005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76006_3,X-RAY STRESS VIEW,ProFee,0989,76006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76010_3,"X-RAY, NOSE TO RECTUM",ProFee,0989,76010,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
76012_3,PERCUT VERTEBROPLASTY FLUOR,ProFee,0989,76012,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76013_3,"PERCUT VERTEBROPLASTY, CT",ProFee,0989,76013,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76020_3,X-RAYS FOR BONE AGE,ProFee,0989,76020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76040_3,"X-RAYS, BONE EVALUATION",ProFee,0989,76040,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76061_3,"X-RAYS, BONE SURVEY",ProFee,0989,76061,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76062_3,"X-RAYS, BONE SURVEY",ProFee,0989,76062,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76065_3,"X-RAYS, BONE EVALUATION",ProFee,0989,76065,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76066_3,"JOINT SURVEY, SINGLE VIEW",ProFee,0989,76066,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76070_3,"CT BONE DENSITY, AXIAL",ProFee,0989,76070,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76071_3,"CT BONE DENSITY, PERIPHERAL",ProFee,0989,76071,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76075_3,"DXA BONE DENSITY,  AXIAL",ProFee,0989,76075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76076_3,DXA BONE DENSITY/PERIPHERAL,ProFee,0989,76076,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76077_3,DXA BONE DENSITY/V-FRACTURE,ProFee,0989,76077,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76078_3,RADIOGRAPHIC ABSORPTIOMETRY,ProFee,0989,76078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76080_3,X-RAY EXAM OF FISTULA,ProFee,0989,76080,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
76082_3,COMPUTER MAMMOGRAM ADD-ON,ProFee,0989,76082,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76083_3,COMPUTER MAMMOGRAM ADD-ON,ProFee,0989,76083,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76086_3,X-RAY OF MAMMARY DUCT,ProFee,0989,76086,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76088_3,X-RAY OF MAMMARY DUCTS,ProFee,0989,76088,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76090_3,"MAMMOGRAM, ONE BREAST",ProFee,0989,76090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76091_3,"MAMMOGRAM, BOTH BREASTS",ProFee,0989,76091,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76092_3,"MAMMOGRAM, SCREENING",ProFee,0989,76092,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76093_3,"MAGNETIC IMAGE, BREAST",ProFee,0989,76093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76094_3,"MAGNETIC IMAGE, BOTH BREASTS",ProFee,0989,76094,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76095_3,STEREOTACTIC BREAST BIOPSY,ProFee,0989,76095,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76096_3,"X-RAY OF NEEDLE WIRE, BREAST",ProFee,0989,76096,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76098_3,"X-RAY EXAM, BREAST SPECIMEN",ProFee,0989,76098,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
76100_3,X-RAY EXAM OF BODY SECTION,ProFee,0989,76100,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
76101_3,COMPLEX BODY SECTION X-RAY,ProFee,0989,76101,,,,0,3.00,2.25,2.25,40.50,0.00,40.50,40.50,N/A
76102_3,COMPLEX BODY SECTION X-RAYS,ProFee,0989,76102,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
76120_3,CINE/VIDEO X-RAYS,ProFee,0989,76120,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
76125_3,CINE/VIDEO X-RAYS ADD-ON,ProFee,0989,76125,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
76140_3,X-RAY CONSULTATION,ProFee,0989,76140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76150_3,"X-RAY EXAM, DRY PROCESS",ProFee,0989,76150,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76350_3,SPECIAL X-RAY CONTRAST STUDY,ProFee,0989,76350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76355_3,CT SCAN FOR LOCALIZATION,ProFee,0989,76355,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76360_3,CT SCAN FOR NEEDLE BIOPSY,ProFee,0989,76360,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76362_3,CT GUIDE FOR TISSUE ABLATION,ProFee,0989,76362,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76370_3,CT SCAN FOR THERAPY GUIDE,ProFee,0989,76370,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76376_3,3D RENDER W/O POSTPROCESS,ProFee,0989,76376,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
76377_3,3D RENDERING W/POSTPROCESS,ProFee,0989,76377,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
76380_3,CAT SCAN FOLLOW-UP STUDY,ProFee,0989,76380,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
76390_3,MR SPECTROSCOPY,ProFee,0989,76390,,,,0,3.00,2.25,2.25,99.50,0.00,99.50,99.50,N/A
76391_3,MR ELASTOGRAPHY,ProFee,0989,76391,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76393_3,MR GUIDANCE FOR NEEDLE PLACE,ProFee,0989,76393,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76394_3,MRI FOR TISSUE ABLATION,ProFee,0989,76394,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76400_3,"MAGNETIC IMAGE, BONE MARROW",ProFee,0989,76400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76496_3,FLUOROSCOPIC PROCEDURE,ProFee,0989,76496,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
76497_3,CT PROCEDURE,ProFee,0989,76497,,,,0,3.00,2.25,2.25,42.00,0.00,42.00,42.00,N/A
76498_3,MRI PROCEDURE,ProFee,0989,76498,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
76499_3,RADIOGRAPHIC PROCEDURE,ProFee,0989,76499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76506_3,ECHO EXAM OF HEAD,ProFee,0989,76506,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
76510_3,"OPHTH US, B & QUANT A",ProFee,0989,76510,,,,0,3.00,2.25,2.25,102.00,0.00,102.00,102.00,N/A
76511_3,"OPHTH US, QUANT A ONLY",ProFee,0989,76511,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
76512_3,"OPHTH US, B W/NON-QUANT A",ProFee,0989,76512,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
76513_3,"ECHO EXAM OF EYE, WATER BATH",ProFee,0989,76513,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
76514_3,"ECHO EXAM OF EYE, THICKNESS",ProFee,0989,76514,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
76516_3,ECHO EXAM OF EYE,ProFee,0989,76516,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
76519_3,ECHO EXAM OF EYE,ProFee,0989,76519,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
76529_3,ECHO EXAM OF EYE,ProFee,0989,76529,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
76536_3,US EXAM OF HEAD AND NECK,ProFee,0989,76536,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
76604_3,"US EXAM, CHEST, B-SCAN",ProFee,0989,76604,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
76641_3,ULTRASOUND BREAST COMPLETE,ProFee,0989,76641,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
76642_3,ULTRASOUND BREAST LIMITED,ProFee,0989,76642,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
76645_3,"US EXAM, BREAST(S)",ProFee,0989,76645,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76700_3,"US EXAM, ABDOM, COMPLETE",ProFee,0989,76700,,,,0,3.00,2.25,2.25,57.50,0.00,57.50,57.50,N/A
76705_3,ECHO EXAM OF ABDOMEN,ProFee,0989,76705,,,,0,3.00,2.25,2.25,42.00,0.00,42.00,42.00,N/A
76706_3,US ABDL AORTA SCREEN AAA,ProFee,0989,76706,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
76770_3,"US EXAM ABDO BACK WALL, COMP",ProFee,0989,76770,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
76775_3,"US EXAM ABDO BACK WALL, LIM",ProFee,0989,76775,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
76776_3,US EXAM K TRANSPL W/DOPPLER,ProFee,0989,76776,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
76778_3,US EXAM KIDNEY TRANSPLANT,ProFee,0989,76778,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76800_3,"US EXAM, SPINAL CANAL",ProFee,0989,76800,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
76801_3,"OB US < 14 WKS, SINGLE FETUS",ProFee,0989,76801,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
76802_3,"OB US < 14 WKS, ADD'L FETUS",ProFee,0989,76802,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
76805_3,"OB US >/= 14 WKS, SNGL FETUS",ProFee,0989,76805,,,,0,3.00,2.25,2.25,72.00,0.00,72.00,72.00,N/A
76810_3,"OB US >/= 14 WKS, ADDL FETUS",ProFee,0989,76810,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
76811_3,"OB US, DETAILED, SNGL FETUS",ProFee,0989,76811,,,,0,3.00,2.25,2.25,139.50,0.00,139.50,139.50,N/A
76812_3,"OB US, DETAILED, ADDL FETUS",ProFee,0989,76812,,,,0,3.00,2.25,2.25,131.00,0.00,131.00,131.00,N/A
76813_3,"OB US NUCHAL MEAS, 1 GEST",ProFee,0989,76813,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
76814_3,"OB US NUCHAL MEAS, ADD-ON",ProFee,0989,76814,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
76815_3,"OB US, LIMITED, FETUS(S)",ProFee,0989,76815,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
76816_3,"OB US, FOLLOW-UP, PER FETUS",ProFee,0989,76816,,,,0,3.00,2.25,2.25,62.50,0.00,62.50,62.50,N/A
76817_3,"TRANSVAGINAL US, OBSTETRIC",ProFee,0989,76817,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
76818_3,FETAL BIOPHYS PROFILE W/NST,ProFee,0989,76818,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
76819_3,FETAL BIOPHYS PROFIL W/O NST,ProFee,0989,76819,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
76820_3,UMBILICAL ARTERY ECHO,ProFee,0989,76820,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
76821_3,MIDDLE CEREBRAL ARTERY ECHO,ProFee,0989,76821,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
76825_3,ECHO EXAM OF FETAL HEART,ProFee,0989,76825,,,,0,3.00,2.25,2.25,119.50,0.00,119.50,119.50,N/A
76826_3,ECHO EXAM OF FETAL HEART,ProFee,0989,76826,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
76827_3,ECHO EXAM OF FETAL HEART,ProFee,0989,76827,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
76828_3,ECHO EXAM OF FETAL HEART,ProFee,0989,76828,,,,0,3.00,2.25,2.25,40.50,0.00,40.50,40.50,N/A
76830_3,"TRANSVAGINAL US, NON-OB",ProFee,0989,76830,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
76831_3,"ECHO EXAM, UTERUS",ProFee,0989,76831,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
76856_3,"US EXAM, PELVIC, COMPLETE",ProFee,0989,76856,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
76857_3,"US EXAM, PELVIC, LIMITED",ProFee,0989,76857,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
76870_3,"US EXAM, SCROTUM",ProFee,0989,76870,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
76872_3,"US, TRANSRECTAL",ProFee,0989,76872,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
76873_3,"ECHOGRAP TRANS R, PROS STUDY",ProFee,0989,76873,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
76880_3,"US EXAM, EXTREMITY",ProFee,0989,76880,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76881_3,US XTR NON-VASC COMPLETE,ProFee,0989,76881,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
76882_3,US XTR NON-VASC LMTD,ProFee,0989,76882,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
76885_3,"US EXAM INFANT HIPS, DYNAMIC",ProFee,0989,76885,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
76886_3,"US EXAM INFANT HIPS, STATIC",ProFee,0989,76886,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
76932_3,ECHO GUIDE FOR HEART BIOPSY,ProFee,0989,76932,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
76936_3,ECHO GUIDE FOR ARTERY REPAIR,ProFee,0989,76936,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
76937_3,"US GUIDE, VASCULAR ACCESS",ProFee,0989,76937,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
76940_3,"US GUIDE, TISSUE ABLATION",ProFee,0989,76940,,,,0,3.00,2.25,2.25,147.00,0.00,147.00,147.00,N/A
76941_3,ECHO GUIDE FOR TRANSFUSION,ProFee,0989,76941,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
76942_3,ECHO GUIDE FOR BIOPSY,ProFee,0989,76942,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
76945_3,"ECHO GUIDE, VILLUS SAMPLING",ProFee,0989,76945,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
76946_3,ECHO GUIDE FOR AMNIOCENTESIS,ProFee,0989,76946,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
76948_3,"ECHO GUIDE, OVA ASPIRATION",ProFee,0989,76948,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
76950_3,ECHO GUIDANCE RADIOTHERAPY,ProFee,0989,76950,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76965_3,ECHO GUIDANCE RADIOTHERAPY,ProFee,0989,76965,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
76970_3,ULTRASOUND EXAM FOLLOW-UP,ProFee,0989,76970,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
76975_3,GI ENDOSCOPIC ULTRASOUND,ProFee,0989,76975,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
76977_3,US BONE DENSITY MEASURE,ProFee,0989,76977,,,,0,3.00,2.25,2.25,4.00,0.00,4.00,4.00,N/A
76978_3,US TRGT DYN MBUBB 1ST LES,ProFee,0989,76978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76979_3,US TRGT DYN MBUBB EA ADDL,ProFee,0989,76979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76981_3,USE PARENCHYMA,ProFee,0989,76981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76982_3,USE 1ST TARGET LESION,ProFee,0989,76982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76983_3,USE EA ADDL TARGET LESION,ProFee,0989,76983,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
76986_3,ULTRASOUND GUIDE INTRAOPER,ProFee,0989,76986,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
76998_3,"US GUIDE, INTRAOP",ProFee,0989,76998,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
76999_3,ECHO EXAMINATION PROCEDURE,ProFee,0989,76999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77001_3,FLUOROGUIDE FOR VEIN DEVICE,ProFee,0989,77001,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
77002_3,NEEDLE LOCALIZATION BY XRAY,ProFee,0989,77002,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
77003_3,FLUOROGUIDE FOR SPINE INJECT,ProFee,0989,77003,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
77011_3,CT SCAN FOR LOCALIZATION,ProFee,0989,77011,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
77012_3,CT SCAN FOR NEEDLE BIOPSY,ProFee,0989,77012,,,,0,3.00,2.25,2.25,81.50,0.00,81.50,81.50,N/A
77013_3,CT GUIDE FOR TISSUE ABLATION,ProFee,0989,77013,,,,0,3.00,2.25,2.25,274.00,0.00,274.00,274.00,N/A
77014_3,CT SCAN FOR THERAPY GUIDE,ProFee,0989,77014,,,,0,3.00,2.25,2.25,63.00,0.00,63.00,63.00,N/A
77021_3,MR GUIDANCE FOR NEEDLE PLACE,ProFee,0989,77021,,,,0,3.00,2.25,2.25,104.50,0.00,104.50,104.50,N/A
77022_3,MRI FOR TISSUE ABLATION,ProFee,0989,77022,,,,0,3.00,2.25,2.25,307.50,0.00,307.50,307.50,N/A
77031_3,STEREOTACT GUIDE FOR BRST BX,ProFee,0989,77031,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77032_3,"GUIDANCE FOR NEEDLE, BREAST",ProFee,0989,77032,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77046_3,MRI BREAST C- UNILATERAL,ProFee,0989,77046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77047_3,MRI BREAST C- BILATERAL,ProFee,0989,77047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77048_3,MRI BREAST C-+ W/CAD UNI,ProFee,0989,77048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77049_3,MRI BREAST C-+ W/CAD BI,ProFee,0989,77049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77051_3,COMPUTER DX MAMMOGRAM ADD-ON,ProFee,0989,77051,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77052_3,COMP SCREEN MAMMOGRAM ADD-ON,ProFee,0989,77052,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77053_3,X-RAY OF MAMMARY DUCT,ProFee,0989,77053,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
77054_3,X-RAY OF MAMMARY DUCTS,ProFee,0989,77054,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
77055_3,"MAMMOGRAM, ONE BREAST",ProFee,0989,77055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77056_3,"MAMMOGRAM, BOTH BREASTS",ProFee,0989,77056,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77057_3,"MAMMOGRAM, SCREENING",ProFee,0989,77057,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77058_3,"MRI, ONE BREAST",ProFee,0989,77058,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
77059_3,"MRI, BOTH BREASTS",ProFee,0989,77059,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
77061_3,BREAST TOMOSYNTHESIS UNI,ProFee,0989,77061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77062_3,BREAST TOMOSYNTHESIS BI,ProFee,0989,77062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77063_3,BREAST TOMOSYNTHESIS BI,ProFee,0989,77063,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
77065_3,DX MAMMO INCL CAD UNI,ProFee,0989,77065,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
77066_3,DX MAMMO INCL CAD BI,ProFee,0989,77066,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
77067_3,SCR MAMMO BI INCL CAD,ProFee,0989,77067,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
77071_3,X-RAY STRESS VIEW,ProFee,0989,77071,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
77072_3,X-RAYS FOR BONE AGE,ProFee,0989,77072,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
77073_3,"X-RAYS, BONE LENGTH STUDIES",ProFee,0989,77073,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
77074_3,"X-RAYS, BONE SURVEY, LIMITED",ProFee,0989,77074,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
77075_3,"X-RAYS, BONE SURVEY COMPLETE",ProFee,0989,77075,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
77076_3,"X-RAYS, BONE SURVEY, INFANT",ProFee,0989,77076,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
77077_3,"JOINT SURVEY, SINGLE VIEW",ProFee,0989,77077,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
77078_3,"CT BONE DENSITY, AXIAL",ProFee,0989,77078,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
77079_3,"CT BONE DENSITY, PERIPHERAL",ProFee,0989,77079,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77080_3,"DXA BONE DENSITY, AXIAL",ProFee,0989,77080,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
77081_3,DXA BONE DENSITY/PERIPHERAL,ProFee,0989,77081,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
77082_3,"DXA BONE DENSITY, VERT FX",ProFee,0989,77082,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77083_3,RADIOGRAPHIC ABSORPTIOMETRY,ProFee,0989,77083,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77084_3,"MAGNETIC IMAGE, BONE MARROW",ProFee,0989,77084,,,,0,3.00,2.25,2.25,114.50,0.00,114.50,114.50,N/A
77085_3,DXA BONE DENSITY STUDY,ProFee,0989,77085,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
77086_3,FRACTURE ASSESSMENT VIA DXA,ProFee,0989,77086,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
77261_3,RADIATION THERAPY PLANNING,ProFee,0989,77261,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
77262_3,RADIATION THERAPY PLANNING,ProFee,0989,77262,,,,0,3.00,2.25,2.25,153.00,0.00,153.00,153.00,N/A
77263_3,RADIATION THERAPY PLANNING,ProFee,0989,77263,,,,0,3.00,2.25,2.25,237.00,0.00,237.00,237.00,N/A
77280_3,SET RADIATION THERAPY FIELD,ProFee,0989,77280,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
77285_3,SET RADIATION THERAPY FIELD,ProFee,0989,77285,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
77290_3,SET RADIATION THERAPY FIELD,ProFee,0989,77290,,,,0,3.00,2.25,2.25,116.00,0.00,116.00,116.00,N/A
77293_3,RESPIRATOR MOTION MGMT SIMUL,ProFee,0989,77293,,,,0,3.00,2.25,2.25,148.00,0.00,148.00,148.00,N/A
77295_3,SET RADIATION THERAPY FIELD,ProFee,0989,77295,,,,0,3.00,2.25,2.25,317.50,0.00,317.50,317.50,N/A
77299_3,RADIATION THERAPY PLANNING,ProFee,0989,77299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77300_3,RADIATION THERAPY DOSE PLAN,ProFee,0989,77300,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
77301_3,"RADIOTHERAPY DOSE PLAN, IMRT",ProFee,0989,77301,,,,0,3.00,2.25,2.25,590.50,0.00,590.50,590.50,N/A
77305_3,TELETX ISODOSE PLAN SIMPLE,ProFee,0989,77305,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77306_3,TELETHX ISODOSE PLAN SIMPLE,ProFee,0989,77306,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
77307_3,TELETHX ISODOSE PLAN CPLX,ProFee,0989,77307,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
77310_3,TELETX ISODOSE PLAN INTERMED,ProFee,0989,77310,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77315_3,TELETX ISODOSE PLAN COMPLEX,ProFee,0989,77315,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77316_3,BRACHYTX ISODOSE PLAN SIMPLE,ProFee,0989,77316,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
77317_3,BRACHYTX ISODOSE INTERMED,ProFee,0989,77317,,,,0,3.00,2.25,2.25,135.00,0.00,135.00,135.00,N/A
77318_3,BRACHYTX ISODOSE COMPLEX,ProFee,0989,77318,,,,0,3.00,2.25,2.25,214.00,0.00,214.00,214.00,N/A
77321_3,SPECIAL TELETX PORT PLAN,ProFee,0989,77321,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
77326_3,BRACHYTX ISODOSE CALC SIMP,ProFee,0989,77326,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77327_3,BRACHYTX ISODOSE CALC INTERM,ProFee,0989,77327,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77328_3,BRACHYTX ISODOSE PLAN COMPL,ProFee,0989,77328,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77331_3,SPECIAL RADIATION DOSIMETRY,ProFee,0989,77331,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
77332_3,RADIATION TREATMENT AID(S),ProFee,0989,77332,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
77333_3,RADIATION TREATMENT AID(S),ProFee,0989,77333,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
77334_3,RADIATION TREATMENT AID(S),ProFee,0989,77334,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
77336_3,RADIATION PHYSICS CONSULT,ProFee,0989,77336,,,,0,3.00,2.25,2.25,115.00,0.00,115.00,115.00,N/A
77338_3,DESIGN MLC DEVICE FOR IMRT,ProFee,0989,77338,,,,0,3.00,2.25,2.25,317.50,0.00,317.50,317.50,N/A
77370_3,RADIATION PHYSICS CONSULT,ProFee,0989,77370,,,,0,3.00,2.25,2.25,177.00,0.00,177.00,177.00,N/A
77371_3,"SRS, MULTISOURCE",ProFee,0989,77371,,,,0,3.00,2.25,2.25,1761.50,0.00,1761.50,1761.50,N/A
77372_3,"SRS, LINEAR BASED",ProFee,0989,77372,,,,0,3.00,2.25,2.25,1553.50,0.00,1553.50,1553.50,N/A
77373_3,SBRT DELIVERY,ProFee,0989,77373,,,,0,3.00,2.25,2.25,1976.00,0.00,1976.00,1976.00,N/A
77385_3,NTSTY MODUL RAD TX DLVR SMPL,ProFee,0989,77385,,,,0,3.00,2.25,2.25,496.50,0.00,496.50,496.50,N/A
77386_3,NTSTY MODUL RAD TX DLVR CPLX,ProFee,0989,77386,,,,0,3.00,2.25,2.25,498.00,0.00,498.00,498.00,N/A
77387_3,GUIDANCE FOR RADJ TX DLVR,ProFee,0989,77387,,,,0,3.00,2.25,2.25,93.00,0.00,93.00,93.00,N/A
77399_3,EXTERNAL RADIATION DOSIMETRY,ProFee,0989,77399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77401_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77401,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
77402_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77402,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
77403_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77403,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77404_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77404,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77406_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77406,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77407_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77407,,,,0,3.00,2.25,2.25,287.00,0.00,287.00,287.00,N/A
77408_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77408,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77409_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77409,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77411_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77411,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77412_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77412,,,,0,3.00,2.25,2.25,386.50,0.00,386.50,386.50,N/A
77413_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77413,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77414_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77414,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77416_3,RADIATION TREATMENT DELIVERY,ProFee,0989,77416,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77417_3,RADIOLOGY PORT FILM(S),ProFee,0989,77417,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
77418_3,"RADIATION TX DELIVERY, IMRT",ProFee,0989,77418,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77421_3,STEREOSCOPIC X-RAY GUIDANCE,ProFee,0989,77421,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77422_3,"NEUTRON BEAM TX, SIMPLE",ProFee,0989,77423,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
77423_3,"NEUTRON BEAM TX, COMPLEX",ProFee,0989,77423,,,,0,3.00,2.25,2.25,139.00,0.00,139.00,139.00,N/A
77424_3,IO RAD TX DELIVERY BY X-RAY,ProFee,0989,77424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77425_3,IO RAD TX DELIVER BY ELCTRNS,ProFee,0989,77425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77427_3,"RADIATION TX MANAGEMENT, X5",ProFee,0989,77427,,,,0,3.00,2.25,2.25,265.50,0.00,265.50,265.50,N/A
77431_3,RADIATION THERAPY MANAGEMENT,ProFee,0989,77431,,,,0,3.00,2.25,2.25,146.00,0.00,146.00,146.00,N/A
77432_3,STEREOTACTIC RADIATION TRMT,ProFee,0989,77432,,,,0,3.00,2.25,2.25,597.50,0.00,597.50,597.50,N/A
77435_3,SBRT MANAGEMENT,ProFee,0989,77435,,,,0,3.00,2.25,2.25,901.00,0.00,901.00,901.00,N/A
77469_3,IO RADIATION TX MANAGEMENT,ProFee,0989,77469,,,,0,3.00,2.25,2.25,455.50,0.00,455.50,455.50,N/A
77470_3,SPECIAL RADIATION TREATMENT,ProFee,0989,77470,,,,0,3.00,2.25,2.25,150.00,0.00,150.00,150.00,N/A
77499_3,RADIATION THERAPY MANAGEMENT,ProFee,0989,77499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77520_3,"PROTON TRMT, SIMPLE W/O COMP",ProFee,0989,77520,,,,0,3.00,2.25,2.25,1136.00,0.00,1136.00,1136.00,N/A
77522_3,"PROTON TRMT, SIMPLE W/COMP",ProFee,0989,77522,,,,0,3.00,2.25,2.25,1134.00,0.00,1134.00,1134.00,N/A
77523_3,"PROTON TRMT, INTERMEDIATE",ProFee,0989,77523,,,,0,3.00,2.25,2.25,1329.50,0.00,1329.50,1329.50,N/A
77525_3,"PROTON TREATMENT, COMPLEX",ProFee,0989,77525,,,,0,3.00,2.25,2.25,1448.00,0.00,1448.00,1448.00,N/A
77600_3,HYPERTHERMIA TREATMENT,ProFee,0989,77600,,,,0,3.00,2.25,2.25,100.50,0.00,100.50,100.50,N/A
77605_3,HYPERTHERMIA TREATMENT,ProFee,0989,77605,,,,0,3.00,2.25,2.25,145.00,0.00,145.00,145.00,N/A
77610_3,HYPERTHERMIA TREATMENT,ProFee,0989,77610,,,,0,3.00,2.25,2.25,94.00,0.00,94.00,94.00,N/A
77615_3,HYPERTHERMIA TREATMENT,ProFee,0989,77615,,,,0,3.00,2.25,2.25,135.50,0.00,135.50,135.50,N/A
77620_3,HYPERTHERMIA TREATMENT,ProFee,0989,77620,,,,0,3.00,2.25,2.25,123.00,0.00,123.00,123.00,N/A
77750_3,INFUSE RADIOACTIVE MATERIALS,ProFee,0989,77750,,,,0,3.00,2.25,2.25,369.50,0.00,369.50,369.50,N/A
77761_3,APPLY INTRCAV RADIAT SIMPLE,ProFee,0989,77761,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
77762_3,APPLY INTRCAV RADIAT INTERM,ProFee,0989,77762,,,,0,3.00,2.25,2.25,426.50,0.00,426.50,426.50,N/A
77763_3,APPLY INTRCAV RADIAT COMPL,ProFee,0989,77763,,,,0,3.00,2.25,2.25,644.50,0.00,644.50,644.50,N/A
77767_3,HDR RDNCL SKN SURF BRACHYTX,ProFee,0989,77767,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
77768_3,HDR RDNCL SKN SURF BRACHYTX,ProFee,0989,77768,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
77770_3,HDR RDNCL NTRSTL/ICAV BRCHTX,ProFee,0989,77770,,,,0,3.00,2.25,2.25,144.00,0.00,144.00,144.00,N/A
77771_3,HDR RDNCL NTRSTL/ICAV BRCHTX,ProFee,0989,77771,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
77772_3,HDR RDNCL NTRSTL/ICAV BRCHTX,ProFee,0989,77772,,,,0,3.00,2.25,2.25,398.50,0.00,398.50,398.50,N/A
77776_3,APPLY INTERSTIT RADIAT SIMPL,ProFee,0989,77799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77777_3,APPLY INTERSTIT RADIAT INTER,ProFee,0989,77799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
77778_3,APPLY INTERSTIT RADIAT COMPL,ProFee,0989,77778,,,,0,3.00,2.25,2.25,647.00,0.00,647.00,647.00,N/A
77781_3,HIGH INTENSITY BRACHYTHERAPY,ProFee,0989,77781,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77782_3,HIGH INTENSITY BRACHYTHERAPY,ProFee,0989,77782,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77783_3,HIGH INTENSITY BRACHYTHERAPY,ProFee,0989,77783,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77784_3,HIGH INTENSITY BRACHYTHERAPY,ProFee,0989,77784,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
77785_3,"HDR BRACHYTX, 1 CHANNEL",ProFee,0989,77770,,,,0,3.00,2.25,2.25,144.00,0.00,144.00,144.00,N/A
77786_3,"HDR BRACHYTX, 2-12 CHANNEL",ProFee,0989,77771,,,,0,3.00,2.25,2.25,281.50,0.00,281.50,281.50,N/A
77787_3,HDR BRACHYTX OVER 12 CHAN,ProFee,0989,77772,,,,0,3.00,2.25,2.25,398.50,0.00,398.50,398.50,N/A
77789_3,APPLY SURFACE RADIATION,ProFee,0989,77789,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
77790_3,RADIATION HANDLING,ProFee,0989,77790,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
77799_3,RADIUM/RADIOISOTOPE THERAPY,ProFee,0989,77799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78000_3,"THYROID, SINGLE UPTAKE",ProFee,0989,78000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78001_3,"THYROID, MULTIPLE UPTAKES",ProFee,0989,78001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78003_3,THYROID SUPPRESS/STIMUL,ProFee,0989,78003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78006_3,THYROID IMAGING WITH UPTAKE,ProFee,0989,78006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78007_3,"THYROID IMAGE, MULT UPTAKES",ProFee,0989,78007,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78010_3,THYROID IMAGING,ProFee,0989,78010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78011_3,THYROID IMAGING WITH FLOW,ProFee,0989,78011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78012_3,THYROID UPTAKE MEASUREMENT,ProFee,0989,78012,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
78013_3,THYROID IMAGING W/BLOOD FLOW,ProFee,0989,78013,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
78014_3,THYROID IMAGING W/BLOOD FLOW,ProFee,0989,78014,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
78015_3,THYROID MET IMAGING,ProFee,0989,78015,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
78016_3,THYROID MET IMAGING/STUDIES,ProFee,0989,78016,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
78018_3,"THYROID MET IMAGING, BODY",ProFee,0989,78018,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
78020_3,THYROID MET UPTAKE,ProFee,0989,78020,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
78070_3,PARATHYROID NUCLEAR IMAGING,ProFee,0989,78070,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
78071_3,PARATHYRD PLANAR W/WO SUBTRJ,ProFee,0989,78071,,,,0,3.00,2.25,2.25,83.50,0.00,83.50,83.50,N/A
78072_3,PARATHYRD PLANAR W/SPECT&CT,ProFee,0989,78072,,,,0,3.00,2.25,2.25,109.50,0.00,109.50,109.50,N/A
78075_3,ADRENAL NUCLEAR IMAGING,ProFee,0989,78075,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
78099_3,ENDOCRINE NUCLEAR PROCEDURE,ProFee,0989,78099,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78102_3,"BONE MARROW IMAGING, LTD",ProFee,0989,78102,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
78103_3,"BONE MARROW IMAGING, MULT",ProFee,0989,78103,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
78104_3,"BONE MARROW IMAGING, BODY",ProFee,0989,78104,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
78110_3,"PLASMA VOLUME, SINGLE",ProFee,0989,78110,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
78111_3,"PLASMA VOLUME, MULTIPLE",ProFee,0989,78111,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
78120_3,"RED CELL MASS, SINGLE",ProFee,0989,78120,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
78121_3,"RED CELL MASS, MULTIPLE",ProFee,0989,78121,,,,0,3.00,2.25,2.25,19.00,0.00,19.00,19.00,N/A
78122_3,BLOOD VOLUME,ProFee,0989,78122,,,,0,3.00,2.25,2.25,30.00,0.00,30.00,30.00,N/A
78130_3,RED CELL SURVIVAL STUDY,ProFee,0989,78130,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
78135_3,RED CELL SURVIVAL KINETICS,ProFee,0989,78135,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
78140_3,RED CELL SEQUESTRATION,ProFee,0989,78140,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
78185_3,SPLEEN IMAGING,ProFee,0989,78185,,,,0,3.00,2.25,2.25,24.00,0.00,24.00,24.00,N/A
78190_3,"PLATELET SURVIVAL, KINETICS",ProFee,0989,78191,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
78191_3,PLATELET SURVIVAL,ProFee,0989,78191,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
78195_3,LYMPH SYSTEM IMAGING,ProFee,0989,78195,,,,0,3.00,2.25,2.25,83.50,0.00,83.50,83.50,N/A
78199_3,BLOOD/LYMPH NUCLEAR EXAM,ProFee,0989,78199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78201_3,LIVER IMAGING,ProFee,0989,78201,,,,0,3.00,2.25,2.25,30.00,0.00,30.00,30.00,N/A
78202_3,LIVER IMAGING WITH FLOW,ProFee,0989,78202,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
78215_3,LIVER AND SPLEEN IMAGING,ProFee,0989,78215,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
78216_3,LIVER & SPLEEN IMAGE/FLOW,ProFee,0989,78216,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
78220_3,LIVER FUNCTION STUDY,ProFee,0989,78220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78223_3,HEPATOBILIARY IMAGING,ProFee,0989,78223,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78226_3,HEPATOBILIARY SYSTEM IMAGING,ProFee,0989,78226,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
78227_3,HEPATOBIL SYST IMAGE W/DRUG,ProFee,0989,78227,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
78230_3,SALIVARY GLAND IMAGING,ProFee,0989,78230,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
78231_3,SERIAL SALIVARY IMAGING,ProFee,0989,78231,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
78232_3,SALIVARY GLAND FUNCTION EXAM,ProFee,0989,78232,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
78258_3,ESOPHAGEAL MOTILITY STUDY,ProFee,0989,78258,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
78261_3,GASTRIC MUCOSA IMAGING,ProFee,0989,78261,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
78262_3,GASTROESOPHAGEAL REFLUX EXAM,ProFee,0989,78262,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
78264_3,GASTRIC EMPTYING STUDY,ProFee,0989,78264,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
78265_3,GASTRIC EMPTYING IMAG STUDY,ProFee,0989,78265,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
78266_3,GASTRIC EMPTYING IMAG STUDY,ProFee,0989,78266,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
78267_3,BREATH TST ATTAIN/ANAL C-14,ProFee,0989,78267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78268_3,"BREATH TEST ANALYSIS, C-14",ProFee,0989,78268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78270_3,VIT B-12 ABSORPTION EXAM,ProFee,0989,78270,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
78271_3,"VIT B-12 ABSRP EXAM, INT FAC",ProFee,0989,78271,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
78272_3,"VIT B-12 ABSORP, COMBINED",ProFee,0989,78272,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
78278_3,ACUTE GI BLOOD LOSS IMAGING,ProFee,0989,78278,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
78282_3,GI PROTEIN LOSS EXAM,ProFee,0989,78282,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
78290_3,MECKEL'S DIVERT EXAM,ProFee,0989,78290,,,,0,3.00,2.25,2.25,47.50,0.00,47.50,47.50,N/A
78291_3,LEVEEN/SHUNT PATENCY EXAM,ProFee,0989,78291,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
78299_3,GI NUCLEAR PROCEDURE,ProFee,0989,78299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78300_3,"BONE IMAGING, LIMITED AREA",ProFee,0989,78300,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
78305_3,"BONE IMAGING, MULTIPLE AREAS",ProFee,0989,78305,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
78306_3,"BONE IMAGING, WHOLE BODY",ProFee,0989,78306,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
78315_3,"BONE IMAGING, 3 PHASE",ProFee,0989,78315,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
78350_3,"BONE MINERAL, SINGLE PHOTON",ProFee,0989,78350,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
78351_3,"BONE MINERAL, DUAL PHOTON",ProFee,0989,78351,,,,0,3.00,2.25,2.25,22.00,0.00,22.00,22.00,N/A
78399_3,MUSCULOSKELETAL NUCLEAR EXAM,ProFee,0989,78399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78414_3,NON-IMAGING HEART FUNCTION,ProFee,0989,78414,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
78428_3,CARDIAC SHUNT IMAGING,ProFee,0989,78428,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
78429_3,MYOCRD IMG PET 1 STD W/CT,ProFee,0989,78429,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78430_3,MYOCRD IMG PET RST/STRS W/CT,ProFee,0989,78430,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78431_3,MYOCRD IMG PET RST&STRS CT,ProFee,0989,78431,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78432_3,MYOCRD IMG PET 2RTRACER,ProFee,0989,78432,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78433_3,MYOCRD IMG PET 2RTRACER CT,ProFee,0989,78433,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78434_3,AQMBF PET REST & RX STRESS,ProFee,0989,78434,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78445_3,VASCULAR FLOW IMAGING,ProFee,0989,78445,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
78451_3,"HT MUSCLE IMAGE SPECT, SING",ProFee,0989,78451,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
78452_3,"HT MUSCLE IMAGE SPECT, MULT",ProFee,0989,78452,,,,0,3.00,2.25,2.25,112.50,0.00,112.50,112.50,N/A
78453_3,"HT MUSCLE IMAGE,PLANAR,SING",ProFee,0989,78453,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
78454_3,"HT MUSC IMAGE, PLANAR, MULT",ProFee,0989,78454,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
78456_3,ACUTE VENOUS THROMBUS IMAGE,ProFee,0989,78456,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
78457_3,VENOUS THROMBOSIS IMAGING,ProFee,0989,78457,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
78458_3,"VEN THROMBOSIS IMAGES, BILAT",ProFee,0989,78458,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
78459_3,HEART MUSCLE IMAGING (PET),ProFee,0989,78459,,,,0,3.00,2.25,2.25,100.50,0.00,100.50,100.50,N/A
78460_3,"HEART MUSCLE BLOOD, SINGLE",ProFee,0989,78460,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78461_3,"HEART MUSCLE BLOOD, MULTIPLE",ProFee,0989,78461,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78464_3,"HEART IMAGE (3D), SINGLE",ProFee,0989,78464,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78465_3,"HEART IMAGE (3D), MULTIPLE",ProFee,0989,78465,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78466_3,HEART INFARCT IMAGE,ProFee,0989,78466,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
78468_3,HEART INFARCT IMAGE (EF),ProFee,0989,78468,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
78469_3,HEART INFARCT IMAGE (3D),ProFee,0989,78469,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
78472_3,"GATED HEART, PLANAR, SINGLE",ProFee,0989,78472,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
78473_3,"GATED HEART, MULTIPLE",ProFee,0989,78473,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
78478_3,HEART WALL MOTION ADD-ON,ProFee,0989,78478,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78480_3,HEART FUNCTION ADD-ON,ProFee,0989,78480,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78481_3,"HEART FIRST PASS, SINGLE",ProFee,0989,78481,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
78483_3,"HEART FIRST PASS, MULTIPLE",ProFee,0989,78483,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
78491_3,"HEART IMAGE (PET), SINGLE",ProFee,0989,78491,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
78492_3,"HEART IMAGE (PET), MULTIPLE",ProFee,0989,78492,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
78494_3,"HEART IMAGE, SPECT",ProFee,0989,78494,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
78496_3,HEART FIRST PASS ADD-ON,ProFee,0989,78496,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
78499_3,CARDIOVASCULAR NUCLEAR EXAM,ProFee,0989,78499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78579_3,LUNG VENTILATION IMAGING,ProFee,0989,78579,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
78580_3,LUNG PERFUSION IMAGING,ProFee,0989,78580,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
78582_3,LUNG VENTILAT&PERFUS IMAGING,ProFee,0989,78582,,,,0,3.00,2.25,2.25,75.00,0.00,75.00,75.00,N/A
78584_3,LUNG V/Q IMAGE SINGLE BREATH,ProFee,0989,78584,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78585_3,LUNG V/Q IMAGING,ProFee,0989,78585,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78586_3,"AEROSOL LUNG IMAGE, SINGLE",ProFee,0989,78586,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78587_3,"AEROSOL LUNG IMAGE, MULTIPLE",ProFee,0989,78587,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78588_3,PERFUSION LUNG IMAGE,ProFee,0989,78588,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78591_3,"VENT IMAGE, 1 BREATH, 1 PROJ",ProFee,0989,78591,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78593_3,"VENT IMAGE, 1 PROJ, GAS",ProFee,0989,78593,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78594_3,"VENT IMAGE, MULT PROJ, GAS",ProFee,0989,78594,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78596_3,LUNG DIFFERENTIAL FUNCTION,ProFee,0989,78596,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78597_3,LUNG PERFUSION DIFFERENTIAL,ProFee,0989,78597,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
78598_3,LUNG PERF&VENTILAT DIFERENTL,ProFee,0989,78598,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
78599_3,RESPIRATORY NUCLEAR EXAM,ProFee,0989,78599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78600_3,"BRAIN IMAGING, LTD STATIC",ProFee,0989,78600,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
78601_3,"BRAIN IMAGING, LTD W/FLOW",ProFee,0989,78601,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
78605_3,"BRAIN IMAGING, COMPLETE",ProFee,0989,78605,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
78606_3,"BRAIN IMAGING, COMPL W/FLOW",ProFee,0989,78606,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
78608_3,BRAIN IMAGING (PET),ProFee,0989,78608,,,,0,3.00,2.25,2.25,102.00,0.00,102.00,102.00,N/A
78609_3,BRAIN IMAGING (PET),ProFee,0989,78609,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
78610_3,BRAIN FLOW IMAGING ONLY,ProFee,0989,78610,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
78615_3,CEREBRAL VASCULAR FLOW IMAGE,ProFee,0989,78615,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78630_3,CEREBROSPINAL FLUID SCAN,ProFee,0989,78630,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
78635_3,CSF VENTRICULOGRAPHY,ProFee,0989,78635,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
78645_3,CSF SHUNT EVALUATION,ProFee,0989,78645,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
78650_3,CSF LEAKAGE IMAGING,ProFee,0989,78650,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
78660_3,NUCLEAR EXAM OF TEAR FLOW,ProFee,0989,78660,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
78699_3,NERVOUS SYSTEM NUCLEAR EXAM,ProFee,0989,78699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78700_3,"KIDNEY IMAGING, STATIC",ProFee,0989,78700,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
78701_3,KIDNEY IMAGING WITH FLOW,ProFee,0989,78701,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
78704_3,IMAGING RENOGRAM,ProFee,0989,78704,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78707_3,KIDNEY FLOW/FUNCTION IMAGE,ProFee,0989,78707,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
78708_3,KIDNEY FLOW/FUNCTION IMAGE,ProFee,0989,78708,,,,0,3.00,2.25,2.25,84.00,0.00,84.00,84.00,N/A
78709_3,KIDNEY FLOW/FUNCTION IMAGE,ProFee,0989,78709,,,,0,3.00,2.25,2.25,97.00,0.00,97.00,97.00,N/A
78715_3,RENAL VASCULAR FLOW EXAM,ProFee,0989,78715,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78725_3,KIDNEY FUNCTION STUDY,ProFee,0989,78725,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
78730_3,URINARY BLADDER RETENTION,ProFee,0989,78730,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
78740_3,URETERAL REFLUX STUDY,ProFee,0989,78740,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
78760_3,TESTICULAR IMAGING,ProFee,0989,78760,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78761_3,TESTICULAR IMAGING/FLOW,ProFee,0989,78761,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
78799_3,GENITOURINARY NUCLEAR EXAM,ProFee,0989,78799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
78800_3,"TUMOR IMAGING, LIMITED AREA",ProFee,0989,78800,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
78801_3,"TUMOR IMAGING, MULT AREAS",ProFee,0989,78801,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
78802_3,"TUMOR IMAGING, WHOLE BODY",ProFee,0989,78802,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
78803_3,TUMOR IMAGING (3D),ProFee,0989,78803,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
78804_3,"TUMOR IMAGING, WHOLE BODY",ProFee,0989,78804,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
78808_3,IV INJ RA DRUG DX STUDY,ProFee,0989,78808,,,,0,3.00,2.25,2.25,56.00,0.00,56.00,56.00,N/A
78811_3,"TUMOR IMAGING (PET), LIMITED",ProFee,0989,78811,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
78812_3,TUMOR IMAGE (PET)/SKUL-THIGH,ProFee,0989,78812,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
78813_3,TUMOR IMAGE (PET) FULL BODY,ProFee,0989,78813,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
78814_3,"TUMOR IMAGE PET/CT, LIMITED",ProFee,0989,78814,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
78815_3,TUMORIMAGE PET/CT SKUL-THIGH,ProFee,0989,78815,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
78816_3,TUMOR IMAGE PET/CT FULL BODY,ProFee,0989,78816,,,,0,3.00,2.25,2.25,171.00,0.00,171.00,171.00,N/A
78830_3,RP LOCLZJ TUM SPECT W/CT 1,ProFee,0989,78830,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78831_3,RP LOCLZJ TUM SPECT 2 AREAS,ProFee,0989,78831,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78832_3,RP LOCLZJ TUM SPECT W/CT 2,ProFee,0989,78832,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78835_3,RP QUAN MEAS SINGLE AREA,ProFee,0989,78835,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78890_3,NUCLEAR MEDICINE DATA PROC,ProFee,0989,78890,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78891_3,NUCLEAR MED DATA PROC,ProFee,0989,78891,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
78999_3,NUCLEAR DIAGNOSTIC EXAM,ProFee,0989,78999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
79005_3,"NUCLEAR RX, ORAL ADMIN",ProFee,0989,79005,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
79101_3,"NUCLEAR RX, IV ADMIN",ProFee,0989,79101,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
79200_3,"NUCLEAR RX, INTRACAV ADMIN",ProFee,0989,79200,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
79300_3,"NUCLR RX, INTERSTIT COLLOID",ProFee,0989,79300,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
79403_3,HEMATOPOIETIC NUCLEAR TX,ProFee,0989,79403,,,,0,3.00,2.25,2.25,156.00,0.00,156.00,156.00,N/A
79440_3,"NUCLEAR RX, INTRA-ARTICULAR",ProFee,0989,79440,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
79445_3,"NUCLEAR RX, INTRA-ARTERIAL",ProFee,0989,79445,,,,0,3.00,2.25,2.25,163.00,0.00,163.00,163.00,N/A
79999_3,NUCLEAR MEDICINE THERAPY,ProFee,0989,79999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80047_3,METABOLIC PANEL IONIZED CA,ProFee,0989,80047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80048_3,BASIC METABOLIC PANEL,ProFee,0989,80048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80050_3,GENERAL HEALTH PANEL,ProFee,0989,80050,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
80051_3,ELECTROLYTE PANEL,ProFee,0989,80051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80053_3,COMPREHEN METABOLIC PANEL,ProFee,0989,80053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80055_3,OBSTETRIC PANEL,ProFee,0989,80055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80061_3,LIPID PANEL,ProFee,0989,80061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80069_3,RENAL FUNCTION PANEL,ProFee,0989,80069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80074_3,ACUTE HEPATITIS PANEL,ProFee,0989,80074,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80076_3,HEPATIC FUNCTION PANEL,ProFee,0989,80076,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80081_3,OBSTETRIC PANEL,ProFee,0989,80081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80101_3,"DRUG SCREEN, SINGLE",ProFee,0989,80101,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80102_3,DRUG CONFIRMATION,ProFee,0989,80102,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80103_3,"DRUG ANALYSIS, TISSUE PREP",ProFee,0989,80103,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80104_3,DRUG SCRN 1+ CLASS NONCHROMO,ProFee,0989,80104,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80145_3,DRUG ASSAY ADALIMUMAB,ProFee,0989,80145,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80150_3,ASSAY OF AMIKACIN,ProFee,0989,80150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80152_3,ASSAY OF AMITRIPTYLINE,ProFee,0989,80152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80154_3,ASSAY OF BENZODIAZEPINES,ProFee,0989,80154,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80155_3,DRUG ASSAY CAFFEINE,ProFee,0989,80155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80156_3,"ASSAY, CARBAMAZEPINE, TOTAL",ProFee,0989,80156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80157_3,"ASSAY, CARBAMAZEPINE, FREE",ProFee,0989,80157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80158_3,ASSAY OF CYCLOSPORINE,ProFee,0989,80158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80159_3,DRUG ASSAY CLOZAPINE,ProFee,0989,80159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80160_3,ASSAY OF DESIPRAMINE,ProFee,0989,80160,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80162_3,ASSAY OF DIGOXIN,ProFee,0989,80162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80163_3,ASSAY OF DIGOXIN FREE,ProFee,0989,80163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80164_3,"ASSAY, DIPROPYLACETIC ACID",ProFee,0989,80164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80165_3,DIPROPYLACETIC ACID FREE,ProFee,0989,80165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80166_3,ASSAY OF DOXEPIN,ProFee,0989,80166,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80168_3,ASSAY OF ETHOSUXIMIDE,ProFee,0989,80168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80169_3,DRUG ASSAY EVEROLIMUS,ProFee,0989,80169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80170_3,ASSAY OF GENTAMICIN,ProFee,0989,80170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80171_3,DRUG SCREEN QUANT GABAPENTIN,ProFee,0989,80171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80172_3,ASSAY OF GOLD,ProFee,0989,80172,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80173_3,ASSAY OF HALOPERIDOL,ProFee,0989,80173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80174_3,ASSAY OF IMIPRAMINE,ProFee,0989,80174,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80175_3,DRUG SCREEN QUAN LAMOTRIGINE,ProFee,0989,80175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80176_3,ASSAY OF LIDOCAINE,ProFee,0989,80176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80177_3,DRUG SCRN QUAN LEVETIRACETAM,ProFee,0989,80177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80178_3,ASSAY OF LITHIUM,ProFee,0989,80178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80180_3,DRUG SCRN QUAN MYCOPHENOLATE,ProFee,0989,80180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80182_3,ASSAY OF NORTRIPTYLINE,ProFee,0989,80182,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80183_3,DRUG SCRN QUANT OXCARBAZEPIN,ProFee,0989,80183,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80184_3,ASSAY OF PHENOBARBITAL,ProFee,0989,80184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80185_3,"ASSAY OF PHENYTOIN, TOTAL",ProFee,0989,80185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80186_3,"ASSAY OF PHENYTOIN, FREE",ProFee,0989,80186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80187_3,DRUG ASSAY POSACONAZOLE,ProFee,0989,80187,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80188_3,ASSAY OF PRIMIDONE,ProFee,0989,80188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80190_3,ASSAY OF PROCAINAMIDE,ProFee,0989,80190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80192_3,ASSAY OF PROCAINAMIDE,ProFee,0989,80192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80194_3,ASSAY OF QUINIDINE,ProFee,0989,80194,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80195_3,ASSAY OF SIROLIMUS,ProFee,0989,80195,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80196_3,ASSAY OF SALICYLATE,ProFee,0989,80196,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80197_3,ASSAY OF TACROLIMUS,ProFee,0989,80197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80198_3,ASSAY OF THEOPHYLLINE,ProFee,0989,80198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80199_3,DRUG SCREEN QUANT TIAGABINE,ProFee,0989,80199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80200_3,ASSAY OF TOBRAMYCIN,ProFee,0989,80200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80201_3,ASSAY OF TOPIRAMATE,ProFee,0989,80201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80202_3,ASSAY OF VANCOMYCIN,ProFee,0989,80202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80203_3,DRUG SCREEN QUANT ZONISAMIDE,ProFee,0989,80203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80230_3,DRUG ASSAY INFLIXIMAB,ProFee,0989,80230,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80235_3,DRUG ASSAY LACOSAMIDE,ProFee,0989,80235,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80280_3,DRUG ASSAY VEDOLIZUMAB,ProFee,0989,80280,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80285_3,DRUG ASSAY VORICONAZOLE,ProFee,0989,80285,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80299_3,"QUANTITATIVE ASSAY, DRUG",ProFee,0989,80299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80305_3,DRUG TEST PRSMV DIR OPT OBS,ProFee,0989,80305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80306_3,DRUG TEST PRSMV INSTRMNT,ProFee,0989,80306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80307_3,DRUG TEST PRSMV CHEM ANLYZR,ProFee,0989,80307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80320_3,DRUG SCREEN QUANTALCOHOLS,ProFee,0989,80320,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80321_3,ALCOHOLS BIOMARKERS 1OR 2,ProFee,0989,80321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80322_3,ALCOHOLS BIOMARKERS 3/MORE,ProFee,0989,80322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80323_3,ALKALOIDS NOS,ProFee,0989,80323,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80324_3,DRUG SCREEN AMPHETAMINES 1/2,ProFee,0989,80324,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80325_3,AMPHETAMINES 3OR 4,ProFee,0989,80325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80326_3,AMPHETAMINES 5 OR MORE,ProFee,0989,80326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80327_3,ANABOLIC STEROID 1 OR 2,ProFee,0989,80327,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80328_3,ANABOLIC STEROID 3 OR MORE,ProFee,0989,80328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80329_3,ANALGESICS NON-OPIOID 1 OR 2,ProFee,0989,80329,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80330_3,ANALGESICS NON-OPIOID 3-5,ProFee,0989,80330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80331_3,ANALGESICS NON-OPIOID 6/MORE,ProFee,0989,80331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80332_3,ANTIDEPRESSANTS CLASS 1 OR 2,ProFee,0989,80332,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80333_3,ANTIDEPRESSANTS CLASS 3-5,ProFee,0989,80333,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80334_3,ANTIDEPRESSANTS CLASS 6/MORE,ProFee,0989,80334,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80335_3,ANTIDEPRESSANT TRICYCLIC 1/2,ProFee,0989,80335,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80336_3,ANTIDEPRESSANT TRICYCLIC 3-5,ProFee,0989,80336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80337_3,TRICYCLIC & CYCLICALS 6/MORE,ProFee,0989,80337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80338_3,ANTIDEPRESSANT NOT SPECIFIED,ProFee,0989,80338,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80339_3,ANTIEPILEPTICS NOS 1-3,ProFee,0989,80339,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80340_3,ANTIEPILEPTICS NOS 4-6,ProFee,0989,80340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80341_3,ANTIEPILEPTICS NOS 7/MORE,ProFee,0989,80341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80342_3,ANTIPSYCHOTICS NOS 1-3,ProFee,0989,80342,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80343_3,ANTIPSYCHOTICS NOS 4-6,ProFee,0989,80343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80344_3,ANTIPSYCHOTICS NOS 7/MORE,ProFee,0989,80344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80345_3,DRUG SCREENING BARBITURATES,ProFee,0989,80345,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80346_3,BENZODIAZEPINES1-12,ProFee,0989,80346,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80347_3,BENZODIAZEPINES 13 OR MORE,ProFee,0989,80347,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80348_3,DRUG SCREENING BUPRENORPHINE,ProFee,0989,80348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80349_3,CANNABINOIDS NATURAL,ProFee,0989,80349,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80350_3,CANNABINOIDS SYNTHETIC 1-3,ProFee,0989,80350,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80351_3,CANNABINOIDS SYNTHETIC 4-6,ProFee,0989,80351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80352_3,CANNABINOID SYNTHETIC 7/MORE,ProFee,0989,80352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80353_3,DRUG SCREENING COCAINE,ProFee,0989,80353,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80354_3,DRUG SCREENING FENTANYL,ProFee,0989,80354,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80355_3,GABAPENTIN NON-BLOOD,ProFee,0989,80355,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80356_3,HEROIN METABOLITE,ProFee,0989,80356,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80357_3,KETAMINE AND NORKETAMINE,ProFee,0989,80357,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80358_3,DRUG SCREENING METHADONE,ProFee,0989,80358,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80359_3,METHYLENEDIOXYAMPHETAMINES,ProFee,0989,80359,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80360_3,METHYLPHENIDATE,ProFee,0989,80360,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80361_3,OPIATES 1 OR MORE,ProFee,0989,80361,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80362_3,OPIOIDS & OPIATE ANALOGS 1/2,ProFee,0989,80362,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80363_3,OPIOIDS & OPIATE ANALOGS 3/4,ProFee,0989,80363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80364_3,OPIOID &OPIATE ANALOG 5/MORE,ProFee,0989,80364,,,,0,3.00,2.25,2.25,122.99,0.00,122.99,122.99,N/A
80365_3,DRUG SCREENING OXYCODONE,ProFee,0989,80365,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80366_3,DRUG SCREENING PREGABALIN,ProFee,0989,80366,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80367_3,DRUG SCREENING PROPOXYPHENE,ProFee,0989,80367,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80368_3,SEDATIVE HYPNOTICS,ProFee,0989,80368,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80369_3,SKELETAL MUSCLE RELAXANT 1/2,ProFee,0989,80369,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80370_3,SKEL MUSC RELAXANT 3 OR MORE,ProFee,0989,80370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80371_3,STIMULANTS SYNTHETIC,ProFee,0989,80371,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80372_3,DRUG SCREENING TAPENTADOL,ProFee,0989,80372,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80373_3,DRUG SCREENING TRAMADOL,ProFee,0989,80373,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80374_3,STEREOISOMER ANALYSIS,ProFee,0989,80374,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80375_3,DRUG/SUBSTANCE NOS 1-3,ProFee,0989,80375,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80376_3,DRUG/SUBSTANCE NOS 4-6,ProFee,0989,80376,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80377_3,DRUG/SUBSTANCE NOS 7/MORE,ProFee,0989,80377,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
80400_3,ACTH STIMULATION PANEL,ProFee,0989,80400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80402_3,ACTH STIMULATION PANEL,ProFee,0989,80402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80406_3,ACTH STIMULATION PANEL,ProFee,0989,80406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80408_3,ALDOSTERONE SUPPRESSION EVAL,ProFee,0989,80408,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80410_3,CALCITONIN STIMUL PANEL,ProFee,0989,80410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80412_3,CRH STIMULATION PANEL,ProFee,0989,80412,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80414_3,TESTOSTERONE RESPONSE,ProFee,0989,80414,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80415_3,ESTRADIOL RESPONSE PANEL,ProFee,0989,80415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80416_3,RENIN STIMULATION PANEL,ProFee,0989,80416,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80417_3,RENIN STIMULATION PANEL,ProFee,0989,80417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80418_3,PITUITARY EVALUATION PANEL,ProFee,0989,80418,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80420_3,DEXAMETHASONE PANEL,ProFee,0989,80420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80422_3,GLUCAGON TOLERANCE PANEL,ProFee,0989,80422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80424_3,GLUCAGON TOLERANCE PANEL,ProFee,0989,80424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80426_3,GONADOTROPIN HORMONE PANEL,ProFee,0989,80426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80428_3,GROWTH HORMONE PANEL,ProFee,0989,80428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80430_3,GROWTH HORMONE PANEL,ProFee,0989,80430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80432_3,INSULIN SUPPRESSION PANEL,ProFee,0989,80432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80434_3,INSULIN TOLERANCE PANEL,ProFee,0989,80434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80435_3,INSULIN TOLERANCE PANEL,ProFee,0989,80435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80436_3,METYRAPONE PANEL,ProFee,0989,80436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80438_3,TRH STIMULATION PANEL,ProFee,0989,80438,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80439_3,TRH STIMULATION PANEL,ProFee,0989,80439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
80440_3,TRH STIMULATION PANEL,ProFee,0989,80440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
80500_3,LAB PATHOLOGY CONSULTATION,ProFee,0989,80500,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
80502_3,LAB PATHOLOGY CONSULTATION,ProFee,0989,80502,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
81000_3,"URINALYSIS, NONAUTO W/SCOPE",ProFee,0989,81000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81001_3,"URINALYSIS, AUTO W/SCOPE",ProFee,0989,81001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81003_2,"URINALYSIS, AUTO, W/O SCOPE",ProFee,0989,81003,,,,0,48.00,36.00,36.00,36.00,0.00,N/A,N/A,N/A
81003_3,"URINALYSIS, AUTO, W/O SCOPE",ProFee,0989,81003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81005_2,URINALYSIS,ProFee,0989,81005,,,,0,56.00,42.00,42.00,42.00,0.00,N/A,N/A,N/A
81005_3,URINALYSIS,ProFee,0989,81005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81007_3,URINE SCREEN FOR BACTERIA,ProFee,0989,81007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81015_3,MICROSCOPIC EXAM OF URINE,ProFee,0989,81015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81020_3,"URINALYSIS, GLASS TEST",ProFee,0989,81020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81025_2,URINE PREGNANCY TEST,Outpatient,0300,81025,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
81025_2,URINE PREGNANCY TEST,Inpatient,0300,81025,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
81025_3,URINE PREGNANCY TEST,Outpatient,0300,81025,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
81025_3,URINE PREGNANCY TEST,Inpatient,0300,81025,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
81050_3,"URINALYSIS, VOLUME MEASURE",ProFee,0989,81050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81099_3,URINALYSIS TEST PROCEDURE,ProFee,0989,81099,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81105_3,HPA-1 GENOTYPING,ProFee,0989,81105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81106_3,HPA-2 GENOTYPING,ProFee,0989,81106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81107_3,HPA-3 GENOTYPING,ProFee,0989,81107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81108_3,HPA-4 GENOTYPING,ProFee,0989,81108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81109_3,HPA-5 GENOTYPING,ProFee,0989,81109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81110_3,HPA-6 GENOTYPING,ProFee,0989,81110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81111_3,HPA-9 GENOTYPING,ProFee,0989,81111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81112_3,HPA-15 GENOTYPING,ProFee,0989,81112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81120_3,IDH1 COMMON VARIANTS,ProFee,0989,81120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81121_3,IDH2 COMMON VARIANTS,ProFee,0989,81121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81161_3,DMD DUP/DELET ANALYSIS,ProFee,0989,81161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81162_3,BRCA1&2 GEN FULL SEQ DUP/DEL,ProFee,0989,81162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81163_3,BRCA1&2 GENE FULL SEQ ALYS,ProFee,0989,81163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81164_3,BRCA1&2 GEN FUL DUP/DEL ALYS,ProFee,0989,81164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81165_3,BRCA1 GENE FULL SEQ ALYS,ProFee,0989,81165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81166_3,BRCA1 GENE FULL DUP/DEL ALYS,ProFee,0989,81166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81167_3,BRCA2 GENE FULL DUP/DEL ALYS,ProFee,0989,81167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81170_3,ABL1 GENE,ProFee,0989,81170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81171_3,AFF2 GENE DETC ABNOR ALLELES,ProFee,0989,81171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81172_3,AFF2 GENE CHARAC ALLELES,ProFee,0989,81172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81173_3,AR GENE FULL GENE SEQUENCE,ProFee,0989,81173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81174_3,AR GENE KNOWN FAMIL VARIANT,ProFee,0989,81174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81175_3,ASXL1 FULL GENE SEQUENCE,ProFee,0989,81175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81176_3,ASXL1 GENE TARGET SEQ ALYS,ProFee,0989,81176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81177_3,ATN1 GENE DETC ABNOR ALLELES,ProFee,0989,81177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81178_3,ATXN1 GENE DETC ABNOR ALLELE,ProFee,0989,81178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81179_3,ATXN2 GENE DETC ABNOR ALLELE,ProFee,0989,81179,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81180_3,ATXN3 GENE DETC ABNOR ALLELE,ProFee,0989,81180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81181_3,ATXN7 GENE DETC ABNOR ALLELE,ProFee,0989,81181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81182_3,ATXN8OS GEN DETC ABNOR ALLEL,ProFee,0989,81182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81183_3,ATXN10 GENE DETC ABNOR ALLEL,ProFee,0989,81183,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81184_3,CACNA1A GEN DETC ABNOR ALLEL,ProFee,0989,81184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81185_3,CACNA1A GENE FULL GENE SEQ,ProFee,0989,81185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81186_3,CACNA1A GEN KNOWN FAMIL VRNT,ProFee,0989,81186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81187_3,CNBP GENE DETC ABNOR ALLELE,ProFee,0989,81187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81188_3,CSTB GENE DETC ABNOR ALLELE,ProFee,0989,81188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81189_3,CSTB GENE FULL GENE SEQUENCE,ProFee,0989,81189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81190_3,CSTB GENE KNOWN FAMIL VRNT,ProFee,0989,81190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81200_3,ASPA GENE,ProFee,0989,81200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81201_3,APC GENE FULL SEQUENCE,ProFee,0989,81201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81202_3,APC GENE KNOWN FAM VARIANTS,ProFee,0989,81202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81203_3,APC GENE DUP/DELET VARIANTS,ProFee,0989,81203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81204_3,AR GENE CHARAC ALLELES,ProFee,0989,81204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81205_3,BCKDHB GENE,ProFee,0989,81205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81206_3,BCR/ABL1 GENE MAJOR BP,ProFee,0989,81206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81207_3,BCR/ABL1 GENE MINOR BP,ProFee,0989,81207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81208_3,BCR/ABL1 GENE OTHER BP,ProFee,0989,81208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81209_3,BLM GENE,ProFee,0989,81209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81210_3,BRAF GENE,ProFee,0989,81210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81211_3,BRCA1&2 SEQ & COM DUP/DEL,ProFee,0989,81211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81212_3,BRCA1&2 185&5385&6174 VAR,ProFee,0989,81212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81213_3,BRCA1&2 UNCOM DUP/DEL VAR,ProFee,0989,81213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81214_3,BRCA1 FULL SEQ & COM DUP/DEL,ProFee,0989,81214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81215_3,BRCA1 GENE KNOWN FAM VARIANT,ProFee,0989,81215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81216_3,BRCA2 GENE FULL SEQUENCE,ProFee,0989,81216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81217_3,BRCA2 GENE KNOWN FAM VARIANT,ProFee,0989,81217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81218_3,CEBPA GENE FULL SEQUENCE,ProFee,0989,81218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81219_3,CALR GENE COM VARIANTS,ProFee,0989,81219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81220_3,CFTR GENE COM VARIANTS,ProFee,0989,81220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81221_3,CFTR GENE KNOWN FAM VARIANTS,ProFee,0989,81221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81222_3,CFTR GENE DUP/DELET VARIANTS,ProFee,0989,81222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81223_3,CFTR GENE FULL SEQUENCE,ProFee,0989,81223,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81224_3,CFTR GENE INTRON POLY T,ProFee,0989,81224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81225_3,CYP2C19 GENE COM VARIANTS,ProFee,0989,81225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81226_3,CYP2D6 GENE COM VARIANTS,ProFee,0989,81226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81227_3,CYP2C9 GENE COM VARIANTS,ProFee,0989,81227,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81228_3,CYTOGEN MICRARRAY COPY NMBR,ProFee,0989,81228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81229_3,CYTOGEN M ARRAY COPY NO&SNP,ProFee,0989,81229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81230_3,CYP3A4 GENE COMMON VARIANTS,ProFee,0989,81230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81231_3,CYP3A5 GENE COMMON VARIANTS,ProFee,0989,81231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81232_3,DPYD GENE COMMON VARIANTS,ProFee,0989,81232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81233_3,BTK GENE COMMON VARIANTS,ProFee,0989,81233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81234_3,DMPK GENE DETC ABNOR ALLELE,ProFee,0989,81234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81235_3,EGFR GENE COM VARIANTS,ProFee,0989,81235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81236_3,EZH2 GENE FULL GENE SEQUENCE,ProFee,0989,81236,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81237_3,EZH2 GENE COMMON VARIANTS,ProFee,0989,81237,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81238_3,F9 FULL GENE SEQUENCE,ProFee,0989,81238,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81239_3,DMPK GENE CHARAC ALLELES,ProFee,0989,81239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81240_3,F2 GENE,ProFee,0989,81240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81241_3,F5 GENE,ProFee,0989,81241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81242_3,FANCC GENE,ProFee,0989,81242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81243_3,FMR1 GENE DETECTION,ProFee,0989,81243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81244_3,FMR1 GENE CHARACTERIZATION,ProFee,0989,81244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81245_3,FLT3 GENE,ProFee,0989,81245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81246_3,FLT3 GENE ANALYSIS,ProFee,0989,81246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81247_3,G6PD GENE ALYS CMN VARIANT,ProFee,0989,81247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81248_3,G6PD KNOWN FAMILIAL VARIANT,ProFee,0989,81248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81249_3,G6PD FULL GENE SEQUENCE,ProFee,0989,81249,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81250_3,G6PC GENE,ProFee,0989,81250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81251_3,GBA GENE,ProFee,0989,81251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81252_3,GJB2 GENE FULL SEQUENCE,ProFee,0989,81252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81253_3,GJB2 GENE KNOWN FAM VARIANTS,ProFee,0989,81253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81254_3,GJB6 GENE COM VARIANTS,ProFee,0989,81254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81255_3,HEXA GENE,ProFee,0989,81255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81256_3,HFE GENE,ProFee,0989,81256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81257_3,HBA1/HBA2 GENE,ProFee,0989,81257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81258_3,HBA1/HBA2 GENE FAM VRNT,ProFee,0989,81258,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81259_3,HBA1/HBA2 FULL GENE SEQUENCE,ProFee,0989,81259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81260_3,IKBKAP GENE,ProFee,0989,81260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81261_3,IGH GENE REARRANGE AMP METH,ProFee,0989,81261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81262_3,IGH GENE REARRANG DIR PROBE,ProFee,0989,81262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81263_3,IGH VARI REGIONAL MUTATION,ProFee,0989,81263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81264_3,IGK REARRANGEABN CLONAL POP,ProFee,0989,81264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81265_3,STR MARKERS SPECIMEN ANAL,ProFee,0989,81265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81266_3,STR MARKERS SPEC ANAL ADDL,ProFee,0989,81266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81267_3,CHIMERISM ANAL NO CELL SELEC,ProFee,0989,81267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81268_3,CHIMERISM ANAL W/CELL SELECT,ProFee,0989,81268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81269_3,HBA1/HBA2 GENE DUP/DEL VRNTS,ProFee,0989,81269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81270_3,JAK2 GENE,ProFee,0989,81270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81271_3,HTT GENE DETC ABNOR ALLELES,ProFee,0989,81271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81272_3,KIT GENE TARGETED SEQ ANALYS,ProFee,0989,81272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81273_3,KIT GENE ANALYS D816 VARIANT,ProFee,0989,81273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81274_3,HTT GENE CHARAC ALLELES,ProFee,0989,81274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81275_3,KRAS GENE,ProFee,0989,81275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81276_3,KRAS GENE ADDL VARIANTS,ProFee,0989,81276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81277_3,CYTOGENOMIC NEO MICRORA ALYS,ProFee,0989,81277,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81280_3,LONG QT SYND GENE FULL SEQ,ProFee,0989,81280,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81281_3,LONG QT SYND KNOWN FAM VAR,ProFee,0989,81281,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81282_3,LONG QT SYN GENE DUP/DLT VAR,ProFee,0989,81282,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81283_3,IFNL3 GENE,ProFee,0989,81283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81284_3,FXN GENE DETC ABNOR ALLELES,ProFee,0989,81284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81285_3,FXN GENE CHARAC ALLELES,ProFee,0989,81285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81286_3,FXN GENE FULL GENE SEQUENCE,ProFee,0989,81286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81287_3,MGMT GENE PRMTR MTHYLTN ALYS,ProFee,0989,81287,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81288_3,MLH1 GENE,ProFee,0989,81288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81289_3,FXN GENE KNOWN FAMIL VARIANT,ProFee,0989,81289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81290_3,MCOLN1 GENE,ProFee,0989,81290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81291_3,MTHFR GENE,ProFee,0989,81291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81292_3,MLH1 GENE FULL SEQ,ProFee,0989,81292,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81293_3,MLH1 GENE KNOWN VARIANTS,ProFee,0989,81293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81294_3,MLH1 GENE DUP/DELETE VARIANT,ProFee,0989,81294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81295_3,MSH2 GENE FULL SEQ,ProFee,0989,81295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81296_3,MSH2 GENE KNOWN VARIANTS,ProFee,0989,81296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81297_3,MSH2 GENE DUP/DELETE VARIANT,ProFee,0989,81297,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81298_3,MSH6 GENE FULL SEQ,ProFee,0989,81298,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81299_3,MSH6 GENE KNOWN VARIANTS,ProFee,0989,81299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81300_3,MSH6 GENE DUP/DELETE VARIANT,ProFee,0989,81300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81301_3,MICROSATELLITE INSTABILITY,ProFee,0989,81301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81302_3,MECP2 GENE FULL SEQ,ProFee,0989,81302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81303_3,MECP2 GENE KNOWN VARIANT,ProFee,0989,81303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81304_3,MECP2 GENE DUP/DELET VARIANT,ProFee,0989,81304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81305_3,MYD88 GENE P.LEU265PRO VRNT,ProFee,0989,81305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81306_3,NUDT15 GENE COMMON VARIANTS,ProFee,0989,81306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81307_3,PALB2 GENE FULL GENE SEQ,ProFee,0989,81307,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81308_3,PALB2 GENE KNOWN FAMIL VRNT,ProFee,0989,81308,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81309_3,PIK3CA GENE TRGT SEQ ALYS,ProFee,0989,81309,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81310_3,NPM1 GENE,ProFee,0989,81310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81311_3,NRAS GENE VARIANTS EXON 2&3,ProFee,0989,81311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81312_3,PABPN1 GENE DETC ABNOR ALLEL,ProFee,0989,81312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81313_3,PCA3/KLK3 ANTIGEN,ProFee,0989,81313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81314_3,PDGFRA GENE,ProFee,0989,81314,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81315_3,PML/RARALPHA COM BREAKPOINTS,ProFee,0989,81315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81316_3,PML/RARALPHA 1 BREAKPOINT,ProFee,0989,81316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81317_3,PMS2 GENE FULL SEQ ANALYSIS,ProFee,0989,81317,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81318_3,PMS2 KNOWN FAMILIAL VARIANTS,ProFee,0989,81318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81319_3,PMS2 GENE DUP/DELET VARIANTS,ProFee,0989,81319,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81320_3,PLCG2 GENE COMMON VARIANTS,ProFee,0989,81320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81321_3,PTEN GENE FULL SEQUENCE,ProFee,0989,81321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81322_3,PTEN GENE KNOWN FAM VARIANT,ProFee,0989,81322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81323_3,PTEN GENE DUP/DELET VARIANT,ProFee,0989,81323,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81324_3,PMP22 GENE DUP/DELET,ProFee,0989,81324,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81325_3,PMP22 GENE FULL SEQUENCE,ProFee,0989,81325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81326_3,PMP22 GENE KNOWN FAM VARIANT,ProFee,0989,81326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81327_3,SEPT9 GEN PRMTR MTHYLTN ALYS,ProFee,0989,81327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81328_3,SLCO1B1 GENE COM VARIANTS,ProFee,0989,81328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81329_3,SMN1 GENE DOS/DELETION ALYS,ProFee,0989,81329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81330_3,SMPD1 GENE COMMON VARIANTS,ProFee,0989,81330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81331_3,SNRPN/UBE3A GENE,ProFee,0989,81331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81332_3,SERPINA1 GENE,ProFee,0989,81332,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81333_3,TGFBI GENE COMMON VARIANTS,ProFee,0989,81333,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81334_3,RUNX1 GENE TARGETED SEQ ALYS,ProFee,0989,81334,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81335_3,TPMT GENE COM VARIANTS,ProFee,0989,81335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81336_3,SMN1 GENE FULL GENE SEQUENCE,ProFee,0989,81336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81337_3,SMN1 GEN NOWN FAMIL SEQ VRNT,ProFee,0989,81337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81340_3,TRB@ GENE REARRANGE AMPLIFY,ProFee,0989,81340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81341_3,TRB@ GENE REARRANGE DIRPROBE,ProFee,0989,81341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81342_3,TRG GENE REARRANGEMENT ANAL,ProFee,0989,81342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81343_3,PPP2R2B GEN DETC ABNOR ALLEL,ProFee,0989,81343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81344_3,TBP GENE DETC ABNOR ALLELES,ProFee,0989,81344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81345_3,TERT GENE TARGETED SEQ ALYS,ProFee,0989,81345,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81346_3,TYMS GENE COM VARIANTS,ProFee,0989,81346,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81350_3,UGT1A1 GENE,ProFee,0989,81350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81355_3,VKORC1 GENE,ProFee,0989,81355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81361_3,HBB GENE COM VARIANTS,ProFee,0989,81361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81362_3,HBB GENE KNOWN FAM VARIANT,ProFee,0989,81362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81363_3,HBB GENE DUP/DEL VARIANTS,ProFee,0989,81363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81364_3,HBB FULL GENE SEQUENCE,ProFee,0989,81364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81370_3,HLA I & II TYPING LR,ProFee,0989,81370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81371_3,HLA I & II TYPE VERIFY LR,ProFee,0989,81371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81372_3,HLA I TYPING COMPLETE LR,ProFee,0989,81372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81373_3,HLA I TYPING 1 LOCUS LR,ProFee,0989,81373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81374_3,HLA I TYPING 1 ANTIGEN LR,ProFee,0989,81374,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81375_3,HLA II TYPING AG EQUIV LR,ProFee,0989,81375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81376_3,HLA II TYPING 1 LOCUS LR,ProFee,0989,81376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81377_3,HLA II TYPE 1 AG EQUIV LR,ProFee,0989,81377,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81378_3,HLA I & II TYPING HR,ProFee,0989,81378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81379_3,HLA I TYPING COMPLETE HR,ProFee,0989,81379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81380_3,HLA I TYPING 1 LOCUS HR,ProFee,0989,81380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81381_3,HLA I TYPING 1 ALLELE HR,ProFee,0989,81381,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81382_3,HLA II TYPING 1 LOC HR,ProFee,0989,81382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81383_3,HLA II TYPING 1 ALLELE HR,ProFee,0989,81383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81400_3,MOPATH PROCEDURE LEVEL 1,ProFee,0989,81400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81401_3,MOPATH PROCEDURE LEVEL 2,ProFee,0989,81401,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81402_3,MOPATH PROCEDURE LEVEL 3,ProFee,0989,81402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81403_3,MOPATH PROCEDURE LEVEL 4,ProFee,0989,81403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81404_3,MOPATH PROCEDURE LEVEL 5,ProFee,0989,81404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81405_3,MOPATH PROCEDURE LEVEL 6,ProFee,0989,81405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81406_3,MOPATH PROCEDURE LEVEL 7,ProFee,0989,81406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81407_3,MOPATH PROCEDURE LEVEL 8,ProFee,0989,81407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81408_3,MOPATH PROCEDURE LEVEL 9,ProFee,0989,81408,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81410_3,AORTIC DYSFUNCTION/DILATION,ProFee,0989,81410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81411_3,AORTIC DYSFUNCTION/DILATION,ProFee,0989,81411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81412_3,ASHKENAZI JEWISH ASSOC DIS,ProFee,0989,81412,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81413_3,CAR ION CHNNLPATH INC 10 GNS,ProFee,0989,81413,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81414_3,CAR ION CHNNLPATH INC 2 GNS,ProFee,0989,81414,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81415_3,EXOME SEQUENCE ANALYSIS,ProFee,0989,81415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81416_3,EXOME SEQUENCE ANALYSIS,ProFee,0989,81416,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81417_3,EXOME RE-EVALUATION,ProFee,0989,81417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81420_3,FETAL CHRMOML ANEUPLOIDY,ProFee,0989,81420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81422_3,FETAL CHRMOML MICRODELTJ,ProFee,0989,81422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81425_3,GENOME SEQUENCE ANALYSIS,ProFee,0989,81425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81426_3,GENOME SEQUENCE ANALYSIS,ProFee,0989,81426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81427_3,GENOME RE-EVALUATION,ProFee,0989,81427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81430_3,HEARING LOSS SEQUENCE ANALYS,ProFee,0989,81430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81431_3,HEARING LOSS DUP/DEL ANALYS,ProFee,0989,81431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81432_3,HRDTRY BRST CA-RLATD DSORDRS,ProFee,0989,81432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81433_3,HRDTRY BRST CA-RLATD DSORDRS,ProFee,0989,81433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81434_3,HEREDITARY RETINAL DISORDERS,ProFee,0989,81434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81435_3,HEREDITARY COLON CA DSORDRS,ProFee,0989,81435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81436_3,HEREDITARY COLON CA DSORDRS,ProFee,0989,81436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81437_3,HEREDTRY NURONDCRN TUM DSRDR,ProFee,0989,81437,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81438_3,HEREDTRY NURONDCRN TUM DSRDR,ProFee,0989,81438,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81439_3,HRDTRY CARDMYPY GENE PANEL,ProFee,0989,81439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81440_3,MITOCHONDRIAL GENE,ProFee,0989,81440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81442_3,NOONAN SPECTRUM DISORDERS,ProFee,0989,81442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81443_3,GENETIC TSTG SEVERE INH COND,ProFee,0989,81443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81445_3,TARGETED GENOMIC SEQ ANALYS,ProFee,0989,81445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81448_3,HRDTRY PERPH NEURPHY PANEL,ProFee,0989,81448,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81450_3,TARGETED GENOMIC SEQ ANALYS,ProFee,0989,81450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81455_3,TARGETED GENOMIC SEQ ANALYS,ProFee,0989,81455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81460_3,WHOLE MITOCHONDRIAL GENOME,ProFee,0989,81460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81465_3,WHOLE MITOCHONDRIAL GENOME,ProFee,0989,81465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81470_3,X-LINKED INTELLECTUAL DBLT,ProFee,0989,81470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81471_3,X-LINKED INTELLECTUAL DBLT,ProFee,0989,81471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81479_3,UNLISTED MOLECULAR PATHOLOGY,ProFee,0989,81479,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81490_3,AUTOIMMUNE RHEUMATOID ARTHR,ProFee,0989,81490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81493_3,COR ARTERY DISEASE MRNA,ProFee,0989,81493,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81500_3,ONCO (OVAR) TWO PROTEINS,ProFee,0989,81500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81503_3,ONCO (OVAR) FIVE PROTEINS,ProFee,0989,81503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81504_3,ONCOLOGY TISSUE OF ORIGIN,ProFee,0989,81504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81506_3,ENDO ASSAY SEVEN ANAL,ProFee,0989,81506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81507_3,FETAL ANEUPLOIDY TRISOM RISK,ProFee,0989,81507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81508_3,FTL CGEN ABNOR TWO PROTEINS,ProFee,0989,81508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81509_3,FTL CGEN ABNOR 3 PROTEINS,ProFee,0989,81509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81510_3,FTL CGEN ABNOR THREE ANAL,ProFee,0989,81510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81511_3,FTL CGEN ABNOR FOUR ANAL,ProFee,0989,81511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81512_3,FTL CGEN ABNOR FIVE ANAL,ProFee,0989,81512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81518_3,ONC BRST MRNA 11 GENES,ProFee,0989,81518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81519_3,ONCOLOGY BREAST MRNA,ProFee,0989,81519,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81520_3,ONC BREAST MRNA 58 GENES,ProFee,0989,81520,,,,0,3.00,2.25,2.25,4304.00,0.00,4304.00,4304.00,N/A
81521_3,ONC BREAST MRNA 70 GENES,ProFee,0989,81521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81522_3,ONC BREAST MRNA 12 GENES,ProFee,0989,81522,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81525_3,ONCOLOGY COLON MRNA,ProFee,0989,81525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81528_3,ONCOLOGY COLORECTAL SCR,ProFee,0989,81528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81535_3,ONCOLOGY GYNECOLOGIC,ProFee,0989,81535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81536_3,ONCOLOGY GYNECOLOGIC,ProFee,0989,81536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81538_3,ONCOLOGY LUNG,ProFee,0989,81538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81539_3,ONCOLOGY PROSTATE PROB SCORE,ProFee,0989,81539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81540_3,ONCOLOGY TUM UNKNOWN ORIGIN,ProFee,0989,81540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81541_3,ONC PROSTATE MRNA 46 GENES,ProFee,0989,81541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81542_3,ONC PROSTATE MRNA 22 CNT GEN,ProFee,0989,81542,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81545_3,ONCOLOGY THYROID,ProFee,0989,81545,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81551_3,ONC PROSTATE 3 GENES,ProFee,0989,81551,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81552_3,ONC UVEAL MLNMA MRNA 15 GENE,ProFee,0989,81552,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
81595_3,CARDIOLOGY HRT TRNSPL MRNA,ProFee,0989,81595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81596_3,NFCT DS CHRNC HCV 6 ASSAYS,ProFee,0989,81596,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
81599_3,UNLISTED MAAA,ProFee,0989,81599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82000_3,ASSAY OF BLOOD ACETALDEHYDE,ProFee,0989,82000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82003_3,ASSAY OF ACETAMINOPHEN,ProFee,0989,82003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82009_3,TEST FOR ACETONE/KETONES,ProFee,0989,82009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82010_3,ACETONE ASSAY,ProFee,0989,82010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82013_3,ACETYLCHOLINESTERASE ASSAY,ProFee,0989,82013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82016_3,"ACYLCARNITINES, QUAL",ProFee,0989,82016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82017_3,"ACYLCARNITINES, QUANT",ProFee,0989,82017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82024_3,ASSAY OF ACTH,ProFee,0989,82024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82030_3,ASSAY OF ADP & AMP,ProFee,0989,82030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82040_3,ASSAY OF SERUM ALBUMIN,ProFee,0989,82040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82042_3,ASSAY OF URINE ALBUMIN,ProFee,0989,82042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82043_3,"MICROALBUMIN, QUANTITATIVE",ProFee,0989,82043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82044_3,"MICROALBUMIN, SEMIQUANT",ProFee,0989,82044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82045_3,"ALBUMIN, ISCHEMIA MODIFIED",ProFee,0989,82045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82055_3,ASSAY OF ETHANOL,ProFee,0989,82055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82085_3,ASSAY OF ALDOLASE,ProFee,0989,82085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82088_3,ASSAY OF ALDOSTERONE,ProFee,0989,82088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82101_3,ASSAY OF URINE ALKALOIDS,ProFee,0989,82101,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82103_3,"ALPHA-1-ANTITRYPSIN, TOTAL",ProFee,0989,82103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82104_3,"ALPHA-1-ANTITRYPSIN, PHENO",ProFee,0989,82104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82105_3,"ALPHA-FETOPROTEIN, SERUM",ProFee,0989,82105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82106_3,"ALPHA-FETOPROTEIN, AMNIOTIC",ProFee,0989,82106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82107_3,ALPHA-FETOPROTEIN L3,ProFee,0989,82107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82108_3,ASSAY OF ALUMINUM,ProFee,0989,82108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82120_3,"AMINES, VAGINAL FLUID QUAL",ProFee,0989,82120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82127_3,"AMINO ACID, SINGLE QUAL",ProFee,0989,82127,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82128_3,"AMINO ACIDS, MULT QUAL",ProFee,0989,82128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82131_3,"AMINO ACIDS, SINGLE QUANT",ProFee,0989,82131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82135_3,"ASSAY, AMINOLEVULINIC ACID",ProFee,0989,82135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82136_3,"AMINO ACIDS, QUANT, 2-5",ProFee,0989,82136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82139_3,"AMINO ACIDS, QUAN, 6 OR MORE",ProFee,0989,82139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82140_3,ASSAY OF AMMONIA,ProFee,0989,82140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82143_3,AMNIOTIC FLUID SCAN,ProFee,0989,82143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82145_3,ASSAY OF AMPHETAMINES,ProFee,0989,82145,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82150_3,ASSAY OF AMYLASE,ProFee,0989,82150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82154_3,ANDROSTANEDIOL GLUCURONIDE,ProFee,0989,82154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82157_3,ASSAY OF ANDROSTENEDIONE,ProFee,0989,82157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82160_3,ASSAY OF ANDROSTERONE,ProFee,0989,82160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82163_3,ASSAY OF ANGIOTENSIN II,ProFee,0989,82163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82164_3,ANGIOTENSIN I ENZYME TEST,ProFee,0989,82164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82172_3,ASSAY OF APOLIPOPROTEIN,ProFee,0989,82172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82175_3,ASSAY OF ARSENIC,ProFee,0989,82175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82180_3,ASSAY OF ASCORBIC ACID,ProFee,0989,82180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82190_3,ATOMIC ABSORPTION,ProFee,0989,82190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82205_3,ASSAY OF BARBITURATES,ProFee,0989,82205,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82232_3,ASSAY OF BETA-2 PROTEIN,ProFee,0989,82232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82239_3,"BILE ACIDS, TOTAL",ProFee,0989,82239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82240_3,"BILE ACIDS, CHOLYLGLYCINE",ProFee,0989,82240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82247_3,"BILIRUBIN, TOTAL",ProFee,0989,82247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82248_3,"BILIRUBIN, DIRECT",ProFee,0989,82248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82252_3,FECAL BILIRUBIN TEST,ProFee,0989,82252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82261_3,ASSAY OF BIOTINIDASE,ProFee,0989,82261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82271_3,"OCCULT BLOOD, FECES, SINGLE",ProFee,0989,82271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82272_2,BLOOD OCCULT PEROXIDASE,Inpatient,0300,82272,,,,0,53.00,39.75,39.75,50.35,47.70,50.35,50.35,47.70
82272_2,BLOOD OCCULT PEROXIDASE,Outpatient,0300,82272,,,,0,53.00,39.75,39.75,50.35,47.70,50.35,50.35,47.70
82272_3,BLOOD OCCULT PEROXIDASE,Outpatient,0300,82272,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
82272_3,BLOOD OCCULT PEROXIDASE,Inpatient,0300,82272,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
82274_2,"ASSAY TEST FOR BLOOD, FECAL",ProFee,0989,82274,,,,0,48.00,36.00,36.00,36.00,0.00,N/A,N/A,N/A
82274_3,"ASSAY TEST FOR BLOOD, FECAL",ProFee,0989,82274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82286_3,ASSAY OF BRADYKININ,ProFee,0989,82286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82300_3,ASSAY OF CADMIUM,ProFee,0989,82300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82306_3,ASSAY OF VITAMIN D,ProFee,0989,82306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82307_3,ASSAY OF VITAMIN D,ProFee,0989,82307,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82308_3,ASSAY OF CALCITONIN,ProFee,0989,82308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82310_3,ASSAY OF CALCIUM,ProFee,0989,82310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82330_3,ASSAY OF CALCIUM,ProFee,0989,82330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82331_3,CALCIUM INFUSION TEST,ProFee,0989,82331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82340_3,ASSAY OF CALCIUM IN URINE,ProFee,0989,82340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82355_3,"CALCULUS ANALYSIS, QUAL",ProFee,0989,82355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82360_3,"CALCULUS ASSAY, QUANT",ProFee,0989,82360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82365_3,CALCULUS SPECTROSCOPY,ProFee,0989,82365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82370_3,"X-RAY ASSAY, CALCULUS",ProFee,0989,82370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82373_3,"ASSAY, C-D TRANSFER MEASURE",ProFee,0989,82373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82374_3,"ASSAY, BLOOD CARBON DIOXIDE",ProFee,0989,82374,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82375_3,"ASSAY, BLOOD CARBON MONOXIDE",ProFee,0989,82375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82376_3,TEST FOR CARBON MONOXIDE,ProFee,0989,82376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82378_3,CARCINOEMBRYONIC ANTIGEN,ProFee,0989,82378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82379_3,ASSAY OF CARNITINE,ProFee,0989,82379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82380_3,ASSAY OF CAROTENE,ProFee,0989,82380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82382_3,"ASSAY, URINE CATECHOLAMINES",ProFee,0989,82382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82383_3,"ASSAY, BLOOD CATECHOLAMINES",ProFee,0989,82383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82384_3,"ASSAY, THREE CATECHOLAMINES",ProFee,0989,82384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82387_3,ASSAY OF CATHEPSIN-D,ProFee,0989,82387,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82390_3,ASSAY OF CERULOPLASMIN,ProFee,0989,82390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82397_3,CHEMILUMINESCENT ASSAY,ProFee,0989,82397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82415_3,ASSAY OF CHLORAMPHENICOL,ProFee,0989,82415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82435_3,ASSAY OF BLOOD CHLORIDE,ProFee,0989,82435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82436_3,ASSAY OF URINE CHLORIDE,ProFee,0989,82436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82438_3,"ASSAY, OTHER FLUID CHLORIDES",ProFee,0989,82438,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82441_3,TEST FOR CHLOROHYDROCARBONS,ProFee,0989,82441,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82465_3,"ASSAY, BLD/SERUM CHOLESTEROL",ProFee,0989,82465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82480_3,"ASSAY, SERUM CHOLINESTERASE",ProFee,0989,82480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82482_3,"ASSAY, RBC CHOLINESTERASE",ProFee,0989,82482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82485_3,"ASSAY, CHONDROITIN SULFATE",ProFee,0989,82485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82486_3,GAS/LIQUID CHROMATOGRAPHY,ProFee,0989,82486,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82487_3,PAPER CHROMATOGRAPHY,ProFee,0989,82487,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82488_3,PAPER CHROMATOGRAPHY,ProFee,0989,82488,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82489_3,THIN LAYER CHROMATOGRAPHY,ProFee,0989,82489,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82491_3,"CHROMOTOGRAPHY, QUANT, SING",ProFee,0989,82491,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82492_3,"CHROMOTOGRAPHY, QUANT, MULT",ProFee,0989,82492,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82495_3,ASSAY OF CHROMIUM,ProFee,0989,82495,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82507_3,ASSAY OF CITRATE,ProFee,0989,82507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82520_3,ASSAY OF COCAINE,ProFee,0989,82520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82523_3,COLLAGEN CROSSLINKS,ProFee,0989,82523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82525_3,ASSAY OF COPPER,ProFee,0989,82525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82528_3,ASSAY OF CORTICOSTERONE,ProFee,0989,82528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82530_3,"CORTISOL, FREE",ProFee,0989,82530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82533_3,TOTAL CORTISOL,ProFee,0989,82533,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82540_3,ASSAY OF CREATINE,ProFee,0989,82540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82541_3,"COLUMN CHROMOTOGRAPHY, QUAL",ProFee,0989,82541,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82542_3,"COLUMN CHROMOTOGRAPHY, QUANT",ProFee,0989,82542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82543_3,COLUMN CHROMOTOGRAPH/ISOTOPE,ProFee,0989,82543,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82544_3,COLUMN CHROMOTOGRAPH/ISOTOPE,ProFee,0989,82544,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82550_3,ASSAY OF CK (CPK),ProFee,0989,82550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82552_3,ASSAY OF CPK IN BLOOD,ProFee,0989,82552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82553_3,"CREATINE, MB FRACTION",ProFee,0989,82553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82554_3,"CREATINE, ISOFORMS",ProFee,0989,82554,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82565_3,ASSAY OF CREATININE,ProFee,0989,82565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82570_3,ASSAY OF URINE CREATININE,ProFee,0989,82570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82575_3,CREATININE CLEARANCE TEST,ProFee,0989,82575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82585_3,ASSAY OF CRYOFIBRINOGEN,ProFee,0989,82585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82595_3,ASSAY OF CRYOGLOBULIN,ProFee,0989,82595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82600_3,ASSAY OF CYANIDE,ProFee,0989,82600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82607_3,VITAMIN B-12,ProFee,0989,82607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82608_3,B-12 BINDING CAPACITY,ProFee,0989,82608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82610_3,CYSTATIN C,ProFee,0989,82610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82615_3,TEST FOR URINE CYSTINES,ProFee,0989,82615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82626_3,DEHYDROEPIANDROSTERONE,ProFee,0989,82626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82627_3,DEHYDROEPIANDROSTERONE,ProFee,0989,82627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82633_3,DESOXYCORTICOSTERONE,ProFee,0989,82633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82634_3,DEOXYCORTISOL,ProFee,0989,82634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82638_3,ASSAY OF DIBUCAINE NUMBER,ProFee,0989,82638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82642_3,DIHYDROTESTOSTERONE,ProFee,0989,82642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82646_3,ASSAY OF DIHYDROCODEINONE,ProFee,0989,82646,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82649_3,ASSAY OF DIHYDROMORPHINONE,ProFee,0989,82649,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82651_3,ASSAY OF DIHYDROTESTOSTERONE,ProFee,0989,82651,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82652_3,ASSAY OF DIHYDROXYVITAMIN D,ProFee,0989,82652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82654_3,ASSAY OF DIMETHADIONE,ProFee,0989,82654,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82656_3,"PANCREATIC ELASTASE, FECAL",ProFee,0989,82656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82657_3,ENZYME CELL ACTIVITY,ProFee,0989,82657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82658_3,"ENZYME CELL ACTIVITY, RA",ProFee,0989,82658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82664_3,ELECTROPHORETIC TEST,ProFee,0989,82664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82666_3,ASSAY OF EPIANDROSTERONE,ProFee,0989,82666,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82668_3,ASSAY OF ERYTHROPOIETIN,ProFee,0989,82668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82670_3,ASSAY OF ESTRADIOL,ProFee,0989,82670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82671_3,ASSAY OF ESTROGENS,ProFee,0989,82671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82672_3,ASSAY OF ESTROGEN,ProFee,0989,82672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82677_3,ASSAY OF ESTRIOL,ProFee,0989,82677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82679_3,ASSAY OF ESTRONE,ProFee,0989,82679,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82690_3,ASSAY OF ETHCHLORVYNOL,ProFee,0989,82690,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82693_3,ASSAY OF ETHYLENE GLYCOL,ProFee,0989,82693,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82696_3,ASSAY OF ETIOCHOLANOLONE,ProFee,0989,82696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82705_3,"FATS/LIPIDS, FECES, QUAL",ProFee,0989,82705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82710_3,"FATS/LIPIDS, FECES, QUANT",ProFee,0989,82710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82715_3,ASSAY OF FECAL FAT,ProFee,0989,82715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82725_3,ASSAY OF BLOOD FATTY ACIDS,ProFee,0989,82725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82726_3,LONG CHAIN FATTY ACIDS,ProFee,0989,82726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82728_3,ASSAY OF FERRITIN,ProFee,0989,82728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82731_3,ASSAY OF FETAL FIBRONECTIN,ProFee,0989,82731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82735_3,ASSAY OF FLUORIDE,ProFee,0989,82735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82742_3,ASSAY OF FLURAZEPAM,ProFee,0989,82742,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82746_3,BLOOD FOLIC ACID SERUM,ProFee,0989,82746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82747_3,"ASSAY OF FOLIC ACID, RBC",ProFee,0989,82747,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82757_3,ASSAY OF SEMEN FRUCTOSE,ProFee,0989,82757,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82759_3,ASSAY OF RBC GALACTOKINASE,ProFee,0989,82759,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82760_3,ASSAY OF GALACTOSE,ProFee,0989,82760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82775_3,ASSAY GALACTOSE TRANSFERASE,ProFee,0989,82775,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82776_3,GALACTOSE TRANSFERASE TEST,ProFee,0989,82776,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82777_3,GALECTIN-3,ProFee,0989,82777,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82784_3,ASSAY OF GAMMAGLOBULIN IGM,ProFee,0989,82784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82785_3,ASSAY OF GAMMAGLOBULIN IGE,ProFee,0989,82785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82787_3,"IGG 1, 2, 3 OR 4, EACH",ProFee,0989,82787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82800_3,BLOOD PH,ProFee,0989,82800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82803_3,"BLOOD GASES: PH, PO2 & PCO2",ProFee,0989,82803,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82805_3,BLOOD GASES W/02 SATURATION,ProFee,0989,82805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82810_3,"BLOOD GASES, O2 SAT ONLY",ProFee,0989,82810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82820_3,HEMOGLOBIN-OXYGEN AFFINITY,ProFee,0989,82820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82926_3,ASSAY OF GASTRIC ACID,ProFee,0989,82926,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82928_3,ASSAY OF GASTRIC ACID,ProFee,0989,82928,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82930_3,GASTRIC ANALY W/PH EA SPEC,ProFee,0989,82930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82938_3,GASTRIN TEST,ProFee,0989,82938,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82941_3,ASSAY OF GASTRIN,ProFee,0989,82941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82943_3,ASSAY OF GLUCAGON,ProFee,0989,82943,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82945_3,GLUCOSE OTHER FLUID,ProFee,0989,82945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82946_3,GLUCAGON TOLERANCE TEST,ProFee,0989,82946,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82947_3,"ASSAY, GLUCOSE, BLOOD QUANT",ProFee,0989,82947,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82948_2,REAGENT STRIP/BLOOD GLUCOSE,ProFee,0989,82948,,,,0,35.00,26.25,26.25,26.25,0.00,N/A,N/A,N/A
82948_3,REAGENT STRIP/BLOOD GLUCOSE,ProFee,0989,82948,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82950_3,GLUCOSE TEST,ProFee,0989,82950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82951_3,GLUCOSE TOLERANCE TEST (GTT),ProFee,0989,82951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82952_3,GTT-ADDED SAMPLES,ProFee,0989,82952,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82953_3,GLUCOSE-TOLBUTAMIDE TEST,ProFee,0989,82953,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82955_3,ASSAY OF G6PD ENZYME,ProFee,0989,82955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82960_3,TEST FOR G6PD ENZYME,ProFee,0989,82960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82963_3,ASSAY OF GLUCOSIDASE,ProFee,0989,82963,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82965_3,ASSAY OF GDH ENZYME,ProFee,0989,82965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82975_3,ASSAY OF GLUTAMINE,ProFee,0989,82975,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82977_3,ASSAY OF GGT,ProFee,0989,82977,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82978_3,ASSAY OF GLUTATHIONE,ProFee,0989,82978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82979_3,"ASSAY, RBC GLUTATHIONE",ProFee,0989,82979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
82980_3,ASSAY OF GLUTETHIMIDE,ProFee,0989,82980,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
82985_3,GLYCATED PROTEIN,ProFee,0989,82985,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83001_3,GONADOTROPIN (FSH),ProFee,0989,83001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83002_3,GONADOTROPIN (LH),ProFee,0989,83002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83003_3,"ASSAY, GROWTH HORMONE (HGH)",ProFee,0989,83003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83006_3,GROWTH STIMULATION GENE 2,ProFee,0989,83006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83008_3,ASSAY OF GUANOSINE,ProFee,0989,83008,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83009_3,"H PYLORI (C-13), BLOOD",ProFee,0989,83009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83010_3,"ASSAY OF HAPTOGLOBIN, QUANT",ProFee,0989,83010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83012_3,ASSAY OF HAPTOGLOBINS,ProFee,0989,83012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83013_3,"H PYLORI (C-13), BREATH",ProFee,0989,83013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83014_3,H PYLORI DRUG ADMIN,ProFee,0989,83014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83015_3,HEAVY METAL SCREEN,ProFee,0989,83015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83018_3,"QUANTITATIVE SCREEN, METALS",ProFee,0989,83018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83020_3,HEMOGLOBIN ELECTROPHORESIS,ProFee,0989,83020,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
83021_3,HEMOGLOBIN CHROMOTOGRAPHY,ProFee,0989,83021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83026_3,"HEMOGLOBIN, COPPER SULFATE",ProFee,0989,83026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83030_3,"FETAL HEMOGLOBIN, CHEMICAL",ProFee,0989,83030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83033_3,"FETAL HEMOGLOBIN ASSAY, QUAL",ProFee,0989,83033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83036_3,GLYCATED HEMOGLOBIN TEST,ProFee,0989,83036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83037_3,"GLYCOSYLATED HB, HOME DEVICE",ProFee,0989,83037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83045_3,BLOOD METHEMOGLOBIN TEST,ProFee,0989,83045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83050_3,BLOOD METHEMOGLOBIN ASSAY,ProFee,0989,83050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83051_3,ASSAY OF PLASMA HEMOGLOBIN,ProFee,0989,83051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83055_3,BLOOD SULFHEMOGLOBIN TEST,ProFee,0989,83055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83060_3,BLOOD SULFHEMOGLOBIN ASSAY,ProFee,0989,83060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83065_3,ASSAY OF HEMOGLOBIN HEAT,ProFee,0989,83065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83068_3,HEMOGLOBIN STABILITY SCREEN,ProFee,0989,83068,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83069_3,ASSAY OF URINE HEMOGLOBIN,ProFee,0989,83069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83070_3,"ASSAY OF HEMOSIDERIN, QUAL",ProFee,0989,83070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83071_3,"ASSAY OF HEMOSIDERIN, QUANT",ProFee,0989,83071,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83080_3,ASSAY OF B HEXOSAMINIDASE,ProFee,0989,83080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83088_3,ASSAY OF HISTAMINE,ProFee,0989,83088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83090_3,ASSAY OF HOMOCYSTINE,ProFee,0989,83090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83150_3,ASSAY OF FOR HVA,ProFee,0989,83150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83491_3,ASSAY OF CORTICOSTEROIDS,ProFee,0989,83491,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83497_3,ASSAY OF 5-HIAA,ProFee,0989,83497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83498_3,ASSAY OF PROGESTERONE,ProFee,0989,83498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83499_3,ASSAY OF PROGESTERONE,ProFee,0989,83498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83500_3,"ASSAY, FREE HYDROXYPROLINE",ProFee,0989,83500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83505_3,"ASSAY, TOTAL HYDROXYPROLINE",ProFee,0989,83505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83516_3,"IMMUNOASSAY, NONANTIBODY",ProFee,0989,83516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83518_3,"IMMUNOASSAY, DIPSTICK",ProFee,0989,83518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83519_3,"IMMUNOASSAY, NONANTIBODY",ProFee,0989,83519,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83520_3,"IMMUNOASSAY, RIA",ProFee,0989,83520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83525_3,ASSAY OF INSULIN,ProFee,0989,83525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83527_3,ASSAY OF INSULIN,ProFee,0989,83527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83528_3,ASSAY OF INTRINSIC FACTOR,ProFee,0989,83528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83540_3,ASSAY OF IRON,ProFee,0989,83540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83550_3,IRON BINDING TEST,ProFee,0989,83550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83570_3,ASSAY OF IDH ENZYME,ProFee,0989,83570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83582_3,ASSAY OF KETOGENIC STEROIDS,ProFee,0989,83582,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83586_3,ASSAY 17- KETOSTEROIDS,ProFee,0989,83586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83593_3,"FRACTIONATION, KETOSTEROIDS",ProFee,0989,83593,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83605_3,ASSAY OF LACTIC ACID,ProFee,0989,83605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83615_3,LACTATE (LD) (LDH) ENZYME,ProFee,0989,83615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83625_3,ASSAY OF LDH ENZYMES,ProFee,0989,83625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83630_3,"LACTOFERRIN, FECAL (QUAL)",ProFee,0989,83630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83631_3,"LACTOFERRIN, FECAL (QUANT)",ProFee,0989,83631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83632_3,PLACENTAL LACTOGEN,ProFee,0989,83632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83633_3,TEST URINE FOR LACTOSE,ProFee,0989,83633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83634_3,ASSAY OF URINE FOR LACTOSE,ProFee,0989,83634,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83655_3,ASSAY OF LEAD,ProFee,0989,83655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83661_3,"L/S RATIO, FETAL LUNG",ProFee,0989,83661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83662_3,"FOAM STABILITY, FETAL LUNG",ProFee,0989,83662,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83663_3,"FLUORO POLARIZE, FETAL LUNG",ProFee,0989,83663,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83664_3,"LAMELLAR BDY, FETAL LUNG",ProFee,0989,83664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83670_3,ASSAY OF LAP ENZYME,ProFee,0989,83670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83690_3,ASSAY OF LIPASE,ProFee,0989,83690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83695_3,ASSAY OF LIPOPROTEIN(A),ProFee,0989,83695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83698_3,ASSAY LIPOPROTEIN PLA2,ProFee,0989,83698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83700_3,"LIPOPRO BLD, ELECTROPHORETIC",ProFee,0989,83700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83701_3,"LIPOPROTEIN BLD, HR FRACTION",ProFee,0989,83701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83704_3,"LIPOPROTEIN, BLD, BY NMR",ProFee,0989,83704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83718_3,ASSAY OF LIPOPROTEIN,ProFee,0989,83718,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83719_3,ASSAY OF BLOOD LIPOPROTEIN,ProFee,0989,83719,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83721_3,ASSAY OF BLOOD LIPOPROTEIN,ProFee,0989,83721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83722_3,LIPOPRTN DIR MEAS SD LDL CHL,ProFee,0989,83722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83727_3,ASSAY OF LRH HORMONE,ProFee,0989,83727,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83735_3,ASSAY OF MAGNESIUM,ProFee,0989,83735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83775_3,ASSAY OF MD ENZYME,ProFee,0989,83775,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83785_3,ASSAY OF MANGANESE,ProFee,0989,83785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83788_3,MASS SPECTROMETRY QUAL,ProFee,0989,83788,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83789_3,MASS SPECTROMETRY QUANT,ProFee,0989,83789,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83805_3,ASSAY OF MEPROBAMATE,ProFee,0989,83805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83825_3,ASSAY OF MERCURY,ProFee,0989,83825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83835_3,ASSAY OF METANEPHRINES,ProFee,0989,83835,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83840_3,ASSAY OF METHADONE,ProFee,0989,83840,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83857_3,ASSAY OF METHEMALBUMIN,ProFee,0989,83857,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83858_3,ASSAY OF METHSUXIMIDE,ProFee,0989,83858,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83861_3,MICROFLUID ANALY TEARS,ProFee,0989,83861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83864_3,MUCOPOLYSACCHARIDES,ProFee,0989,83864,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83866_3,MUCOPOLYSACCHARIDES SCREEN,ProFee,0989,83866,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83872_3,ASSAY SYNOVIAL FLUID MUCIN,ProFee,0989,83872,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83873_3,ASSAY OF CSF PROTEIN,ProFee,0989,83873,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83874_3,ASSAY OF MYOGLOBIN,ProFee,0989,83874,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83876_3,"ASSAY, MYELOPEROXIDASE",ProFee,0989,83876,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83880_3,NATRIURETIC PEPTIDE,ProFee,0989,83880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83883_3,"ASSAY, NEPHELOMETRY NOT SPEC",ProFee,0989,83883,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83885_3,ASSAY OF NICKEL,ProFee,0989,83885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83887_3,ASSAY OF NICOTINE,ProFee,0989,83887,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83890_3,MOLECULE ISOLATE,ProFee,0989,83890,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83891_3,MOLECULE ISOLATE NUCLEIC,ProFee,0989,83891,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83892_3,MOLECULAR DIAGNOSTICS,ProFee,0989,83892,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83893_3,MOLECULE DOT/SLOT/BLOT,ProFee,0989,83893,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83894_3,MOLECULE GEL ELECTROPHOR,ProFee,0989,83894,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83896_3,MOLECULAR DIAGNOSTICS,ProFee,0989,83896,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83897_3,MOLECULE NUCLEIC TRANSFER,ProFee,0989,83897,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83898_3,MOLECULE NUCLEIC AMPLI,ProFee,0989,83898,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83900_3,MOLECULE NUCLEIC AMPLI 2 SEQ,ProFee,0989,83900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83901_3,MOLECULE NUCLEIC AMPLI,ProFee,0989,83901,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83902_3,MOLECULAR DIAGNOSTICS,ProFee,0989,83902,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83903_3,MOLECULE MUTATION SCAN,ProFee,0989,83903,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83904_3,MOLECULE MUTATION IDENTIFY,ProFee,0989,83904,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83905_3,MOLECULE MUTATION IDENTIFY,ProFee,0989,83905,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83906_3,MOLECULE MUTATION IDENTIFY,ProFee,0989,83906,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83907_3,LYSE CELLS FOR NUCLEIC EXT,ProFee,0989,83907,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83908_3,"NUCLEIC ACID, SIGNAL AMPLI",ProFee,0989,83908,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83909_3,"NUCLEIC ACID, HIGH RESOLUTE",ProFee,0989,83909,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83912_3,GENETIC EXAMINATION,ProFee,0989,83912,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83913_3,"MOLECULAR, RNA STABILIZATION",ProFee,0989,83913,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83914_3,MUTATION IDENT OLA/SBCE/ASPE,ProFee,0989,83914,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83915_3,ASSAY OF NUCLEOTIDASE,ProFee,0989,83915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83916_3,OLIGOCLONAL BANDS,ProFee,0989,83916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83918_3,"ORGANIC ACIDS, TOTAL, QUANT",ProFee,0989,83918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83919_3,"ORGANIC ACIDS, QUAL, EACH",ProFee,0989,83919,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83921_3,"ORGANIC ACID,  SINGLE, QUANT",ProFee,0989,83921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83925_3,ASSAY OF OPIATES,ProFee,0989,83925,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
83930_3,ASSAY OF BLOOD OSMOLALITY,ProFee,0989,83930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83935_3,ASSAY OF URINE OSMOLALITY,ProFee,0989,83935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83937_3,ASSAY OF OSTEOCALCIN,ProFee,0989,83937,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83945_3,ASSAY OF OXALATE,ProFee,0989,83945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83950_3,"ONCOPROTEIN, HER-2/NEU",ProFee,0989,83950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83951_3,"ONCOPROTEIN, DCP",ProFee,0989,83951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83970_3,ASSAY OF PARATHORMONE,ProFee,0989,83970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83986_3,ASSAY OF BODY FLUID ACIDITY,ProFee,0989,83986,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83987_3,EXHALED BREATH CONDENSATE,ProFee,0989,83987,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83992_3,ASSAY FOR PHENCYCLIDINE,ProFee,0989,83992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
83993_3,ASSAY FOR CALPROTECTIN FECAL,ProFee,0989,83993,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84022_3,ASSAY OF PHENOTHIAZINE,ProFee,0989,84022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
84030_3,ASSAY OF BLOOD PKU,ProFee,0989,84030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84035_3,ASSAY OF PHENYLKETONES,ProFee,0989,84035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84060_3,ASSAY ACID PHOSPHATASE,ProFee,0989,84060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84061_3,"PHOSPHATASE, FORENSIC EXAM",ProFee,0989,84061,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
84066_3,ASSAY PROSTATE PHOSPHATASE,ProFee,0989,84066,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84075_3,ASSAY ALKALINE PHOSPHATASE,ProFee,0989,84075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84078_3,ASSAY ALKALINE PHOSPHATASE,ProFee,0989,84078,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84080_3,ASSAY ALKALINE PHOSPHATASES,ProFee,0989,84080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84081_3,AMNIOTIC FLUID ENZYME TEST,ProFee,0989,84081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84085_3,ASSAY OF RBC PG6D ENZYME,ProFee,0989,84085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84087_3,ASSAY PHOSPHOHEXOSE ENZYMES,ProFee,0989,84087,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84100_3,ASSAY OF PHOSPHORUS,ProFee,0989,84100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84105_3,ASSAY OF URINE PHOSPHORUS,ProFee,0989,84105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84106_3,TEST FOR PORPHOBILINOGEN,ProFee,0989,84106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84110_3,ASSAY OF PORPHOBILINOGEN,ProFee,0989,84110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84112_3,PLACENTA ALPHA MICRO IG C/V,ProFee,0989,84112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84119_3,TEST URINE FOR PORPHYRINS,ProFee,0989,84119,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84120_3,ASSAY OF URINE PORPHYRINS,ProFee,0989,84120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84126_3,ASSAY OF FECES PORPHYRINS,ProFee,0989,84126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84127_3,ASSAY OF FECES PORPHYRINS,ProFee,0989,84127,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
84132_3,ASSAY OF SERUM POTASSIUM,ProFee,0989,84132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84133_3,ASSAY OF URINE POTASSIUM,ProFee,0989,84133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84134_3,ASSAY OF PREALBUMIN,ProFee,0989,84134,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84135_3,ASSAY OF PREGNANEDIOL,ProFee,0989,84135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84138_3,ASSAY OF PREGNANETRIOL,ProFee,0989,84138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84140_3,ASSAY OF PREGNENOLONE,ProFee,0989,84140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84143_3,ASSAY OF 17-HYDROXYPREGNENO,ProFee,0989,84143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84144_3,ASSAY OF PROGESTERONE,ProFee,0989,84144,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84145_3,PROCALCITONIN (PCT),ProFee,0989,84145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84146_3,ASSAY OF PROLACTIN,ProFee,0989,84146,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84150_3,ASSAY OF PROSTAGLANDIN,ProFee,0989,84150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84152_3,"ASSAY OF PSA, COMPLEXED",ProFee,0989,84152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84153_3,"ASSAY OF PSA, TOTAL",ProFee,0989,84153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84154_3,"ASSAY OF PSA, FREE",ProFee,0989,84154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84155_3,"ASSAY OF PROTEIN, SERUM",ProFee,0989,84155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84156_3,"ASSAY OF PROTEIN, URINE",ProFee,0989,84156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84157_3,"ASSAY OF PROTEIN, OTHER",ProFee,0989,84157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84160_3,"ASSAY OF PROTEIN, ANY SOURCE",ProFee,0989,84160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84163_3,"PAPPA, SERUM",ProFee,0989,84163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84165_3,"PROTEIN E-PHORESIS, SERUM",ProFee,0989,84165,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
84166_3,PROTEIN E-PHORESIS/URINE/CSF,ProFee,0989,84166,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
84181_3,WESTERN BLOT TEST,ProFee,0989,84181,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
84182_3,"PROTEIN, WESTERN BLOT TEST",ProFee,0989,84182,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
84202_3,ASSAY RBC PROTOPORPHYRIN,ProFee,0989,84202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84203_3,TEST RBC PROTOPORPHYRIN,ProFee,0989,84203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84206_3,ASSAY OF PROINSULIN,ProFee,0989,84206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84207_3,ASSAY OF VITAMIN B-6,ProFee,0989,84207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84210_3,ASSAY OF PYRUVATE,ProFee,0989,84210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84220_3,ASSAY OF PYRUVATE KINASE,ProFee,0989,84220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84228_3,ASSAY OF QUININE,ProFee,0989,84228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84233_3,ASSAY OF ESTROGEN,ProFee,0989,84233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84234_3,ASSAY OF PROGESTERONE,ProFee,0989,84234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84235_3,ASSAY OF ENDOCRINE HORMONE,ProFee,0989,84235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84238_3,"ASSAY, NONENDOCRINE RECEPTOR",ProFee,0989,84238,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84244_3,ASSAY OF RENIN,ProFee,0989,84244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84252_3,ASSAY OF VITAMIN B-2,ProFee,0989,84252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84255_3,ASSAY OF SELENIUM,ProFee,0989,84255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84260_3,ASSAY OF SEROTONIN,ProFee,0989,84260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84270_3,ASSAY OF SEX HORMONE GLOBUL,ProFee,0989,84270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84275_3,ASSAY OF SIALIC ACID,ProFee,0989,84275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84285_3,ASSAY OF SILICA,ProFee,0989,84285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84295_3,ASSAY OF SERUM SODIUM,ProFee,0989,84295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84300_3,ASSAY OF URINE SODIUM,ProFee,0989,84300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84302_3,ASSAY OF SWEAT SODIUM,ProFee,0989,84302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84305_3,ASSAY OF SOMATOMEDIN,ProFee,0989,84305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84307_3,ASSAY OF SOMATOSTATIN,ProFee,0989,84307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84311_3,SPECTROPHOTOMETRY,ProFee,0989,84311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84315_3,BODY FLUID SPECIFIC GRAVITY,ProFee,0989,84315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84375_3,"CHROMATOGRAM ASSAY, SUGARS",ProFee,0989,84375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84376_3,"SUGARS, SINGLE, QUAL",ProFee,0989,84376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84377_3,"SUGARS, MULTIPLE, QUAL",ProFee,0989,84377,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84378_3,"SUGARS, SINGLE, QUANT",ProFee,0989,84378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84379_3,SUGARS MULTIPLE QUANT,ProFee,0989,84379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84392_3,ASSAY OF URINE SULFATE,ProFee,0989,84392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84402_3,ASSAY OF TESTOSTERONE,ProFee,0989,84402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84403_3,ASSAY OF TOTAL TESTOSTERONE,ProFee,0989,84403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84410_3,TESTOSTERONE BIOAVAILABLE,ProFee,0989,84410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84425_3,ASSAY OF VITAMIN B-1,ProFee,0989,84425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84430_3,ASSAY OF THIOCYANATE,ProFee,0989,84430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84431_3,"THROMBOXANE, URINE",ProFee,0989,84431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84432_3,ASSAY OF THYROGLOBULIN,ProFee,0989,84432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84436_3,ASSAY OF TOTAL THYROXINE,ProFee,0989,84436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84437_3,ASSAY OF NEONATAL THYROXINE,ProFee,0989,84437,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84439_3,ASSAY OF FREE THYROXINE,ProFee,0989,84439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84442_3,ASSAY OF THYROID ACTIVITY,ProFee,0989,84442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84443_3,ASSAY THYROID STIM HORMONE,ProFee,0989,84443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84445_3,ASSAY OF TSI,ProFee,0989,84445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84446_3,ASSAY OF VITAMIN E,ProFee,0989,84446,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84449_3,ASSAY OF TRANSCORTIN,ProFee,0989,84449,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84450_3,TRANSFERASE (AST) (SGOT),ProFee,0989,84450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84460_3,ALANINE AMINO (ALT) (SGPT),ProFee,0989,84460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84466_3,ASSAY OF TRANSFERRIN,ProFee,0989,84466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84478_3,ASSAY OF TRIGLYCERIDES,ProFee,0989,84478,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84479_3,ASSAY OF THYROID (T3 OR T4),ProFee,0989,84479,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84480_3,"ASSAY, TRIIODOTHYRONINE (T3)",ProFee,0989,84480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84481_3,FREE ASSAY (FT-3),ProFee,0989,84481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84482_3,T3 REVERSE,ProFee,0989,84482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84484_3,"ASSAY OF TROPONIN, QUANT",ProFee,0989,84484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84485_3,ASSAY DUODENAL FLUID TRYPSIN,ProFee,0989,84485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84488_3,TEST FECES FOR TRYPSIN,ProFee,0989,84488,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84490_3,ASSAY OF FECES FOR TRYPSIN,ProFee,0989,84490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84510_3,ASSAY OF TYROSINE,ProFee,0989,84510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84512_3,"ASSAY OF TROPONIN, QUAL",ProFee,0989,84512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84520_3,ASSAY OF UREA NITROGEN,ProFee,0989,84520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84525_3,UREA NITROGEN SEMI-QUANT,ProFee,0989,84525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84540_3,ASSAY OF URINE/UREA-N,ProFee,0989,84540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84545_3,UREA-N CLEARANCE TEST,ProFee,0989,84545,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84550_3,ASSAY OF BLOOD/URIC ACID,ProFee,0989,84550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84560_3,ASSAY OF URINE/URIC ACID,ProFee,0989,84560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84577_3,ASSAY OF FECES/UROBILINOGEN,ProFee,0989,84577,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84578_3,TEST URINE UROBILINOGEN,ProFee,0989,84578,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84580_3,ASSAY OF URINE UROBILINOGEN,ProFee,0989,84580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84583_3,ASSAY OF URINE UROBILINOGEN,ProFee,0989,84583,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84585_3,ASSAY OF URINE VMA,ProFee,0989,84585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84586_3,ASSAY OF VIP,ProFee,0989,84586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84588_3,ASSAY OF VASOPRESSIN,ProFee,0989,84588,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84590_3,ASSAY OF VITAMIN A,ProFee,0989,84590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84591_3,ASSAY OF NOS VITAMIN,ProFee,0989,84591,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84597_3,ASSAY OF VITAMIN K,ProFee,0989,84597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84600_3,ASSAY OF VOLATILES,ProFee,0989,84600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84620_3,XYLOSE TOLERANCE TEST,ProFee,0989,84620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84630_3,ASSAY OF ZINC,ProFee,0989,84630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84681_3,ASSAY OF C-PEPTIDE,ProFee,0989,84681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84702_3,CHORIONIC GONADOTROPIN TEST,ProFee,0989,84702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84704_3,"HCG, FREE BETACHAIN TEST",ProFee,0989,84704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
84830_3,OVULATION TESTS,ProFee,0989,84830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
8499_2,Acetaminophen 500 MG Tablet,ProFee,0989,J8499,,,,0,11.00,8.25,8.25,8.25,0.00,N/A,N/A,N/A
8499_3,Acetaminophen 500 MG Tablet,ProFee,0989,J8499,,,,0,11.00,8.25,8.25,8.25,0.00,N/A,N/A,N/A
84999_3,CLINICAL CHEMISTRY TEST,ProFee,0989,84999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85002_3,BLEEDING TIME TEST,ProFee,0989,85002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85004_3,AUTOMATED DIFF WBC COUNT,ProFee,0989,85004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85007_3,BL SMEAR W/DIFF WBC COUNT,ProFee,0989,85007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85008_3,BL SMEAR W/O DIFF WBC COUNT,ProFee,0989,85008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85009_3,MANUAL DIFF WBC COUNT B-COAT,ProFee,0989,85009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85014_3,HEMATOCRIT,ProFee,0989,85014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85018_3,HEMOGLOBIN,ProFee,0989,85018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85025_3,COMPLETE CBC W/AUTO DIFF WBC,ProFee,0989,85025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85027_3,"COMPLETE CBC, AUTOMATED",ProFee,0989,85027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85032_3,"MANUAL CELL COUNT, EACH",ProFee,0989,85032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85041_3,AUTOMATED RBC COUNT,ProFee,0989,85041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85044_3,MANUAL RETICULOCYTE COUNT,ProFee,0989,85044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85045_3,AUTOMATED RETICULOCYTE COUNT,ProFee,0989,85045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85046_3,RETICYTE/HGB CONCENTRATE,ProFee,0989,85046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85048_3,AUTOMATED LEUKOCYTE COUNT,ProFee,0989,85048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85049_3,AUTOMATED PLATELET COUNT,ProFee,0989,85049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85055_3,RETICULATED PLATELET ASSAY,ProFee,0989,85055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85060_3,BLOOD SMEAR INTERPRETATION,ProFee,0989,85060,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
85097_3,BONE MARROW INTERPRETATION,ProFee,0989,85097,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
85130_3,CHROMOGENIC SUBSTRATE ASSAY,ProFee,0989,85130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85170_3,BLOOD CLOT RETRACTION,ProFee,0989,85170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85175_3,BLOOD CLOT LYSIS TIME,ProFee,0989,85175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85210_3,BLOOD CLOT FACTOR II TEST,ProFee,0989,85210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85220_3,BLOOD CLOT FACTOR V TEST,ProFee,0989,85220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85230_3,BLOOD CLOT FACTOR VII TEST,ProFee,0989,85230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85240_3,BLOOD CLOT FACTOR VIII TEST,ProFee,0989,85240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85244_3,BLOOD CLOT FACTOR VIII TEST,ProFee,0989,85244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85245_3,BLOOD CLOT FACTOR VIII TEST,ProFee,0989,85245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85246_3,BLOOD CLOT FACTOR VIII TEST,ProFee,0989,85246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85247_3,BLOOD CLOT FACTOR VIII TEST,ProFee,0989,85247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85250_3,BLOOD CLOT FACTOR IX TEST,ProFee,0989,85250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85260_3,BLOOD CLOT FACTOR X TEST,ProFee,0989,85260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85270_3,BLOOD CLOT FACTOR XI TEST,ProFee,0989,85270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85280_3,BLOOD CLOT FACTOR XII TEST,ProFee,0989,85280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85290_3,BLOOD CLOT FACTOR XIII TEST,ProFee,0989,85290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85291_3,BLOOD CLOT FACTOR XIII TEST,ProFee,0989,85291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85292_3,BLOOD CLOT FACTOR ASSAY,ProFee,0989,85292,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85293_3,BLOOD CLOT FACTOR ASSAY,ProFee,0989,85293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85300_3,ANTITHROMBIN III TEST,ProFee,0989,85300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85301_3,ANTITHROMBIN III TEST,ProFee,0989,85301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85302_3,BLOOD CLOT INHIBITOR ANTIGEN,ProFee,0989,85302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85303_3,BLOOD CLOT INHIBITOR TEST,ProFee,0989,85303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85305_3,BLOOD CLOT INHIBITOR ASSAY,ProFee,0989,85305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85306_3,BLOOD CLOT INHIBITOR TEST,ProFee,0989,85306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85307_3,ASSAY ACTIVATED PROTEIN C,ProFee,0989,85307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85335_3,FACTOR INHIBITOR TEST,ProFee,0989,85335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85337_3,THROMBOMODULIN,ProFee,0989,85337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85345_3,COAGULATION TIME,ProFee,0989,85345,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85347_3,COAGULATION TIME,ProFee,0989,85347,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85348_3,COAGULATION TIME,ProFee,0989,85348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85360_3,EUGLOBULIN LYSIS,ProFee,0989,85360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85362_3,FIBRIN DEGRADATION PRODUCTS,ProFee,0989,85362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85366_3,FIBRINOGEN TEST,ProFee,0989,85366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85370_3,FIBRINOGEN TEST,ProFee,0989,85370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85378_3,"FIBRIN DEGRADE, SEMIQUANT",ProFee,0989,85378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85379_3,"FIBRIN DEGRADATION, QUANT",ProFee,0989,85379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85380_3,"FIBRIN DEGRADATION, VTE",ProFee,0989,85380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85384_3,FIBRINOGEN,ProFee,0989,85384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85385_3,FIBRINOGEN,ProFee,0989,85385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85390_3,FIBRINOLYSINS SCREEN,ProFee,0989,85390,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
85396_3,"CLOTTING ASSAY, WHOLE BLOOD",ProFee,0989,85396,,,,0,3.00,2.25,2.25,29.50,0.00,29.50,29.50,N/A
85397_3,CLOTTING FUNCT ACTIVITY,ProFee,0989,85397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85400_3,FIBRINOLYTIC PLASMIN,ProFee,0989,85400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85410_3,FIBRINOLYTIC ANTIPLASMIN,ProFee,0989,85410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85415_3,FIBRINOLYTIC PLASMINOGEN,ProFee,0989,85415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85420_3,FIBRINOLYTIC PLASMINOGEN,ProFee,0989,85420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85421_3,FIBRINOLYTIC PLASMINOGEN,ProFee,0989,85421,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85441_3,"HEINZ BODIES, DIRECT",ProFee,0989,85441,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85445_3,"HEINZ BODIES, INDUCED",ProFee,0989,85445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85460_3,"HEMOGLOBIN, FETAL",ProFee,0989,85460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85461_3,"HEMOGLOBIN, FETAL",ProFee,0989,85461,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85475_3,HEMOLYSIN,ProFee,0989,85475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85520_3,HEPARIN ASSAY,ProFee,0989,85520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85525_3,HEPARIN NEUTRALIZATION,ProFee,0989,85525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85530_3,HEPARIN-PROTAMINE TOLERANCE,ProFee,0989,85530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85536_3,IRON STAIN PERIPHERAL BLOOD,ProFee,0989,85536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85540_3,WBC ALKALINE PHOSPHATASE,ProFee,0989,85540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85547_3,RBC MECHANICAL FRAGILITY,ProFee,0989,85547,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85549_3,MURAMIDASE,ProFee,0989,85549,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85555_3,RBC OSMOTIC FRAGILITY,ProFee,0989,85555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85557_3,RBC OSMOTIC FRAGILITY,ProFee,0989,85557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85576_3,BLOOD PLATELET AGGREGATION,ProFee,0989,85576,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
85597_3,PLATELET NEUTRALIZATION,ProFee,0989,85597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85598_3,HEXAGNAL PHOSPH PLTLT NEUTRL,ProFee,0989,85598,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85610_3,PROTHROMBIN TIME,ProFee,0989,85610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85611_3,PROTHROMBIN TEST,ProFee,0989,85611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85612_3,VIPER VENOM PROTHROMBIN TIME,ProFee,0989,85612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85613_3,"RUSSELL VIPER VENOM, DILUTED",ProFee,0989,85613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85635_3,REPTILASE TEST,ProFee,0989,85635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85651_3,"RBC SED RATE, NONAUTOMATED",ProFee,0989,85651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85652_3,"RBC SED RATE, AUTOMATED",ProFee,0989,85652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85660_3,RBC SICKLE CELL TEST,ProFee,0989,85660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85670_3,"THROMBIN TIME, PLASMA",ProFee,0989,85670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85675_3,"THROMBIN TIME, TITER",ProFee,0989,85675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85705_3,THROMBOPLASTIN INHIBITION,ProFee,0989,85705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85730_3,"THROMBOPLASTIN TIME, PARTIAL",ProFee,0989,85730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85732_3,"THROMBOPLASTIN TIME, PARTIAL",ProFee,0989,85732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85810_3,BLOOD VISCOSITY EXAMINATION,ProFee,0989,85810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
85999_3,HEMATOLOGY PROCEDURE,ProFee,0989,85999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86000_3,"AGGLUTININS, FEBRILE",ProFee,0989,86000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86001_3,ALLERGEN SPECIFIC IGG,ProFee,0989,86001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86003_3,ALLERGEN SPECIFIC IGE,ProFee,0989,86003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86005_3,ALLERGEN SPECIFIC IGE,ProFee,0989,86005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86008_3,ALLG SPEC IGE RECOMB EA,ProFee,0989,86008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86021_3,WBC ANTIBODY IDENTIFICATION,ProFee,0989,86021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86022_3,PLATELET ANTIBODIES,ProFee,0989,86022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86023_3,IMMUNOGLOBULIN ASSAY,ProFee,0989,86023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86038_3,ANTINUCLEAR ANTIBODIES,ProFee,0989,86038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86039_3,ANTINUCLEAR ANTIBODIES (ANA),ProFee,0989,86039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86060_3,"ANTISTREPTOLYSIN O, TITER",ProFee,0989,86060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86063_3,"ANTISTREPTOLYSIN O, SCREEN",ProFee,0989,86063,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86077_3,PHYSICIAN BLOOD BANK SERVICE,ProFee,0989,86077,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
86078_3,PHYSICIAN BLOOD BANK SERVICE,ProFee,0989,86078,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
86079_3,PHYSICIAN BLOOD BANK SERVICE,ProFee,0989,86079,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
86140_3,C-REACTIVE PROTEIN,ProFee,0989,86140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86141_3,"C-REACTIVE PROTEIN, HS",ProFee,0989,86141,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86146_3,GLYCOPROTEIN ANTIBODY,ProFee,0989,86146,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86147_3,CARDIOLIPIN ANTIBODY,ProFee,0989,86147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86148_3,PHOSPHOLIPID ANTIBODY,ProFee,0989,86148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86152_3,CELL ENUMERATION & ID,ProFee,0989,86152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86153_3,CELL ENUMERATION PHYS INTERP,ProFee,0989,86153,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
86155_3,CHEMOTAXIS ASSAY,ProFee,0989,86155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86156_3,"COLD AGGLUTININ, SCREEN",ProFee,0989,86156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86157_3,"COLD AGGLUTININ, TITER",ProFee,0989,86157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86160_3,"COMPLEMENT, ANTIGEN",ProFee,0989,86160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86161_3,COMPLEMENT/FUNCTION ACTIVITY,ProFee,0989,86161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86162_3,"COMPLEMENT, TOTAL (CH50)",ProFee,0989,86162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86171_3,"COMPLEMENT FIXATION, EACH",ProFee,0989,86171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86185_3,COUNTERIMMUNOELECTROPHORESIS,ProFee,0989,86185,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86200_3,CCP ANTIBODY,ProFee,0989,86200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86215_3,"DEOXYRIBONUCLEASE, ANTIBODY",ProFee,0989,86215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86225_3,DNA ANTIBODY,ProFee,0989,86225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86226_3,"DNA ANTIBODY, SINGLE STRAND",ProFee,0989,86226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86235_3,NUCLEAR ANTIGEN ANTIBODY,ProFee,0989,86235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86243_3,FC RECEPTOR,ProFee,0989,86243,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86255_3,"FLUORESCENT ANTIBODY, SCREEN",ProFee,0989,86255,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86256_3,"FLUORESCENT ANTIBODY, TITER",ProFee,0989,86256,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86277_3,GROWTH HORMONE ANTIBODY,ProFee,0989,86277,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86280_3,HEMAGGLUTINATION INHIBITION,ProFee,0989,86280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86294_3,"IMMUNOASSAY, TUMOR, QUAL",ProFee,0989,86294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86300_3,"IMMUNOASSAY, TUMOR, CA 15-3",ProFee,0989,86300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86301_3,"IMMUNOASSAY, TUMOR, CA 19-9",ProFee,0989,86301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86304_3,"IMMUNOASSAY, TUMOR, CA 125",ProFee,0989,86304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86305_3,HUMAN EPIDIDYMIS PROTEIN 4,ProFee,0989,86305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86308_3,HETEROPHILE ANTIBODIES,ProFee,0989,86308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86309_3,HETEROPHILE ANTIBODIES,ProFee,0989,86309,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86310_3,HETEROPHILE ANTIBODIES,ProFee,0989,86310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86316_3,"IMMUNOASSAY, TUMOR OTHER",ProFee,0989,86316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86317_3,"IMMUNOASSAY,INFECTIOUS AGENT",ProFee,0989,86317,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86318_3,"IMMUNOASSAY,INFECTIOUS AGENT",ProFee,0989,86318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86320_3,SERUM IMMUNOELECTROPHORESIS,ProFee,0989,86320,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86325_3,OTHER IMMUNOELECTROPHORESIS,ProFee,0989,86325,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86327_3,IMMUNOELECTROPHORESIS ASSAY,ProFee,0989,86327,,,,0,3.00,2.25,2.25,29.50,0.00,29.50,29.50,N/A
86329_3,IMMUNODIFFUSION,ProFee,0989,86329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86331_3,IMMUNODIFFUSION OUCHTERLONY,ProFee,0989,86331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86332_3,IMMUNE COMPLEX ASSAY,ProFee,0989,86332,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86334_3,"IMMUNOFIX E-PHORESIS, SERUM",ProFee,0989,86334,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86335_3,IMMUNFIX E-PHORSIS/URINE/CSF,ProFee,0989,86335,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
86336_3,INHIBIN A,ProFee,0989,86336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86337_3,INSULIN ANTIBODIES,ProFee,0989,86337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86340_3,INTRINSIC FACTOR ANTIBODY,ProFee,0989,86340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86341_3,ISLET CELL ANTIBODY,ProFee,0989,86341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86343_3,LEUKOCYTE HISTAMINE RELEASE,ProFee,0989,86343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86344_3,LEUKOCYTE PHAGOCYTOSIS,ProFee,0989,86344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86352_3,CELL FUNCTION ASSAY W/STIM,ProFee,0989,86352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86353_3,LYMPHOCYTE TRANSFORMATION,ProFee,0989,86353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86355_3,"B CELLS, TOTAL COUNT",ProFee,0989,86355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86356_3,MONONUCLEAR CELL ANTIGEN,ProFee,0989,86356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86357_3,"NK CELLS, TOTAL COUNT",ProFee,0989,86357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86359_3,"T CELLS, TOTAL COUNT",ProFee,0989,86359,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86360_3,"T CELL, ABSOLUTE COUNT/RATIO",ProFee,0989,86360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86361_3,"T CELL, ABSOLUTE COUNT",ProFee,0989,86361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86367_3,"STEM CELLS, TOTAL COUNT",ProFee,0989,86367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86376_3,MICROSOMAL ANTIBODY,ProFee,0989,86376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86378_3,MIGRATION INHIBITORY FACTOR,ProFee,0989,86378,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86382_3,"NEUTRALIZATION TEST, VIRAL",ProFee,0989,86382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86384_3,NITROBLUE TETRAZOLIUM DYE,ProFee,0989,86384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86386_3,NUCLEAR MATRIX PROTEIN 22,ProFee,0989,86386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86403_3,PARTICLE AGGLUTINATION TEST,ProFee,0989,86403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86406_3,PARTICLE AGGLUTINATION TEST,ProFee,0989,86406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86430_3,RHEUMATOID FACTOR TEST,ProFee,0989,86430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86431_3,"RHEUMATOID FACTOR, QUANT",ProFee,0989,86431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86480_3,"TB TEST, CELL IMMUN MEASURE",ProFee,0989,86480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86481_3,TB AG RESPONSE T-CELL SUSP,ProFee,0989,86481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86485_3,"SKIN TEST, CANDIDA",ProFee,0989,86485,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
86486_3,"SKIN TEST, NOS ANTIGEN",ProFee,0989,86486,,,,0,3.00,2.25,2.25,7.00,0.00,7.00,7.00,N/A
86490_3,COCCIDIOIDOMYCOSIS SKIN TEST,ProFee,0989,86490,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
86510_3,HISTOPLASMOSIS SKIN TEST,ProFee,0989,86510,,,,0,3.00,2.25,2.25,9.00,0.00,9.00,9.00,N/A
86580_2,TB INTRADERMAL TEST,ProFee,0989,86580,,,,0,25.00,18.75,11.50,18.75,0.00,11.50,11.50,N/A
86580_3,TB INTRADERMAL TEST,ProFee,0989,86580,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
86586_3,"SKIN TEST, UNLISTED",ProFee,0989,86586,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86590_3,"STREPTOKINASE, ANTIBODY",ProFee,0989,86590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86592_3,"BLOOD SEROLOGY, QUALITATIVE",ProFee,0989,86592,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86593_3,"BLOOD SEROLOGY, QUANTITATIVE",ProFee,0989,86593,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86602_3,ANTINOMYCES ANTIBODY,ProFee,0989,86602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86603_3,ADENOVIRUS ANTIBODY,ProFee,0989,86603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86606_3,ASPERGILLUS ANTIBODY,ProFee,0989,86606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86609_3,BACTERIUM ANTIBODY,ProFee,0989,86609,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86611_3,BARTONELLA ANTIBODY,ProFee,0989,86611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86612_3,BLASTOMYCES ANTIBODY,ProFee,0989,86612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86615_3,BORDETELLA ANTIBODY,ProFee,0989,86615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86617_3,LYME DISEASE ANTIBODY,ProFee,0989,86617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86618_3,LYME DISEASE ANTIBODY,ProFee,0989,86618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86619_3,BORRELIA ANTIBODY,ProFee,0989,86619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86622_3,BRUCELLA ANTIBODY,ProFee,0989,86622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86625_3,CAMPYLOBACTER ANTIBODY,ProFee,0989,86625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86628_3,CANDIDA ANTIBODY,ProFee,0989,86628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86631_3,CHLAMYDIA ANTIBODY,ProFee,0989,86631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86632_3,CHLAMYDIA IGM ANTIBODY,ProFee,0989,86632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86635_3,COCCIDIOIDES ANTIBODY,ProFee,0989,86635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86638_3,Q FEVER ANTIBODY,ProFee,0989,86638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86641_3,CRYPTOCOCCUS ANTIBODY,ProFee,0989,86641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86644_3,CMV ANTIBODY,ProFee,0989,86644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86645_3,"CMV ANTIBODY, IGM",ProFee,0989,86645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86648_3,DIPHTHERIA ANTIBODY,ProFee,0989,86648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86651_3,ENCEPHALITIS ANTIBODY,ProFee,0989,86651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86652_3,ENCEPHALITIS ANTIBODY,ProFee,0989,86652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86653_3,ENCEPHALITIS ANTIBODY,ProFee,0989,86653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86654_3,ENCEPHALITIS ANTIBODY,ProFee,0989,86654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86658_3,ENTEROVIRUS ANTIBODY,ProFee,0989,86658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86663_3,EPSTEIN-BARR ANTIBODY,ProFee,0989,86663,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86664_3,EPSTEIN-BARR ANTIBODY,ProFee,0989,86664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86665_3,EPSTEIN-BARR ANTIBODY,ProFee,0989,86665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86666_3,EHRLICHIA ANTIBODY,ProFee,0989,86666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86668_3,FRANCISELLA TULARENSIS,ProFee,0989,86668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86671_3,FUNGUS ANTIBODY,ProFee,0989,86671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86674_3,GIARDIA LAMBLIA ANTIBODY,ProFee,0989,86674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86677_3,HELICOBACTER PYLORI,ProFee,0989,86677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86682_3,HELMINTH ANTIBODY,ProFee,0989,86682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86684_3,HEMOPHILUS INFLUENZA,ProFee,0989,86684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86687_3,HTLV-I ANTIBODY,ProFee,0989,86687,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86688_3,HTLV-II ANTIBODY,ProFee,0989,86688,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86689_3,HTLV/HIV CONFIRMATORY TEST,ProFee,0989,86689,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86692_3,"HEPATITIS, DELTA AGENT",ProFee,0989,86692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86694_3,HERPES SIMPLEX TEST,ProFee,0989,86694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86695_3,HERPES SIMPLEX TEST,ProFee,0989,86695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86696_3,HERPES SIMPLEX TYPE 2,ProFee,0989,86696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86698_3,HISTOPLASMA,ProFee,0989,86698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86701_3,HIV-1,ProFee,0989,86701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86702_3,HIV-2,ProFee,0989,86702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86703_3,"HIV-1/HIV-2, SINGLE ASSAY",ProFee,0989,86703,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86704_3,"HEP B CORE ANTIBODY, TOTAL",ProFee,0989,86704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86705_3,"HEP B CORE ANTIBODY, IGM",ProFee,0989,86705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86706_3,HEP B SURFACE ANTIBODY,ProFee,0989,86706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86707_3,HEP BE ANTIBODY,ProFee,0989,86707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86708_3,"HEP A ANTIBODY, TOTAL",ProFee,0989,86708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86709_3,"HEP A ANTIBODY, IGM",ProFee,0989,86709,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86710_3,INFLUENZA VIRUS ANTIBODY,ProFee,0989,86710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86711_3,JOHN CUNNINGHAM ANTIBODY,ProFee,0989,86711,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86713_3,LEGIONELLA ANTIBODY,ProFee,0989,86713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86717_3,LEISHMANIA ANTIBODY,ProFee,0989,86717,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86720_3,LEPTOSPIRA ANTIBODY,ProFee,0989,86720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86723_3,LISTERIA MONOCYTOGENES AB,ProFee,0989,86723,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86727_3,LYMPH CHORIOMENINGITIS AB,ProFee,0989,86727,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86729_3,LYMPHO VENEREUM ANTIBODY,ProFee,0989,86729,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86732_3,MUCORMYCOSIS ANTIBODY,ProFee,0989,86732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86735_3,MUMPS ANTIBODY,ProFee,0989,86735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86738_3,MYCOPLASMA ANTIBODY,ProFee,0989,86738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86741_3,NEISSERIA MENINGITIDIS,ProFee,0989,86741,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86744_3,NOCARDIA ANTIBODY,ProFee,0989,86744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86747_3,PARVOVIRUS ANTIBODY,ProFee,0989,86747,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86750_3,MALARIA ANTIBODY,ProFee,0989,86750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86753_3,PROTOZOA ANTIBODY NOS,ProFee,0989,86753,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86756_3,RESPIRATORY VIRUS ANTIBODY,ProFee,0989,86756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86757_3,RICKETTSIA ANTIBODY,ProFee,0989,86757,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86759_3,ROTAVIRUS ANTIBODY,ProFee,0989,86759,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86762_3,RUBELLA ANTIBODY,ProFee,0989,86762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86765_3,RUBEOLA ANTIBODY,ProFee,0989,86765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86768_3,SALMONELLA ANTIBODY,ProFee,0989,86768,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86771_3,SHIGELLA ANTIBODY,ProFee,0989,86771,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86774_3,TETANUS ANTIBODY,ProFee,0989,86774,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86777_3,TOXOPLASMA ANTIBODY,ProFee,0989,86777,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86778_3,"TOXOPLASMA ANTIBODY, IGM",ProFee,0989,86778,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86780_3,TREPONEMA PALLIDUM,ProFee,0989,86780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86781_3,"TREPONEMA PALLIDUM, CONFIRM",ProFee,0989,86781,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86784_3,TRICHINELLA ANTIBODY,ProFee,0989,86784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86787_3,VARICELLA-ZOSTER ANTIBODY,ProFee,0989,86787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86788_3,"WEST NILE VIRUS AB, IGM",ProFee,0989,86788,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86789_3,WEST NILE VIRUS ANTIBODY,ProFee,0989,86789,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86790_3,VIRUS ANTIBODY NOS,ProFee,0989,86790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86793_3,YERSINIA ANTIBODY,ProFee,0989,86793,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86794_3,ZIKA VIRUS IGM ANTIBODY,ProFee,0989,86794,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86800_3,THYROGLOBULIN ANTIBODY,ProFee,0989,86800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86803_3,HEPATITIS C AB TEST,ProFee,0989,86803,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86804_3,"HEP C AB TEST, CONFIRM",ProFee,0989,86804,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86805_3,LYMPHOCYTOTOXICITY ASSAY,ProFee,0989,86805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86806_3,LYMPHOCYTOTOXICITY ASSAY,ProFee,0989,86806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86807_3,CYTOTOXIC ANTIBODY SCREENING,ProFee,0989,86807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86808_3,CYTOTOXIC ANTIBODY SCREENING,ProFee,0989,86808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86812_3,"HLA TYPING, A, B, OR C",ProFee,0989,86812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86813_3,"HLA TYPING, A, B, OR C",ProFee,0989,86813,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86816_3,"HLA TYPING, DR/DQ",ProFee,0989,86816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86817_3,"HLA TYPING, DR/DQ",ProFee,0989,86817,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86821_3,"LYMPHOCYTE CULTURE, MIXED",ProFee,0989,86821,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86822_3,"LYMPHOCYTE CULTURE, PRIMED",ProFee,0989,86822,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86825_3,"HLA X-MATCH, NON-CYTOTOXIC",ProFee,0989,86825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86826_3,"HLA X-MATCH, NON-CYT ADD-ON",ProFee,0989,86826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86828_3,HLA CLASS I&II ANTIBODY QUAL,ProFee,0989,86828,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86829_3,HLA CLASS I/II ANTIBODY QUAL,ProFee,0989,86829,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86830_3,HLA CLASS I PHENOTYPE QUAL,ProFee,0989,86830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86831_3,HLA CLASS II PHENOTYPE QUAL,ProFee,0989,86831,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86832_3,HLA CLASS I HIGH DEFIN QUAL,ProFee,0989,86832,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86833_3,HLA CLASS II HIGH DEFIN QUAL,ProFee,0989,86833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86834_3,HLA CLASS I SEMIQUANT PANEL,ProFee,0989,86834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86835_3,HLA CLASS II SEMIQUANT PANEL,ProFee,0989,86835,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86849_3,IMMUNOLOGY PROCEDURE,ProFee,0989,86849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86850_3,RBC ANTIBODY SCREEN,ProFee,0989,86850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86860_3,RBC ANTIBODY ELUTION,ProFee,0989,86860,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
86870_3,RBC ANTIBODY IDENTIFICATION,ProFee,0989,86870,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
86880_3,"COOMBS TEST, DIRECT",ProFee,0989,86880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86885_3,"COOMBS TEST, INDIRECT, QUAL",ProFee,0989,86885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86886_3,"COOMBS TEST, INDIRECT, TITER",ProFee,0989,86886,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86890_3,AUTOLOGOUS BLOOD PROCESS,ProFee,0989,86890,,,,0,3.00,2.25,2.25,146.00,0.00,146.00,146.00,N/A
86891_3,"AUTOLOGOUS BLOOD, OP SALVAGE",ProFee,0989,86891,,,,0,3.00,2.25,2.25,206.00,0.00,206.00,206.00,N/A
86900_3,"BLOOD TYPING, ABO",ProFee,0989,86900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86901_3,"BLOOD TYPING, RH (D)",ProFee,0989,86901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86902_3,BLOOD TYPE ANTIGEN DONOR EA,ProFee,0989,86902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86903_3,"BLOOD TYPING, ANTIGEN SCREEN",ProFee,0989,86903,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
86904_3,"BLOOD TYPING, PATIENT SERUM",ProFee,0989,86904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86905_3,"BLOOD TYPING, RBC ANTIGENS",ProFee,0989,86905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86906_3,"BLOOD TYPING, RH PHENOTYPE",ProFee,0989,86906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86910_3,"BLOOD TYPING, PATERNITY TEST",ProFee,0989,86910,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
86911_3,"BLOOD TYPING, ANTIGEN SYSTEM",ProFee,0989,86911,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
86920_3,COMPATIBILITY TEST,ProFee,0989,86920,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
86921_3,COMPATIBILITY TEST,ProFee,0989,86921,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
86922_3,COMPATIBILITY TEST,ProFee,0989,86922,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
86923_3,"COMPATIBILITY TEST, ELECTRIC",ProFee,0989,86923,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
86927_3,"PLASMA, FRESH FROZEN",ProFee,0989,86927,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
86930_3,FROZEN BLOOD PREP,ProFee,0989,86930,,,,0,3.00,2.25,2.25,171.50,0.00,171.50,171.50,N/A
86931_3,FROZEN BLOOD THAW,ProFee,0989,86931,,,,0,3.00,2.25,2.25,128.50,0.00,128.50,128.50,N/A
86932_3,FROZEN BLOOD FREEZE/THAW,ProFee,0989,86932,,,,0,3.00,2.25,2.25,146.00,0.00,146.00,146.00,N/A
86940_3,"HEMOLYSINS/AGGLUTININS, AUTO",ProFee,0989,86940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86941_3,HEMOLYSINS/AGGLUTININS,ProFee,0989,86941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
86945_3,BLOOD PRODUCT/IRRADIATION,ProFee,0989,86945,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
86950_3,LEUKACYTE TRANSFUSION,ProFee,0989,86950,,,,0,3.00,2.25,2.25,111.50,0.00,111.50,111.50,N/A
86960_3,VOL REDUCTION OF BLOOD/PROD,ProFee,0989,86960,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
86965_3,POOLING BLOOD PLATELETS,ProFee,0989,86965,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
86970_3,RBC PRETREATMENT,ProFee,0989,86970,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
86971_3,RBC PRETREATMENT,ProFee,0989,86971,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
86972_3,RBC PRETREATMENT,ProFee,0989,86972,,,,0,3.00,2.25,2.25,60.00,0.00,60.00,60.00,N/A
86975_3,"RBC PRETREATMENT, SERUM",ProFee,0989,86975,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
86976_3,"RBC PRETREATMENT, SERUM",ProFee,0989,86976,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
86977_3,"RBC PRETREATMENT, SERUM",ProFee,0989,86977,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
86978_3,"RBC PRETREATMENT, SERUM",ProFee,0989,86978,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
86985_3,SPLIT BLOOD OR PRODUCTS,ProFee,0989,86985,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
86999_3,TRANSFUSION PROCEDURE,ProFee,0989,86999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87001_3,SMALL ANIMAL INOCULATION,ProFee,0989,87001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87003_3,SMALL ANIMAL INOCULATION,ProFee,0989,87003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87015_3,SPECIMEN CONCENTRATION,ProFee,0989,87015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87040_3,BLOOD CULTURE FOR BACTERIA,ProFee,0989,87040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87045_3,"FECES CULTURE, BACTERIA",ProFee,0989,87045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87046_3,"STOOL CULTR, BACTERIA, EACH",ProFee,0989,87046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87070_3,"CULTURE, BACTERIA, OTHER",ProFee,0989,87070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87071_3,CULTURE BACTERI AEROBIC OTHR,ProFee,0989,87071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87073_3,CULTURE BACTERIA ANAEROBIC,ProFee,0989,87073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87075_3,"CULTR BACTERIA, EXCEPT BLOOD",ProFee,0989,87075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87076_3,"CULTURE ANAEROBE IDENT, EACH",ProFee,0989,87076,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87077_3,CULTURE AEROBIC IDENTIFY,ProFee,0989,87077,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87081_3,CULTURE SCREEN ONLY,ProFee,0989,87081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87084_3,CULTURE OF SPECIMEN BY KIT,ProFee,0989,87084,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87086_3,URINE CULTURE/COLONY COUNT,ProFee,0989,87086,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87088_3,URINE BACTERIA CULTURE,ProFee,0989,87088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87101_3,SKIN FUNGI CULTURE,ProFee,0989,87101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87102_3,FUNGUS ISOLATION CULTURE,ProFee,0989,87102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87103_3,BLOOD FUNGUS CULTURE,ProFee,0989,87103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87106_3,"FUNGI IDENTIFICATION, YEAST",ProFee,0989,87106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87107_3,"FUNGI IDENTIFICATION, MOLD",ProFee,0989,87107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87109_3,MYCOPLASMA,ProFee,0989,87109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87110_3,CHLAMYDIA CULTURE,ProFee,0989,87110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87116_3,MYCOBACTERIA CULTURE,ProFee,0989,87116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87118_3,MYCOBACTERIC IDENTIFICATION,ProFee,0989,87118,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87140_3,CULTURE TYPE IMMUNOFLUORESC,ProFee,0989,87140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87143_3,"CULTURE TYPING, GLC/HPLC",ProFee,0989,87143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87147_3,"CULTURE TYPE, IMMUNOLOGIC",ProFee,0989,87147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87149_3,"CULTURE TYPE, NUCLEIC ACID",ProFee,0989,87149,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87150_3,"DNA/RNA, AMPLIFIED PROBE",ProFee,0989,87150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87152_3,CULTURE TYPE PULSE FIELD GEL,ProFee,0989,87152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87153_3,DNA/RNA SEQUENCING,ProFee,0989,87153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87158_3,"CULTURE TYPING, ADDED METHOD",ProFee,0989,87158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87164_3,DARK FIELD EXAMINATION,ProFee,0989,87164,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
87166_3,DARK FIELD EXAMINATION,ProFee,0989,87166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87168_3,MACROSCOPIC EXAM ARTHROPOD,ProFee,0989,87168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87169_3,MACROSCOPIC EXAM PARASITE,ProFee,0989,87169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87172_3,PINWORM EXAM,ProFee,0989,87172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87176_3,"TISSUE HOMOGENIZATION, CULTR",ProFee,0989,87176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87177_3,OVA AND PARASITES SMEARS,ProFee,0989,87177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87181_3,"MICROBE SUSCEPTIBLE, DIFFUSE",ProFee,0989,87181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87184_3,"MICROBE SUSCEPTIBLE, DISK",ProFee,0989,87184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87185_3,"MICROBE SUSCEPTIBLE, ENZYME",ProFee,0989,87185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87186_3,"MICROBE SUSCEPTIBLE, MIC",ProFee,0989,87186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87187_3,"MICROBE SUSCEPTIBLE, MLC",ProFee,0989,87187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87188_3,"MICROBE SUSCEPT, MACROBROTH",ProFee,0989,87188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87190_3,"MICROBE SUSCEPT, MYCOBACTERI",ProFee,0989,87190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87197_3,"BACTERICIDAL LEVEL, SERUM",ProFee,0989,87197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87205_3,"SMEAR, GRAM STAIN",ProFee,0989,87205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87206_3,"SMEAR, FLUORESCENT/ACID STAI",ProFee,0989,87206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87207_3,"SMEAR, SPECIAL STAIN",ProFee,0989,87207,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
87209_3,"SMEAR, COMPLEX STAIN",ProFee,0989,87209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87230_3,"ASSAY, TOXIN OR ANTITOXIN",ProFee,0989,87230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87250_3,"VIRUS INOCULATE, EGGS/ANIMAL",ProFee,0989,87250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87252_3,"VIRUS INOCULATION, TISSUE",ProFee,0989,87252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87253_3,"VIRUS INOCULATE TISSUE, ADDL",ProFee,0989,87253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87254_3,"VIRUS INOCULATION, SHELL VIA",ProFee,0989,87254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87255_3,"GENET VIRUS ISOLATE, HSV",ProFee,0989,87255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87260_3,"ADENOVIRUS AG, IF",ProFee,0989,87260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87265_3,"PERTUSSIS AG, IF",ProFee,0989,87265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87267_3,"ENTEROVIRUS ANTIBODY, DFA",ProFee,0989,87267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87269_3,"GIARDIA AG, IF",ProFee,0989,87269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87270_3,"CHLAMYDIA TRACHOMATIS AG, IF",ProFee,0989,87270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87271_3,"CRYPTOSPORIDUM/GARDIA AG, IF",ProFee,0989,87271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87272_3,"CRYPTOSPORIDIUM AG, IF",ProFee,0989,87272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87273_3,"HERPES SIMPLEX 2, AG, IF",ProFee,0989,87273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87274_3,"HERPES SIMPLEX 1, AG, IF",ProFee,0989,87274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87275_3,"INFLUENZA B, AG, IF",ProFee,0989,87275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87276_3,"INFLUENZA A, AG, IF",ProFee,0989,87276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87277_3,"LEGIONELLA MICDADEI, AG, IF",ProFee,0989,87277,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87278_3,"LEGION PNEUMOPHILIA AG, IF",ProFee,0989,87278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87279_3,"PARAINFLUENZA, AG, IF",ProFee,0989,87279,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87280_3,"RESPIRATORY SYNCYTIAL AG, IF",ProFee,0989,87280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87281_3,"PNEUMOCYSTIS CARINII, AG, IF",ProFee,0989,87281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87283_3,"RUBEOLA, AG, IF",ProFee,0989,87283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87285_3,"TREPONEMA PALLIDUM, AG, IF",ProFee,0989,87285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87290_3,"VARICELLA ZOSTER, AG, IF",ProFee,0989,87290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87299_3,"ANTIBODY DETECTION, NOS, IF",ProFee,0989,87299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87300_3,"AG DETECTION, POLYVAL, IF",ProFee,0989,87300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87301_3,"ADENOVIRUS AG, EIA",ProFee,0989,87301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87305_3,"ASPERGILLUS AG, EIA",ProFee,0989,87305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87320_3,"CHYLMD TRACH AG, EIA",ProFee,0989,87320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87324_3,"CLOSTRIDIUM AG, EIA",ProFee,0989,87324,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87327_3,"CRYPTOCOCCUS NEOFORM AG, EIA",ProFee,0989,87327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87328_3,"CRYPTOSPORIDIUM AG, EIA",ProFee,0989,87328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87329_3,"GIARDIA AG, EIA",ProFee,0989,87329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87332_3,"CYTOMEGALOVIRUS AG, EIA",ProFee,0989,87332,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87335_3,"E COLI 0157 AG, EIA",ProFee,0989,87335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87336_3,"ENTAMOEB HIST DISPR, AG, EIA",ProFee,0989,87336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87337_3,"ENTAMOEB HIST GROUP, AG, EIA",ProFee,0989,87337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87338_3,"HPYLORI, STOOL, EIA",ProFee,0989,87338,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87339_3,"H PYLORI AG, EIA",ProFee,0989,87339,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87340_3,"HEPATITIS B SURFACE AG, EIA",ProFee,0989,87340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87341_3,"HEPATITIS B SURFACE, AG, EIA",ProFee,0989,87341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87350_3,"HEPATITIS BE AG, EIA",ProFee,0989,87350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87380_3,"HEPATITIS DELTA AG, EIA",ProFee,0989,87380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87385_3,"HISTOPLASMA CAPSUL AG, EIA",ProFee,0989,87385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87389_3,HIV-1 AG W/HIV-1 & HIV-2 AB,ProFee,0989,87389,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87390_3,"HIV-1 AG, EIA",ProFee,0989,87390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87391_3,"HIV-2 AG, EIA",ProFee,0989,87391,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87400_3,"INFLUENZA A/B, AG, EIA",ProFee,0989,87400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87420_3,"RESP SYNCYTIAL AG, EIA",ProFee,0989,87420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87425_3,"ROTAVIRUS AG, EIA",ProFee,0989,87425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87427_3,"SHIGA-LIKE TOXIN AG, EIA",ProFee,0989,87427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87430_3,"STREP A AG, EIA",ProFee,0989,87430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87449_3,"AG DETECT NOS, EIA, MULT",ProFee,0989,87449,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87450_3,"AG DETECT NOS, EIA, SINGLE",ProFee,0989,87450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87451_3,"AG DETECT POLYVAL, EIA, MULT",ProFee,0989,87451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87470_3,"BARTONELLA, DNA, DIR PROBE",ProFee,0989,87470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87471_3,"BARTONELLA, DNA, AMP PROBE",ProFee,0989,87471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87472_3,"BARTONELLA, DNA, QUANT",ProFee,0989,87472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87475_3,"LYME DIS, DNA, DIR PROBE",ProFee,0989,87475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87476_3,"LYME DIS, DNA, AMP PROBE",ProFee,0989,87476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87477_3,"LYME DIS, DNA, QUANT",ProFee,0989,87477,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87480_3,"CANDIDA, DNA, DIR PROBE",ProFee,0989,87480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87481_3,"CANDIDA, DNA, AMP PROBE",ProFee,0989,87481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87482_3,"CANDIDA, DNA, QUANT",ProFee,0989,87482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87483_3,CNS DNA AMP PROBE TYPE 12-25,ProFee,0989,87483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87485_3,"CHYLMD PNEUM, DNA, DIR PROBE",ProFee,0989,87485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87486_3,"CHYLMD PNEUM, DNA, AMP PROBE",ProFee,0989,87486,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87487_3,"CHYLMD PNEUM, DNA, QUANT",ProFee,0989,87487,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87490_3,"CHYLMD TRACH, DNA, DIR PROBE",ProFee,0989,87490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87491_3,"CHYLMD TRACH, DNA, AMP PROBE",ProFee,0989,87491,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87492_3,"CHYLMD TRACH, DNA, QUANT",ProFee,0989,87492,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87493_3,C DIFF AMPLIFIED PROBE,ProFee,0989,87493,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87495_3,"CYTOMEG, DNA, DIR PROBE",ProFee,0989,87495,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87496_3,"CYTOMEG, DNA, AMP PROBE",ProFee,0989,87496,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87497_3,"CYTOMEG, DNA, QUANT",ProFee,0989,87497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87498_3,"ENTEROVIRUS, DNA, AMP PROBE",ProFee,0989,87498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87500_3,"VANOMYCIN, DNA, AMP PROBE",ProFee,0989,87500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87501_3,INFLUENZA DNA AMP PROB 1+,ProFee,0989,87501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87502_3,INFLUENZA DNA AMP PROBE,ProFee,0989,87502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87503_3,INFLUENZA DNA AMP PROB ADDL,ProFee,0989,87503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87505_3,NFCT AGENT DETECTION GI,ProFee,0989,87505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87506_3,IADNA-DNA/RNA PROBE TQ 6-11,ProFee,0989,87506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87507_3,IADNA-DNA/RNA PROBE TQ 12-25,ProFee,0989,87507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87510_3,"GARDNER VAG, DNA, DIR PROBE",ProFee,0989,87510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87511_3,"GARDNER VAG, DNA, AMP PROBE",ProFee,0989,87511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87512_3,"GARDNER VAG, DNA, QUANT",ProFee,0989,87512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87515_3,"HEPATITIS B, DNA, DIR PROBE",ProFee,0989,87515,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87516_3,"HEPATITIS B, DNA, AMP PROBE",ProFee,0989,87516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87517_3,"HEPATITIS B, DNA, QUANT",ProFee,0989,87517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87520_3,"HEPATITIS C, RNA, DIR PROBE",ProFee,0989,87520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87521_3,"HEPATITIS C, RNA, AMP PROBE",ProFee,0989,87521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87522_3,"HEPATITIS C, RNA, QUANT",ProFee,0989,87522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87525_3,"HEPATITIS G, DNA, DIR PROBE",ProFee,0989,87525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87526_3,"HEPATITIS G, DNA, AMP PROBE",ProFee,0989,87526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87527_3,"HEPATITIS G, DNA, QUANT",ProFee,0989,87527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87528_3,"HSV, DNA, DIR PROBE",ProFee,0989,87528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87529_3,"HSV, DNA, AMP PROBE",ProFee,0989,87529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87530_3,"HSV, DNA, QUANT",ProFee,0989,87530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87531_3,"HHV-6, DNA, DIR PROBE",ProFee,0989,87531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87532_3,"HHV-6, DNA, AMP PROBE",ProFee,0989,87532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87533_3,"HHV-6, DNA, QUANT",ProFee,0989,87533,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87534_3,"HIV-1, DNA, DIR PROBE",ProFee,0989,87534,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87535_3,"HIV-1, DNA, AMP PROBE",ProFee,0989,87535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87536_3,"HIV-1, DNA, QUANT",ProFee,0989,87536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87537_3,"HIV-2, DNA, DIR PROBE",ProFee,0989,87537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87538_3,"HIV-2, DNA, AMP PROBE",ProFee,0989,87538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87539_3,"HIV-2, DNA, QUANT",ProFee,0989,87539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87540_3,"LEGION PNEUMO, DNA, DIR PROB",ProFee,0989,87540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87541_3,"LEGION PNEUMO, DNA, AMP PROB",ProFee,0989,87541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87542_3,"LEGION PNEUMO, DNA, QUANT",ProFee,0989,87542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87550_3,"MYCOBACTERIA, DNA, DIR PROBE",ProFee,0989,87550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87551_3,"MYCOBACTERIA, DNA, AMP PROBE",ProFee,0989,87551,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87552_3,"MYCOBACTERIA, DNA, QUANT",ProFee,0989,87552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87555_3,"M.TUBERCULO, DNA, DIR PROBE",ProFee,0989,87555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87556_3,"M.TUBERCULO, DNA, AMP PROBE",ProFee,0989,87556,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87557_3,"M.TUBERCULO, DNA, QUANT",ProFee,0989,87557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87560_3,"M.AVIUM-INTRA, DNA, DIR PROB",ProFee,0989,87560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87561_3,"M.AVIUM-INTRA, DNA, AMP PROB",ProFee,0989,87561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87562_3,"M.AVIUM-INTRA, DNA, QUANT",ProFee,0989,87562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87563_3,M. GENITALIUM AMP PROBE,ProFee,0989,87563,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87580_3,"M.PNEUMON, DNA, DIR PROBE",ProFee,0989,87580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87581_3,"M.PNEUMON, DNA, AMP PROBE",ProFee,0989,87581,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87582_3,"M.PNEUMON, DNA, QUANT",ProFee,0989,87582,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87590_3,"N.GONORRHOEAE, DNA, DIR PROB",ProFee,0989,87590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87591_3,"N.GONORRHOEAE, DNA, AMP PROB",ProFee,0989,87591,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87592_3,"N.GONORRHOEAE, DNA, QUANT",ProFee,0989,87592,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87620_3,"HPV, DNA, DIR PROBE",ProFee,0989,87620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87621_3,"HPV, DNA, AMP PROBE",ProFee,0989,87621,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87622_3,"HPV, DNA, QUANT",ProFee,0989,87622,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
87623_3,HPV LOW-RISK TYPES,ProFee,0989,87623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87624_3,HPV HIGH-RISK TYPES,ProFee,0989,87624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87625_3,HPV TYPES 16 & 18 ONLY,ProFee,0989,87625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87631_3,RESP VIRUS 3-5 TARGETS,ProFee,0989,87631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87632_3,RESP VIRUS 6-11 TARGETS,ProFee,0989,87632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87633_3,RESP VIRUS 12-25 TARGETS,ProFee,0989,87633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87634_3,RSV DNA/RNA AMP PROBE,ProFee,0989,87634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87640_3,"STAPH A, DNA, AMP PROBE",ProFee,0989,87640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87641_3,"MR-STAPH, DNA, AMP PROBE",ProFee,0989,87641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87650_3,"STREP A, DNA, DIR PROBE",ProFee,0989,87650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87651_3,"STREP A, DNA, AMP PROBE",ProFee,0989,87651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87652_3,"STREP A, DNA, QUANT",ProFee,0989,87652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87653_3,"STREP B, DNA, AMP PROBE",ProFee,0989,87653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87660_3,"TRICHOMONAS VAGIN, DIR PROBE",ProFee,0989,87660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87661_3,TRICHOMONAS VAGINALIS AMPLIF,ProFee,0989,87661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87662_3,ZIKA VIRUS DNA/RNA AMP PROBE,ProFee,0989,87662,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87797_3,"DETECT AGENT NOS, DNA, DIR",ProFee,0989,87797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87798_3,"DETECT AGENT NOS, DNA, AMP",ProFee,0989,87798,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87799_3,"DETECT AGENT NOS, DNA, QUANT",ProFee,0989,87799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87800_3,"DETECT AGNT MULT, DNA, DIREC",ProFee,0989,87800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87801_3,"DETECT AGNT MULT, DNA, AMPLI",ProFee,0989,87801,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87802_3,STREP B ASSAY W/OPTIC,ProFee,0989,87802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87803_3,CLOSTRIDIUM TOXIN A W/OPTIC,ProFee,0989,87803,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87804_3,INFLUENZA ASSAY W/OPTIC,ProFee,0989,87804,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87806_3,HIV ANTIGEN W/HIV ANTIBODIES,ProFee,0989,87806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87807_3,RSV ASSAY W/OPTIC,ProFee,0989,87807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87808_3,TRICHOMONAS ASSAY W/OPTIC,ProFee,0989,87808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87809_3,ADENOVIRUS ASSAY W/OPTIC,ProFee,0989,87809,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87810_3,CHYLMD TRACH ASSAY W/OPTIC,ProFee,0989,87810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87850_3,N. GONORRHOEAE ASSAY W/OPTIC,ProFee,0989,87850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87880_3,STREP A ASSAY W/OPTIC,ProFee,0989,87880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87899_3,AGENT NOS ASSAY W/OPTIC,ProFee,0989,87899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87900_3,"PHENOTYPE, INFECT AGENT DRUG",ProFee,0989,87900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87901_3,"GENOTYPE, DNA, HIV REVERSE T",ProFee,0989,87901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87902_3,"GENOTYPE, DNA, HEPATITIS C",ProFee,0989,87902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87903_3,"PHENOTYPE, DNA HIV W/CULTURE",ProFee,0989,87903,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87904_3,"PHENOTYPE, DNA HIV W/CLT ADD",ProFee,0989,87904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87905_3,SIALIDASE ENZYME ASSAY,ProFee,0989,87905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87906_3,GENOTYPE DNA HIV REVERSE T,ProFee,0989,87906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87910_3,GENOTYPE CYTOMEGALOVIRUS,ProFee,0989,87910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87912_3,GENOTYPE DNA HEPATITIS B,ProFee,0989,87912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
87999_3,MICROBIOLOGY PROCEDURE,ProFee,0989,87999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88000_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88000,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
88005_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88005,,,,0,3.00,2.25,2.25,361.00,0.00,361.00,361.00,N/A
88007_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88007,,,,0,3.00,2.25,2.25,378.50,0.00,378.50,378.50,N/A
88012_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88012,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
88014_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88014,,,,0,3.00,2.25,2.25,284.00,0.00,284.00,284.00,N/A
88016_3,"AUTOPSY (NECROPSY), GROSS",ProFee,0989,88016,,,,0,3.00,2.25,2.25,395.50,0.00,395.50,395.50,N/A
88020_3,"AUTOPSY (NECROPSY), COMPLETE",ProFee,0989,88020,,,,0,3.00,2.25,2.25,533.00,0.00,533.00,533.00,N/A
88025_3,"AUTOPSY (NECROPSY), COMPLETE",ProFee,0989,88025,,,,0,3.00,2.25,2.25,516.00,0.00,516.00,516.00,N/A
88027_3,"AUTOPSY (NECROPSY), COMPLETE",ProFee,0989,88027,,,,0,3.00,2.25,2.25,550.50,0.00,550.50,550.50,N/A
88028_3,"AUTOPSY (NECROPSY), COMPLETE",ProFee,0989,88028,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
88029_3,"AUTOPSY (NECROPSY), COMPLETE",ProFee,0989,88029,,,,0,3.00,2.25,2.25,309.50,0.00,309.50,309.50,N/A
88036_3,LIMITED AUTOPSY,ProFee,0989,88036,,,,0,3.00,2.25,2.25,155.00,0.00,155.00,155.00,N/A
88037_3,LIMITED AUTOPSY,ProFee,0989,88037,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
88040_3,FORENSIC AUTOPSY (NECROPSY),ProFee,0989,88040,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
88045_3,CORONER'S AUTOPSY (NECROPSY),ProFee,0989,88045,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
88099_3,NECROPSY (AUTOPSY) PROCEDURE,ProFee,0989,88099,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88104_3,"CYTOPATHOLOGY, FLUIDS",ProFee,0989,88104,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
88106_3,"CYTOPATHOLOGY, FLUIDS",ProFee,0989,88106,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
88107_3,"CYTOPATHOLOGY, FLUIDS",ProFee,0989,88107,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88108_3,"CYTOPATH, CONCENTRATE TECH",ProFee,0989,88108,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
88112_3,"CYTOPATH, CELL ENHANCE TECH",ProFee,0989,88112,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
88120_3,CYTP URNE 3-5 PROBES EA SPEC,ProFee,0989,88120,,,,0,3.00,2.25,2.25,84.50,0.00,84.50,84.50,N/A
88121_3,CYTP URINE 3-5 PROBES CMPTR,ProFee,0989,88121,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
88125_3,FORENSIC CYTOPATHOLOGY,ProFee,0989,88125,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
88130_3,SEX CHROMATIN IDENTIFICATION,ProFee,0989,88130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88140_3,SEX CHROMATIN IDENTIFICATION,ProFee,0989,88140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88141_3,"CYTOPATH, C/V, INTERPRET",ProFee,0989,88141,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
88142_2,"CYTOPATH, C/V, THIN LAYER",ProFee,0989,88142,,,,0,39.00,29.25,29.25,29.25,0.00,N/A,N/A,N/A
88142_3,"CYTOPATH, C/V, THIN LAYER",ProFee,0989,88142,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88143_3,CYTOPATH C/V THIN LAYER REDO,ProFee,0989,88143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88147_3,"CYTOPATH, C/V, AUTOMATED",ProFee,0989,88147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88148_3,"CYTOPATH, C/V, AUTO RESCREEN",ProFee,0989,88148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88150_3,"CYTOPATH, C/V, MANUAL",ProFee,0989,88150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88152_3,"CYTOPATH, C/V, AUTO REDO",ProFee,0989,88152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88153_3,"CYTOPATH, C/V, REDO",ProFee,0989,88153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88154_3,"CYTOPATH, C/V, SELECT",ProFee,0989,88154,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88155_3,"CYTOPATH, C/V, INDEX ADD-ON",ProFee,0989,88155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88160_3,"CYTOPATH SMEAR, OTHER SOURCE",ProFee,0989,88160,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
88161_3,"CYTOPATH SMEAR, OTHER SOURCE",ProFee,0989,88161,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
88162_3,"CYTOPATH SMEAR, OTHER SOURCE",ProFee,0989,88162,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
88164_3,"CYTOPATH TBS, C/V, MANUAL",ProFee,0989,88164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88165_3,"CYTOPATH TBS, C/V, REDO",ProFee,0989,88165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88166_3,"CYTOPATH TBS, C/V, AUTO REDO",ProFee,0989,88166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88167_3,"CYTOPATH TBS, C/V, SELECT",ProFee,0989,88167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88172_3,CYTOPATHOLOGY EVAL OF FNA,ProFee,0989,88172,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
88173_3,"CYTOPATH EVAL, FNA, REPORT",ProFee,0989,88173,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
88174_3,"CYTOPATH, C/V AUTO, IN FLUID",ProFee,0989,88174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88175_3,CYTOPATH C/V AUTO FLUID REDO,ProFee,0989,88175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88177_3,CYTP C/V AUTO THIN LYR ADDL,ProFee,0989,88177,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
88182_3,CELL MARKER STUDY,ProFee,0989,88182,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
88184_3,"FLOWCYTOMETRY/ TC, 1 MARKER",ProFee,0989,88184,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
88185_3,"FLOWCYTOMETRY/TC, ADD-ON",ProFee,0989,88185,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
88187_3,"FLOWCYTOMETRY/READ, 2-8",ProFee,0989,88187,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
88188_3,"FLOWCYTOMETRY/READ, 9-15",ProFee,0989,88188,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
88189_3,"FLOWCYTOMETRY/READ, 16 & >",ProFee,0989,88189,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
88199_3,CYTOPATHOLOGY PROCEDURE,ProFee,0989,88199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88230_3,"TISSUE CULTURE, LYMPHOCYTE",ProFee,0989,88230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88233_3,"TISSUE CULTURE, SKIN/BIOPSY",ProFee,0989,88233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88235_3,"TISSUE CULTURE, PLACENTA",ProFee,0989,88235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88237_3,"TISSUE CULTURE, BONE MARROW",ProFee,0989,88237,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88239_3,"TISSUE CULTURE, TUMOR",ProFee,0989,88239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88240_3,CELL CRYOPRESERVE/STORAGE,ProFee,0989,88240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88241_3,FROZEN CELL PREPARATION,ProFee,0989,88241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88245_3,"CHROMOSOME ANALYSIS, 20-25",ProFee,0989,88245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88248_3,"CHROMOSOME ANALYSIS, 50-100",ProFee,0989,88248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88249_3,"CHROMOSOME ANALYSIS, 100",ProFee,0989,88249,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88261_3,"CHROMOSOME ANALYSIS, 5",ProFee,0989,88261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88262_3,"CHROMOSOME ANALYSIS, 15-20",ProFee,0989,88262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88263_3,"CHROMOSOME ANALYSIS, 45",ProFee,0989,88263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88264_3,"CHROMOSOME ANALYSIS, 20-25",ProFee,0989,88264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88267_3,"CHROMOSOME ANALYS, PLACENTA",ProFee,0989,88267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88269_3,"CHROMOSOME ANALYS, AMNIOTIC",ProFee,0989,88269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88271_3,"CYTOGENETICS, DNA PROBE",ProFee,0989,88271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88272_3,"CYTOGENETICS, 3-5",ProFee,0989,88272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88273_3,"CYTOGENETICS, 10-30",ProFee,0989,88273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88274_3,"CYTOGENETICS, 25-99",ProFee,0989,88274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88275_3,"CYTOGENETICS, 100-300",ProFee,0989,88275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88280_3,CHROMOSOME KARYOTYPE STUDY,ProFee,0989,88280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88283_3,CHROMOSOME BANDING STUDY,ProFee,0989,88283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88285_3,"CHROMOSOME COUNT, ADDITIONAL",ProFee,0989,88285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88289_3,"CHROMOSOME STUDY, ADDITIONAL",ProFee,0989,88289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88291_3,CYTO/MOLECULAR REPORT,ProFee,0989,88291,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
88299_3,CYTOGENETIC STUDY,ProFee,0989,88299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88300_3,"SURGICAL PATH, GROSS",ProFee,0989,88300,,,,0,3.00,2.25,2.25,6.50,0.00,6.50,6.50,N/A
88302_3,TISSUE EXAM BY PATHOLOGIST,ProFee,0989,88302,,,,0,3.00,2.25,2.25,10.50,0.00,10.50,10.50,N/A
88304_3,TISSUE EXAM BY PATHOLOGIST,ProFee,0989,88304,,,,0,3.00,2.25,2.25,17.00,0.00,17.00,17.00,N/A
88305_3,TISSUE EXAM BY PATHOLOGIST,ProFee,0989,88305,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
88307_3,TISSUE EXAM BY PATHOLOGIST,ProFee,0989,88307,,,,0,3.00,2.25,2.25,122.00,0.00,122.00,122.00,N/A
88309_3,TISSUE EXAM BY PATHOLOGIST,ProFee,0989,88309,,,,0,3.00,2.25,2.25,216.50,0.00,216.50,216.50,N/A
88311_3,DECALCIFY TISSUE,ProFee,0989,88311,,,,0,3.00,2.25,2.25,18.50,0.00,18.50,18.50,N/A
88312_3,SPECIAL STAINS,ProFee,0989,88312,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
88313_3,SPECIAL STAINS,ProFee,0989,88313,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
88314_3,HISTOCHEMICAL STAIN,ProFee,0989,88314,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
88318_3,CHEMICAL HISTOCHEMISTRY,ProFee,0989,88318,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88319_3,ENZYME HISTOCHEMISTRY,ProFee,0989,88319,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
88321_3,MICROSLIDE CONSULTATION,ProFee,0989,88321,,,,0,3.00,2.25,2.25,122.50,0.00,122.50,122.50,N/A
88323_3,MICROSLIDE CONSULTATION,ProFee,0989,88323,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
88325_3,COMPREHENSIVE REVIEW OF DATA,ProFee,0989,88325,,,,0,3.00,2.25,2.25,218.50,0.00,218.50,218.50,N/A
88329_3,PATH CONSULT INTROP,ProFee,0989,88329,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
88331_3,"PATH CONSULT INTRAOP, 1 BLOC",ProFee,0989,88331,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
88332_3,"PATH CONSULT INTRAOP, ADD'L",ProFee,0989,88332,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
88333_3,"INTRAOP CYTO PATH CONSULT, 1",ProFee,0989,88333,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
88334_3,"INTRAOP CYTO PATH CONSULT, 2",ProFee,0989,88334,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
88341_3,IMMUNOHISTO ANTB ADDL SLIDE,ProFee,0989,88341,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
88342_3,IMMUNOHISTOCHEMISTRY,ProFee,0989,88342,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
88344_3,IMMUNOHISTO ANTIBODY SLIDE,ProFee,0989,88344,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
88346_3,IMMUNOFLUORESCENT STUDY,ProFee,0989,88346,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
88347_3,IMMUNOFLUORESCENT STUDY,ProFee,0989,88347,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88348_3,ELECTRON MICROSCOPY,ProFee,0989,88348,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
88349_3,SCANNING ELECTRON MICROSCOPY,ProFee,0989,88349,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88350_3,IMMUNOFLUOR ANTB ADDL STAIN,ProFee,0989,88350,,,,0,3.00,2.25,2.25,42.00,0.00,42.00,42.00,N/A
88355_3,"ANALYSIS, SKELETAL MUSCLE",ProFee,0989,88355,,,,0,3.00,2.25,2.25,119.00,0.00,119.00,119.00,N/A
88356_3,"ANALYSIS, NERVE",ProFee,0989,88356,,,,0,3.00,2.25,2.25,180.00,0.00,180.00,180.00,N/A
88358_3,"ANALYSIS, TUMOR",ProFee,0989,88358,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
88360_3,TUMOR IMMUNOHISTOCHEM/MANUAL,ProFee,0989,88360,,,,0,3.00,2.25,2.25,65.00,0.00,65.00,65.00,N/A
88361_3,TUMOR IMMUNOHISTOCHEM/COMPUT,ProFee,0989,88361,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
88362_3,NERVE TEASING PREPARATIONS,ProFee,0989,88362,,,,0,3.00,2.25,2.25,161.00,0.00,161.00,161.00,N/A
88363_3,XM ARCHIVE TISSUE MOLEC ANAL,ProFee,0989,88363,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
88364_3,INSITU HYBRIDIZATION (FISH),ProFee,0989,88364,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
88365_3,INSITU HYBRIDIZATION (FISH),ProFee,0989,88365,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
88366_3,INSITU HYBRIDIZATION (FISH),ProFee,0989,88366,,,,0,3.00,2.25,2.25,91.00,0.00,91.00,91.00,N/A
88367_3,"INSITU HYBRIDIZATION, AUTO",ProFee,0989,88367,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
88368_3,"INSITU HYBRIDIZATION, MANUAL",ProFee,0989,88368,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
88369_3,M/PHMTRC ALYSISHQUANT/SEMIQ,ProFee,0989,88369,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
88371_3,"PROTEIN, WESTERN BLOT TISSUE",ProFee,0989,88371,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
88372_3,PROTEIN ANALYSIS W/PROBE,ProFee,0989,88372,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
88373_3,M/PHMTRC ALYS ISHQUANT/SEMIQ,ProFee,0989,88373,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
88374_3,M/PHMTRC ALYS ISHQUANT/SEMIQ,ProFee,0989,88374,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
88375_3,OPTICAL ENDOMICROSCPY INTERP,ProFee,0989,88375,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
88377_3,M/PHMTRC ALYS ISHQUANT/SEMIQ,ProFee,0989,88377,,,,0,3.00,2.25,2.25,93.00,0.00,93.00,93.00,N/A
88380_3,MICRODISSECTION,ProFee,0989,88380,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
88381_3,"MICRODISSECTION, MANUAL",ProFee,0989,88381,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
88384_3,"EVAL MOLECULAR PROBES, 11-50",ProFee,0989,88384,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88385_3,"EVAL  MOLECUL PROBES, 51-250",ProFee,0989,88385,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88386_3,"EVAL MOLECUL PROBES, 251-500",ProFee,0989,88386,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88387_3,TISS EXAM MOLECULAR STUDY,ProFee,0989,88387,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
88388_3,TISS EX MOLECUL STUDY ADD-ON,ProFee,0989,88388,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
88399_3,SURGICAL PATHOLOGY PROCEDURE,ProFee,0989,88399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88400_3,BILIRUBIN TOTAL TRANSCUT,ProFee,0989,88400,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
88720_3,BILIRUBIN TOTAL TRANSCUT,ProFee,0989,88720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88738_3,HGB QUANT TRANSCUTANEOUS,ProFee,0989,88738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88740_3,TRANSCUTANEOUS CARBOXYHB,ProFee,0989,88740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88741_3,TRANSCUTANEOUS METHB,ProFee,0989,88741,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
88749_3,IN VIVO LAB SERVICE,ProFee,0989,88749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89049_3,CHCT FOR MAL HYPERTHERMIA,ProFee,0989,89049,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
89050_3,BODY FLUID CELL COUNT,ProFee,0989,89050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89051_3,BODY FLUID CELL COUNT,ProFee,0989,89051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89055_3,"LEUKOCYTE ASSESSMENT, FECAL",ProFee,0989,89055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89060_3,"EXAM,SYNOVIAL FLUID CRYSTALS",ProFee,0989,89060,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
89100_3,SAMPLE INTESTINAL CONTENTS,ProFee,0989,89100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89105_3,SAMPLE INTESTINAL CONTENTS,ProFee,0989,89105,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89125_3,SPECIMEN FAT STAIN,ProFee,0989,89125,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89130_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89132_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89132,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89135_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89136_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89136,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89140_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89141_3,SAMPLE STOMACH CONTENTS,ProFee,0989,89141,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89160_3,EXAM FECES FOR MEAT FIBERS,ProFee,0989,89160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89190_3,NASAL SMEAR FOR EOSINOPHILS,ProFee,0989,89190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89220_3,SPUTUM SPECIMEN COLLECTION,ProFee,0989,89220,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
89225_3,"STARCH GRANULES, FECES",ProFee,0989,89225,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89230_3,COLLECT SWEAT FOR TEST,ProFee,0989,89230,,,,0,3.00,2.25,2.25,5.00,0.00,5.00,5.00,N/A
89235_3,WATER LOAD TEST,ProFee,0989,89235,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
89240_3,PATHOLOGY LAB PROCEDURE,ProFee,0989,89240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89250_3,CULTR OOCYTE/EMBRYO <4 DAYS,ProFee,0989,89250,,,,0,3.00,2.25,2.25,1332.50,0.00,1332.50,1332.50,N/A
89251_3,CULTR OOCYTE/EMBRYO <4 DAYS,ProFee,0989,89251,,,,0,3.00,2.25,2.25,1386.00,0.00,1386.00,1386.00,N/A
89253_3,EMBRYO HATCHING,ProFee,0989,89253,,,,0,3.00,2.25,2.25,488.05,0.00,488.05,488.05,N/A
89254_3,OOCYTE IDENTIFICATION,ProFee,0989,89254,,,,0,3.00,2.25,2.25,857.86,0.00,857.86,857.86,N/A
89255_3,PREPARE EMBRYO FOR TRANSFER,ProFee,0989,89255,,,,0,3.00,2.25,2.25,483.70,0.00,483.70,483.70,N/A
89257_3,SPERM IDENTIFICATION,ProFee,0989,89257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89258_3,CRYOPRESERVATION; EMBRYO(S),ProFee,0989,89258,,,,0,3.00,2.25,2.25,670.57,0.00,670.57,670.57,N/A
89259_3,"CRYOPRESERVATION, SPERM",ProFee,0989,89259,,,,0,3.00,2.25,2.25,60.00,0.00,60.00,60.00,N/A
89260_3,"SPERM ISOLATION, SIMPLE",ProFee,0989,89260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89261_3,"SPERM ISOLATION, COMPLEX",ProFee,0989,89261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89264_3,IDENTIFY SPERM TISSUE,ProFee,0989,89264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89268_3,INSEMINATION OF OOCYTES,ProFee,0989,89268,,,,0,3.00,2.25,2.25,200.00,0.00,200.00,200.00,N/A
89272_3,EXTENDED CULTURE OF OOCYTES,ProFee,0989,89272,,,,0,3.00,2.25,2.25,400.00,0.00,400.00,400.00,N/A
89280_3,ASSIST OOCYTE FERTILIZATION,ProFee,0989,89280,,,,0,3.00,2.25,2.25,1100.00,0.00,1100.00,1100.00,N/A
89281_3,ASSIST OOCYTE FERTILIZATION,ProFee,0989,89281,,,,0,3.00,2.25,2.25,1200.00,0.00,1200.00,1200.00,N/A
89290_3,"BIOPSY, OOCYTE POLAR BODY",ProFee,0989,89290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89291_3,"BIOPSY, OOCYTE POLAR BODY",ProFee,0989,89291,,,,0,3.00,2.25,2.25,1560.00,0.00,1560.00,1560.00,N/A
89300_3,SEMEN ANALYSIS W/HUHNER,ProFee,0989,89300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89310_3,SEMEN ANALYSIS W/COUNT,ProFee,0989,89310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89320_3,"SEMEN ANALYSIS, COMPLETE",ProFee,0989,89320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89321_3,SEMEN ANALYSIS & MOTILITY,ProFee,0989,89321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89322_3,"SEMEN ANAL, STRICT CRITERIA",ProFee,0989,89322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89325_3,SPERM ANTIBODY TEST,ProFee,0989,89325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89329_3,SPERM EVALUATION TEST,ProFee,0989,89329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89330_3,"EVALUATION, CERVICAL MUCUS",ProFee,0989,89330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89331_3,RETROGRADE EJACULATION ANAL,ProFee,0989,89331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89335_3,CRYOPRESERVE TESTICULAR TISS,ProFee,0989,89335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89337_3,CRYOPRESERVATION OOCYTE(S),ProFee,0989,89337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89342_3,STORAGE/YEAR; EMBRYO(S),ProFee,0989,89342,,,,0,3.00,2.25,2.25,471.60,0.00,471.60,471.60,N/A
89343_3,STORAGE/YEAR; SPERM/SEMEN,ProFee,0989,89343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89344_3,STORAGE/YEAR; REPROD TISSUE,ProFee,0989,89344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89346_3,STORAGE/YEAR; OOCYTE(S),ProFee,0989,89346,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89352_3,THAWING CRYOPRESRVED; EMBRYO,ProFee,0989,89352,,,,0,3.00,2.25,2.25,347.50,0.00,347.50,347.50,N/A
89353_3,THAWING CRYOPRESRVED; SPERM,ProFee,0989,89353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89354_3,THAW CRYOPRSVRD; REPROD TISS,ProFee,0989,89354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89356_3,THAWING CRYOPRESRVED; OOCYTE,ProFee,0989,89356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
89398_3,UNLISTED REPROD MED LAB PROC,ProFee,0989,89398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9001F_3,AORTIC ANEURYSM<5CM DIAM CT,ProFee,0989,9001F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9002F_3,AORTIC ANEURYSM 5-5.4CM DIAM,ProFee,0989,9002F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9003F_3,AORTIC ANRYSM5.5-5.9CM DIAM,ProFee,0989,9003F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9004F_3,AORTIC ANRYSM 6/> CM DIAM,ProFee,0989,9004F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9005F_3,ASYMPT CAROT/VRTBRBAS STEN,ProFee,0989,9005F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9006F_3,SYMPT STEN-TIA/STRK<120DAYS,ProFee,0989,9006F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
9007F_3,OTHER CAROT STEN 120 DAYS/>,ProFee,0989,9007F,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90283_3,"HUMAN IG, IV",ProFee,0989,90283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90284_3,"HUMAN IG, SC",ProFee,0989,90284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90287_3,BOTULINUM ANTITOXIN,ProFee,0989,90287,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90288_3,"BOTULISM IG, IV",ProFee,0989,90288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90291_3,"CMV IG, IV",ProFee,0989,90291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90296_3,DIPHTHERIA ANTITOXIN,ProFee,0989,90296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90371_3,"HEP B IG, IM",ProFee,0989,90371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90375_3,"RABIES IG, IM/SC",ProFee,0989,90375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90376_3,"RABIES IG, HEAT TREATED",ProFee,0989,90376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90378_3,"RSV IG, IM, 50MG",ProFee,0989,90378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90379_3,"RSV IG, IV",ProFee,0989,90379,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90384_3,"RH IG, FULL-DOSE, IM",ProFee,0989,90384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90385_3,"RH IG, MINIDOSE, IM",ProFee,0989,90385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90386_3,"RH IG, IV",ProFee,0989,90386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90389_3,"TETANUS IG, IM",ProFee,0989,90389,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90393_3,"VACCINA IG, IM",ProFee,0989,90393,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90396_3,"VARICELLA-ZOSTER IG, IM",ProFee,0989,90396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90399_3,IMMUNE GLOBULIN,ProFee,0989,90399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90460_2,IMADM ANY ROUTE 1ST VAC/TOX,Inpatient,0771,90460,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90460_2,IMADM ANY ROUTE 1ST VAC/TOX,Outpatient,0771,90460,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90460_3,IMADM ANY ROUTE 1ST VAC/TOX,Outpatient,0771,90460,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90460_3,IMADM ANY ROUTE 1ST VAC/TOX,Inpatient,0771,90460,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90461_2,INADM ANY ROUTE ADDL VAC/TOX,Outpatient,0771,90461,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
90461_2,INADM ANY ROUTE ADDL VAC/TOX,Inpatient,0771,90461,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
90461_3,INADM ANY ROUTE ADDL VAC/TOX,Inpatient,0771,90461,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
90461_3,INADM ANY ROUTE ADDL VAC/TOX,Outpatient,0771,90461,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
90465_3,"IMMUNE ADMIN 1 INJ, < 8 YRS",ProFee,0989,90465,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90466_3,"IMMUNE ADMIN ADDL INJ, < 8 Y",ProFee,0989,90466,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90467_3,"IMMUNE ADMIN O OR N, < 8 YRS",ProFee,0989,90467,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90468_3,"IMMUNE ADMIN O/N, ADDL < 8 Y",ProFee,0989,90468,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90470_3,IMMUNE ADMIN H1N1 IM/NASAL,ProFee,0989,90470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90471_2,IMMUNIZATION ADMIN,Outpatient,0771,90471,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90471_2,IMMUNIZATION ADMIN,Inpatient,0771,90471,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90471_3,IMMUNIZATION ADMIN,Outpatient,0771,90471,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90471_3,IMMUNIZATION ADMIN,Inpatient,0771,90471,,,,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90472_2,"IMMUNIZATION ADMIN, EACH ADD",Outpatient,0771,90472,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
90472_2,"IMMUNIZATION ADMIN, EACH ADD",Inpatient,0771,90472,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
90472_3,"IMMUNIZATION ADMIN, EACH ADD",Inpatient,0771,90472,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
90472_3,"IMMUNIZATION ADMIN, EACH ADD",Outpatient,0771,90472,,,,0,19.00,14.25,14.25,18.05,17.10,18.05,18.05,17.10
90473_3,IMMUNE ADMIN ORAL/NASAL,ProFee,0989,90473,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
90474_3,IMMUNE ADMIN ORAL/NASAL ADDL,ProFee,0989,90474,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
90476_2,"ADENOVIRUS VACCINE, TYPE 4",ProFee,0989,90476,,,,0,55.00,41.25,41.25,41.25,0.00,N/A,N/A,N/A
90476_3,"ADENOVIRUS VACCINE, TYPE 4",ProFee,0989,90476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90477_3,"ADENOVIRUS VACCINE, TYPE 7",ProFee,0989,90477,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90581_3,"ANTHRAX VACCINE, SC",ProFee,0989,90581,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90585_3,"BCG VACCINE, PERCUT",ProFee,0989,90585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90586_3,"BCG VACCINE, INTRAVESICAL",ProFee,0989,90586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90587_3,DENGUE VACC QUAD 3 DOSE SUBQ,ProFee,0989,90587,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90619_3,MENACWY-TT VACCINE IM,ProFee,0989,90619,,,49281-0589-58,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90620_3,MENB-4C VACC 2 DOSE IM,ProFee,0989,90620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90621_3,MENB-FHBP VACC 2/3 DOSE IM,ProFee,0989,90621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90625_3,CHOLERA VACCINE LIVE ORAL,ProFee,0989,90625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90630_3,FLU VACC IIV4 NO PRESERV ID,ProFee,0989,90630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90632_1,"HEP A VACCINE, ADULT IM",Inpatient,0636,90632,,,00064-8410-10,1,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
90632_1,"HEP A VACCINE, ADULT IM",Outpatient,0636,90632,,,00064-8410-10,1,104.00,78.00,78.00,98.80,93.60,98.80,98.80,93.60
90632VFC_3,"HEP A VACCINE, ADULT IM",Outpatient,0521,90632,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90632VFC_3,"HEP A VACCINE, ADULT IM",Inpatient,0521,90632,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90633_1,"Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscu",Inpatient,0636,90633,,,00064-0950-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90633_1,"Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscu",Outpatient,0636,90633,,,00064-0950-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90633_2,"HEP A VACC, PED/ADOL, 2 DOSE",Inpatient,0771,90633,,,00064-0950-10,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90633_2,"HEP A VACC, PED/ADOL, 2 DOSE",Outpatient,0771,90633,,,00064-0950-10,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90633_3,"HEP A VACC, PED/ADOL, 2 DOSE",Inpatient,0771,90633,,,00064-0950-10,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90633_3,"HEP A VACC, PED/ADOL, 2 DOSE",Outpatient,0771,90633,,,00064-0950-10,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90633VFC_3,"HEP A VACC, PED/ADOL, 2 DOSE",Outpatient,0771,90633,,,00064-0950-10,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90633VFC_3,"HEP A VACC, PED/ADOL, 2 DOSE",Inpatient,0771,90633,,,00064-0950-10,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90634_3,"HEP A VACC, PED/ADOL, 3 DOSE",ProFee,0989,90634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90636_3,"HEP A/HEP B VACC, ADULT IM",ProFee,0989,90636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90644_3,"HIB/MEN/TT VACCINE, IM",ProFee,0989,90644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90645_3,"HIB VACCINE, HBOC, IM",ProFee,0989,90645,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90646_3,"HIB VACCINE, PRP-D, IM",ProFee,0989,90646,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90647_3,"HIB VACCINE, PRP-OMP, IM",ProFee,0989,90647,,,00006-4897-01,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90647VFC_3,HIB VACCINE PRP-OMP IM VFC,ProFee,0989,90647,,,00006-4897-00,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90648_1,"HIB VACCINE, PRP-T, IM",Outpatient,0636,90648,,,00064-8970-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90648_1,"HIB VACCINE, PRP-T, IM",Inpatient,0636,90648,,,00064-8970-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90648_2,"HIB VACCINE, PRP-T, IM",Outpatient,0521,90648,,,00064-8970-10,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90648_2,"HIB VACCINE, PRP-T, IM",Inpatient,0521,90648,,,00064-8970-10,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90648_3,"HIB VACCINE, PRP-T, IM",Inpatient,0521,90648,,,00064-8970-10,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90648_3,"HIB VACCINE, PRP-T, IM",Outpatient,0521,90648,,,00064-8970-10,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90648VFC_3,"HIB VACCINE, PRP-T, IM",ProFee,0989,90648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90649_1,H Papilloma,Inpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_1,H Papilloma,Outpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_1{2},H PAPILLOMA VACC 3 DOSE IM,Outpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_1{2},H PAPILLOMA VACC 3 DOSE IM,Inpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_1{3},H PAPILLOMA VACC 3 DOSE IM,Outpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_1{3},H PAPILLOMA VACC 3 DOSE IM,Inpatient,0636,90649,,,07005-3544-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_2,H PAPILLOMA VACC 3 DOSE IM,Inpatient,0521,90649,,,07005-3544-00,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90649_2,H PAPILLOMA VACC 3 DOSE IM,Outpatient,0521,90649,,,07005-3544-00,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90649_3,H PAPILLOMA VACC 3 DOSE IM,Outpatient,0521,90649,,,07005-3544-00,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90649_3,H PAPILLOMA VACC 3 DOSE IM,Inpatient,0521,90649,,,07005-3544-00,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90649VFC_3,H PAPILLOMA VACC 3 DOSE IM,ProFee,0989,90649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90650_2,HPV TYP BIVAL 3 DOSE IM,Outpatient,0521,90650,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90650_2,HPV TYP BIVAL 3 DOSE IM,Inpatient,0521,90650,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90650_3,HPV TYP BIVAL 3 DOSE IM,Outpatient,0521,90650,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90650_3,HPV TYP BIVAL 3 DOSE IM,Inpatient,0521,90650,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90650VFC_3,HPV TYP BIVAL 3 DOSE IM,ProFee,0989,90650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90651_1,HPV9 IM,Inpatient,0636,90651,,,00006-4119-03,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90651_1,HPV9 IM,Outpatient,0636,90651,,,00006-4119-03,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90651_1{2},HPV9 IM,Inpatient,0636,90651,,,00006-4119-03,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90651_1{2},HPV9 IM,Outpatient,0636,90651,,,00006-4119-03,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90651_2,HPV9 IM,Outpatient,0521,90651,,,00006-4119-03,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90651_2,HPV9 IM,Inpatient,0521,90651,,,00006-4119-03,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90651_3,HPV9 IM,Inpatient,0521,90651,,,00006-4119-03,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90651_3,HPV9 IM,Outpatient,0521,90651,,,00006-4119-03,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90651VFC_3,HPV9 IM VFC,ProFee,0989,90651,,,00006-4121-02,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90653_3,IIV ADJUVANT VACCINE IM,ProFee,0989,90653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90654_3,"FLU VACCINE NO PRESERV, ID",ProFee,0989,90654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90655VFC_3,FLU VACCINE NO PRESERV6-35M,ProFee,0989,90655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90656_3,FLU VACCINE NO PRESERV 3 & >,ProFee,0989,90656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90657VFC_3,"FLU VACCINE, 3 YRS, IM",ProFee,0989,90657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90658_1,"FLU VACCINE, 3 YRS & >, IM",Outpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1,"FLU VACCINE, 3 YRS & >, IM",Inpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{2},"FLU VACCINE, 3 YRS & >, IM",Inpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{2},"FLU VACCINE, 3 YRS & >, IM",Outpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{3},"FLU VACCINE, 3 YRS & >, IM",Inpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{3},"FLU VACCINE, 3 YRS & >, IM",Outpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{4},"FLU VACCINE, 3 YRS & >, IM",Inpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{4},"FLU VACCINE, 3 YRS & >, IM",Outpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{5},"FLU VACCINE, 3 YRS & >, IM",Outpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90658_1{5},"FLU VACCINE, 3 YRS & >, IM",Inpatient,0636,90658,,,49281-6311-53,1,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
90660_3,"FLU VACCINE, NASAL",ProFee,0989,90660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90661_3,FLU VACC CELL CULT PRSV FREE,ProFee,0989,90661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90662_1,Influenza High Dose,Outpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_1,Influenza High Dose,Inpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_1{2},"Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunoge",Inpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_1{2},"Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunoge",Outpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_1{3},Influenza VACC HIGH DOSE,Inpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_1{3},Influenza VACC HIGH DOSE,Outpatient,0636,90662,,,49281-0121-65,1,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
90662_2,Influenza VACC HIGH DOSE,Outpatient,0521,90662,,,49281-0121-65,0,57.00,42.75,42.75,54.15,51.30,54.15,0.00,51.30
90662_2,Influenza VACC HIGH DOSE,Inpatient,0521,90662,,,49281-0121-65,0,57.00,42.75,42.75,54.15,51.30,54.15,54.15,51.30
90662_3,Influenza VACC HIGH DOSE,Outpatient,0521,90662,,,49281-0121-65,0,59.00,44.25,44.25,56.05,53.10,56.05,0.00,53.10
90662_3,Influenza VACC HIGH DOSE,Inpatient,0521,90662,,,49281-0121-65,0,59.00,44.25,44.25,56.05,53.10,56.05,56.05,53.10
90662VFC_3,FLU VACC HIGH DOSE,ProFee,0989,90662,,,49281-0120-65,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90663_3,FLU VACC PANDEMIC,ProFee,0989,90663,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90664_3,FLU VACC PANDEMIC INTRANASAL,ProFee,0989,90664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90665_3,"LYME DISEASE VACCINE, IM",ProFee,0989,90665,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90666_3,FLU VAC PANDEM PRSRV FREE IM,ProFee,0989,90666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90667_3,FLU VAC PANDEMIC ADJUVANT IM,ProFee,0989,90667,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90668_3,FLU VAC PANDEMIC SPLT IM,ProFee,0989,90668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90670_1,"PNEUMOCOCCAL VACC, 13 VAL IM",Outpatient,0636,90670,,,00005-1971-02,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90670_1,"PNEUMOCOCCAL VACC, 13 VAL IM",Inpatient,0636,90670,,,00005-1971-02,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90670_2,"PNEUMOCOCCAL VACC, 13 VAL IM",Inpatient,0521,90670,,,00005-1971-02,0,73.00,54.75,54.75,69.35,65.70,69.35,69.35,65.70
90670_2,"PNEUMOCOCCAL VACC, 13 VAL IM",Outpatient,0521,90670,,,00005-1971-02,0,73.00,54.75,54.75,69.35,65.70,69.35,0.00,65.70
90670_3,"PNEUMOCOCCAL VACC, 13 VAL IM",Outpatient,0521,90670,,,00005-1971-02,0,74.00,55.50,55.50,70.30,66.60,70.30,0.00,66.60
90670_3,"PNEUMOCOCCAL VACC, 13 VAL IM",Inpatient,0521,90670,,,00005-1971-02,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
90670VFC_2,"PNEUMOCOCCAL VACC, 13 VAL IM",Inpatient,0521,90670,,,00005-1971-02,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90670VFC_2,"PNEUMOCOCCAL VACC, 13 VAL IM",Outpatient,0521,90670,,,00005-1971-02,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90670VFC_3,"PNEUMOCOCCAL VACC, 13 VAL IM",Outpatient,0521,90670,,,00005-1971-02,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90670VFC_3,"PNEUMOCOCCAL VACC, 13 VAL IM",Inpatient,0521,90670,,,00005-1971-02,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90672_3,LAIV4 VACCINE INTRANASAL,ProFee,0989,90672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90673_3,RIV3 VACCINE NO PRESERV IM,ProFee,0989,90673,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90674_3,CCIIV4 VAC NO PRSV 0.5 ML IM,ProFee,0989,90674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90675_3,"RABIES VACCINE, IM",ProFee,0989,90675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90676_3,"RABIES VACCINE, ID",ProFee,0989,90676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90680_1,"ROTOVIRUS VACCINE, ORAL",Inpatient,0636,90680,,,00006-4047-41,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90680_1,"ROTOVIRUS VACCINE, ORAL",Outpatient,0636,90680,,,00006-4047-41,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90680_2,"ROTOVIRUS VACCINE, ORAL",Outpatient,0521,90680,,,00006-4047-41,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90680_2,"ROTOVIRUS VACCINE, ORAL",Inpatient,0521,90680,,,00006-4047-41,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90680_3,"ROTOVIRUS VACCINE, ORAL",Outpatient,0521,90680,,,00006-4047-41,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90680_3,"ROTOVIRUS VACCINE, ORAL",Inpatient,0521,90680,,,00006-4047-41,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90680VFC_3,"ROTOVIRUS VACCINE, ORAL VFC",ProFee,0989,90680,,,00006-4047-41,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90681_2,ROTAVIRUS VACC 2 DOSE ORAL,ProFee,0989,90681,,,,0,20.00,15.00,15.00,15.00,0.00,N/A,N/A,N/A
90681_3,ROTAVIRUS VACC 2 DOSE ORAL,ProFee,0989,90681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90682_3,RIV4 VACC RECOMBINANT DNA IM,ProFee,0989,90682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90685VFC_3,Influenza Pediatrics,ProFee,0989,90685,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90686_1,"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.",Outpatient,0636,90686,,,49281-0419-88,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90686_1,"Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.",Inpatient,0636,90686,,,49281-0419-88,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90686_1{2},Influenza Preservative Free,Inpatient,0636,90686,,,49281-0419-88,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90686_1{2},Influenza Preservative Free,Outpatient,0636,90686,,,49281-0419-88,1,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90686VFC_3,Influenza Preservative Free,ProFee,0989,90686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90688_2,Influenza MULTIDOSE VIAL 0.5ML,Outpatient,0771,90688,,,49281-1208-80,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90688_2,Influenza MULTIDOSE VIAL 0.5ML,Inpatient,0771,90688,,,49281-1208-80,0,26.00,19.50,19.50,24.70,23.40,24.70,24.70,23.40
90688_3,Influenza MULTIDOSE VIAL 0.5ML,Inpatient,0771,90688,,,49281-1208-80,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
90688_3,Influenza MULTIDOSE VIAL 0.5ML,Outpatient,0771,90688,,,49281-1208-80,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
90688VFC_2,Influenza MDV 0.5ML,Inpatient,0771,90688,,,49281-0631-15,0,16.27,12.20,12.20,15.46,14.64,15.46,15.46,14.64
90688VFC_2,Influenza MDV 0.5ML,Outpatient,0771,90688,,,49281-0631-15,0,16.27,12.20,12.20,15.46,14.64,15.46,15.46,14.64
90688VFC_3,Influenza MDV 0.5ML,Inpatient,0771,90688,,,49281-0631-15,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90688VFC_3,Influenza MDV 0.5ML,Outpatient,0771,90688,,,49281-0631-15,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90689_3,VACC IIV4 NO PRSRV 0.25ML IM,ProFee,0989,90689,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90690_3,"TYPHOID VACCINE, ORAL",ProFee,0989,90690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90691_3,"TYPHOID VACCINE, IM",ProFee,0989,90691,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90692_3,"TYPHOID VACCINE, H-P, SC/ID",ProFee,0989,90692,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90693_3,"TYPHOID VACCINE, AKD, SC",ProFee,0989,90693,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90694_3,VACC AIIV4 NO PRSRV 0.5ML IM,ProFee,0989,90694,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90696_1,"Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine,",Inpatient,0636,90696,,,58160-0812-11,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90696_1,"Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine,",Outpatient,0636,90696,,,58160-0812-11,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90696_1{2},DTAP-IPV VACC 4-6 YR IM,Inpatient,0636,90696,,,58160-0812-11,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90696_1{2},DTAP-IPV VACC 4-6 YR IM,Outpatient,0636,90696,,,58160-0812-11,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90696_2,DTAP-IPV VACC 4-6 YR IM,Outpatient,0521,90696,,,58160-0812-11,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90696_2,DTAP-IPV VACC 4-6 YR IM,Inpatient,0521,90696,,,58160-0812-11,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90696_3,DTAP-IPV VACC 4-6 YR IM,Outpatient,0521,90696,,,58160-0812-11,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90696_3,DTAP-IPV VACC 4-6 YR IM,Inpatient,0521,90696,,,58160-0812-11,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90696VFC_3,DTAP-IPV VACC 4-6 YR IM,ProFee,0989,90696,,,58160-0812-11,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90697_3,DTAP-IPV-HIB-HEPB VACCINE IM,ProFee,0989,90697,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90698_1,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine, haemophilus influe",Inpatient,0636,90698,,,49281-0510-05,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90698_1,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine, haemophilus influe",Outpatient,0636,90698,,,49281-0510-05,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90698_2,"DTAP-HIB-IP VACCINE, IM",Outpatient,0521,90698,,,49281-0510-05,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90698_2,"DTAP-HIB-IP VACCINE, IM",Inpatient,0521,90698,,,49281-0510-05,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90698_3,"DTAP-HIB-IP VACCINE, IM",Inpatient,0521,90698,,,49281-0510-05,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90698_3,"DTAP-HIB-IP VACCINE, IM",Outpatient,0521,90698,,,49281-0510-05,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90698VFC_3,"DTAP-HIB-IP VACCINE, IM",ProFee,0989,90698,,,49281-0510-05,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90700_1,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine",Inpatient,0636,90700,,,49281-0286-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90700_1,"Diphtheria, tetanus toxoids, and acellular pertussis vaccine",Outpatient,0636,90700,,,49281-0286-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90700_2,"DTAP VACCINE, < 7 YRS, IM",Inpatient,0521,90700,,,49281-0286-10,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90700_2,"DTAP VACCINE, < 7 YRS, IM",Outpatient,0521,90700,,,49281-0286-10,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90700_3,"DTAP VACCINE, < 7 YRS, IM",Outpatient,0521,90700,,,49281-0286-10,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90700_3,"DTAP VACCINE, < 7 YRS, IM",Inpatient,0521,90700,,,49281-0286-10,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90700VFC_3,"DTAP VACCINE, < 7 YRS, IM",Inpatient,0521,90700,,,49281-0286-10,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90700VFC_3,"DTAP VACCINE, < 7 YRS, IM",Outpatient,0521,90700,,,49281-0286-10,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90701_3,"DTP VACCINE, IM",ProFee,0989,90701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90702_3,"DT VACCINE < 7, IM",ProFee,0989,90702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90703VFC_3,"TETANUS VACCINE, IM",ProFee,0989,90703,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90704_3,"MUMPS VACCINE, SC",ProFee,0989,90704,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90705_3,"MEASLES VACCINE, SC",ProFee,0989,90705,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90706VFC_3,"RUBELLA VACCINE, SC",ProFee,0989,90706,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90707_1,"Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use",Outpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_1,"Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use",Inpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_1{2},"MMR VACCINE, SC",Inpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_1{2},"MMR VACCINE, SC",Outpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_1{3},"MMR VACCINE, SC",Inpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_1{3},"MMR VACCINE, SC",Outpatient,0636,90707,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_2,"MMR VACCINE, SC",Outpatient,0521,90707,,,00006-4171-01,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90707_2,"MMR VACCINE, SC",Inpatient,0521,90707,,,00006-4171-01,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90707_3,"MMR VACCINE, SC",Inpatient,0521,90707,,,00006-4171-01,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90707_3,"MMR VACCINE, SC",Outpatient,0521,90707,,,00006-4171-01,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90707VFC_3,"MMR VACCINE, SC",ProFee,0989,90707,,,00006-4681-00,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90708_3,"MEASLES-RUBELLA VACCINE, SC",ProFee,0989,90708,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90710_1,"Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us",Outpatient,0636,90710,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90710_1,"Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous us",Inpatient,0636,90710,,,00006-4171-01,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90710_2,"MMRV VACCINE, SC",Inpatient,0521,90710,,,00006-4171-01,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90710_2,"MMRV VACCINE, SC",Outpatient,0521,90710,,,00006-4171-01,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90710_3,"MMRV VACCINE, SC",Inpatient,0521,90710,,,00006-4171-01,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90710_3,"MMRV VACCINE, SC",Outpatient,0521,90710,,,00006-4171-01,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90710VFC_3,"MMRV VACCINE, SC",ProFee,0989,90710,,,00006-4171-01,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90712_3,ORAL POLIOVIRUS VACCINE,ProFee,0989,90712,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90713_1,"POLIOVIRUS, IPV, SC",Inpatient,0636,90713,,,49281-0860-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90713_1,"POLIOVIRUS, IPV, SC",Outpatient,0636,90713,,,49281-0860-10,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90713_2,"POLIOVIRUS, IPV, SC",Inpatient,0521,90713,,,49281-0860-10,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90713_2,"POLIOVIRUS, IPV, SC",Outpatient,0521,90713,,,49281-0860-10,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90713_3,"POLIOVIRUS, IPV, SC",Outpatient,0521,90713,,,49281-0860-10,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90713_3,"POLIOVIRUS, IPV, SC",Inpatient,0521,90713,,,49281-0860-10,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90713VFC_3,"POLIOVIRUS, IPV, SC",ProFee,0989,90713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90714_2,TD VACCINE >7 IM,Outpatient,0521,90714,,,01353-3131-00,0,85.00,63.75,63.75,80.75,76.50,80.75,0.00,76.50
90714_2,TD VACCINE >7 IM,Inpatient,0521,90714,,,01353-3131-00,0,85.00,63.75,63.75,80.75,76.50,80.75,80.75,76.50
90714_3,TD VACCINE >7 IM,Inpatient,0521,90714,,,01353-3131-00,0,86.00,64.50,64.50,81.70,77.40,81.70,81.70,77.40
90714_3,TD VACCINE >7 IM,Outpatient,0521,90714,,,01353-3131-00,0,86.00,64.50,64.50,81.70,77.40,81.70,0.00,77.40
90714VFC_3,TD VACCINE > 7 IM,ProFee,0989,90714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90715_1,TDAP VACCINE >7 IM,Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1,TDAP VACCINE >7 IM,Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{2},"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in i",Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{2},"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), for use in i",Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{3},"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when adminis",Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{3},"Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when adminis",Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{4},TDAP VACCINE >7 IM,Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{4},TDAP VACCINE >7 IM,Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{5},TDAP VACCINE >7 IM,Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{5},TDAP VACCINE >7 IM,Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{6},TDAP VACCINE >7 IM,Inpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_1{6},TDAP VACCINE >7 IM,Outpatient,0636,90715,,,01353-3131-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_2,TDAP VACCINE >7 IM,Outpatient,0521,90715,,,01353-3131-00,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90715_2,TDAP VACCINE >7 IM,Inpatient,0521,90715,,,01353-3131-00,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90715_3,TDAP VACCINE >7 IM,Outpatient,0521,90715,,,01353-3131-00,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90715_3,TDAP VACCINE >7 IM,Inpatient,0521,90715,,,01353-3131-00,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90715VFC_3,TDAP VACCINE >7 IM,ProFee,0989,90715,,,49281-0400-89,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90716_1,"Varicella virus vaccine, live, for subcutaneous use",Outpatient,0636,90716,,,00006-4827-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90716_1,"Varicella virus vaccine, live, for subcutaneous use",Inpatient,0636,90716,,,00006-4827-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90716_1{2},"CHICKEN POX VACCINE, SC",Outpatient,0636,90716,,,00006-4827-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90716_1{2},"CHICKEN POX VACCINE, SC",Inpatient,0636,90716,,,00006-4827-00,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90716_2,"CHICKEN POX VACCINE, SC",Outpatient,0521,90716,,,00006-4827-00,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90716_2,"CHICKEN POX VACCINE, SC",Inpatient,0521,90716,,,00006-4827-00,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90716_3,"CHICKEN POX VACCINE, SC",Outpatient,0521,90716,,,00006-4827-00,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90716_3,"CHICKEN POX VACCINE, SC",Inpatient,0521,90716,,,00006-4827-00,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90716VFC_3,CHICKEN POX VACCINE VFC,Outpatient,0521,90716,,,00006-4827-00,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90716VFC_3,CHICKEN POX VACCINE VFC,Inpatient,0521,90716,,,00006-4827-00,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90717_3,"YELLOW FEVER VACCINE, SC",ProFee,0989,90717,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90718_1,"TD VACCINE > 7, IM",Inpatient,0636,90718,,,13533-0131-00,1,70.00,52.50,52.50,66.50,63.00,66.50,66.50,63.00
90718_1,"TD VACCINE > 7, IM",Outpatient,0636,90718,,,13533-0131-00,1,70.00,52.50,52.50,66.50,63.00,66.50,66.50,63.00
90718VFC_3,"TD VACCINE > 7, IM",ProFee,0989,90718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90719_3,"DIPHTHERIA VACCINE, IM",ProFee,0989,90719,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90720_3,"DTP/HIB VACCINE, IM",ProFee,0989,90720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90721_3,"DTAP/HIB VACCINE, IM",ProFee,0989,90721,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90723_2,"DTAP-HEP B-IPV VACCINE, IM",Inpatient,0521,90723,,,58160-0811-52,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90723_2,"DTAP-HEP B-IPV VACCINE, IM",Outpatient,0521,90723,,,58160-0811-52,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90723_3,"DTAP-HEP B-IPV VACCINE, IM",Outpatient,0521,90723,,,58160-0811-52,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90723_3,"DTAP-HEP B-IPV VACCINE, IM",Inpatient,0521,90723,,,58160-0811-52,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90723VFC_3,"DTAP-HEP, B-IPV VACCINE, IM VFC",ProFee,0989,90723,,,58160-0811-52,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90725_3,"CHOLERA VACCINE, INJECTABLE",ProFee,0989,90725,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90727_3,"PLAGUE VACCINE, IM",ProFee,0989,90727,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90732VFC_2,PNEUMOCOCCAL VACCINE,ProFee,0989,90732,,,,0,23.00,17.25,17.25,17.25,0.00,N/A,N/A,N/A
90732VFC_3,PNEUMOCOCCAL VACCINE,ProFee,0989,90732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90733_2,"MENINGOCOCCAL VACCINE, SC",Outpatient,0521,90733,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90733_2,"MENINGOCOCCAL VACCINE, SC",Inpatient,0521,90733,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90733_3,"MENINGOCOCCAL VACCINE, SC",Inpatient,0521,90733,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90733_3,"MENINGOCOCCAL VACCINE, SC",Outpatient,0521,90733,,,,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90733VFC_3,"MENINGOCOCCAL VACCINE, SC",ProFee,0989,90733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90734_1,"Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for",Inpatient,0636,90734,,,49281-0589-58,1,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
90734_1,"Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for",Outpatient,0636,90734,,,49281-0589-58,1,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
90734_1{2},"MENINGOCOCCAL VACCINE, IM",Inpatient,0636,90734,,,49281-0589-58,1,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
90734_1{2},"MENINGOCOCCAL VACCINE, IM",Outpatient,0636,90734,,,49281-0589-58,1,172.00,129.00,129.00,163.40,154.80,163.40,163.40,154.80
90734_2,"MENINGOCOCCAL VACCINE, IM",Inpatient,0521,90734,,,49281-0589-58,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
90734_2,"MENINGOCOCCAL VACCINE, IM",Outpatient,0521,90734,,,49281-0589-58,0,177.00,132.75,132.75,168.15,159.30,168.15,0.00,159.30
90734_3,"MENINGOCOCCAL VACCINE, IM",Inpatient,0521,90734,,,49281-0589-58,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
90734_3,"MENINGOCOCCAL VACCINE, IM",Outpatient,0521,90734,,,49281-0589-58,0,175.00,131.25,131.25,166.25,157.50,166.25,0.00,157.50
90734VFC_3,"MENINGOCOCCAL VACCINE, IM",ProFee,0989,90734,,,49281-0589-58,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90735_3,"ENCEPHALITIS VACCINE, SC",ProFee,0989,90735,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90736VFC_3,"ZOSTER VACC, SC",ProFee,0989,90736,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90738_3,INACTIVATED JE VACC IM,ProFee,0989,90738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90739_1,HEP B IM,Inpatient,0636,90739,,,58160-0821-43,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90739_1,HEP B IM,Outpatient,0636,90739,,,58160-0821-43,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90739_2,HEP B IM,Inpatient,0521,90739,,,58160-0821-43,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90739_2,HEP B IM,Outpatient,0521,90739,,,58160-0821-43,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90739_3,HEP B IM,Outpatient,0521,90739,,,58160-0821-43,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
90739_3,HEP B IM,Inpatient,0521,90739,,,58160-0821-43,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
90739VFC_3,HEP B IM VFC,ProFee,0989,90739,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90740_3,"HEPB VACC, ILL PAT 3 DOSE IM",ProFee,0989,90740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90743_2,"HEP B VACC, ADOL, 2 DOSE, IM",Outpatient,0521,90743,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,0.00,159.30
90743_2,"HEP B VACC, ADOL, 2 DOSE, IM",Inpatient,0521,90743,,,,0,177.00,132.75,132.75,168.15,159.30,168.15,168.15,159.30
90743_3,"HEP B VACC, ADOL, 2 DOSE, IM",Inpatient,0521,90743,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,166.25,157.50
90743_3,"HEP B VACC, ADOL, 2 DOSE, IM",Outpatient,0521,90743,,,,0,175.00,131.25,131.25,166.25,157.50,166.25,0.00,157.50
90744_1,"Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramus",Inpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_1,"Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramus",Outpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_1{2},HEPB VACC PED/ADOL 3 DOSE IM,Inpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_1{2},HEPB VACC PED/ADOL 3 DOSE IM,Outpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_1{3},HEPB VACC PED/ADOL 3 DOSE IM,Inpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_1{3},HEPB VACC PED/ADOL 3 DOSE IM,Outpatient,0636,90744,,,58160-8214-30,1,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_2,HEPB VACC PED/ADOL 3 DOSE IM,Inpatient,0521,90744,,,58160-8214-30,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
90744_2,HEPB VACC PED/ADOL 3 DOSE IM,Outpatient,0521,90744,,,58160-8214-30,0,20.00,15.00,15.00,19.00,18.00,19.00,0.00,18.00
90744_3,HEPB VACC PED/ADOL 3 DOSE IM,Inpatient,0521,90744,,,58160-8214-30,0,23.00,17.25,17.25,21.85,20.70,21.85,21.85,20.70
90744_3,HEPB VACC PED/ADOL 3 DOSE IM,Outpatient,0521,90744,,,58160-8214-30,0,23.00,17.25,17.25,21.85,20.70,21.85,0.00,20.70
90744VFC_3,HEPB VACC PED/ADOL 3 DOSE IM,ProFee,0989,90744,,,00006-4981-00,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90746VFC_3,"HEP B VACCINE, ADULT, IM",ProFee,0989,90746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90747_3,"HEPB VACC, ILL PAT 4 DOSE IM",ProFee,0989,90747,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90748_3,"HEP B/HIB VACCINE, IM",ProFee,0989,90748,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90749_3,VACCINE TOXOID,ProFee,0989,90749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90750_3,HZV VACC RECOMBINANT IM,ProFee,0989,90750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90756_3,CCIIV4 VACC ABX FREE IM,ProFee,0989,90756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90760_3,"HYDRATION IV INFUSION, INIT",ProFee,0989,90760,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90761_3,"HYDRATE IV INFUSION, ADD-ON",ProFee,0989,90761,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90765_3,"THER/PROPH/DIAG IV INF, INIT",ProFee,0989,90765,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90766_3,"THER/PROPH/DG IV INF, ADD-ON",ProFee,0989,90766,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90767_3,TX/PROPH/DG ADDL SEQ IV INF,ProFee,0989,90767,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90768_3,THER/DIAG CONCURRENT INF,ProFee,0989,90768,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90769_3,"SC THER INFUSION, UP TO 1 HR",ProFee,0989,90769,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90770_3,"SC THER INFUSION, ADDL HR",ProFee,0989,90770,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90771_3,"SC THER INFUSION, RESET PUMP",ProFee,0989,90771,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90773_3,"THER/PROPH/DIAG INJ, IA",ProFee,0989,90773,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90774_3,"THER/PROPH/DIAG INJ, IV PUSH",ProFee,0989,90774,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90775_3,THER/PROPH/DIAG INJ ADD-ON,ProFee,0989,90775,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90776_3,TX/PRO/DX INJ SAME DRUG ADON,ProFee,0989,90776,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90779_3,THER/PROP/DIAG INJ/INF PROC,ProFee,0989,90779,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90785_3,PSYTX COMPLEX INTERACTIVE,ProFee,0989,90785,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
90791_3,PSYCH DIAGNOSTIC EVALUATION,ProFee,0989,90791,,,,0,3.00,2.25,2.25,178.00,0.00,178.00,178.00,N/A
90792_3,PSYCH DIAG EVAL W/MED SRVCS,ProFee,0989,90792,,,,0,3.00,2.25,2.25,200.50,0.00,200.50,200.50,N/A
90801_3,PSY DX INTERVIEW,ProFee,0989,90801,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90802_3,INTAC PSY DX INTERVIEW,ProFee,0989,90802,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90804_3,"PSYTX, OFFICE, 20-30 MIN",ProFee,0989,90804,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90805_3,"PSYTX, OFF, 20-30 MIN W/E&M",ProFee,0989,90805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90806_3,"PSYTX, OFF, 45-50 MIN",ProFee,0989,90806,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90807_3,"PSYTX, OFF, 45-50 MIN W/E&M",ProFee,0989,90807,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90808_3,"PSYTX, OFFICE, 75-80 MIN",ProFee,0989,90808,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90809_3,"PSYTX, OFF, 75-80, W/E&M",ProFee,0989,90809,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90810_3,"INTAC PSYTX, OFF, 20-30 MIN",ProFee,0989,90810,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90811_3,"INTAC PSYTX, 20-30, W/E&M",ProFee,0989,90811,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90812_3,"INTAC PSYTX, OFF, 45-50 MIN",ProFee,0989,90812,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90813_3,"INTAC PSYTX, 45-50 MIN W/E&M",ProFee,0989,90813,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90814_3,"INTAC PSYTX, OFF, 75-80 MIN",ProFee,0989,90814,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90815_3,"INTAC PSYTX, 75-80 W/E&M",ProFee,0989,90815,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90816_3,"PSYTX, HOSP, 20-30 MIN",ProFee,0989,90816,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90817_3,"PSYTX, HOSP, 20-30 MIN W/E&M",ProFee,0989,90817,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90818_3,"PSYTX, HOSP, 45-50 MIN",ProFee,0989,90818,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90819_3,"PSYTX, HOSP, 45-50 MIN W/E&M",ProFee,0989,90819,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90821_3,"PSYTX, HOSP, 75-80 MIN",ProFee,0989,90821,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90822_3,"PSYTX, HOSP, 75-80 MIN W/E&M",ProFee,0989,90822,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90823_3,"INTAC PSYTX, HOSP, 20-30 MIN",ProFee,0989,90823,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90824_3,"INTAC PSYTX, HSP 20-30 W/E&M",ProFee,0989,90824,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90826_3,"INTAC PSYTX, HOSP, 45-50 MIN",ProFee,0989,90826,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90827_3,"INTAC PSYTX, HSP 45-50 W/E&M",ProFee,0989,90827,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90828_3,"INTAC PSYTX, HOSP, 75-80 MIN",ProFee,0989,90828,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90829_3,"INTAC PSYTX, HSP 75-80 W/E&M",ProFee,0989,90829,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90832_3,PSYTX W PT 30 MINUTES,ProFee,0989,90832,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
90833_3,PSYTX W PT W E/M 30 MIN,ProFee,0989,90833,,,,0,3.00,2.25,2.25,92.50,0.00,92.50,92.50,N/A
90834_3,PSYTX W PT 45 MINUTES,ProFee,0989,90834,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
90836_3,PSYTX W PT W E/M 45 MIN,ProFee,0989,90836,,,,0,3.00,2.25,2.25,116.50,0.00,116.50,116.50,N/A
90837_3,PSYTX W PT 60 MINUTES,ProFee,0989,90837,,,,0,3.00,2.25,2.25,135.92,0.00,135.92,135.92,N/A
90838_3,PSYTX W PT W E/M 60 MIN,ProFee,0989,90838,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
90839_3,PSYTX CRISIS INITIAL 60 MIN,ProFee,0989,90839,,,,0,3.00,2.25,2.25,185.00,0.00,185.00,185.00,N/A
90840_3,PSYTX CRISIS EA ADDL 30 MIN,ProFee,0989,90840,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
90845_3,PSYCHOANALYSIS,ProFee,0989,90845,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
90846_3,FAMILY PSYTX W/O PATIENT,ProFee,0989,90846,,,,0,3.00,2.25,2.25,143.00,0.00,143.00,143.00,N/A
90847_3,FAMILY PSYTX W/PATIENT,ProFee,0989,90847,,,,0,3.00,2.25,2.25,149.00,0.00,149.00,149.00,N/A
90849_3,MULTIPLE FAMILY GROUP PSYTX,ProFee,0989,90849,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
90853_3,GROUP PSYCHOTHERAPY,ProFee,0989,90853,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
90857_3,INTAC GROUP PSYTX,ProFee,0989,90857,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90862_3,MEDICATION MANAGEMENT,ProFee,0989,90862,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90863_3,PHARMACOLOGIC MGMT W/PSYTX,ProFee,0989,90863,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
90865_3,NARCOSYNTHESIS,ProFee,0989,90865,,,,0,3.00,2.25,2.25,181.00,0.00,181.00,181.00,N/A
90867_3,TCRANIAL MAGN STIM TX PLAN,ProFee,0989,90867,,,,0,3.00,2.25,2.25,359.00,0.00,359.00,359.00,N/A
90868_3,TCRANIAL MAGN STIM TX DELI,ProFee,0989,90868,,,,0,3.00,2.25,2.25,252.50,0.00,252.50,252.50,N/A
90869_3,TCRAN MAGN STIM REDETEMINE,ProFee,0989,90869,,,,0,3.00,2.25,2.25,323.50,0.00,323.50,323.50,N/A
90870_3,ELECTROCONVULSIVE THERAPY,ProFee,0989,90870,,,,0,3.00,2.25,2.25,156.50,0.00,156.50,156.50,N/A
90875_3,PSYCHOPHYSIOLOGICAL THERAPY,ProFee,0989,90875,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
90876_3,PSYCHOPHYSIOLOGICAL THERAPY,ProFee,0989,90876,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
90880_3,HYPNOTHERAPY,ProFee,0989,90880,,,,0,3.00,2.25,2.25,130.00,0.00,130.00,130.00,N/A
90882_3,ENVIRONMENTAL MANIPULATION,ProFee,0989,90882,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
90885_3,PSY EVALUATION OF RECORDS,ProFee,0989,90885,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
90887_3,CONSULTATION WITH FAMILY,ProFee,0989,90887,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
90889_3,PREPARATION OF REPORT,ProFee,0989,90889,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
90899_3,PSYCHIATRIC SERVICE/THERAPY,ProFee,0989,90899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
90901_3,"BIOFEEDBACK TRAIN, ANY METH",ProFee,0989,90901,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
90912_3,BFB TRAINING 1ST 15 MIN,ProFee,0989,90912,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90913_3,BFB TRAINING EA ADDL 15 MIN,ProFee,0989,90913,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90918_3,"ESRD RELATED SERVICES, MONTH",ProFee,0989,90918,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90919_3,"ESRD RELATED SERVICES, MONTH",ProFee,0989,90919,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90920_3,"ESRD RELATED SERVICES, MONTH",ProFee,0989,90920,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90921_3,"ESRD RELATED SERVICES, MONTH",ProFee,0989,90921,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90922_3,"ESRD RELATED SERVICES, DAY",ProFee,0989,90922,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90923_3,"ESRD RELATED SERVICES, DAY",ProFee,0989,90923,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90924_3,"ESRD RELATED SERVICES, DAY",ProFee,0989,90924,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90925_3,"ESRD RELATED SERVICES, DAY",ProFee,0989,90925,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
90935_3,"HEMODIALYSIS, ONE EVALUATION",ProFee,0989,90935,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
90937_3,"HEMODIALYSIS, REPEATED EVAL",ProFee,0989,90937,,,,0,3.00,2.25,2.25,147.00,0.00,147.00,147.00,N/A
90940_3,HEMODIALYSIS ACCESS STUDY,ProFee,0989,90940,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
90945_3,"DIALYSIS, ONE EVALUATION",ProFee,0989,90945,,,,0,3.00,2.25,2.25,121.00,0.00,121.00,121.00,N/A
90947_3,"DIALYSIS, REPEATED EVAL",ProFee,0989,90947,,,,0,3.00,2.25,2.25,175.00,0.00,175.00,175.00,N/A
90951_3,"ESRD SERV, 4 VISITS P MO, <2",ProFee,0989,90951,,,,0,3.00,2.25,2.25,1334.50,0.00,1334.50,1334.50,N/A
90952_3,"ESRD SERV, 2-3 VSTS P MO, <2",ProFee,0989,90952,,,,0,3.00,2.25,2.25,1032.00,0.00,1032.00,1032.00,N/A
90953_3,"ESRD SERV, 1 VISIT P MO, <2",ProFee,0989,90953,,,,0,3.00,2.25,2.25,688.00,0.00,688.00,688.00,N/A
90954_3,"ESRD SERV, 4 VSTS P MO, 2-11",ProFee,0989,90954,,,,0,3.00,2.25,2.25,1150.00,0.00,1150.00,1150.00,N/A
90955_3,"ESRD SRV 2-3 VSTS P MO, 2-11",ProFee,0989,90955,,,,0,3.00,2.25,2.25,645.50,0.00,645.50,645.50,N/A
90956_3,"ESRD SRV, 1 VISIT P MO, 2-11",ProFee,0989,90956,,,,0,3.00,2.25,2.25,448.50,0.00,448.50,448.50,N/A
90957_3,"ESRD SRV, 4 VSTS P MO, 12-19",ProFee,0989,90957,,,,0,3.00,2.25,2.25,909.50,0.00,909.50,909.50,N/A
90958_3,ESRD SRV 2-3 VSTS P MO 12-19,ProFee,0989,90958,,,,0,3.00,2.25,2.25,617.00,0.00,617.00,617.00,N/A
90959_3,"ESRD SERV, 1 VST P MO, 12-19",ProFee,0989,90959,,,,0,3.00,2.25,2.25,419.00,0.00,419.00,419.00,N/A
90960_3,"ESRD SRV, 4 VISITS P MO, 20+",ProFee,0989,90960,,,,0,3.00,2.25,2.25,400.50,0.00,400.50,400.50,N/A
90961_3,"ESRD SRV, 2-3 VSTS P MO, 20+",ProFee,0989,90961,,,,0,3.00,2.25,2.25,337.00,0.00,337.00,337.00,N/A
90962_3,"ESRD SERV, 1 VISIT P MO, 20+",ProFee,0989,90962,,,,0,3.00,2.25,2.25,260.50,0.00,260.50,260.50,N/A
90963_3,"ESRD HOME PT, SERV P MO, <2",ProFee,0989,90963,,,,0,3.00,2.25,2.25,771.50,0.00,771.50,771.50,N/A
90964_3,"ESRD HOME PT SERV P MO, 2-11",ProFee,0989,90964,,,,0,3.00,2.25,2.25,673.50,0.00,673.50,673.50,N/A
90965_3,ESRD HOME PT SERV P MO 12-19,ProFee,0989,90965,,,,0,3.00,2.25,2.25,640.50,0.00,640.50,640.50,N/A
90966_3,"ESRD HOME PT, SERV P MO, 20+",ProFee,0989,90966,,,,0,3.00,2.25,2.25,336.00,0.00,336.00,336.00,N/A
90967_3,"ESRD HOME PT SERV P DAY, <2",ProFee,0989,90967,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
90968_3,"ESRD HOME PT SRV P DAY, 2-11",ProFee,0989,90968,,,,0,3.00,2.25,2.25,22.00,0.00,22.00,22.00,N/A
90969_3,ESRD HOME PT SRV P DAY 12-19,ProFee,0989,90969,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
90970_3,"ESRD HOME PT SERV P DAY, 20+",ProFee,0989,90970,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
90989_3,"DIALYSIS TRAINING, COMPLETE",ProFee,0989,90989,,,,0,3.00,2.25,2.25,516.00,0.00,516.00,516.00,N/A
90993_3,"DIALYSIS TRAINING, INCOMPL",ProFee,0989,90993,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
90997_3,HEMOPERFUSION,ProFee,0989,90997,,,,0,3.00,2.25,2.25,126.00,0.00,126.00,126.00,N/A
90999_3,DIALYSIS PROCEDURE,ProFee,0989,90999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
91000_3,ESOPHAGEAL INTUBATION,ProFee,0989,91000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91010_3,ESOPHAGUS MOTILITY STUDY,ProFee,0989,91010,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
91011_3,ESOPHAGUS MOTILITY STUDY,ProFee,0989,91011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91012_3,ESOPHAGUS MOTILITY STUDY,ProFee,0989,91012,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91013_3,ESOPHGL MOTIL W/STIM/PERFUS,ProFee,0989,91013,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
91020_3,GASTRIC MOTILITY,ProFee,0989,91020,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
91022_3,DUODENAL MOTILITY STUDY,ProFee,0989,91022,,,,0,3.00,2.25,2.25,107.00,0.00,107.00,107.00,N/A
91030_3,ACID PERFUSION OF ESOPHAGUS,ProFee,0989,91030,,,,0,3.00,2.25,2.25,68.00,0.00,68.00,68.00,N/A
91034_3,GASTROESOPHAGEAL REFLUX TEST,ProFee,0989,91034,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
91035_3,G-ESOPH REFLX TST W/ELECTROD,ProFee,0989,91035,,,,0,3.00,2.25,2.25,119.50,0.00,119.50,119.50,N/A
91037_3,ESOPH IMPED FUNCTION TEST,ProFee,0989,91037,,,,0,3.00,2.25,2.25,72.00,0.00,72.00,72.00,N/A
91038_3,ESOPH IMPED FUNCT TEST > 1H,ProFee,0989,91038,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
91040_3,ESOPH BALLOON DISTENSION TST,ProFee,0989,91040,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
91052_3,GASTRIC ANALYSIS TEST,ProFee,0989,91052,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91055_3,GASTRIC INTUBATION FOR SMEAR,ProFee,0989,91055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91060_3,GASTRIC SALINE LOAD TEST,ProFee,0989,91060,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91065_3,BREATH HYDROGEN TEST,ProFee,0989,91065,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
91100_3,PASS INTESTINE BLEEDING TUBE,ProFee,0989,91100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91110_3,GI TRACT CAPSULE ENDOSCOPY,ProFee,0989,91110,,,,0,3.00,2.25,2.25,184.50,0.00,184.50,184.50,N/A
91111_3,ESOPHAGEAL CAPSULE ENDOSCOPY,ProFee,0989,91111,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
91112_3,GI WIRELESS CAPSULE MEASURE,ProFee,0989,91112,,,,0,3.00,2.25,2.25,155.50,0.00,155.50,155.50,N/A
91117_3,COLON MOTILITY 6 HR STUDY,ProFee,0989,91117,,,,0,3.00,2.25,2.25,199.00,0.00,199.00,199.00,N/A
91120_3,RECTAL SENSATION TEST,ProFee,0989,91120,,,,0,3.00,2.25,2.25,71.00,0.00,71.00,71.00,N/A
91122_3,ANAL PRESSURE RECORD,ProFee,0989,91122,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
91123_3,IRRIGATE FECAL IMPACTION,ProFee,0989,91123,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
91132_3,ELECTROGASTROGRAPHY,ProFee,0989,91132,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
91133_3,ELECTROGASTROGRAPHY W/TEST,ProFee,0989,91133,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
91200_3,LIVER ELASTOGRAPHY,ProFee,0989,91200,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
91299_3,GASTROENTEROLOGY PROCEDURE,ProFee,0989,91299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92002_3,"EYE EXAM, NEW PATIENT",ProFee,0989,92002,,,,0,3.00,2.25,2.25,49.30,0.00,49.30,49.30,N/A
92004_3,"EYE EXAM, NEW PATIENT",ProFee,0989,92004,,,,0,3.00,2.25,2.25,102.23,0.00,102.23,102.23,N/A
92012_3,EYE EXAM ESTABLISHED PAT,ProFee,0989,92012,,,,0,3.00,2.25,2.25,54.38,0.00,54.38,54.38,N/A
92014_3,EYE EXAM & TREATMENT,ProFee,0989,92014,,,,0,3.00,2.25,2.25,81.93,0.00,81.93,81.93,N/A
92015_3,REFRACTION,ProFee,0989,92015,,,,0,3.00,2.25,2.25,19.94,0.00,19.94,19.94,N/A
92018_3,NEW EYE EXAM & TREATMENT,ProFee,0989,92018,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
92019_3,EYE EXAM & TREATMENT,ProFee,0989,92019,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
92020_3,SPECIAL EYE EVALUATION,ProFee,0989,92020,,,,0,3.00,2.25,2.25,30.00,0.00,30.00,30.00,N/A
92025_3,CORNEAL TOPOGRAPHY,ProFee,0989,92025,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
92060_3,SPECIAL EYE EVALUATION,ProFee,0989,92060,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
92065_3,ORTHOPTIC/PLEOPTIC TRAINING,ProFee,0989,92065,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
92070_3,FITTING OF CONTACT LENS,ProFee,0989,92070,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92071_3,CONTACT LENS FITTING FOR TX,ProFee,0989,92071,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
92072_3,FIT CONTAC LENS FOR MANAGMNT,ProFee,0989,92072,,,,0,3.00,2.25,2.25,143.50,0.00,143.50,143.50,N/A
92081_3,VISUAL FIELD EXAMINATION(S),ProFee,0989,92081,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
92082_3,VISUAL FIELD EXAMINATION(S),ProFee,0989,92082,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
92083_3,VISUAL FIELD EXAMINATION(S),ProFee,0989,92083,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
92120_3,TONOGRAPHY & EYE EVALUATION,ProFee,0989,92120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92130_3,WATER PROVOCATION TONOGRAPHY,ProFee,0989,92130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92132_3,CMPTR OPHTH DX IMG ANT SEGMT,ProFee,0989,92132,,,,0,3.00,2.25,2.25,23.50,0.00,23.50,23.50,N/A
92133_3,CMPTR OPHTH IMG OPTIC NERVE,ProFee,0989,92133,,,,0,3.00,2.25,2.25,32.00,0.00,32.00,32.00,N/A
92134_3,CPTR OPHTH DX IMG POST SEGMT,ProFee,0989,92134,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
92135_3,OPTHALMIC DX IMAGING,ProFee,0989,92135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92136_3,OPHTHALMIC BIOMETRY,ProFee,0989,92136,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
92140_3,GLAUCOMA PROVOCATIVE TESTS,ProFee,0989,92140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92145_3,CORNEAL HYSTERESIS DETER,ProFee,0989,92145,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
92201_3,OPSCPY EXTND RTA DRAW UNI/BI,ProFee,0989,92201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92202_3,OPSCPY EXTND ON/MAC DRAW,ProFee,0989,92202,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92227_3,REMOTE DX RETINAL IMAGING,ProFee,0989,92227,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
92228_3,REMOTE RETINAL IMAGING MGMT,ProFee,0989,92228,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
92230_3,EYE EXAM WITH PHOTOS,ProFee,0989,92230,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
92235_3,EYE EXAM WITH PHOTOS,ProFee,0989,92235,,,,0,3.00,2.25,2.25,62.00,0.00,62.00,62.00,N/A
92240_3,ICG ANGIOGRAPHY,ProFee,0989,92240,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
92242_3,FLUORESCEIN ICG ANGIOGRAPHY,ProFee,0989,92242,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
92250_3,EYE EXAM WITH PHOTOS,ProFee,0989,92250,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
92260_3,OPHTHALMOSCOPY/DYNAMOMETRY,ProFee,0989,92260,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
92265_3,EYE MUSCLE EVALUATION,ProFee,0989,92265,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
92270_3,ELECTRO-OCULOGRAPHY,ProFee,0989,92270,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
92273_3,FULL FIELD ERG W/I&R,ProFee,0989,92273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92274_3,MULTIFOCAL ERG W/I&R,ProFee,0989,92274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92275_3,ELECTRORETINOGRAPHY,ProFee,0989,92275,,,,0,3.00,2.25,2.25,77.50,0.00,77.50,77.50,N/A
92283_3,COLOR VISION EXAMINATION,ProFee,0989,92283,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
92284_3,DARK ADAPTATION EYE EXAM,ProFee,0989,92284,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
92285_3,EYE PHOTOGRAPHY,ProFee,0989,92285,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
92286_3,INTERNAL EYE PHOTOGRAPHY,ProFee,0989,92286,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
92287_3,INTERNAL EYE PHOTOGRAPHY,ProFee,0989,92287,,,,0,3.00,2.25,2.25,66.50,0.00,66.50,66.50,N/A
92310_3,CONTACT LENS FITTING,ProFee,0989,92310,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
92311_3,CONTACT LENS FITTING,ProFee,0989,92311,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
92312_3,CONTACT LENS FITTING,ProFee,0989,92312,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
92313_3,CONTACT LENS FITTING,ProFee,0989,92313,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
92314_3,PRESCRIPTION OF CONTACT LENS,ProFee,0989,92314,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
92315_3,PRESCRIPTION OF CONTACT LENS,ProFee,0989,92315,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
92316_3,PRESCRIPTION OF CONTACT LENS,ProFee,0989,92316,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
92317_3,PRESCRIPTION OF CONTACT LENS,ProFee,0989,92317,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
92325_3,MODIFICATION OF CONTACT LENS,ProFee,0989,92325,,,,0,3.00,2.25,2.25,61.50,0.00,61.50,61.50,N/A
92326_3,REPLACEMENT OF CONTACT LENS,ProFee,0989,92326,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
92340_3,FITTING OF SPECTACLES,ProFee,0989,92340,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
92341_3,FITTING OF SPECTACLES,ProFee,0989,92341,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
92342_3,FITTING OF SPECTACLES,ProFee,0989,92342,,,,0,3.00,2.25,2.25,38.50,0.00,38.50,38.50,N/A
92352_3,SPECIAL SPECTACLES FITTING,ProFee,0989,92352,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
92353_3,SPECIAL SPECTACLES FITTING,ProFee,0989,92353,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
92354_3,SPECIAL SPECTACLES FITTING,ProFee,0989,92354,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
92355_3,SPECIAL SPECTACLES FITTING,ProFee,0989,92355,,,,0,3.00,2.25,2.25,30.00,0.00,30.00,30.00,N/A
92358_3,EYE PROSTHESIS SERVICE,ProFee,0989,92358,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
92370_3,REPAIR & ADJUST SPECTACLES,ProFee,0989,92370,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
92371_3,REPAIR & ADJUST SPECTACLES,ProFee,0989,92371,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
92499_3,EYE SERVICE OR PROCEDURE,ProFee,0989,92499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92502_3,EAR AND THROAT EXAMINATION,ProFee,0989,92502,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
92504_3,EAR MICROSCOPY EXAMINATION,ProFee,0989,92504,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
92506_3,SPEECH/HEARING EVALUATION,ProFee,0989,92506,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92507_3,SPEECH/HEARING THERAPY,ProFee,0989,92507,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
92508_3,SPEECH/HEARING THERAPY,ProFee,0989,92508,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
92511_3,NASOPHARYNGOSCOPY,ProFee,0989,92511,,,,0,3.00,2.25,2.25,36.92,0.00,36.92,36.92,N/A
92512_3,NASAL FUNCTION STUDIES,ProFee,0989,92512,,,,0,3.00,2.25,2.25,27.95,0.00,27.95,27.95,N/A
92516_3,FACIAL NERVE FUNCTION TEST,ProFee,0989,92516,,,,0,3.00,2.25,2.25,22.43,0.00,22.43,22.43,N/A
92520_3,LARYNGEAL FUNCTION STUDIES,ProFee,0989,92520,,,,0,3.00,2.25,2.25,40.02,0.00,40.02,40.02,N/A
92521_3,EVALUATION OF SPEECH FLUENCY,ProFee,0989,92521,,,,0,3.00,2.25,2.25,111.44,0.00,111.44,111.44,N/A
92522_3,EVALUATE SPEECH PRODUCTION,ProFee,0989,92522,,,,0,3.00,2.25,2.25,89.70,0.00,89.70,89.70,N/A
92523_3,SPEECH SOUND LANG COMPREHEN,ProFee,0989,92523,,,,0,3.00,2.25,2.25,193.20,0.00,193.20,193.20,N/A
92524_3,BEHAVRAL QUALIT ANALYS VOICE,ProFee,0989,92524,,,,0,3.00,2.25,2.25,85.91,0.00,85.91,85.91,N/A
92526_3,ORAL FUNCTION THERAPY,ProFee,0989,92526,,,,0,3.00,2.25,2.25,121.50,0.00,121.50,121.50,N/A
92531_3,SPONTANEOUS NYSTAGMUS STUDY,ProFee,0989,92531,,,,0,3.00,2.25,2.25,15.53,0.00,15.53,15.53,N/A
92532_3,POSITIONAL NYSTAGMUS TEST,ProFee,0989,92532,,,,0,3.00,2.25,2.25,18.29,0.00,18.29,18.29,N/A
92533_3,CALORIC VESTIBULAR TEST,ProFee,0989,92533,,,,0,3.00,2.25,2.25,25.88,0.00,25.88,25.88,N/A
92534_3,OPTOKINETIC NYSTAGMUS TEST,ProFee,0989,92534,,,,0,3.00,2.25,2.25,19.67,0.00,19.67,19.67,N/A
92537_3,CALORIC VSTBLR TEST W/REC,ProFee,0989,92537,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
92538_3,CALORIC VSTBLR TEST W/REC,ProFee,0989,92538,,,,0,3.00,2.25,2.25,22.50,0.00,22.50,22.50,N/A
92540_3,BASIC VESTIBULAR EVALUATION,ProFee,0989,92540,,,,0,3.00,2.25,2.25,77.97,0.00,77.97,77.97,N/A
92541_3,SPONTANEOUS NYSTAGMUS TEST,ProFee,0989,92541,,,,0,3.00,2.25,2.25,20.70,0.00,20.70,20.70,N/A
92542_3,POSITIONAL NYSTAGMUS TEST,ProFee,0989,92542,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
92543_3,CALORIC VESTIBULAR TEST,ProFee,0989,92543,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92544_3,OPTOKINETIC NYSTAGMUS TEST,ProFee,0989,92544,,,,0,3.00,2.25,2.25,14.15,0.00,14.15,14.15,N/A
92545_3,OSCILLATING TRACKING TEST,ProFee,0989,92545,,,,0,3.00,2.25,2.25,13.11,0.00,13.11,13.11,N/A
92546_3,SINUSOIDAL ROTATIONAL TEST,ProFee,0989,92546,,,,0,3.00,2.25,2.25,14.84,0.00,14.84,14.84,N/A
92547_3,SUPPLEMENTAL ELECTRICAL TEST,ProFee,0989,92547,,,,0,3.00,2.25,2.25,5.87,0.00,5.87,5.87,N/A
92548_3,POSTUROGRAPHY,ProFee,0989,92548,,,,0,3.00,2.25,2.25,25.53,0.00,25.53,25.53,N/A
92549_3,CDP-SOT 6 COND W/I&R MCT&ADT,ProFee,0989,92549,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92550_3,TYMPANOMETRY & REFLEX THRESH,ProFee,0989,92550,,,,0,3.00,2.25,2.25,21.05,0.00,21.05,21.05,N/A
92551_3,"PURE TONE HEARING TEST, AIR",ProFee,0989,92551,,,,0,3.00,2.25,2.25,12.08,0.00,12.08,12.08,N/A
92552_3,"PURE TONE AUDIOMETRY, AIR",ProFee,0989,92552,,,,0,3.00,2.25,2.25,31.05,0.00,31.05,31.05,N/A
92553_3,"AUDIOMETRY, AIR & BONE",ProFee,0989,92553,,,,0,3.00,2.25,2.25,37.26,0.00,37.26,37.26,N/A
92555_3,SPEECH THRESHOLD AUDIOMETRY,ProFee,0989,92555,,,,0,3.00,2.25,2.25,23.46,0.00,23.46,23.46,N/A
92556_3,"SPEECH AUDIOMETRY, COMPLETE",ProFee,0989,92556,,,,0,3.00,2.25,2.25,37.26,0.00,37.26,37.26,N/A
92557_3,COMPREHENSIVE HEARING TEST,ProFee,0989,92557,,,,0,3.00,2.25,2.25,32.09,0.00,32.09,32.09,N/A
92558_3,EVOKED AUDITORY TEST QUAL,ProFee,0989,92558,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
92559_3,GROUP AUDIOMETRIC TESTING,ProFee,0989,92700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92560_3,"BEKESY AUDIOMETRY, SCREEN",ProFee,0989,92700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92561_3,"BEKESY AUDIOMETRY, DIAGNOSIS",ProFee,0989,92700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92562_3,LOUDNESS BALANCE TEST,ProFee,0989,92562,,,,0,3.00,2.25,2.25,45.54,0.00,45.54,45.54,N/A
92563_3,TONE DECAY HEARING TEST,ProFee,0989,92563,,,,0,3.00,2.25,2.25,30.36,0.00,30.36,30.36,N/A
92564_3,SISI HEARING TEST,ProFee,0989,92700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92565_3,"STENGER TEST, PURE TONE",ProFee,0989,92565,,,,0,3.00,2.25,2.25,15.18,0.00,15.18,15.18,N/A
92567_3,TYMPANOMETRY,ProFee,0989,92567,,,,0,3.00,2.25,2.25,10.70,0.00,10.70,10.70,N/A
92568_3,ACOUSTIC REFLEX TESTING,ProFee,0989,92568,,,,0,3.00,2.25,2.25,15.18,0.00,15.18,15.18,N/A
92569_3,ACOUSTIC REFLEX DECAY TEST,ProFee,0989,92569,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92570_3,ACOUSTIC IMMITTANCE TESTING,ProFee,0989,92570,,,,0,3.00,2.25,2.25,29.33,0.00,29.33,29.33,N/A
92571_3,FILTERED SPEECH HEARING TEST,ProFee,0989,92571,,,,0,3.00,2.25,2.25,26.91,0.00,26.91,26.91,N/A
92572_3,STAGGERED SPONDAIC WORD TEST,ProFee,0989,92572,,,,0,3.00,2.25,2.25,51.75,0.00,51.75,51.75,N/A
92573_3,LOMBARD TEST,ProFee,0989,92573,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92575_3,SENSORINEURAL ACUITY TEST,ProFee,0989,92575,,,,0,3.00,2.25,2.25,46.23,0.00,46.23,46.23,N/A
92576_3,SYNTHETIC SENTENCE TEST,ProFee,0989,92576,,,,0,3.00,2.25,2.25,36.92,0.00,36.92,36.92,N/A
92577_3,"STENGER TEST, SPEECH",ProFee,0989,92577,,,,0,3.00,2.25,2.25,14.15,0.00,14.15,14.15,N/A
92579_3,VISUAL AUDIOMETRY (VRA),ProFee,0989,92579,,,,0,3.00,2.25,2.25,37.61,0.00,37.61,37.61,N/A
92582_3,CONDITIONING PLAY AUDIOMETRY,ProFee,0989,92582,,,,0,3.00,2.25,2.25,66.59,0.00,66.59,66.59,N/A
92583_3,SELECT PICTURE AUDIOMETRY,ProFee,0989,92583,,,,0,3.00,2.25,2.25,48.30,0.00,48.30,48.30,N/A
92584_3,ELECTROCOCHLEOGRAPHY,ProFee,0989,92584,,,,0,3.00,2.25,2.25,72.45,0.00,72.45,72.45,N/A
92585_3,"AUDITOR EVOKE POTENT, COMPRE",ProFee,0989,92585,,,,0,3.00,2.25,2.25,26.22,0.00,26.22,26.22,N/A
92586_3,"AUDITOR EVOKE POTENT, LIMIT",ProFee,0989,92586,,,,0,3.00,2.25,2.25,87.29,0.00,87.29,87.29,N/A
92587_3,EVOKED AUDITORY TEST,ProFee,0989,92587,,,,0,3.00,2.25,2.25,17.94,0.00,17.94,17.94,N/A
92588_3,EVOKED AUDITORY TEST,ProFee,0989,92588,,,,0,3.00,2.25,2.25,28.29,0.00,28.29,28.29,N/A
92590_3,"HEARING AID EXAM, ONE EAR",ProFee,0989,92590,,,,0,3.00,2.25,2.25,53.82,0.00,53.82,53.82,N/A
92591_3,"HEARING AID EXAM, BOTH EARS",ProFee,0989,92591,,,,0,3.00,2.25,2.25,68.31,0.00,68.31,68.31,N/A
92592_3,"HEARING AID CHECK, ONE EAR",ProFee,0989,92592,,,,0,3.00,2.25,2.25,21.39,0.00,21.39,21.39,N/A
92593_3,"HEARING AID CHECK, BOTH EARS",ProFee,0989,92593,,,,0,3.00,2.25,2.25,34.85,0.00,34.85,34.85,N/A
92594_3,"ELECTRO HEARNG AID TEST, ONE",ProFee,0989,92594,,,,0,3.00,2.25,2.25,20.36,0.00,20.36,20.36,N/A
92595_3,"ELECTRO HEARNG AID TST, BOTH",ProFee,0989,92595,,,,0,3.00,2.25,2.25,43.82,0.00,43.82,43.82,N/A
92596_3,EAR PROTECTOR EVALUATION,ProFee,0989,92596,,,,0,3.00,2.25,2.25,66.93,0.00,66.93,66.93,N/A
92597_3,ORAL SPEECH DEVICE EVAL,ProFee,0989,92597,,,,0,3.00,2.25,2.25,70.38,0.00,70.38,70.38,N/A
92601_3,COCHLEAR IMPLT F/UP EXAM < 7,ProFee,0989,92601,,,,0,3.00,2.25,2.25,123.51,0.00,123.51,123.51,N/A
92602_3,REPROGRAM COCHLEAR IMPLT < 7,ProFee,0989,92602,,,,0,3.00,2.25,2.25,70.04,0.00,70.04,70.04,N/A
92603_3,COCHLEAR IMPLT F/UP EXAM 7 >,ProFee,0989,92603,,,,0,3.00,2.25,2.25,119.72,0.00,119.72,119.72,N/A
92604_3,REPROGRAM COCHLEAR IMPLT 7 >,ProFee,0989,92604,,,,0,3.00,2.25,2.25,66.93,0.00,66.93,66.93,N/A
92605_3,EVAL FOR NONSPEECH DEVICE RX,ProFee,0989,92605,,,,0,3.00,2.25,2.25,126.50,0.00,126.50,126.50,N/A
92606_3,NON-SPEECH DEVICE SERVICE,ProFee,0989,92606,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
92607_3,"EX FOR SPEECH DEVICE RX, 1HR",ProFee,0989,92607,,,,0,3.00,2.25,2.25,185.50,0.00,185.50,185.50,N/A
92608_3,EX FOR SPEECH DEVICE RX ADDL,ProFee,0989,92608,,,,0,3.00,2.25,2.25,74.50,0.00,74.50,74.50,N/A
92609_3,USE OF SPEECH DEVICE SERVICE,ProFee,0989,92609,,,,0,3.00,2.25,2.25,155.50,0.00,155.50,155.50,N/A
92610_3,EVALUATE SWALLOWING FUNCTION,ProFee,0989,92610,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
92611_3,MOTION FLUOROSCOPY/SWALLOW,ProFee,0989,92611,,,,0,3.00,2.25,2.25,124.00,0.00,124.00,124.00,N/A
92612_3,ENDOSCOPY SWALLOW TST (FEES),ProFee,0989,92612,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
92613_3,ENDOSCOPY SWALLOW TST (FEES),ProFee,0989,92613,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
92614_3,LARYNGOSCOPIC SENSORY TEST,ProFee,0989,92614,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
92615_3,EVAL LARYNGOSCOPY SENSE TST,ProFee,0989,92615,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
92616_3,FEES W/LARYNGEAL SENSE TEST,ProFee,0989,92616,,,,0,3.00,2.25,2.25,141.50,0.00,141.50,141.50,N/A
92617_3,INTERPRT FEES/LARYNGEAL TEST,ProFee,0989,92617,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
92618_3,EX FOR NONSPEECH DEV RX ADD,ProFee,0989,92618,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
92620_3,"AUDITORY FUNCTION, 60 MIN",ProFee,0989,92620,,,,0,3.00,2.25,2.25,117.00,0.00,117.00,117.00,N/A
92621_3,"AUDITORY FUNCTION, + 15 MIN",ProFee,0989,92621,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
92625_3,TINNITUS ASSESSMENT,ProFee,0989,92625,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
92626_3,EVAL AUD REHAB STATUS,ProFee,0989,92626,,,,0,3.00,2.25,2.25,74.52,0.00,74.52,74.52,N/A
92627_3,EVAL AUD STATUS REHAB ADD-ON,ProFee,0989,92627,,,,0,3.00,2.25,2.25,17.60,0.00,17.60,17.60,N/A
92630_3,AUD REHAB PRE-LING HEAR LOSS,ProFee,0989,92630,,,,0,3.00,2.25,2.25,222.00,0.00,222.00,222.00,N/A
92633_3,AUD REHAB POSTLING HEAR LOSS,ProFee,0989,92633,,,,0,3.00,2.25,2.25,222.00,0.00,222.00,222.00,N/A
92640_3,AUD BRAINSTEM IMPLT PROGRAMG,ProFee,0989,92640,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
92700_3,ENT PROCEDURE/SERVICE,ProFee,0989,92700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92920_3,PRQ CARDIAC ANGIOPLAST 1 ART,ProFee,0989,92920,,,,0,3.00,2.25,2.25,773.50,0.00,773.50,773.50,N/A
92921_3,PRQ CARDIAC ANGIO ADDL ART,ProFee,0989,92921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92924_3,PRQ CARD ANGIO/ATHRECT 1 ART,ProFee,0989,92924,,,,0,3.00,2.25,2.25,922.00,0.00,922.00,922.00,N/A
92925_3,PRQ CARD ANGIO/ATHRECT ADDL,ProFee,0989,92925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92928_3,PRQ CARD STENT W/ANGIO 1 VSL,ProFee,0989,92928,,,,0,3.00,2.25,2.25,860.50,0.00,860.50,860.50,N/A
92929_3,PRQ CARD STENT W/ANGIO ADDL,ProFee,0989,92929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92933_3,PRQ CARD STENT/ATH/ANGIO,ProFee,0989,92933,,,,0,3.00,2.25,2.25,964.50,0.00,964.50,964.50,N/A
92934_3,PRQ CARD STENT/ATH/ANGIO,ProFee,0989,92934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92937_3,PRQ REVASC BYP GRAFT 1 VSL,ProFee,0989,92937,,,,0,3.00,2.25,2.25,859.50,0.00,859.50,859.50,N/A
92938_3,PRQ REVASC BYP GRAFT ADDL,ProFee,0989,92938,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92941_3,PRQ CARD REVASC MI 1 VSL,ProFee,0989,92941,,,,0,3.00,2.25,2.25,966.50,0.00,966.50,966.50,N/A
92943_3,PRQ CARD REVASC CHRONIC 1VSL,ProFee,0989,92943,,,,0,3.00,2.25,2.25,966.50,0.00,966.50,966.50,N/A
92944_3,PRQ CARD REVASC CHRONIC ADDL,ProFee,0989,92944,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
92950_3,HEART/LUNG RESUSCITATION CPR,ProFee,0989,92950,,,,0,3.00,2.25,2.25,267.00,0.00,267.00,267.00,N/A
92953_3,TEMPORARY EXTERNAL PACING,ProFee,0989,92953,,,,0,3.00,2.25,1.50,2.25,0.00,1.50,1.50,N/A
92961_3,"CARDIOVERSION, ELECTRIC, INT",ProFee,0989,92961,,,,0,3.00,2.25,2.25,363.00,0.00,363.00,363.00,N/A
92970_3,"CARDIOASSIST, INTERNAL",ProFee,0989,92970,,,,0,3.00,2.25,2.25,287.00,0.00,287.00,287.00,N/A
92971_3,"CARDIOASSIST, EXTERNAL",ProFee,0989,92971,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
92973_3,PERCUT CORONARY THROMBECTOMY,ProFee,0989,92973,,,,0,3.00,2.25,2.25,257.50,0.00,257.50,257.50,N/A
92974_3,"CATH PLACE, CARDIO BRACHYTX",ProFee,0989,92974,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
92975_3,"DISSOLVE CLOT, HEART VESSEL",ProFee,0989,92975,,,,0,3.00,2.25,2.25,548.00,0.00,548.00,548.00,N/A
92977_3,"DISSOLVE CLOT, HEART VESSEL",ProFee,0989,92977,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
92978_3,"INTRAVASC US, HEART ADD-ON",ProFee,0989,92978,,,,0,3.00,2.25,2.25,138.50,0.00,138.50,138.50,N/A
92979_3,"INTRAVASC US, HEART ADD-ON",ProFee,0989,92979,,,,0,3.00,2.25,2.25,111.50,0.00,111.50,111.50,N/A
92980_3,INSERT INTRACORONARY STENT,ProFee,0989,92980,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92981_3,INSERT INTRACORONARY STENT,ProFee,0989,92981,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92982_3,CORONARY ARTERY DILATION,ProFee,0989,92982,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92984_3,CORONARY ARTERY DILATION,ProFee,0989,92984,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92986_3,REVISION OF AORTIC VALVE,ProFee,0989,92986,,,,0,3.00,2.25,2.25,1916.50,0.00,1916.50,1916.50,N/A
92987_3,REVISION OF MITRAL VALVE,ProFee,0989,92987,,,,0,3.00,2.25,2.25,1977.00,0.00,1977.00,1977.00,N/A
92990_3,REVISION OF PULMONARY VALVE,ProFee,0989,92990,,,,0,3.00,2.25,2.25,1579.50,0.00,1579.50,1579.50,N/A
92992_3,REVISION OF HEART CHAMBER,ProFee,0989,92992,,,,0,3.00,2.25,2.25,1549.00,0.00,1549.00,1549.00,N/A
92993_3,REVISION OF HEART CHAMBER,ProFee,0989,92993,,,,0,3.00,2.25,2.25,1225.00,0.00,1225.00,1225.00,N/A
92995_3,CORONARY ATHERECTOMY,ProFee,0989,92995,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92996_3,CORONARY ATHERECTOMY ADD-ON,ProFee,0989,92996,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
92997_3,"PUL ART BALLOON REPR, PERCUT",ProFee,0989,92997,,,,0,3.00,2.25,2.25,952.50,0.00,952.50,952.50,N/A
92998_3,"PUL ART BALLOON REPR, PERCUT",ProFee,0989,92998,,,,0,3.00,2.25,2.25,472.50,0.00,472.50,472.50,N/A
93000_3,"ELECTROCARDIOGRAM, COMPLETE",ProFee,0989,93000,,,,0,3.00,2.25,2.25,24.00,0.00,24.00,24.00,N/A
93005_3,"ELECTROCARDIOGRAM, TRACING",ProFee,0989,93005,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
93010_3,ELECTROCARDIOGRAM REPORT,ProFee,0989,93010,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
93012_3,TRANSMISSION OF ECG,ProFee,0989,93012,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93014_3,REPORT ON TRANSMITTED ECG,ProFee,0989,93014,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93015_3,CARDIOVASCULAR STRESS TEST,ProFee,0989,93015,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
93016_3,CARDIOVASCULAR STRESS TEST,ProFee,0989,93016,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
93017_3,CARDIOVASCULAR STRESS TEST,ProFee,0989,93017,,,,0,3.00,2.25,2.25,48.50,0.00,48.50,48.50,N/A
93018_3,CARDIOVASCULAR STRESS TEST,ProFee,0989,93018,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
93024_3,CARDIAC DRUG STRESS TEST,ProFee,0989,93024,,,,0,3.00,2.25,2.25,81.00,0.00,81.00,81.00,N/A
93025_3,MICROVOLT T-WAVE ASSESS,ProFee,0989,93025,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
93040_3,RHYTHM ECG WITH REPORT,ProFee,0989,93040,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
93041_3,"RHYTHM ECG, TRACING",ProFee,0989,93041,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
93042_3,"RHYTHM ECG, REPORT",ProFee,0989,93042,,,,0,3.00,2.25,2.25,10.00,0.00,10.00,10.00,N/A
93050_3,ART PRESSURE WAVEFORM ANALYS,ProFee,0989,93050,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
93228_3,REMOTE 30 DAY ECG REV/REPORT,ProFee,0989,93228,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
93229_3,REMOTE 30 DAY ECG TECH SUPP,ProFee,0989,93229,,,,0,3.00,2.25,2.25,1032.50,0.00,1032.50,1032.50,N/A
93230_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93230,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93231_3,"ECG MONITOR/RECORD, 24 HRS",ProFee,0989,93231,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93232_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93232,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93233_3,"ECG MONITOR/REVIEW, 24 HRS",ProFee,0989,93233,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93235_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93235,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93236_3,"ECG MONITOR/REPORT, 24 HRS",ProFee,0989,93236,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93237_3,"ECG MONITOR/REVIEW, 24 HRS",ProFee,0989,93237,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93260_3,PRGRMG DEV EVAL IMPLTBL SYS,ProFee,0989,93260,,,,0,3.00,2.25,2.25,61.50,0.00,61.50,61.50,N/A
93261_3,INTERROGATE SUBQ DEFIB,ProFee,0989,93261,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
93264_3,REM MNTR WRLS P-ART PRS SNR,ProFee,0989,93264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
93268_3,ECG RECORD/REVIEW,ProFee,0989,93268,,,,0,3.00,2.25,2.25,291.50,0.00,291.50,291.50,N/A
93270_3,ECG RECORDING,ProFee,0989,93270,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
93271_3,ECG/MONITORING AND ANALYSIS,ProFee,0989,93271,,,,0,3.00,2.25,2.25,242.50,0.00,242.50,242.50,N/A
93272_3,"ECG/REVIEW, INTERPRET ONLY",ProFee,0989,93272,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
93278_3,ECG/SIGNAL-AVERAGED,ProFee,0989,93278,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
93279_3,"PM DEVICE PROGR EVAL,  SNGL",ProFee,0989,93279,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
93280_3,"PM DEVICE PROGR EVAL,  DUAL",ProFee,0989,93280,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
93281_3,"PM DEVICE PROGR EVAL, MULTI",ProFee,0989,93281,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
93282_3,"ICD DEVICE PROG EVAL, 1 SNGL",ProFee,0989,93282,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
93283_3,"ICD DEVICE PROGR EVAL, DUAL",ProFee,0989,93283,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
93284_3,"ICD DEVICE PROGR EVAL, MULT",ProFee,0989,93284,,,,0,3.00,2.25,2.25,89.50,0.00,89.50,89.50,N/A
93285_3,ILR DEVICE EVAL PROGR,ProFee,0989,93285,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
93286_3,PRE-OP PM DEVICE EVAL,ProFee,0989,93286,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
93287_3,PRE-OP ICD DEVICE EVAL,ProFee,0989,93287,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
93288_3,PM DEVICE EVAL IN PERSON,ProFee,0989,93288,,,,0,3.00,2.25,2.25,30.50,0.00,30.50,30.50,N/A
93289_3,ICD DEVICE INTERROGATE,ProFee,0989,93289,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
93290_3,ICM DEVICE EVAL,ProFee,0989,93290,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
93291_3,ILR DEVICE INTERROGATE,ProFee,0989,93291,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
93292_3,WCD DEVICE INTERROGATE,ProFee,0989,93292,,,,0,3.00,2.25,2.25,30.50,0.00,30.50,30.50,N/A
93293_3,PM PHONE R-STRIP DEVICE EVAL,ProFee,0989,93293,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
93294_3,PM DEVICE INTERROGATE REMOTE,ProFee,0989,93294,,,,0,3.00,2.25,2.25,43.50,0.00,43.50,43.50,N/A
93295_3,ICD DEVICE INTERROGAT REMOTE,ProFee,0989,93295,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
93296_3,PM/ICD REMOTE TECH SERV,ProFee,0989,93296,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
93297_3,ICM DEVICE INTERROGAT REMOTE,ProFee,0989,93297,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
93298_3,ILR DEVICE INTERROGAT REMOTE,ProFee,0989,93298,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
93303_3,ECHO TRANSTHORACIC,ProFee,0989,93303,,,,0,3.00,2.25,2.25,90.50,0.00,90.50,90.50,N/A
93304_3,ECHO TRANSTHORACIC,ProFee,0989,93304,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
93306_3,"TTE W/DOPPLER, COMPLETE",ProFee,0989,93306,,,,0,3.00,2.25,2.25,104.00,0.00,104.00,104.00,N/A
93307_3,ECHO EXAM OF HEART,ProFee,0989,93307,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
93308_3,ECHO EXAM OF HEART,ProFee,0989,93308,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
93312_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93312,,,,0,3.00,2.25,2.25,155.50,0.00,155.50,155.50,N/A
93313_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93313,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
93314_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93314,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
93315_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93315,,,,0,3.00,2.25,2.25,183.50,0.00,183.50,183.50,N/A
93316_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93316,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
93317_3,ECHO TRANSESOPHAGEAL,ProFee,0989,93317,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
93318_3,ECHO TRANSESOPHAGEAL INTRAOP,ProFee,0989,93318,,,,0,3.00,2.25,2.25,149.50,0.00,149.50,149.50,N/A
93320_3,"DOPPLER ECHO EXAM, HEART",ProFee,0989,93320,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
93321_3,"DOPPLER ECHO EXAM, HEART",ProFee,0989,93321,,,,0,3.00,2.25,2.25,10.50,0.00,10.50,10.50,N/A
93325_3,DOPPLER COLOR FLOW ADD-ON,ProFee,0989,93325,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
93350_3,ECHO TRANSTHORACIC,ProFee,0989,93350,,,,0,3.00,2.25,2.25,101.00,0.00,101.00,101.00,N/A
93351_3,STRESS TTE COMPLETE,ProFee,0989,93351,,,,0,3.00,2.25,2.25,121.00,0.00,121.00,121.00,N/A
93352_3,ADMIN ECG CONTRAST AGENT,ProFee,0989,93352,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
93355_3,ECHO TRANSESOPHAGEAL (TEE),ProFee,0989,93355,,,,0,3.00,2.25,2.25,324.50,0.00,324.50,324.50,N/A
93356_3,MYOCRD STRAIN IMG SPCKL TRCK,ProFee,0989,93356,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93451_3,RIGHT HEART CATH,ProFee,0989,93451,,,,0,3.00,2.25,2.25,189.50,0.00,189.50,189.50,N/A
93452_3,LEFT HRT CATH W/VENTRCLGRPHY,ProFee,0989,93452,,,,0,3.00,2.25,2.25,346.00,0.00,346.00,346.00,N/A
93453_3,R&L HRT CATH W/VENTRICLGRPHY,ProFee,0989,93453,,,,0,3.00,2.25,2.25,463.00,0.00,463.00,463.00,N/A
93454_3,CORONARY ARTERY ANGIO S&I,ProFee,0989,93454,,,,0,3.00,2.25,2.25,349.50,0.00,349.50,349.50,N/A
93455_3,CORONARY ART/GRFT ANGIO S&I,ProFee,0989,93455,,,,0,3.00,2.25,2.25,408.00,0.00,408.00,408.00,N/A
93456_3,R HRT CORONARY ARTERY ANGIO,ProFee,0989,93456,,,,0,3.00,2.25,2.25,455.00,0.00,455.00,455.00,N/A
93457_3,R HRT ART/GRFT ANGIO,ProFee,0989,93457,,,,0,3.00,2.25,2.25,512.00,0.00,512.00,512.00,N/A
93458_3,L HRT ARTERY/VENTRICLE ANGIO,ProFee,0989,93458,,,,0,3.00,2.25,2.25,432.00,0.00,432.00,432.00,N/A
93459_3,L HRT ART/GRFT ANGIO,ProFee,0989,93459,,,,0,3.00,2.25,2.25,490.00,0.00,490.00,490.00,N/A
93460_3,R&L HRT ART/VENTRICLE ANGIO,ProFee,0989,93460,,,,0,3.00,2.25,2.25,548.50,0.00,548.50,548.50,N/A
93461_3,R&L HRT ART/VENTRICLE ANGIO,ProFee,0989,93461,,,,0,3.00,2.25,2.25,605.50,0.00,605.50,605.50,N/A
93462_3,L HRT CATH TRNSPTL PUNCTURE,ProFee,0989,93462,,,,0,3.00,2.25,2.25,305.50,0.00,305.50,305.50,N/A
93463_3,DRUG ADMIN & HEMODYNMIC MEAS,ProFee,0989,93463,,,,0,3.00,2.25,2.25,140.50,0.00,140.50,140.50,N/A
93464_3,EXERCISE W/HEMODYNAMIC MEAS,ProFee,0989,93464,,,,0,3.00,2.25,2.25,124.50,0.00,124.50,124.50,N/A
93501_3,RIGHT HEART CATHETERIZATION,ProFee,0989,93501,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93503_3,INSERT/PLACE HEART CATHETER,ProFee,0989,93503,,,,0,3.00,2.25,2.25,149.50,0.00,149.50,149.50,N/A
93505_3,BIOPSY OF HEART LINING,ProFee,0989,93505,,,,0,3.00,2.25,2.25,317.00,0.00,317.00,317.00,N/A
93508_3,"CATH PLACEMENT, ANGIOGRAPHY",ProFee,0989,93508,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93510_3,LEFT HEART CATHETERIZATION,ProFee,0989,93510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93511_3,LEFT HEART CATHETERIZATION,ProFee,0989,93511,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93514_3,LEFT HEART CATHETERIZATION,ProFee,0989,93514,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93524_3,LEFT HEART CATHETERIZATION,ProFee,0989,93524,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93526_3,RT & LT HEART CATHETERS,ProFee,0989,93526,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93527_3,RT & LT HEART CATHETERS,ProFee,0989,93527,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93528_3,RT & LT HEART CATHETERS,ProFee,0989,93528,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93529_3,"RT, LT HEART CATHETERIZATION",ProFee,0989,93529,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93530_3,"RT HEART CATH, CONGENITAL",ProFee,0989,93530,,,,0,3.00,2.25,2.25,297.50,0.00,297.50,297.50,N/A
93531_3,"R & L HEART CATH, CONGENITAL",ProFee,0989,93531,,,,0,3.00,2.25,2.25,619.00,0.00,619.00,619.00,N/A
93532_3,"R & L HEART CATH, CONGENITAL",ProFee,0989,93532,,,,0,3.00,2.25,2.25,745.50,0.00,745.50,745.50,N/A
93533_3,"R & L HEART CATH, CONGENITAL",ProFee,0989,93533,,,,0,3.00,2.25,2.25,502.00,0.00,502.00,502.00,N/A
93539_3,"INJECTION, CARDIAC CATH",ProFee,0989,93539,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93540_3,"INJECTION, CARDIAC CATH",ProFee,0989,93540,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93541_3,INJECTION FOR LUNG ANGIOGRAM,ProFee,0989,93541,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93542_3,INJECTION FOR HEART X-RAYS,ProFee,0989,93542,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93543_3,INJECTION FOR HEART X-RAYS,ProFee,0989,93543,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93544_3,INJECTION FOR AORTOGRAPHY,ProFee,0989,93544,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93545_3,INJECT FOR CORONARY X-RAYS,ProFee,0989,93545,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93555_3,"IMAGING, CARDIAC CATH",ProFee,0989,93555,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93556_3,"IMAGING, CARDIAC CATH",ProFee,0989,93556,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93561_3,CARDIAC OUTPUT MEASUREMENT,ProFee,0989,93598,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93562_3,CARDIAC OUTPUT MEASUREMENT,ProFee,0989,93598,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93563_3,INJECT CONGENITAL CARD CATH,ProFee,0989,93563,,,,0,3.00,2.25,2.25,84.50,0.00,84.50,84.50,N/A
93564_3,INJECT HRT CONGNTL ART/GRFT,ProFee,0989,93564,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
93565_3,INJECT L VENTR/ATRIAL ANGIO,ProFee,0989,93565,,,,0,3.00,2.25,2.25,65.50,0.00,65.50,65.50,N/A
93566_3,INJECT R VENTR/ATRIAL ANGIO,ProFee,0989,93566,,,,0,3.00,2.25,2.25,67.50,0.00,67.50,67.50,N/A
93567_3,INJECT SUPRVLV AORTOGRAPHY,ProFee,0989,93567,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
93568_3,INJECT PULM ART HRT CATH,ProFee,0989,93568,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
93571_3,HEART FLOW RESERVE MEASURE,ProFee,0989,93571,,,,0,3.00,2.25,2.25,138.50,0.00,138.50,138.50,N/A
93572_3,HEART FLOW RESERVE MEASURE,ProFee,0989,93572,,,,0,3.00,2.25,2.25,111.50,0.00,111.50,111.50,N/A
93580_3,TRANSCATH CLOSURE OF ASD,ProFee,0989,93580,,,,0,3.00,2.25,2.25,1421.00,0.00,1421.00,1421.00,N/A
93581_3,TRANSCATH CLOSURE OF VSD,ProFee,0989,93581,,,,0,3.00,2.25,2.25,1936.00,0.00,1936.00,1936.00,N/A
93582_3,PERQ TRANSCATH CLOSURE PDA,ProFee,0989,93582,,,,0,3.00,2.25,2.25,968.00,0.00,968.00,968.00,N/A
93583_3,PERQ TRANSCATH SEPTAL REDUXN,ProFee,0989,93583,,,,0,3.00,2.25,2.25,1080.50,0.00,1080.50,1080.50,N/A
93590_3,PERQ TRANSCATH CLS MITRAL,ProFee,0989,93590,,,,0,3.00,2.25,2.25,1553.50,0.00,1553.50,1553.50,N/A
93591_3,PERQ TRANSCATH CLS AORTIC,ProFee,0989,93591,,,,0,3.00,2.25,2.25,1290.00,0.00,1290.00,1290.00,N/A
93592_3,PERQ TRANSCATH CLOSURE EACH,ProFee,0989,93592,,,,0,3.00,2.25,2.25,567.50,0.00,567.50,567.50,N/A
93600_3,BUNDLE OF HIS RECORDING,ProFee,0989,93600,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
93602_3,INTRA-ATRIAL RECORDING,ProFee,0989,93602,,,,0,3.00,2.25,2.25,168.00,0.00,168.00,168.00,N/A
93603_3,RIGHT VENTRICULAR RECORDING,ProFee,0989,93603,,,,0,3.00,2.25,2.25,168.00,0.00,168.00,168.00,N/A
93609_3,"MAP TACHYCARDIA, ADD-ON",ProFee,0989,93609,,,,0,3.00,2.25,2.25,404.50,0.00,404.50,404.50,N/A
93610_3,INTRA-ATRIAL PACING,ProFee,0989,93610,,,,0,3.00,2.25,2.25,238.00,0.00,238.00,238.00,N/A
93612_3,INTRAVENTRICULAR PACING,ProFee,0989,93612,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
93613_3,"ELECTROPHYS MAP 3D, ADD-ON",ProFee,0989,93613,,,,0,3.00,2.25,2.25,469.00,0.00,469.00,469.00,N/A
93615_3,ESOPHAGEAL RECORDING,ProFee,0989,93615,,,,0,3.00,2.25,2.25,55.00,0.00,55.00,55.00,N/A
93616_3,ESOPHAGEAL RECORDING,ProFee,0989,93616,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
93618_3,HEART RHYTHM PACING,ProFee,0989,93618,,,,0,3.00,2.25,2.25,322.00,0.00,322.00,322.00,N/A
93619_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93619,,,,0,3.00,2.25,2.25,568.50,0.00,568.50,568.50,N/A
93620_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93620,,,,0,3.00,2.25,2.25,913.00,0.00,913.00,913.00,N/A
93621_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93621,,,,0,3.00,2.25,2.25,170.50,0.00,170.50,170.50,N/A
93622_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93622,,,,0,3.00,2.25,2.25,250.50,0.00,250.50,250.50,N/A
93623_3,"STIMULATION, PACING HEART",ProFee,0989,93623,,,,0,3.00,2.25,2.25,231.00,0.00,231.00,231.00,N/A
93624_3,ELECTROPHYSIOLOGIC STUDY,ProFee,0989,93624,,,,0,3.00,2.25,2.25,362.50,0.00,362.50,362.50,N/A
93631_3,"HEART PACING, MAPPING",ProFee,0989,93631,,,,0,3.00,2.25,2.25,575.50,0.00,575.50,575.50,N/A
93640_3,EVALUATION HEART DEVICE,ProFee,0989,93640,,,,0,3.00,2.25,2.25,260.00,0.00,260.00,260.00,N/A
93641_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93641,,,,0,3.00,2.25,2.25,454.50,0.00,454.50,454.50,N/A
93642_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93642,,,,0,3.00,2.25,2.25,373.00,0.00,373.00,373.00,N/A
93644_3,ELECTROPHYSIOLOGY EVALUATION,ProFee,0989,93644,,,,0,3.00,2.25,2.25,213.50,0.00,213.50,213.50,N/A
93650_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,93650,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
93651_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,93651,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93652_3,ABLATE HEART DYSRHYTHM FOCUS,ProFee,0989,93652,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93653_3,EP & ABLATE SUPRAVENT ARRHYT,ProFee,0989,93653,,,,0,3.00,2.25,2.25,1216.50,0.00,1216.50,1216.50,N/A
93654_3,EP & ABLATE VENTRIC TACHY,ProFee,0989,93654,,,,0,3.00,2.25,2.25,1629.50,0.00,1629.50,1629.50,N/A
93655_3,ABLATE ARRHYTHMIA ADD ON,ProFee,0989,93655,,,,0,3.00,2.25,2.25,620.00,0.00,620.00,620.00,N/A
93656_3,TX ATRIAL FIB PULM VEIN ISOL,ProFee,0989,93656,,,,0,3.00,2.25,2.25,1634.00,0.00,1634.00,1634.00,N/A
93657_3,TX L/R ATRIAL FIB ADDL,ProFee,0989,93657,,,,0,3.00,2.25,2.25,619.50,0.00,619.50,619.50,N/A
93660_3,TILT TABLE EVALUATION,ProFee,0989,93660,,,,0,3.00,2.25,2.25,133.50,0.00,133.50,133.50,N/A
93662_3,INTRACARDIAC ECG (ICE),ProFee,0989,93662,,,,0,3.00,2.25,2.25,204.00,0.00,204.00,204.00,N/A
93668_3,PERIPHERAL VASCULAR REHAB,ProFee,0989,93668,,,,0,3.00,2.25,2.25,27.50,0.00,27.50,27.50,N/A
93701_3,"BIOIMPEDANCE, THORACIC",ProFee,0989,93701,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
93702_3,BIS XTRACELL FLUID ANALYSIS,ProFee,0989,93702,,,,0,3.00,2.25,2.25,175.00,0.00,175.00,175.00,N/A
93720_3,TOTAL BODY PLETHYSMOGRAPHY,ProFee,0989,93720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93721_3,PLETHYSMOGRAPHY TRACING,ProFee,0989,93721,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93722_3,PLETHYSMOGRAPHY REPORT,ProFee,0989,93722,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93724_3,ANALYZE PACEMAKER SYSTEM,ProFee,0989,93724,,,,0,3.00,2.25,2.25,345.50,0.00,345.50,345.50,N/A
93727_3,ANALYZE ILR SYSTEM,ProFee,0989,93727,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93731_3,ANALYZE PACEMAKER SYSTEM,ProFee,0989,93731,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93732_3,ANALYZE PACEMAKER SYSTEM,ProFee,0989,93732,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93733_3,"TELEPHONE ANALY, PACEMAKER",ProFee,0989,93733,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93734_3,ANALYZE PACEMAKER SYSTEM,ProFee,0989,93734,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93735_3,ANALYZE PACEMAKER SYSTEM,ProFee,0989,93735,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93736_3,"TELEPHONIC ANALY, PACEMAKER",ProFee,0989,93736,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93740_3,TEMPERATURE GRADIENT STUDIES,ProFee,0989,93740,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
93741_3,ANALYZE HT PACE DEVICE SNGL,ProFee,0989,93741,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93742_3,ANALYZE HT PACE DEVICE SNGL,ProFee,0989,93742,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93743_3,ANALYZE HT PACE DEVICE DUAL,ProFee,0989,93743,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93744_3,ANALYZE HT PACE DEVICE DUAL,ProFee,0989,93744,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93745_3,SET-UP CARDIOVERT-DEFIBRILL,ProFee,0989,93745,,,,0,3.00,2.25,2.25,53.00,0.00,53.00,53.00,N/A
93750_3,"INTERROGATION VAD, IN PERSON",ProFee,0989,93750,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
93760_3,CEPHALIC THERMOGRAM,ProFee,0989,93760,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93762_3,PERIPHERAL THERMOGRAM,ProFee,0989,93762,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93770_3,MEASURE VENOUS PRESSURE,ProFee,0989,93770,,,,0,3.00,2.25,2.25,11.50,0.00,11.50,11.50,N/A
93784_3,AMBULATORY BP MONITORING,ProFee,0989,93784,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
93786_3,AMBULATORY BP RECORDING,ProFee,0989,93786,,,,0,3.00,2.25,2.25,42.00,0.00,42.00,42.00,N/A
93788_3,AMBULATORY BP ANALYSIS,ProFee,0989,93788,,,,0,3.00,2.25,2.25,7.50,0.00,7.50,7.50,N/A
93790_3,REVIEW/REPORT BP RECORDING,ProFee,0989,93790,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
93792_3,PT/CAREGIVER TRAING HOME INR,ProFee,0989,93792,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
93793_3,ANTICOAG MGMT PT WARFARIN,ProFee,0989,93793,,,,0,3.00,2.25,2.25,17.00,0.00,17.00,17.00,N/A
93797_3,CARDIAC REHAB,ProFee,0989,93797,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
93798_3,CARDIAC REHAB/MONITOR,ProFee,0989,93798,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
93799_3,CARDIOVASCULAR PROCEDURE,ProFee,0989,93799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
93875_3,EXTRACRANIAL STUDY,ProFee,0989,93875,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93880_3,EXTRACRANIAL STUDY,ProFee,0989,93880,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
93882_3,EXTRACRANIAL STUDY,ProFee,0989,93882,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
93886_3,INTRACRANIAL STUDY,ProFee,0989,93886,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
93888_3,INTRACRANIAL STUDY,ProFee,0989,93888,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
93890_3,"TCD, VASOREACTIVITY STUDY",ProFee,0989,93890,,,,0,3.00,2.25,2.25,73.00,0.00,73.00,73.00,N/A
93892_3,"TCD, EMBOLI DETECT W/O INJ",ProFee,0989,93892,,,,0,3.00,2.25,2.25,85.50,0.00,85.50,85.50,N/A
93893_3,"TCD, EMBOLI DETECT W/INJ",ProFee,0989,93893,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
93895_3,CAROTID INTIMA ATHEROMA EVAL,ProFee,0989,93895,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
93922_3,EXTREMITY STUDY,ProFee,0989,93922,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
93923_3,EXTREMITY STUDY,ProFee,0989,93923,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
93924_3,EXTREMITY STUDY,ProFee,0989,93924,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
93925_3,LOWER EXTREMITY STUDY,ProFee,0989,93925,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
93926_3,LOWER EXTREMITY STUDY,ProFee,0989,93926,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
93930_3,UPPER EXTREMITY STUDY,ProFee,0989,93930,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
93931_3,UPPER EXTREMITY STUDY,ProFee,0989,93931,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
93965_3,EXTREMITY STUDY,ProFee,0989,93965,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93970_3,EXTREMITY STUDY,ProFee,0989,93970,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
93971_3,EXTREMITY STUDY,ProFee,0989,93971,,,,0,3.00,2.25,2.25,32.00,0.00,32.00,32.00,N/A
93975_3,VASCULAR STUDY,ProFee,0989,93975,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
93976_3,VASCULAR STUDY,ProFee,0989,93976,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
93978_3,VASCULAR STUDY,ProFee,0989,93978,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
93979_3,VASCULAR STUDY,ProFee,0989,93979,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
93980_3,PENILE VASCULAR STUDY,ProFee,0989,93980,,,,0,3.00,2.25,2.25,88.00,0.00,88.00,88.00,N/A
93981_3,PENILE VASCULAR STUDY,ProFee,0989,93981,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
93982_3,ANEURYSM PRESSURE SENS STUDY,ProFee,0989,93982,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93985_3,DUP-SCAN HEMO COMPL BI STD,ProFee,0989,93985,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93986_3,DUP-SCAN HEMO COMPL UNI STD,ProFee,0989,93986,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
93990_3,DOPPLER FLOW TESTING,ProFee,0989,93990,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
93998_3,NONINVAS VASC DX STUDY PROC,ProFee,0989,93998,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
94002_3,"VENT MGMT INPAT, INIT DAY",ProFee,0989,94002,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
94003_3,"VENT MGMT INPAT, SUBQ DAY",ProFee,0989,94003,,,,0,3.00,2.25,2.25,95.00,0.00,95.00,95.00,N/A
94004_3,VENT MGMT NF PER DAY,ProFee,0989,94004,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
94005_3,HOME VENT MGMT SUPERVISION,ProFee,0989,94005,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
94011_3,"UP TO 2 YRS OLD, SPIROMETRY",ProFee,0989,94011,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
94012_3,"= 2 YRS, SPIROMTRY W/DILATOR",ProFee,0989,94012,,,,0,3.00,2.25,2.25,201.00,0.00,201.00,201.00,N/A
94013_3,"= 2 YRS, LUNG VOLUMES",ProFee,0989,94013,,,,0,3.00,2.25,2.25,27.50,0.00,27.50,27.50,N/A
94014_3,PATIENT RECORDED SPIROMETRY,ProFee,0989,94014,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
94015_3,PATIENT RECORDED SPIROMETRY,ProFee,0989,94015,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
94016_3,REVIEW PATIENT SPIROMETRY,ProFee,0989,94016,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
94060_2,Bronchodilation Responsiveness Pre- And Post-Bronchodilator Admin,ProFee,0989,94060,,,,0,180.00,135.00,18.50,135.00,0.00,18.50,18.50,N/A
94060_3,Bronchodilation Responsiveness Pre- And Post-Bronchodilator Admin,ProFee,0989,94060,,,,0,180.00,135.00,18.50,135.00,0.00,18.50,18.50,N/A
94070_3,EVALUATION OF WHEEZING,ProFee,0989,94070,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
94200_2,LUNG FUNCTION TEST (MBC/MVV),ProFee,0989,94200,,,,0,220.00,165.00,8.00,165.00,0.00,8.00,8.00,N/A
94200_3,LUNG FUNCTION TEST (MBC/MVV),ProFee,0989,94200,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
94240_3,RESIDUAL LUNG CAPACITY,ProFee,0989,94240,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94250_3,EXPIRED GAS COLLECTION,ProFee,0989,94250,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
94260_3,THORACIC GAS VOLUME,ProFee,0989,94260,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94350_3,LUNG NITROGEN WASHOUT CURVE,ProFee,0989,94350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94360_3,MEASURE AIRFLOW RESISTANCE,ProFee,0989,94360,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94370_3,BREATH AIRWAY CLOSING VOLUME,ProFee,0989,94370,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94375_3,RESPIRATORY FLOW VOLUME LOOP,ProFee,0989,94375,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
94400_3,CO2 BREATHING RESPONSE CURVE,ProFee,0989,94400,,,,0,3.00,2.25,2.25,28.00,0.00,28.00,28.00,N/A
94450_3,HYPOXIA RESPONSE CURVE,ProFee,0989,94450,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
94452_3,HAST W/REPORT,ProFee,0989,94452,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
94453_3,HAST W/OXYGEN TITRATE,ProFee,0989,94453,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
94610_3,SURFACTANT ADMIN THRU TUBE,ProFee,0989,94610,,,,0,3.00,2.25,2.25,79.50,0.00,79.50,79.50,N/A
94617_3,EXERCISE TST BRNCSPSM,ProFee,0989,94617,,,,0,3.00,2.25,2.25,47.50,0.00,47.50,47.50,N/A
94618_3,PULMONARY STRESS TESTING,ProFee,0989,94618,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
94620_3,PULMONARY STRESS TEST/SIMPLE,ProFee,0989,94618,,,,0,3.00,2.25,2.25,32.50,0.00,32.50,32.50,N/A
94621_3,PULM STRESS TEST/COMPLEX,ProFee,0989,94621,,,,0,3.00,2.25,2.25,98.00,0.00,98.00,98.00,N/A
94640_2,AIRWAY INHALATION TREATMENT,ProFee,0989,94640,,,,0,186.00,139.50,26.50,139.50,0.00,26.50,26.50,N/A
94640_3,AIRWAY INHALATION TREATMENT,ProFee,0989,94640,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
94642_3,AEROSOL INHALATION TREATMENT,ProFee,0989,94642,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
94644_3,"CBT, 1ST HOUR",ProFee,0989,94644,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
94645_3,"CBT, EACH ADDL HOUR",ProFee,0989,94645,,,,0,3.00,2.25,2.25,23.00,0.00,23.00,23.00,N/A
94656_3,INITIAL VENTILATOR MGMT,ProFee,0989,94656,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94657_3,CONTINUED VENTILATOR MGMT,ProFee,0989,94657,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94660_3,"POS AIRWAY PRESSURE, CPAP",ProFee,0989,94660,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
94662_3,"NEG PRESS VENTILATION, CNP",ProFee,0989,94662,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
94664_3,EVALUATE PT USE OF INHALER,ProFee,0989,94664,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
94667_3,CHEST WALL MANIPULATION,ProFee,0989,94667,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
94668_3,CHEST WALL MANIPULATION,ProFee,0989,94668,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
94669_3,MECHANICAL CHEST WALL OSCILL,ProFee,0989,94669,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
94680_3,"EXHALED AIR ANALYSIS, O2",ProFee,0989,94680,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
94681_3,"EXHALED AIR ANALYSIS, O2/CO2",ProFee,0989,94681,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
94690_3,EXHALED AIR ANALYSIS,ProFee,0989,94690,,,,0,3.00,2.25,2.25,5.50,0.00,5.50,5.50,N/A
94720_3,MONOXIDE DIFFUSING CAPACITY,ProFee,0989,94720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94725_3,MEMBRANE DIFFUSION CAPACITY,ProFee,0989,94725,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
94726_3,PULM FUNCT TST PLETHYSMOGRAP,ProFee,0989,94726,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
94727_3,PULM FUNCTION TEST BY GAS,ProFee,0989,94727,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
94728_3,PULM FUNCT TEST OSCILLOMETRY,ProFee,0989,94728,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
94729_3,C0/MEMBANE DIFFUSE CAPACITY,ProFee,0989,94729,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
94750_3,PULMONARY COMPLIANCE STUDY,ProFee,0989,94750,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
94761_3,MEASURE BLOOD OXYGEN LEVEL,ProFee,0989,94761,,,,0,3.00,2.25,2.25,6.50,0.00,6.50,6.50,N/A
94770_3,EXHALED CARBON DIOXIDE TEST,ProFee,0989,94770,,,,0,3.00,2.25,2.25,10.50,0.00,10.50,10.50,N/A
94772_3,"BREATH RECORDING, INFANT",ProFee,0989,94772,,,,0,3.00,2.25,2.25,158.00,0.00,158.00,158.00,N/A
94774_3,"PED HOME APNEA REC, COMPL",ProFee,0989,94774,,,,0,3.00,2.25,2.25,435.50,0.00,435.50,435.50,N/A
94775_3,"PED HOME APNEA REC, HK-UP",ProFee,0989,94775,,,,0,3.00,2.25,2.25,68.50,0.00,68.50,68.50,N/A
94776_3,"PED HOME APNEA REC, DOWNLD",ProFee,0989,94776,,,,0,3.00,2.25,2.25,325.50,0.00,325.50,325.50,N/A
94777_3,"PED HOME APNEA REC, REPORT",ProFee,0989,94777,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
94780_3,CAR SEAT/BED TEST 60 MIN,ProFee,0989,94780,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
94781_3,CAR SEAT/BED TEST + 30 MIN,ProFee,0989,94781,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
94799_3,PULMONARY SERVICE/PROCEDURE,ProFee,0989,94799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95004_3,PERCUT ALLERGY SKIN TESTS,ProFee,0989,95004,,,,0,3.00,2.25,2.25,7.50,0.00,7.50,7.50,N/A
95010_3,PERCUT ALLERGY TITRATE TEST,ProFee,0989,95010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95012_3,EXHALED NITRIC OXIDE MEAS,ProFee,0989,95012,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
95015_3,ID ALLERGY TITRATE-DRUG/BUG,ProFee,0989,95015,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95017_3,PERQ & ICUT ALLG TEST VENOMS,ProFee,0989,95017,,,,0,3.00,2.25,2.25,5.50,0.00,5.50,5.50,N/A
95018_3,PERQ&IC ALLG TEST DRUGS/BIOL,ProFee,0989,95018,,,,0,3.00,2.25,2.25,10.00,0.00,10.00,10.00,N/A
95024_3,"ID ALLERGY TEST, DRUG/BUG",ProFee,0989,95024,,,,0,3.00,2.25,1.50,2.25,0.00,1.50,1.50,N/A
95027_3,ID ALLERGY TITRATE-AIRBORNE,ProFee,0989,95027,,,,0,3.00,2.25,2.25,6.50,0.00,6.50,6.50,N/A
95028_3,ID ALLERGY TEST-DELAYED TYPE,ProFee,0989,95028,,,,0,3.00,2.25,2.25,18.50,0.00,18.50,18.50,N/A
95044_3,ALLERGY PATCH TESTS,ProFee,0989,95044,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
95052_3,PHOTO PATCH TEST,ProFee,0989,95052,,,,0,3.00,2.25,2.25,9.50,0.00,9.50,9.50,N/A
95056_3,PHOTOSENSITIVITY TESTS,ProFee,0989,95056,,,,0,3.00,2.25,2.25,65.00,0.00,65.00,65.00,N/A
95060_3,EYE ALLERGY TESTS,ProFee,0989,95060,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
95065_3,NOSE ALLERGY TEST,ProFee,0989,95065,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
95070_3,BRONCHIAL ALLERGY TESTS,ProFee,0989,95070,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
95071_3,BRONCHIAL ALLERGY TESTS,ProFee,0989,95071,,,,0,3.00,2.25,2.25,50.00,0.00,50.00,50.00,N/A
95075_3,INGESTION CHALLENGE TEST,ProFee,0989,95075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95076_3,INGEST CHALLENGE INI 120 MIN,ProFee,0989,95076,,,,0,3.00,2.25,2.25,105.50,0.00,105.50,105.50,N/A
95078_3,PROVOCATIVE TESTING,ProFee,0989,95078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95079_3,INGEST CHALLENGE ADDL 60 MIN,ProFee,0989,95079,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
95115_2,"IMMUNOTHERAPY, ONE INJECTION",Inpatient,0521,95115,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
95115_2,"IMMUNOTHERAPY, ONE INJECTION",Outpatient,0521,95115,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,0.00,42.30
95115_3,"IMMUNOTHERAPY, ONE INJECTION",Inpatient,0521,95115,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,46.55,44.10
95115_3,"IMMUNOTHERAPY, ONE INJECTION",Outpatient,0521,95115,,,,0,49.00,36.75,36.75,46.55,44.10,46.55,0.00,44.10
95117_2,IMMUNOTHERAPY INJECTIONS,Inpatient,0521,95117,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,53.20,50.40
95117_2,IMMUNOTHERAPY INJECTIONS,Outpatient,0521,95117,,,,0,56.00,42.00,42.00,53.20,50.40,53.20,0.00,50.40
95117_3,IMMUNOTHERAPY INJECTIONS,Outpatient,0521,95117,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,0.00,52.20
95117_3,IMMUNOTHERAPY INJECTIONS,Inpatient,0521,95117,,,,0,58.00,43.50,43.50,55.10,52.20,55.10,55.10,52.20
95120_3,"IMMUNOTHERAPY, ONE INJECTION",ProFee,0989,95120,,,,0,3.00,2.25,2.25,15.00,0.00,15.00,15.00,N/A
95125_3,"IMMUNOTHERAPY, MANY ANTIGENS",ProFee,0989,95125,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
95130_3,"IMMUNOTHERAPY, INSECT VENOM",ProFee,0989,95130,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
95131_3,"IMMUNOTHERAPY, INSECT VENOMS",ProFee,0989,95131,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
95132_3,"IMMUNOTHERAPY, INSECT VENOMS",ProFee,0989,95132,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
95133_3,"IMMUNOTHERAPY, INSECT VENOMS",ProFee,0989,95133,,,,0,3.00,2.25,2.25,47.50,0.00,47.50,47.50,N/A
95134_3,"IMMUNOTHERAPY, INSECT VENOMS",ProFee,0989,95134,,,,0,3.00,2.25,2.25,57.00,0.00,57.00,57.00,N/A
95144_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95144,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95145_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95145,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95146_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95146,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95147_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95147,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95148_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95148,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95149_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95149,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95165_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95165,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95170_3,ANTIGEN THERAPY SERVICES,ProFee,0989,95170,,,,0,3.00,2.25,2.25,4.50,0.00,4.50,4.50,N/A
95180_3,RAPID DESENSITIZATION,ProFee,0989,95180,,,,0,3.00,2.25,2.25,145.50,0.00,145.50,145.50,N/A
95199_3,ALLERGY IMMUNOLOGY SERVICES,ProFee,0989,95199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95249_3,CONT GLUC MNTR PT PROV EQP,ProFee,0989,95249,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
95250_3,"GLUCOSE MONITORING, CONT",ProFee,0989,95250,,,,0,3.00,2.25,2.25,217.50,0.00,217.50,217.50,N/A
95251_3,"GLUC MONITOR, CONT, PHYS I&R",ProFee,0989,95251,,,,0,3.00,2.25,2.25,51.00,0.00,51.00,51.00,N/A
95700_3,EEG CONT REC W/VID EEG TECH,ProFee,0989,95700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95705_3,EEG W/O VID 2-12 HR UNMNTR,ProFee,0989,95705,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95706_3,EEG WO VID 2-12HR INTMT MNTR,ProFee,0989,95706,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95707_3,EEG W/O VID 2-12HR CONT MNTR,ProFee,0989,95707,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95708_3,EEG WO VID EA 12-26HR UNMNTR,ProFee,0989,95708,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95709_3,EEG W/O VID EA 12-26HR INTMT,ProFee,0989,95709,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95710_3,EEG W/O VID EA 12-26HR CONT,ProFee,0989,95710,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95711_3,VEEG 2-12 HR UNMONITORED,ProFee,0989,95711,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95712_3,VEEG 2-12 HR INTMT MNTR,ProFee,0989,95712,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95713_3,VEEG 2-12 HR CONT MNTR,ProFee,0989,95713,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95714_3,VEEG EA 12-26 HR UNMNTR,ProFee,0989,95714,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95715_3,VEEG EA 12-26HR INTMT MNTR,ProFee,0989,95715,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95716_3,VEEG EA 12-26HR CONT MNTR,ProFee,0989,95716,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95717_3,EEG PHYS/QHP 2-12 HR W/O VID,ProFee,0989,95717,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95718_3,EEG PHYS/QHP 2-12 HR W/VEEG,ProFee,0989,95718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95719_3,EEG PHYS/QHP EA INCR W/O VID,ProFee,0989,95719,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95720_3,EEG PHY/QHP EA INCR W/VEEG,ProFee,0989,95720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95721_3,EEG PHY/QHP>36<60 HR W/O VID,ProFee,0989,95721,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95722_3,EEG PHY/QHP>36<60 HR W/VEEG,ProFee,0989,95722,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95723_3,EEG PHY/QHP>60<84 HR W/O VID,ProFee,0989,95723,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95724_3,EEG PHY/QHP>60<84 HR W/VEEG,ProFee,0989,95724,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95725_3,EEG PHY/QHP>84 HR W/O VID,ProFee,0989,95725,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95726_3,EEG PHY/QHP>84 HR W/VEEG,ProFee,0989,95726,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95782_3,POLYSOM <6 YRS 4/> PARAMTRS,ProFee,0989,95782,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
95783_3,POLYSOM <6 YRS CPAP/BILVL,ProFee,0989,95783,,,,0,3.00,2.25,2.25,195.50,0.00,195.50,195.50,N/A
95800_3,SLP STDY UNATTENDED,ProFee,0989,95800,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
95801_3,SLP STDY UNATND W/ANAL,ProFee,0989,95801,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
95803_3,ACTIGRAPHY TESTING,ProFee,0989,95803,,,,0,3.00,2.25,2.25,62.50,0.00,62.50,62.50,N/A
95805_3,MULTIPLE SLEEP LATENCY TEST,ProFee,0989,95805,,,,0,3.00,2.25,2.25,84.00,0.00,84.00,84.00,N/A
95806_3,"SLEEP STUDY, UNATTENDED",ProFee,0989,95806,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
95807_3,"SLEEP STUDY, ATTENDED",ProFee,0989,95807,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
95808_3,"POLYSOMNOGRAPHY, 1-3",ProFee,0989,95808,,,,0,3.00,2.25,2.25,126.00,0.00,126.00,126.00,N/A
95810_3,"POLYSOMNOGRAPHY, 4 OR MORE",ProFee,0989,95810,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
95811_3,POLYSOMNOGRAPHY W/CPAP,ProFee,0989,95811,,,,0,3.00,2.25,2.25,180.00,0.00,180.00,180.00,N/A
95812_3,"EEG, 41-60 MINUTES",ProFee,0989,95812,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
95813_3,"EEG, OVER 1 HOUR",ProFee,0989,95813,,,,0,3.00,2.25,2.25,123.50,0.00,123.50,123.50,N/A
95816_3,"EEG, AWAKE AND DROWSY",ProFee,0989,95816,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
95819_3,"EEG, AWAKE AND ASLEEP",ProFee,0989,95819,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
95822_3,"EEG, COMA OR SLEEP ONLY",ProFee,0989,95822,,,,0,3.00,2.25,2.25,82.50,0.00,82.50,82.50,N/A
95824_3,"EEG, CEREBRAL DEATH ONLY",ProFee,0989,95824,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
95829_3,SURGERY ELECTROCORTICOGRAM,ProFee,0989,95829,,,,0,3.00,2.25,2.25,481.50,0.00,481.50,481.50,N/A
95830_3,INSERT ELECTRODES FOR EEG,ProFee,0989,95830,,,,0,3.00,2.25,2.25,131.50,0.00,131.50,131.50,N/A
95836_3,ECOG IMPLTD BRN NPGT <30 D,ProFee,0989,95836,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95851_3,RANGE OF MOTION MEASUREMENTS,ProFee,0989,95851,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
95852_3,RANGE OF MOTION MEASUREMENTS,ProFee,0989,95852,,,,0,3.00,2.25,2.25,8.50,0.00,8.50,8.50,N/A
95857_3,TENSILON TEST,ProFee,0989,95857,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
95860_3,"MUSCLE TEST, ONE LIMB",ProFee,0989,95860,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
95861_3,"MUSCLE TEST, 2 LIMBS",ProFee,0989,95861,,,,0,3.00,2.25,2.25,118.00,0.00,118.00,118.00,N/A
95863_3,"MUSCLE TEST, 3 LIMBS",ProFee,0989,95863,,,,0,3.00,2.25,2.25,142.50,0.00,142.50,142.50,N/A
95864_3,"MUSCLE TEST, 4 LIMBS",ProFee,0989,95864,,,,0,3.00,2.25,2.25,152.00,0.00,152.00,152.00,N/A
95865_3,"MUSCLE TEST, LARYNX",ProFee,0989,95865,,,,0,3.00,2.25,2.25,119.50,0.00,119.50,119.50,N/A
95866_3,"MUSCLE TEST, HEMIDIAPHRAGM",ProFee,0989,95866,,,,0,3.00,2.25,2.25,96.00,0.00,96.00,96.00,N/A
95867_3,MUSCLE TEST CRAN NERV UNILAT,ProFee,0989,95867,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
95868_3,MUSCLE TEST CRAN NERVE BILAT,ProFee,0989,95868,,,,0,3.00,2.25,2.25,90.00,0.00,90.00,90.00,N/A
95869_3,"MUSCLE TEST, THOR PARASPINAL",ProFee,0989,95869,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
95870_3,"MUSCLE TEST, NONPARASPINAL",ProFee,0989,95870,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
95872_3,"MUSCLE TEST, ONE FIBER",ProFee,0989,95872,,,,0,3.00,2.25,2.25,220.50,0.00,220.50,220.50,N/A
95873_3,"GUIDE NERV DESTR, ELEC STIM",ProFee,0989,95873,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
95874_3,"GUIDE NERV DESTR, NEEDLE EMG",ProFee,0989,95874,,,,0,3.00,2.25,2.25,28.50,0.00,28.50,28.50,N/A
95875_3,LIMB EXERCISE TEST,ProFee,0989,95875,,,,0,3.00,2.25,2.25,84.50,0.00,84.50,84.50,N/A
95885_3,MUSC TST DONE W/NERV TST LIM,ProFee,0989,95885,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
95886_3,MUSC TEST DONE W/N TEST COMP,ProFee,0989,95886,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
95887_3,MUSC TST DONE W/N TST NONEXT,ProFee,0989,95887,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
95900_3,MOTOR NERVE CONDUCTION TEST,ProFee,0989,95900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95903_3,MOTOR NERVE CONDUCTION TEST,ProFee,0989,95903,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95904_3,SENSE NERVE CONDUCTION TEST,ProFee,0989,95904,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95905_3,MOTOR/SENS NRVE CONDUCT TEST,ProFee,0989,95905,,,,0,3.00,2.25,2.25,4.00,0.00,4.00,4.00,N/A
95907_3,NVR CNDJ TST 1-2 STUDIES,ProFee,0989,95907,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
95908_3,NRV CNDJ TST 3-4 STUDIES,ProFee,0989,95908,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
95909_3,NRV CNDJ TST 5-6 STUDIES,ProFee,0989,95909,,,,0,3.00,2.25,2.25,115.00,0.00,115.00,115.00,N/A
95910_3,NRV CNDJ TEST 7-8 STUDIES,ProFee,0989,95910,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
95911_3,NRV CNDJ TEST 9-10 STUDIES,ProFee,0989,95911,,,,0,3.00,2.25,2.25,191.50,0.00,191.50,191.50,N/A
95912_3,NRV CNDJ TEST 11-12 STUDIES,ProFee,0989,95912,,,,0,3.00,2.25,2.25,227.50,0.00,227.50,227.50,N/A
95913_3,NRV CNDJ TEST 13/> STUDIES,ProFee,0989,95913,,,,0,3.00,2.25,2.25,269.50,0.00,269.50,269.50,N/A
95920_3,INTRAOP NERVE TEST ADD-ON,ProFee,0989,95920,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95921_3,AUTONOMIC NERV FUNCTION TEST,ProFee,0989,95921,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
95922_3,AUTONOMIC NERV FUNCTION TEST,ProFee,0989,95922,,,,0,3.00,2.25,2.25,69.00,0.00,69.00,69.00,N/A
95923_3,AUTONOMIC NERV FUNCTION TEST,ProFee,0989,95923,,,,0,3.00,2.25,2.25,65.50,0.00,65.50,65.50,N/A
95924_3,ANS PARASYMP & SYMP W/TILT,ProFee,0989,95924,,,,0,3.00,2.25,2.25,127.00,0.00,127.00,127.00,N/A
95925_3,SOMATOSENSORY TESTING,ProFee,0989,95925,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
95926_3,SOMATOSENSORY TESTING,ProFee,0989,95926,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
95927_3,SOMATOSENSORY TESTING,ProFee,0989,95927,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
95928_3,"C MOTOR EVOKED, UPPR LIMBS",ProFee,0989,95928,,,,0,3.00,2.25,2.25,114.00,0.00,114.00,114.00,N/A
95929_3,"C MOTOR EVOKED, LWR LIMBS",ProFee,0989,95929,,,,0,3.00,2.25,2.25,115.00,0.00,115.00,115.00,N/A
95930_3,VISUAL EVOKED POTENTIAL TEST,ProFee,0989,95930,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
95933_3,BLINK REFLEX TEST,ProFee,0989,95933,,,,0,3.00,2.25,2.25,45.00,0.00,45.00,45.00,N/A
95934_3,H-REFLEX TEST,ProFee,0989,95934,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95936_3,H-REFLEX TEST,ProFee,0989,95936,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
95937_3,NEUROMUSCULAR JUNCTION TEST,ProFee,0989,95937,,,,0,3.00,2.25,2.25,49.00,0.00,49.00,49.00,N/A
95938_3,SOMATOSENSORY TESTING,ProFee,0989,95938,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
95939_3,C MOTOR EVOKED UPR&LWR LIMBS,ProFee,0989,95939,,,,0,3.00,2.25,2.25,171.00,0.00,171.00,171.00,N/A
95940_3,IONM IN OPERATNG ROOM 15 MIN,ProFee,0989,95940,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
95941_3,IONM REMOTE/>1 PT OR PER HR,ProFee,0989,95941,,,,0,3.00,2.25,2.25,93.00,0.00,93.00,93.00,N/A
95943_3,PARASYMP&SYMP HRT RATE TEST,ProFee,0989,95943,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
95954_3,EEG MONITORING/GIVING DRUGS,ProFee,0989,95954,,,,0,3.00,2.25,2.25,172.00,0.00,172.00,172.00,N/A
95955_3,EEG DURING SURGERY,ProFee,0989,95955,,,,0,3.00,2.25,2.25,77.00,0.00,77.00,77.00,N/A
95957_3,EEG DIGITAL ANALYSIS,ProFee,0989,95957,,,,0,3.00,2.25,2.25,148.50,0.00,148.50,148.50,N/A
95958_3,EEG MONITORING/FUNCTION TEST,ProFee,0989,95958,,,,0,3.00,2.25,2.25,324.50,0.00,324.50,324.50,N/A
95961_3,"ELECTRODE STIMULATION, BRAIN",ProFee,0989,95961,,,,0,3.00,2.25,2.25,230.50,0.00,230.50,230.50,N/A
95962_3,"ELECTRODE STIM, BRAIN ADD-ON",ProFee,0989,95962,,,,0,3.00,2.25,2.25,247.50,0.00,247.50,247.50,N/A
95965_3,"MEG, SPONTANEOUS",ProFee,0989,95965,,,,0,3.00,2.25,2.25,603.50,0.00,603.50,603.50,N/A
95966_3,"MEG, EVOKED, SINGLE",ProFee,0989,95966,,,,0,3.00,2.25,2.25,307.00,0.00,307.00,307.00,N/A
95967_3,"MEG, EVOKED, EACH ADD'L",ProFee,0989,95967,,,,0,3.00,2.25,2.25,270.50,0.00,270.50,270.50,N/A
95970_3,"ANALYZE NEUROSTIM, NO PROG",ProFee,0989,95970,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
95971_3,"ANALYZE NEUROSTIM, SIMPLE",ProFee,0989,95971,,,,0,3.00,2.25,2.25,58.50,0.00,58.50,58.50,N/A
95972_3,"ANALYZE NEUROSTIM, COMPLEX",ProFee,0989,95972,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
95973_3,"ANALYZE NEUROSTIM, COMPLEX",ProFee,0989,95972,,,,0,3.00,2.25,2.25,59.50,0.00,59.50,59.50,N/A
95974_3,"CRANIAL NEUROSTIM, COMPLEX",ProFee,0989,95974,,,,0,3.00,2.25,2.25,234.00,0.00,234.00,234.00,N/A
95975_3,"CRANIAL NEUROSTIM, COMPLEX",ProFee,0989,95975,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
95976_3,ALYS SMPL CN NPGT PRGRMG,ProFee,0989,95976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95977_3,ALYS CPLX CN NPGT PRGRMG,ProFee,0989,95977,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95978_3,ANALYZE NEUROSTIM BRAIN/1H,ProFee,0989,95978,,,,0,3.00,2.25,2.25,275.50,0.00,275.50,275.50,N/A
95979_3,ANALYZ NEUROSTIM BRAIN ADDON,ProFee,0989,95979,,,,0,3.00,2.25,2.25,127.50,0.00,127.50,127.50,N/A
95980_3,IO ANAL GAST  N-STIM INIT,ProFee,0989,95980,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
95981_3,IO ANAL GAST N-STIM SUBSQ,ProFee,0989,95981,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
95982_3,IO GA N-STIM SUBSQ W/REPROG,ProFee,0989,95982,,,,0,3.00,2.25,2.25,52.50,0.00,52.50,52.50,N/A
95983_3,ALYS BRN NPGT PRGRMG 15 MIN,ProFee,0989,95983,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95984_3,ALYS BRN NPGT PRGRMG ADDL 15,ProFee,0989,95984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
95990_3,SPIN/BRAIN PUMP REFIL & MAIN,ProFee,0989,95990,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
95991_3,SPIN/BRAIN PUMP REFIL & MAIN,ProFee,0989,95991,,,,0,3.00,2.25,2.25,56.50,0.00,56.50,56.50,N/A
95992_3,CANALITH REPOSITIONING PROC,ProFee,0989,95992,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
95999_3,NEUROLOGICAL PROCEDURE,ProFee,0989,95999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96000_3,"MOTION ANALYSIS, VIDEO/3D",ProFee,0989,96000,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
96001_3,MOTION TEST W/FT PRESS MEAS,ProFee,0989,96001,,,,0,3.00,2.25,2.25,184.50,0.00,184.50,184.50,N/A
96002_3,DYNAMIC SURFACE EMG,ProFee,0989,96002,,,,0,3.00,2.25,2.25,31.50,0.00,31.50,31.50,N/A
96003_3,DYNAMIC FINE WIRE EMG,ProFee,0989,96003,,,,0,3.00,2.25,2.25,24.50,0.00,24.50,24.50,N/A
96004_3,PHYS REVIEW OF MOTION TESTS,ProFee,0989,96004,,,,0,3.00,2.25,2.25,164.00,0.00,164.00,164.00,N/A
96020_3,FUNCTIONAL BRAIN MAPPING,ProFee,0989,96020,,,,0,3.00,2.25,2.25,230.00,0.00,230.00,230.00,N/A
96040_3,"GENETIC COUNSELING, 30 MIN",ProFee,0989,96040,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
96101_3,PSYCHO TESTING BY PSYCH/PHYS,ProFee,0989,96101,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
96102_3,PSYCHO TESTING BY TECHNICIAN,ProFee,0989,96102,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
96103_3,PSYCHO TESTING ADMIN BY COMP,ProFee,0989,96103,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
96105_3,ASSESSMENT OF APHASIA,ProFee,0989,96105,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
96110_3,"DEVELOPMENTAL TEST, LIM",ProFee,0989,96110,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
96111_3,"DEVELOPMENTAL TEST, EXTEND",ProFee,0989,96111,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
96112_3,DEVEL TST PHYS/QHP 1ST HR,ProFee,0989,96112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96113_3,DEVEL TST PHYS/QHP EA ADDL,ProFee,0989,96113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96116_3,NEUROBEHAVIORAL STATUS EXAM,ProFee,0989,96116,,,,0,3.00,2.25,2.25,121.00,0.00,121.00,121.00,N/A
96118_3,NEUROPSYCH TST BY PSYCH/PHYS,ProFee,0989,96118,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
96119_3,NEUROPSYCH TESTING BY TECH,ProFee,0989,96119,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
96120_3,NEUROPSYCH TST ADMIN W/COMP,ProFee,0989,96120,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
96121_3,NUBHVL XM PHY/QHP EA ADDL HR,ProFee,0989,96121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96125_3,COGNITIVE TEST BY HC PRO,ProFee,0989,96125,,,,0,3.00,2.25,2.25,168.00,0.00,168.00,168.00,N/A
96127_3,BRIEF EMOTIONAL/BEHAV ASSMT,ProFee,0989,96127,,,,0,3.00,2.25,2.25,9.00,0.00,9.00,9.00,N/A
96130_3,PSYCL TST EVAL PHYS/QHP 1ST,ProFee,0989,96130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96131_3,PSYCL TST EVAL PHYS/QHP EA,ProFee,0989,96131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96132_3,NRPSYC TST EVAL PHYS/QHP 1ST,ProFee,0989,96132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96133_3,NRPSYC TST EVAL PHYS/QHP EA,ProFee,0989,96133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96136_3,PSYCL/NRPSYC TST PHY/QHP 1ST,ProFee,0989,96136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96137_3,PSYCL/NRPSYC TST PHY/QHP EA,ProFee,0989,96137,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96138_3,PSYCL/NRPSYC TECH 1ST,ProFee,0989,96138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96139_3,PSYCL/NRPSYC TST TECH EA,ProFee,0989,96139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96146_3,PSYCL/NRPSYC TST AUTO RESULT,ProFee,0989,96146,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96156_3,HLTH BHV ASSMT/REASSESSMENT,ProFee,0989,96156,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96158_3,HLTH BHV IVNTJ INDIV 1ST 30,ProFee,0989,96158,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96159_3,HLTH BHV IVNTJ INDIV EA ADDL,ProFee,0989,96159,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96160_3,PT-FOCUSED HLTH RISK ASSMT,ProFee,0989,96160,,,,0,3.00,2.25,2.25,5.50,0.00,5.50,5.50,N/A
96161_3,CAREGIVER HEALTH RISK ASSMT,ProFee,0989,96161,,,,0,3.00,2.25,2.25,5.50,0.00,5.50,5.50,N/A
96164_3,HLTH BHV IVNTJ GRP 1ST 30,ProFee,0989,96164,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96165_3,HLTH BHV IVNTJ GRP EA ADDL,ProFee,0989,96165,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96167_3,HLTH BHV IVNTJ FAM 1ST 30,ProFee,0989,96167,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96168_3,HLTH BHV IVNTJ FAM EA ADDL,ProFee,0989,96168,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96170_3,HLTH BHV IVNTJ FAM WO PT 1ST,ProFee,0989,96170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96171_3,HLTH BHV IVNTJ FAM W/O PT EA,ProFee,0989,96171,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96360_3,"HYDRATION IV INFUSION, INIT",ProFee,0989,96360,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
96361_3,"HYDRATE IV INFUSION, ADD-ON",ProFee,0989,96361,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
96365_3,"THER/PROPH/DIAG IV INF, INIT",ProFee,0989,96365,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
96366_3,THER/PROPH/DIAG IV INF ADDON,ProFee,0989,96366,,,,0,3.00,2.25,2.25,31.00,0.00,31.00,31.00,N/A
96367_3,TX/PROPH/DG ADDL SEQ IV INF,ProFee,0989,96367,,,,0,3.00,2.25,2.25,44.50,0.00,44.50,44.50,N/A
96368_3,THER/DIAG CONCURRENT INF,ProFee,0989,96368,,,,0,3.00,2.25,2.25,29.50,0.00,29.50,29.50,N/A
96369_3,"SC THER INFUSION, UP TO 1 HR",ProFee,0989,96369,,,,0,3.00,2.25,2.25,245.50,0.00,245.50,245.50,N/A
96370_3,"SC THER INFUSION, ADDL HR",ProFee,0989,96370,,,,0,3.00,2.25,2.25,22.00,0.00,22.00,22.00,N/A
96371_3,"SC THER INFUSION, RESET PUMP",ProFee,0989,96371,,,,0,3.00,2.25,2.25,90.00,0.00,90.00,90.00,N/A
96372_2,"THER/PROPH/DIAG INJ, SC/IM",Outpatient,0521,96372,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,0.00,40.50
96372_2,"THER/PROPH/DIAG INJ, SC/IM",Inpatient,0521,96372,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
96372_3,"THER/PROPH/DIAG INJ, SC/IM",Inpatient,0521,96372,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
96372_3,"THER/PROPH/DIAG INJ, SC/IM",Outpatient,0521,96372,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,0.00,42.30
96373_3,"THER/PROPH/DIAG INJ, IA",ProFee,0989,96373,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
96374_3,"THER/PROPH/DIAG INJ, IV PUSH",ProFee,0989,96374,,,,0,3.00,2.25,2.25,65.50,0.00,65.50,65.50,N/A
96375_3,TX/PRO/DX INJ NEW DRUG ADDON,ProFee,0989,96375,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
96376_3,TX/PRO/DX INJ NEW DRUG ADON,ProFee,0989,96376,,,,0,3.00,2.25,2.25,17.00,0.00,17.00,17.00,N/A
96377_3,APPLICATON ON-BODY INJECTOR,ProFee,0989,96377,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
96379_3,THER/PROP/DIAG INJ/INF PROC,ProFee,0989,96379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96401_3,"CHEMO, ANTI-NEOPL, SQ/IM",ProFee,0989,96401,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
96402_3,CHEMO HORMON ANTINEOPL SQ/IM,ProFee,0989,96402,,,,0,3.00,2.25,2.25,43.50,0.00,43.50,43.50,N/A
96405_3,INTRALESIONAL CHEMO ADMIN,ProFee,0989,96405,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
96406_3,INTRALESIONAL CHEMO ADMIN,ProFee,0989,96406,,,,0,3.00,2.25,2.25,66.00,0.00,66.00,66.00,N/A
96409_3,"CHEMO, IV PUSH, SNGL DRUG",ProFee,0989,96409,,,,0,3.00,2.25,2.25,155.00,0.00,155.00,155.00,N/A
96411_3,"CHEMO, IV PUSH, ADDL DRUG",ProFee,0989,96411,,,,0,3.00,2.25,2.25,83.00,0.00,83.00,83.00,N/A
96413_3,"CHEMO, IV INFUSION, 1 HR",ProFee,0989,96413,,,,0,3.00,2.25,2.25,201.00,0.00,201.00,201.00,N/A
96415_3,"CHEMO, IV INFUSION, ADDL HR",ProFee,0989,96415,,,,0,3.00,2.25,2.25,44.00,0.00,44.00,44.00,N/A
96416_3,CHEMO PROLONG INFUSE W/PUMP,ProFee,0989,96416,,,,0,3.00,2.25,2.25,204.50,0.00,204.50,204.50,N/A
96417_3,CHEMO IV INFUS EACH ADDL SEQ,ProFee,0989,96417,,,,0,3.00,2.25,2.25,96.50,0.00,96.50,96.50,N/A
96420_3,"CHEMOTHERAPY, PUSH TECHNIQUE",ProFee,0989,96420,,,,0,3.00,2.25,2.25,150.00,0.00,150.00,150.00,N/A
96422_3,"CHEMOTHERAPY,INFUSION METHOD",ProFee,0989,96422,,,,0,3.00,2.25,2.25,262.00,0.00,262.00,262.00,N/A
96423_3,"CHEMO, INFUSE METHOD ADD-ON",ProFee,0989,96423,,,,0,3.00,2.25,2.25,119.00,0.00,119.00,119.00,N/A
96425_3,"CHEMOTHERAPY,INFUSION METHOD",ProFee,0989,96425,,,,0,3.00,2.25,2.25,274.00,0.00,274.00,274.00,N/A
96440_3,"CHEMOTHERAPY, INTRACAVITARY",ProFee,0989,96440,,,,0,3.00,2.25,2.25,179.50,0.00,179.50,179.50,N/A
96445_3,"CHEMOTHERAPY, INTRACAVITARY",ProFee,0989,96445,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
96446_3,CHEMOTX ADMN PRTL CAVITY,ProFee,0989,96446,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
96450_3,"CHEMOTHERAPY, INTO CNS",ProFee,0989,96450,,,,0,3.00,2.25,2.25,114.50,0.00,114.50,114.50,N/A
96521_3,"REFILL/MAINT, PORTABLE PUMP",ProFee,0989,96521,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
96522_3,REFILL/MAINT PUMP/RESVR SYST,ProFee,0989,96522,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
96523_3,IRRIG DRUG DELIVERY DEVICE,ProFee,0989,96523,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
96542_3,CHEMOTHERAPY INJECTION,ProFee,0989,96542,,,,0,3.00,2.25,2.25,60.00,0.00,60.00,60.00,N/A
96549_3,"CHEMOTHERAPY, UNSPECIFIED",ProFee,0989,96549,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
96567_3,"PHOTODYNAMIC TX, SKIN",ProFee,0989,96567,,,,0,3.00,2.25,2.25,162.00,0.00,162.00,162.00,N/A
96570_3,"PHOTODYNAMIC TX, 30 MIN",ProFee,0989,96570,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
96571_3,"PHOTODYNAMIC TX, ADDL 15 MIN",ProFee,0989,96571,,,,0,3.00,2.25,2.25,42.00,0.00,42.00,42.00,N/A
96573_3,PDT DSTR PRMLG LES PHYS/QHP,ProFee,0989,96573,,,,0,3.00,2.25,2.25,268.50,0.00,268.50,268.50,N/A
96574_3,DBRDMT PRMLG LES W/PDT,ProFee,0989,96574,,,,0,3.00,2.25,2.25,346.00,0.00,346.00,346.00,N/A
96900_3,ULTRAVIOLET LIGHT THERAPY,ProFee,0989,96900,,,,0,3.00,2.25,2.25,29.50,0.00,29.50,29.50,N/A
96902_3,TRICHOGRAM,ProFee,0989,96902,,,,0,3.00,2.25,2.25,29.50,0.00,29.50,29.50,N/A
96904_3,WHOLE BODY PHOTOGRAPHY,ProFee,0989,96904,,,,0,3.00,2.25,2.25,88.50,0.00,88.50,88.50,N/A
96910_3,PHOTOCHEMOTHERAPY WITH UV-B,ProFee,0989,96910,,,,0,3.00,2.25,2.25,160.50,0.00,160.50,160.50,N/A
96912_3,PHOTOCHEMOTHERAPY WITH UV-A,ProFee,0989,96912,,,,0,3.00,2.25,2.25,135.50,0.00,135.50,135.50,N/A
96913_3,"PHOTOCHEMOTHERAPY, UV-A OR B",ProFee,0989,96913,,,,0,3.00,2.25,2.25,189.00,0.00,189.00,189.00,N/A
96920_3,"LASER TX, SKIN < 250 SQ CM",ProFee,0989,96920,,,,0,3.00,2.25,2.25,95.50,0.00,95.50,95.50,N/A
96921_3,"LASER TX, SKIN 250-500 SQ CM",ProFee,0989,96921,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
96922_3,"LASER TX, SKIN > 500 SQ CM",ProFee,0989,96922,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
96931_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96931,,,,0,3.00,2.25,2.25,239.00,0.00,239.00,239.00,N/A
96932_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96932,,,,0,3.00,2.25,2.25,173.50,0.00,173.50,173.50,N/A
96933_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96933,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
96934_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96934,,,,0,3.00,2.25,2.25,105.00,0.00,105.00,105.00,N/A
96935_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96935,,,,0,3.00,2.25,2.25,49.50,0.00,49.50,49.50,N/A
96936_3,RCM CELULR SUBCELULR IMG SKN,ProFee,0989,96936,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
96999_3,DERMATOLOGICAL PROCEDURE,ProFee,0989,96999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97001_3,PT EVALUATION,ProFee,0989,97001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97002_3,PT RE-EVALUATION,ProFee,0989,97002,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97003_3,OT EVALUATION,ProFee,0989,97003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97004_3,OT RE-EVALUATION,ProFee,0989,97004,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97005_3,ATHLETIC TRAIN EVAL,ProFee,0989,97005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97006_3,ATHLETIC TRAIN REEVAL,ProFee,0989,97006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97010_3,HOT OR COLD PACKS THERAPY,ProFee,0989,97010,,,,0,3.00,2.25,2.25,6.21,0.00,6.21,6.21,N/A
97012_3,MECHANICAL TRACTION THERAPY,ProFee,0989,97012,,,,0,3.00,2.25,2.25,14.49,0.00,14.49,14.49,N/A
97014_3,ELECTRIC STIMULATION THERAPY,ProFee,0989,97014,,,,0,3.00,2.25,2.25,15.18,0.00,15.18,15.18,N/A
97016_3,VASOPNEUMATIC DEVICE THERAPY,ProFee,0989,97016,,,,0,3.00,2.25,2.25,15.53,0.00,15.53,15.53,N/A
97018_3,PARAFFIN BATH THERAPY,ProFee,0989,97018,,,,0,3.00,2.25,2.25,8.63,0.00,8.63,8.63,N/A
97022_3,WHIRLPOOL THERAPY,ProFee,0989,97022,,,,0,3.00,2.25,2.25,18.63,0.00,18.63,18.63,N/A
97024_3,DIATHERMY TREATMENT,ProFee,0989,97024,,,,0,3.00,2.25,2.25,6.90,0.00,6.90,6.90,N/A
97026_3,INFRARED THERAPY,ProFee,0989,97026,,,,0,3.00,2.25,2.25,6.21,0.00,6.21,6.21,N/A
97028_3,ULTRAVIOLET THERAPY,ProFee,0989,97028,,,,0,3.00,2.25,2.25,7.94,0.00,7.94,7.94,N/A
97032_3,ELECTRICAL STIMULATION,ProFee,0989,97032,,,,0,3.00,2.25,2.25,15.18,0.00,15.18,15.18,N/A
97033_3,ELECTRIC CURRENT THERAPY,ProFee,0989,97033,,,,0,3.00,2.25,2.25,20.36,0.00,20.36,20.36,N/A
97034_3,CONTRAST BATH THERAPY,ProFee,0989,97034,,,,0,3.00,2.25,2.25,14.84,0.00,14.84,14.84,N/A
97035_3,ULTRASOUND THERAPY,ProFee,0989,97035,,,,0,3.00,2.25,2.25,13.11,0.00,13.11,13.11,N/A
97036_3,HYDROTHERAPY,ProFee,0989,97036,,,,0,3.00,2.25,2.25,34.85,0.00,34.85,34.85,N/A
97039_3,PHYSICAL THERAPY TREATMENT,ProFee,0989,97039,,,,0,3.00,2.25,2.25,18.50,0.00,18.50,18.50,N/A
97110_3,THERAPEUTIC EXERCISES,ProFee,0989,97110,,,,0,3.00,2.25,2.25,30.02,0.00,30.02,30.02,N/A
97112_3,NEUROMUSCULAR REEDUCATION,ProFee,0989,97112,,,,0,3.00,2.25,2.25,34.16,0.00,34.16,34.16,N/A
97113_3,AQUATIC THERAPY/EXERCISES,ProFee,0989,97113,,,,0,3.00,2.25,2.25,38.30,0.00,38.30,38.30,N/A
97116_3,GAIT TRAINING THERAPY,ProFee,0989,97116,,,,0,3.00,2.25,2.25,29.67,0.00,29.67,29.67,N/A
97129_3,THER IVNTJ 1ST 15 MIN,ProFee,0989,97129,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97130_3,THER IVNTJ EA ADDL 15 MIN,ProFee,0989,97130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
97139_3,PHYSICAL MEDICINE PROCEDURE,ProFee,0989,97139,,,,0,3.00,2.25,2.25,25.00,0.00,25.00,25.00,N/A
97140_3,MANUAL THERAPY,ProFee,0989,97140,,,,0,3.00,2.25,2.25,27.26,0.00,27.26,27.26,N/A
97150_3,GROUP THERAPEUTIC PROCEDURES,ProFee,0989,97150,,,,0,3.00,2.25,2.25,17.94,0.00,17.94,17.94,N/A
97151_3,BHV ID ASSMT BY PHYS/QHP,ProFee,0989,97151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97152_3,BHV ID SUPRT ASSMT BY 1 TECH,ProFee,0989,97152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97153_3,ADAPTIVE BEHAVIOR TX BY TECH,ProFee,0989,97153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97154_3,GRP ADAPT BHV TX BY TECH,ProFee,0989,97154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97155_3,ADAPT BEHAVIOR TX PHYS/QHP,ProFee,0989,97155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97156_3,FAM ADAPT BHV TX GDN PHY/QHP,ProFee,0989,97156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97157_3,MULT FAM ADAPT BHV TX GDN,ProFee,0989,97157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97158_3,GRP ADAPT BHV TX BY PHY/QHP,ProFee,0989,97158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97161_3,PT EVAL LOW COMPLEX 20 MIN,ProFee,0989,97161,,,,0,3.00,2.25,2.25,82.11,0.00,82.11,82.11,N/A
97162_3,PT EVAL MOD COMPLEX 30 MIN,ProFee,0989,97162,,,,0,3.00,2.25,2.25,82.11,0.00,82.11,82.11,N/A
97163_3,PT EVAL HIGH COMPLEX 45 MIN,ProFee,0989,97163,,,,0,3.00,2.25,2.25,82.11,0.00,82.11,82.11,N/A
97164_3,PT RE-EVAL EST PLAN CARE,ProFee,0989,97164,,,,0,3.00,2.25,2.25,55.55,0.00,55.55,55.55,N/A
97165_3,OT EVAL LOW COMPLEX 30 MIN,ProFee,0989,97165,,,,0,3.00,2.25,2.25,88.67,0.00,88.67,88.67,N/A
97166_3,OT EVAL MOD COMPLEX 45 MIN,ProFee,0989,97166,,,,0,3.00,2.25,2.25,88.67,0.00,88.67,88.67,N/A
97167_3,OT EVAL HIGH COMPLEX 60 MIN,ProFee,0989,97167,,,,0,3.00,2.25,2.25,88.67,0.00,88.67,88.67,N/A
97168_3,OT RE-EVAL EST PLAN CARE,ProFee,0989,97168,,,,0,3.00,2.25,2.25,60.38,0.00,60.38,60.38,N/A
97169_3,ATHLETIC TRN EVAL LOW CMPLX,ProFee,0989,97169,,,,0,3.00,2.25,2.25,53.48,0.00,53.48,53.48,N/A
97170_3,ATHLETIC TRN EVAL MOD CMPLX,ProFee,0989,97170,,,,0,3.00,2.25,2.25,53.48,0.00,53.48,53.48,N/A
97171_3,ATHLETIC TRN EVAL HIGH CMPLX,ProFee,0989,97171,,,,0,3.00,2.25,2.25,53.48,0.00,53.48,53.48,N/A
97172_3,ATHLETIC TRN RE-EVAL PLAN CR,ProFee,0989,97172,,,,0,3.00,2.25,2.25,26.22,0.00,26.22,26.22,N/A
97530_3,THERAPEUTIC ACTIVITIES,ProFee,0989,97530,,,,0,3.00,2.25,2.25,39.68,0.00,39.68,39.68,N/A
97532_3,COGNITIVE SKILLS DEVELOPMENT,ProFee,0989,97127,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97533_3,SENSORY INTEGRATION,ProFee,0989,97533,,,,0,3.00,2.25,2.25,33.47,0.00,33.47,33.47,N/A
97535_3,SELF CARE MNGMENT TRAINING,ProFee,0989,97535,,,,0,3.00,2.25,2.25,33.81,0.00,33.81,33.81,N/A
97537_3,COMMUNITY/WORK REINTEGRATION,ProFee,0989,97537,,,,0,3.00,2.25,2.25,32.43,0.00,32.43,32.43,N/A
97542_3,WHEELCHAIR MNGMENT TRAINING,ProFee,0989,97542,,,,0,3.00,2.25,2.25,32.78,0.00,32.78,32.78,N/A
97545_3,WORK HARDENING,ProFee,0989,97545,,,,0,3.00,2.25,2.25,146.97,0.00,146.97,146.97,N/A
97546_3,WORK HARDENING ADD-ON,ProFee,0989,97546,,,,0,3.00,2.25,2.25,58.65,0.00,58.65,58.65,N/A
97597_3,ACTIVE WOUND CARE/20 CM OR <,ProFee,0989,97597,,,,0,3.00,2.25,2.25,34.00,0.00,34.00,34.00,N/A
97598_3,ACTIVE WOUND CARE > 20 CM,ProFee,0989,97598,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
97602_2,WOUND(S) CARE NON-SELECTIVE,Inpatient,0521,97602,,,,0,666.00,499.50,499.50,632.70,599.40,632.70,632.70,599.40
97602_2,WOUND(S) CARE NON-SELECTIVE,Outpatient,0521,97602,,,,0,666.00,499.50,499.50,632.70,599.40,632.70,0.00,599.40
97602_3,WOUND(S) CARE NON-SELECTIVE,Inpatient,0521,97602,,,,0,650.00,487.50,487.50,617.50,585.00,617.50,617.50,585.00
97602_3,WOUND(S) CARE NON-SELECTIVE,Outpatient,0521,97602,,,,0,650.00,487.50,487.50,617.50,585.00,617.50,0.00,585.00
97605_3,"NEG PRESS WOUND TX, < 50 CM",ProFee,0989,97605,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
97606_3,"NEG PRESS WOUND TX, > 50 CM",ProFee,0989,97606,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
97607_3,NEG PRESS WND TX <=50 SQ CM,ProFee,0989,97607,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
97608_3,NEG PRESS WOUND TX >50 CM,ProFee,0989,97608,,,,0,3.00,2.25,2.25,80.50,0.00,80.50,80.50,N/A
97610_3,LOW FREQUENCY NON-THERMAL US,ProFee,0989,97610,,,,0,3.00,2.25,2.25,24.00,0.00,24.00,24.00,N/A
97750_2,PHYSICAL PERFORMANCE TEST,Outpatient,0521,97750,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
97750_2,PHYSICAL PERFORMANCE TEST,Inpatient,0521,97750,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
97750_3,PHYSICAL PERFORMANCE TEST,Outpatient,0521,97750,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,0.00,122.40
97750_3,PHYSICAL PERFORMANCE TEST,Inpatient,0521,97750,,,,0,136.00,102.00,102.00,129.20,122.40,129.20,129.20,122.40
97755_3,ASSISTIVE TECHNOLOGY ASSESS,ProFee,0989,97755,,,,0,3.00,2.25,2.25,38.30,0.00,38.30,38.30,N/A
97760_3,ORTHOTIC MGMT AND TRAINING,ProFee,0989,97760,,,,0,3.00,2.25,2.25,45.89,0.00,45.89,45.89,N/A
97761_3,PROSTHETIC TRAINING,ProFee,0989,97761,,,,0,3.00,2.25,2.25,39.68,0.00,39.68,39.68,N/A
97762_3,C/O FOR ORTHOTIC/PROSTH USE,ProFee,0989,97763,,,,0,3.00,2.25,2.25,47.27,0.00,47.27,47.27,N/A
97763_3,ORTHC/PROSTC MGMT SBSQ ENC,ProFee,0989,97763,,,,0,3.00,2.25,2.25,47.27,0.00,47.27,47.27,N/A
97799_3,PHYSICAL MEDICINE PROCEDURE,ProFee,0989,97799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
97802_3,"MEDICAL NUTRITION, INDIV, IN",ProFee,0989,97802,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
97803_3,"MED NUTRITION, INDIV, SUBSEQ",ProFee,0989,97803,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
97804_3,"MEDICAL NUTRITION, GROUP",ProFee,0989,97804,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
97810_3,ACUPUNCT W/O STIMUL 15 MIN,ProFee,0989,97810,,,,0,3.00,2.25,2.25,34.80,0.00,34.80,34.80,N/A
97811_3,ACUPUNCT W/O STIMUL ADDL 15M,ProFee,0989,97811,,,,0,3.00,2.25,2.25,28.80,0.00,28.80,28.80,N/A
97813_3,ACUPUNCT W/STIMUL 15 MIN,ProFee,0989,97813,,,,0,3.00,2.25,2.25,37.60,0.00,37.60,37.60,N/A
97814_3,ACUPUNCT W/STIMUL ADDL 15M,ProFee,0989,97814,,,,0,3.00,2.25,2.25,31.60,0.00,31.60,31.60,N/A
98925_3,OSTEOPATHIC MANIPULATION,ProFee,0989,98925,,,,0,3.00,2.25,2.25,22.44,0.00,22.44,22.44,N/A
98926_3,OSTEOPATHIC MANIPULATION,ProFee,0989,98926,,,,0,3.00,2.25,2.25,33.66,0.00,33.66,33.66,N/A
98927_3,OSTEOPATHIC MANIPULATION,ProFee,0989,98927,,,,0,3.00,2.25,2.25,44.55,0.00,44.55,44.55,N/A
98928_3,OSTEOPATHIC MANIPULATION,ProFee,0989,98928,,,,0,3.00,2.25,2.25,55.77,0.00,55.77,55.77,N/A
98929_3,OSTEOPATHIC MANIPULATION,ProFee,0989,98929,,,,0,3.00,2.25,2.25,67.65,0.00,67.65,67.65,N/A
98940_3,CHIROPRACTIC MANIPULATION,ProFee,0989,98940,,,,0,3.00,2.25,2.25,21.12,0.00,21.12,21.12,N/A
98941_3,CHIROPRACTIC MANIPULATION,ProFee,0989,98941,,,,0,3.00,2.25,2.25,32.34,0.00,32.34,32.34,N/A
98942_3,CHIROPRACTIC MANIPULATION,ProFee,0989,98942,,,,0,3.00,2.25,2.25,43.89,0.00,43.89,43.89,N/A
98943_3,CHIROPRACTIC MANIPULATION,ProFee,0989,98943,,,,0,3.00,2.25,2.25,22.11,0.00,22.11,22.11,N/A
98960_3,"SELF-MGMT EDUC & TRAIN, 1 PT",ProFee,0989,98960,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
98961_3,"SELF-MGMT EDUC/TRAIN, 2-4 PT",ProFee,0989,98961,,,,0,3.00,2.25,2.25,19.50,0.00,19.50,19.50,N/A
98962_3,"SELF-MGMT EDUC/TRAIN, 5-8 PT",ProFee,0989,98962,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
98966_2,HC PRO PHONE CALL 5-10 MIN,ProFee,0989,98966,,,,0,45.00,33.75,18.00,33.75,0.00,18.00,18.00,N/A
98966_3,HC PRO PHONE CALL 5-10 MIN,ProFee,0989,98966,,,,0,47.00,35.25,18.00,35.25,0.00,18.00,18.00,N/A
98967_2,HC PRO PHONE CALL 11-20 MIN,ProFee,0989,98967,,,,0,89.00,66.75,36.00,66.75,0.00,36.00,36.00,N/A
98967_3,HC PRO PHONE CALL 11-20 MIN,ProFee,0989,98967,,,,0,90.00,67.50,36.00,67.50,0.00,36.00,36.00,N/A
98968_2,HC PRO PHONE CALL 21-30 MIN,ProFee,0989,98968,,,,0,132.00,99.00,54.00,99.00,0.00,54.00,54.00,N/A
98968_3,HC PRO PHONE CALL 21-30 MIN,ProFee,0989,98968,,,,0,132.00,99.00,54.00,99.00,0.00,54.00,54.00,N/A
98970_3,QNHP OL DIG E/M SVC 5-10MIN,ProFee,0989,98970,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
98971_3,QNHP OL DIG EM SVC 11-20MIN,ProFee,0989,98971,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
98972_3,QNHP OL DIG E/M SVC 21+ MIN,ProFee,0989,98972,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99000_3,SPECIMEN HANDLING,Inpatient,0521,99000,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
99000_3,SPECIMEN HANDLING,Outpatient,0521,99000,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
99001_3,SPECIMEN HANDLING,ProFee,0989,99001,,,,0,3.00,2.25,2.25,8.50,0.00,8.50,8.50,N/A
99002_3,DEVICE HANDLING,ProFee,0989,99002,,,,0,3.00,2.25,2.25,10.00,0.00,10.00,10.00,N/A
99024_3,POSTOP FOLLOW-UP VISIT,ProFee,0989,99024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99027_3,OUT-OF-HOSP ON CALL SERVICE,ProFee,0989,99027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99050_3,MEDICAL SERVICES AFTER HRS,ProFee,0989,99050,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
99075_2,MEDICAL TESTIMONY,Outpatient,0521,99075,,,,0,597.00,447.75,447.75,567.15,537.30,567.15,0.00,537.30
99075_2,MEDICAL TESTIMONY,Inpatient,0521,99075,,,,0,597.00,447.75,447.75,567.15,537.30,567.15,567.15,537.30
99075_3,MEDICAL TESTIMONY,Inpatient,0521,99075,,,,0,583.00,437.25,437.25,553.85,524.70,553.85,553.85,524.70
99075_3,MEDICAL TESTIMONY,Outpatient,0521,99075,,,,0,583.00,437.25,437.25,553.85,524.70,553.85,0.00,524.70
99080_2,SPECIAL REPORTS OR FORMS,Outpatient,0521,99080,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,0.00,86.40
99080_2,SPECIAL REPORTS OR FORMS,Inpatient,0521,99080,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
99080_3,SPECIAL REPORTS OR FORMS,Inpatient,0521,99080,,,,0,97.00,72.75,72.75,92.15,87.30,92.15,92.15,87.30
99080_3,SPECIAL REPORTS OR FORMS,Outpatient,0521,99080,,,,0,97.00,72.75,72.75,92.15,87.30,92.15,0.00,87.30
99151_3,MOD SED SAME PHYS/QHP <5 YRS,ProFee,0989,99151,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
99152_3,MOD SED SAME PHYS/QHP 5/>YRS,ProFee,0989,99152,,,,0,3.00,2.25,2.25,18.00,0.00,18.00,18.00,N/A
99153_3,MOD SED SAME PHYS/QHP EA,ProFee,0989,99153,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
99155_3,MOD SED OTH PHYS/QHP <5 YRS,ProFee,0989,99155,,,,0,3.00,2.25,2.25,137.00,0.00,137.00,137.00,N/A
99156_3,MOD SED OTH PHYS/QHP 5/>YRS,ProFee,0989,99156,,,,0,3.00,2.25,2.25,107.50,0.00,107.50,107.50,N/A
99157_3,MOD SED OTHER PHYS/QHP EA,ProFee,0989,99157,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
99177_3,OCULAR INSTRUMNT SCREEN BIL,ProFee,0989,99177,,,,0,3.00,2.25,2.25,7.00,0.00,7.00,7.00,N/A
99184_3,HYPOTHERMIA ILL NEONATE,ProFee,0989,99184,,,,0,3.00,2.25,2.25,316.00,0.00,316.00,316.00,N/A
99188_3,APP TOPICAL FLUORIDE VARNISH,ProFee,0989,99188,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
99202_2,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99202,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,0.00,137.70
99202_2,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99202,,,,0,153.00,114.75,114.75,145.35,137.70,145.35,145.35,137.70
99202_3,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99202,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,0.00,136.80
99202_3,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99202,,,,0,152.00,114.00,114.00,144.40,136.80,144.40,144.40,136.80
99203_2,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99203,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,207.10,196.20
99203_2,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99203,,,,0,218.00,163.50,163.50,207.10,196.20,207.10,0.00,196.20
99203_3,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99203,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
99203_3,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99203,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,0.00,193.50
99204_2,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99204,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,314.45,297.90
99204_2,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99204,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,0.00,297.90
99204_3,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99204,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
99204_3,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99204,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,0.00,292.50
99205_2,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99205,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,314.45,297.90
99205_2,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99205,,,,0,331.00,248.25,248.25,314.45,297.90,314.45,0.00,297.90
99205_3,"OFFICE/OUTPATIENT VISIT, NEW",Outpatient,0521,99205,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,0.00,292.50
99205_3,"OFFICE/OUTPATIENT VISIT, NEW",Inpatient,0521,99205,,,,0,325.00,243.75,243.75,308.75,292.50,308.75,308.75,292.50
99211_2,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99211,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,0.00,43.20
99211_2,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99211,,,,0,48.00,36.00,36.00,45.60,43.20,45.60,45.60,43.20
99211_3,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99211,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,0.00,45.00
99211_3,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99211,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
99212_2,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99212,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,0.00,81.90
99212_2,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99212,,,,0,91.00,68.25,68.25,86.45,81.90,86.45,86.45,81.90
99212_3,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99212,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,0.00,82.80
99212_3,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99212,,,,0,92.00,69.00,69.00,87.40,82.80,87.40,87.40,82.80
99213_2,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99213,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,0.00,124.20
99213_2,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99213,,,,0,138.00,103.50,103.50,131.10,124.20,131.10,131.10,124.20
99213_3,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99213,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,130.15,123.30
99213_3,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99213,,,,0,137.00,102.75,102.75,130.15,123.30,130.15,0.00,123.30
99214_2,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99214,,,,0,213.00,159.75,159.75,202.35,191.70,202.35,0.00,191.70
99214_2,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99214,,,,0,213.00,159.75,159.75,202.35,191.70,202.35,202.35,191.70
99214_3,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99214,,,,0,210.00,157.50,157.50,199.50,189.00,199.50,0.00,189.00
99214_3,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99214,,,,0,210.00,157.50,157.50,199.50,189.00,199.50,199.50,189.00
99215_2,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99215,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,0.00,217.80
99215_2,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99215,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
99215_3,"OFFICE/OUTPATIENT VISIT, EST",Outpatient,0521,99215,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,0.00,214.20
99215_3,"OFFICE/OUTPATIENT VISIT, EST",Inpatient,0521,99215,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
99217_3,OBSERVATION CARE DISCHARGE,ProFee,0989,99217,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
99218_3,OBSERVATION CARE,ProFee,0989,99218,,,,0,3.00,2.25,2.25,141.50,0.00,141.50,141.50,N/A
99219_3,OBSERVATION CARE,ProFee,0989,99219,,,,0,3.00,2.25,2.25,192.50,0.00,192.50,192.50,N/A
99226_3,SUBSEQUENT OBSERVATION CARE,ProFee,0989,99226,,,,0,3.00,2.25,2.25,148.50,0.00,148.50,148.50,N/A
99231_3,SUBSEQUENT HOSPITAL CARE,ProFee,0989,99231,,,,0,3.00,2.25,2.25,55.50,0.00,55.50,55.50,N/A
99232_3,SUBSEQUENT HOSPITAL CARE,ProFee,0989,99232,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
99233_3,SUBSEQUENT HOSPITAL CARE,ProFee,0989,99233,,,,0,3.00,2.25,2.25,147.50,0.00,147.50,147.50,N/A
99234_3,OBSERV/HOSP SAME DATE,ProFee,0989,99234,,,,0,3.00,2.25,2.25,188.50,0.00,188.50,188.50,N/A
99235_3,OBSERV/HOSP SAME DATE,ProFee,0989,99235,,,,0,3.00,2.25,2.25,239.50,0.00,239.50,239.50,N/A
99236_3,OBSERV/HOSP SAME DATE,ProFee,0989,99236,,,,0,3.00,2.25,2.25,309.00,0.00,309.00,309.00,N/A
99238_3,HOSPITAL DISCHARGE DAY,ProFee,0989,99238,,,,0,3.00,2.25,2.25,103.50,0.00,103.50,103.50,N/A
99239_3,HOSPITAL DISCHARGE DAY,ProFee,0989,99239,,,,0,3.00,2.25,2.25,152.50,0.00,152.50,152.50,N/A
99253_3,INITIAL INPATIENT CONSULT,ProFee,0989,99253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99255_3,INITIAL INPATIENT CONSULT,ProFee,0989,99255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99288_3,DIRECT ADVANCED LIFE SUPPORT,ProFee,0989,99288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99289_3,PED CRIT CARE TRANSPORT,ProFee,0989,99289,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99290_3,PED CRIT CARE TRANSPORT ADDL,ProFee,0989,99290,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99293_2,"PED CRITICAL CARE, INITIAL",ProFee,0989,99293,,,,0,208.00,156.00,156.00,156.00,N/A,N/A,N/A,N/A
99293_3,"PED CRITICAL CARE, INITIAL",ProFee,0989,99293,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99294_3,"PED CRITICAL CARE, SUBSEQ",ProFee,0989,99294,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99295_3,"NEONATE CRIT CARE, INITIAL",ProFee,0989,99295,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99296_3,NEONATE CRITICAL CARE SUBSEQ,ProFee,0989,99296,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99298_3,IC FOR LBW INFANT < 1500 GM,ProFee,0989,99298,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99299_3,"IC, LBW INFANT 1500-2500 GM",ProFee,0989,99299,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99300_3,"IC, INFANT PBW 2501-5000 GM",ProFee,0989,99300,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99304_3,"NURSING FACILITY CARE, INIT",ProFee,0989,99304,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
99305_2,"NURSING FACILITY CARE, INIT",Inpatient,0525,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
99305_2,"NURSING FACILITY CARE, INIT",Outpatient,0525,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,0.00,205.20
99305_3,"NURSING FACILITY CARE, INIT",Outpatient,0525,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,0.00,205.20
99305_3,"NURSING FACILITY CARE, INIT",Inpatient,0525,99305,,,,0,228.00,171.00,171.00,216.60,205.20,216.60,216.60,205.20
99306_3,"NURSING FACILITY CARE, INIT",ProFee,0989,99306,,,,0,3.00,2.25,2.25,236.00,0.00,236.00,236.00,N/A
99307_3,"NURSING FAC CARE, SUBSEQ",ProFee,0989,99307,,,,0,3.00,2.25,2.25,63.00,0.00,63.00,63.00,N/A
99308_3,"NURSING FAC CARE, SUBSEQ",ProFee,0989,99308,,,,0,3.00,2.25,2.25,98.00,0.00,98.00,98.00,N/A
99309_3,"NURSING FAC CARE, SUBSEQ",ProFee,0989,99309,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
99310_3,"NURSING FAC CARE, SUBSEQ",ProFee,0989,99310,,,,0,3.00,2.25,2.25,192.50,0.00,192.50,192.50,N/A
99315_3,NURSING FAC DISCHARGE DAY,ProFee,0989,99315,,,,0,3.00,2.25,2.25,103.00,0.00,103.00,103.00,N/A
99316_3,NURSING FAC DISCHARGE DAY,ProFee,0989,99316,,,,0,3.00,2.25,2.25,150.00,0.00,150.00,150.00,N/A
99318_3,ANNUAL NURSING FAC ASSESSMNT,ProFee,0989,99318,,,,0,3.00,2.25,2.25,136.00,0.00,136.00,136.00,N/A
99324_3,DOMICIL/R-HOME VISIT NEW PAT,ProFee,0989,99324,,,,0,3.00,2.25,2.25,78.00,0.00,78.00,78.00,N/A
99325_3,DOMICIL/R-HOME VISIT NEW PAT,ProFee,0989,99325,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
99326_3,DOMICIL/R-HOME VISIT NEW PAT,ProFee,0989,99326,,,,0,3.00,2.25,2.25,197.00,0.00,197.00,197.00,N/A
99327_3,DOMICIL/R-HOME VISIT NEW PAT,ProFee,0989,99327,,,,0,3.00,2.25,2.25,263.50,0.00,263.50,263.50,N/A
99328_3,DOMICIL/R-HOME VISIT NEW PAT,ProFee,0989,99328,,,,0,3.00,2.25,2.25,308.50,0.00,308.50,308.50,N/A
99334_3,DOMICIL/R-HOME VISIT EST PAT,ProFee,0989,99334,,,,0,3.00,2.25,2.25,85.00,0.00,85.00,85.00,N/A
99335_3,DOMICIL/R-HOME VISIT EST PAT,ProFee,0989,99335,,,,0,3.00,2.25,2.25,134.00,0.00,134.00,134.00,N/A
99336_3,DOMICIL/R-HOME VISIT EST PAT,ProFee,0989,99336,,,,0,3.00,2.25,2.25,191.50,0.00,191.50,191.50,N/A
99337_3,DOMICIL/R-HOME VISIT EST PAT,ProFee,0989,99337,,,,0,3.00,2.25,2.25,273.50,0.00,273.50,273.50,N/A
99339_3,DOMICIL/R-HOME CARE SUPERVIS,ProFee,0989,99339,,,,0,3.00,2.25,2.25,109.50,0.00,109.50,109.50,N/A
99340_3,DOMICIL/R-HOME CARE SUPERVIS,ProFee,0989,99340,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
99341_2,"HOME VISIT, NEW PATIENT",Inpatient,0522,99341,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,152.95,144.90
99341_2,"HOME VISIT, NEW PATIENT",Outpatient,0522,99341,,,,0,161.00,120.75,120.75,152.95,144.90,152.95,0.00,N/A
99341_3,"HOME VISIT, NEW PATIENT",Inpatient,0522,99341,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,152.00,144.00
99341_3,"HOME VISIT, NEW PATIENT",Outpatient,0522,99341,,,,0,160.00,120.00,120.00,152.00,144.00,152.00,0.00,N/A
99342_2,"HOME VISIT, NEW PATIENT",Inpatient,0522,99342,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
99342_2,"HOME VISIT, NEW PATIENT",Outpatient,0522,99342,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,0.00,N/A
99342_3,"HOME VISIT, NEW PATIENT",Outpatient,0522,99342,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,0.00,N/A
99342_3,"HOME VISIT, NEW PATIENT",Inpatient,0522,99342,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
99344_3,"HOME VISIT, NEW PATIENT",ProFee,0989,99344,,,,0,3.00,2.25,2.25,258.50,0.00,258.50,258.50,N/A
99345_3,"HOME VISIT, NEW PATIENT",ProFee,0989,99345,,,,0,3.00,2.25,2.25,314.00,0.00,314.00,314.00,N/A
99347_2,"HOME VISIT, EST PATIENT",Outpatient,0522,99347,,,,0,141.00,105.75,105.75,133.95,126.90,133.95,0.00,N/A
99347_2,"HOME VISIT, EST PATIENT",Inpatient,0522,99347,,,,0,141.00,105.75,105.75,133.95,126.90,133.95,133.95,126.90
99347_3,"HOME VISIT, EST PATIENT",Outpatient,0522,99347,,,,0,140.00,105.00,105.00,133.00,126.00,133.00,0.00,N/A
99347_3,"HOME VISIT, EST PATIENT",Inpatient,0522,99347,,,,0,140.00,105.00,105.00,133.00,126.00,133.00,133.00,126.00
99348_2,"HOME VISIT, EST PATIENT",Inpatient,0522,99348,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
99348_2,"HOME VISIT, EST PATIENT",Outpatient,0522,99348,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,N/A
99348_3,"HOME VISIT, EST PATIENT",Outpatient,0522,99348,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,N/A
99348_3,"HOME VISIT, EST PATIENT",Inpatient,0522,99348,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
99349_2,"HOME VISIT, EST PATIENT",Inpatient,0522,99349,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
99349_2,"HOME VISIT, EST PATIENT",Outpatient,0522,99349,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,N/A
99349_3,"HOME VISIT, EST PATIENT",Outpatient,0522,99349,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,N/A
99349_3,"HOME VISIT, EST PATIENT",Inpatient,0522,99349,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
99350_2,"HOME VISIT, EST PATIENT",Inpatient,0522,99350,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,377.15,357.30
99350_2,"HOME VISIT, EST PATIENT",Outpatient,0522,99350,,,,0,397.00,297.75,297.75,377.15,357.30,377.15,0.00,N/A
99350_3,"HOME VISIT, EST PATIENT",Inpatient,0522,99350,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,369.55,350.10
99350_3,"HOME VISIT, EST PATIENT",Outpatient,0522,99350,,,,0,389.00,291.75,291.75,369.55,350.10,369.55,0.00,N/A
99354_3,"PROLONGED SERVICE, OFFICE",ProFee,0989,99354,,,,0,3.00,2.25,2.25,172.50,0.00,172.50,172.50,N/A
99355_3,"PROLONGED SERVICE, OFFICE",ProFee,0989,99355,,,,0,3.00,2.25,2.25,129.50,0.00,129.50,129.50,N/A
99356_3,"PROLONGED SERVICE, INPATIENT",ProFee,0989,99356,,,,0,3.00,2.25,2.25,130.50,0.00,130.50,130.50,N/A
99357_3,"PROLONGED SERVICE, INPATIENT",ProFee,0989,99357,,,,0,3.00,2.25,2.25,131.00,0.00,131.00,131.00,N/A
99359_3,"PROLONGED SERV, W/O CONTACT",ProFee,0989,99359,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
99360_3,PHYSICIAN STANDBY SERVICES,ProFee,0989,99360,,,,0,3.00,2.25,2.25,87.00,0.00,87.00,87.00,N/A
99361_3,PHYSICIAN/TEAM CONFERENCE,ProFee,0989,99361,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99362_3,PHYSICIAN/TEAM CONFERENCE,ProFee,0989,99362,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99363_3,"ANTICOAG MGMT, INIT",ProFee,0989,99363,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99364_3,"ANTICOAG MGMT, SUBSEQ",ProFee,0989,99364,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99366_2,TEAM CONF W/PAT BY HC PRO,ProFee,0989,99366,,,,0,161.00,120.75,59.50,120.75,0.00,59.50,59.50,N/A
99366_3,TEAM CONF W/PAT BY HC PRO,ProFee,0989,99366,,,,0,160.00,120.00,59.50,120.00,0.00,59.50,59.50,N/A
99368_3,TEAM CONF W/O PAT BY HC PRO,ProFee,0989,99368,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
99371_3,PHYSICIAN PHONE CONSULTATION,ProFee,0989,99371,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99372_3,PHYSICIAN PHONE CONSULTATION,ProFee,0989,99372,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99373_3,PHYSICIAN PHONE CONSULTATION,ProFee,0989,99373,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99374_3,HOME HEALTH CARE SUPERVISION,ProFee,0989,99374,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
99375_3,HOME HEALTH CARE SUPERVISION,ProFee,0989,99375,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
99377_3,HOSPICE CARE SUPERVISION,ProFee,0989,99377,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
99378_3,HOSPICE CARE SUPERVISION,ProFee,0989,99378,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
99379_3,NURSING FAC CARE SUPERVISION,ProFee,0989,99379,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
99380_3,NURSING FAC CARE SUPERVISION,Outpatient,0521,99380,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
99380_3,NURSING FAC CARE SUPERVISION,Inpatient,0521,99380,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
99381_2,"PREV VISIT, NEW, INFANT",Outpatient,0521,99381,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,0.00,218.70
99381_2,"PREV VISIT, NEW, INFANT",Inpatient,0521,99381,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,230.85,218.70
99381_3,"PREV VISIT, NEW, INFANT",Inpatient,0521,99381,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,230.85,218.70
99381_3,"PREV VISIT, NEW, INFANT",Outpatient,0521,99381,,,,0,243.00,182.25,182.25,230.85,218.70,230.85,0.00,218.70
99382_2,"PREV VISIT, NEW, AGE 1-4",Inpatient,0521,99382,,,,0,261.00,195.75,195.75,247.95,234.90,247.95,247.95,234.90
99382_2,"PREV VISIT, NEW, AGE 1-4",Outpatient,0521,99382,,,,0,261.00,195.75,195.75,247.95,234.90,247.95,0.00,234.90
99382_3,"PREV VISIT, NEW, AGE 1-4",Inpatient,0521,99382,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,244.15,231.30
99382_3,"PREV VISIT, NEW, AGE 1-4",Outpatient,0521,99382,,,,0,257.00,192.75,192.75,244.15,231.30,244.15,0.00,231.30
99383_2,"PREV VISIT, NEW, AGE 5-11",Inpatient,0521,99383,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,241.30,228.60
99383_2,"PREV VISIT, NEW, AGE 5-11",Outpatient,0521,99383,,,,0,254.00,190.50,190.50,241.30,228.60,241.30,0.00,228.60
99383_3,"PREV VISIT, NEW, AGE 5-11",Inpatient,0521,99383,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,237.50,225.00
99383_3,"PREV VISIT, NEW, AGE 5-11",Outpatient,0521,99383,,,,0,250.00,187.50,187.50,237.50,225.00,237.50,0.00,225.00
99384_2,"PREV VISIT, NEW, AGE 12-17",Outpatient,0521,99384,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,256.50
99384_2,"PREV VISIT, NEW, AGE 12-17",Inpatient,0521,99384,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
99384_3,"PREV VISIT, NEW, AGE 12-17",Outpatient,0521,99384,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,252.00
99384_3,"PREV VISIT, NEW, AGE 12-17",Inpatient,0521,99384,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
99385_2,"PREV VISIT, NEW, AGE 18-39",Inpatient,0521,99385,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
99385_2,"PREV VISIT, NEW, AGE 18-39",Outpatient,0521,99385,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,256.50
99385_3,"PREV VISIT, NEW, AGE 18-39",Outpatient,0521,99385,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,252.00
99385_3,"PREV VISIT, NEW, AGE 18-39",Inpatient,0521,99385,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
99386_2,"PREV VISIT, NEW, AGE 40-64",Outpatient,0521,99386,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,0.00,286.20
99386_2,"PREV VISIT, NEW, AGE 40-64",Inpatient,0521,99386,,,,0,318.00,238.50,238.50,302.10,286.20,302.10,302.10,286.20
99386_3,"PREV VISIT, NEW, AGE 40-64",Inpatient,0521,99386,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,296.40,280.80
99386_3,"PREV VISIT, NEW, AGE 40-64",Outpatient,0521,99386,,,,0,312.00,234.00,234.00,296.40,280.80,296.40,0.00,280.80
99387_2,"PREV VISIT, NEW, 65 & OVER",Inpatient,0521,99387,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,270.75,256.50
99387_2,"PREV VISIT, NEW, 65 & OVER",Outpatient,0521,99387,,,,0,285.00,213.75,213.75,270.75,256.50,270.75,0.00,256.50
99387_3,"PREV VISIT, NEW, 65 & OVER",Inpatient,0521,99387,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,266.00,252.00
99387_3,"PREV VISIT, NEW, 65 & OVER",Outpatient,0521,99387,,,,0,280.00,210.00,210.00,266.00,252.00,266.00,0.00,252.00
99391_2,"PREV VISIT, EST, INFANT",Inpatient,0521,99391,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,183.35,173.70
99391_2,"PREV VISIT, EST, INFANT",Outpatient,0521,99391,,,,0,193.00,144.75,144.75,183.35,173.70,183.35,0.00,173.70
99391_3,"PREV VISIT, EST, INFANT",Outpatient,0521,99391,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,0.00,171.90
99391_3,"PREV VISIT, EST, INFANT",Inpatient,0521,99391,,,,0,191.00,143.25,143.25,181.45,171.90,181.45,181.45,171.90
99392_2,"PREV VISIT, EST, AGE 1-4",Inpatient,0521,99392,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
99392_2,"PREV VISIT, EST, AGE 1-4",Outpatient,0521,99392,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,0.00,187.20
99392_3,"PREV VISIT, EST, AGE 1-4",Inpatient,0521,99392,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,194.75,184.50
99392_3,"PREV VISIT, EST, AGE 1-4",Outpatient,0521,99392,,,,0,205.00,153.75,153.75,194.75,184.50,194.75,0.00,184.50
99393_2,"PREV VISIT, EST, AGE 5-11",Inpatient,0521,99393,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,197.60,187.20
99393_2,"PREV VISIT, EST, AGE 5-11",Outpatient,0521,99393,,,,0,208.00,156.00,156.00,197.60,187.20,197.60,0.00,187.20
99393_3,"PREV VISIT, EST, AGE 5-11",Outpatient,0521,99393,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
99393_3,"PREV VISIT, EST, AGE 5-11",Inpatient,0521,99393,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
99394_2,PREV VISIT EST AGE 12-17,Outpatient,0521,99394,,,,0,252.00,189.00,189.00,239.40,226.80,239.40,0.00,226.80
99394_2,PREV VISIT EST AGE 12-17,Inpatient,0521,99394,,,,0,252.00,189.00,189.00,239.40,226.80,239.40,239.40,226.80
99394_3,PREV VISIT EST AGE 12-17,Outpatient,0521,99394,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,0.00,223.20
99394_3,PREV VISIT EST AGE 12-17,Inpatient,0521,99394,,,,0,248.00,186.00,186.00,235.60,223.20,235.60,235.60,223.20
99395_2,"PREV VISIT, EST, AGE 18-39",Inpatient,0521,99395,,,,0,259.00,194.25,194.25,246.05,233.10,246.05,246.05,233.10
99395_2,"PREV VISIT, EST, AGE 18-39",Outpatient,0521,99395,,,,0,259.00,194.25,194.25,246.05,233.10,246.05,0.00,233.10
99395_3,"PREV VISIT, EST, AGE 18-39",Outpatient,0521,99395,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,0.00,229.50
99395_3,"PREV VISIT, EST, AGE 18-39",Inpatient,0521,99395,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,242.25,229.50
99396_2,"PREV VISIT, EST, AGE 40-64",Inpatient,0521,99396,,,,0,249.00,186.75,186.75,236.55,224.10,236.55,236.55,224.10
99396_2,"PREV VISIT, EST, AGE 40-64",Outpatient,0521,99396,,,,0,249.00,186.75,186.75,236.55,224.10,236.55,0.00,224.10
99396_3,"PREV VISIT, EST, AGE 40-64",Inpatient,0521,99396,,,,0,245.00,183.75,183.75,232.75,220.50,232.75,232.75,220.50
99396_3,"PREV VISIT, EST, AGE 40-64",Outpatient,0521,99396,,,,0,245.00,183.75,183.75,232.75,220.50,232.75,0.00,220.50
99397_2,"PREV VISIT, EST, 65 & OVER",Outpatient,0521,99397,,,,0,259.00,194.25,194.25,246.05,233.10,246.05,0.00,233.10
99397_2,"PREV VISIT, EST, 65 & OVER",Inpatient,0521,99397,,,,0,259.00,194.25,194.25,246.05,233.10,246.05,246.05,233.10
99397_3,"PREV VISIT, EST, 65 & OVER",Inpatient,0521,99397,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,242.25,229.50
99397_3,"PREV VISIT, EST, 65 & OVER",Outpatient,0521,99397,,,,0,255.00,191.25,191.25,242.25,229.50,242.25,0.00,229.50
99406_2,BEHAV CHNG SMOKING 3-10 MIN,Outpatient,0521,99406,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,0.00,36.00
99406_2,BEHAV CHNG SMOKING 3-10 MIN,Inpatient,0521,99406,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
99406_3,BEHAV CHNG SMOKING 3-10 MIN,Inpatient,0521,99406,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
99406_3,BEHAV CHNG SMOKING 3-10 MIN,Outpatient,0521,99406,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,0.00,37.80
99407_2,BEHAV CHNG SMOKING < 10 MIN,Inpatient,0521,99407,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
99407_2,BEHAV CHNG SMOKING < 10 MIN,Outpatient,0521,99407,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,0.00,45.00
99407_3,BEHAV CHNG SMOKING < 10 MIN,Inpatient,0521,99407,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,49.40,46.80
99407_3,BEHAV CHNG SMOKING < 10 MIN,Outpatient,0521,99407,,,,0,52.00,39.00,39.00,49.40,46.80,49.40,0.00,46.80
99408_3,"AUDIT/DAST, 15-30 MIN",ProFee,0989,99408,,,,0,3.00,2.25,2.25,47.00,0.00,47.00,47.00,N/A
99409_3,"AUDIT/DAST, OVER 30 MIN",ProFee,0989,99409,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
99415_3,PROLONG CLINCL STAFF SVC,ProFee,0989,99415,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
99416_3,PROLONG CLINCL STAFF SVC ADD,ProFee,0989,99416,,,,0,3.00,2.25,2.25,6.50,0.00,6.50,6.50,N/A
99420_3,HEALTH RISK ASSESSMENT TEST,ProFee,0989,99420,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99421_3,OL DIG E/M SVC 5-10 MIN,ProFee,0989,99421,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99422_3,OL DIG E/M SVC 11-20 MIN,ProFee,0989,99422,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99423_3,OL DIG E/M SVC 21+ MIN,ProFee,0989,99423,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99429_3,UNLISTED PREVENTIVE SERVICE,ProFee,0989,99429,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99431_3,"INITIAL CARE, NORMAL NEWBORN",ProFee,0989,99431,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99432_3,"NEWBORN CARE, NOT IN HOSP",ProFee,0989,99432,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99433_3,NORMAL NEWBORN CARE/HOSPITAL,ProFee,0989,99433,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99435_3,NEWBORN DISCHARGE DAY HOSP,ProFee,0989,99435,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99436_3,"ATTENDANCE, BIRTH",ProFee,0989,99436,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99440_3,NEWBORN RESUSCITATION,ProFee,0989,99440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99441_2,PHONE E/M BY PHYS 5-10 MIN,ProFee,0989,99441,,,,0,45.00,33.75,18.00,33.75,0.00,18.00,18.00,N/A
99441_3,PHONE E/M BY PHYS 5-10 MIN,ProFee,0989,99441,,,,0,47.00,35.25,18.00,35.25,0.00,18.00,18.00,N/A
99442_2,PHONE E/M BY PHYS 11-20 MIN,ProFee,0989,99442,,,,0,89.00,66.75,36.00,66.75,0.00,36.00,36.00,N/A
99442_3,PHONE E/M BY PHYS 11-20 MIN,ProFee,0989,99442,,,,0,90.00,67.50,36.00,67.50,0.00,36.00,36.00,N/A
99443_2,PHONE E/M BY PHYS 21-30 MIN,ProFee,0989,99443,,,,0,132.00,99.00,54.00,99.00,0.00,54.00,54.00,N/A
99443_3,PHONE E/M BY PHYS 21-30 MIN,ProFee,0989,99443,,,,0,132.00,99.00,54.00,99.00,0.00,54.00,54.00,N/A
99446_3,NTRPROF PH1/NTRNET/EHR 5-10,ProFee,0989,99446,,,,0,3.00,2.25,2.25,25.50,0.00,25.50,25.50,N/A
99447_3,NTRPROF PH1/NTRNET/EHR 11-20,ProFee,0989,99447,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
99448_3,NTRPROF PH1/NTRNET/EHR 21-30,ProFee,0989,99448,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
99449_3,NTRPROF PH1/NTRNET/EHR 31/>,ProFee,0989,99449,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
99450_2,LIFE/DISABILITY EVALUATION,ProFee,0989,99450,,,,0,186.00,139.50,139.50,139.50,0.00,N/A,N/A,N/A
99450_3,LIFE/DISABILITY EVALUATION,ProFee,0989,99450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99451_3,NTRPROF PH1/NTRNET/EHR 5/>,ProFee,0989,99451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99452_3,NTRPROF PH1/NTRNET/EHR RFRL,ProFee,0989,99452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99453_3,REM MNTR PHYSIOL PARAM SETUP,ProFee,0989,99453,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99454_3,REM MNTR PHYSIOL PARAM DEV,ProFee,0989,99454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99455_2,Work Related Or Medical Disability Examination,ProFee,0989,99455,,,,0,116.00,87.00,87.00,87.00,0.00,N/A,N/A,N/A
99455_3,Work Related Or Medical Disability Examination,ProFee,0989,99455,,,,0,116.00,87.00,87.00,87.00,0.00,N/A,N/A,N/A
99456_2,DISABILITY EXAMINATION,ProFee,0989,99456,,,,0,186.00,139.50,139.50,139.50,0.00,N/A,N/A,N/A
99456_3,DISABILITY EXAMINATION,ProFee,0989,99456,,,,0,184.00,138.00,138.00,138.00,0.00,N/A,N/A,N/A
99457_3,REM PHYSIOL MNTR 1ST 20 MIN,ProFee,0989,99457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99458_3,REM PHYSIOL MNTR EA ADDL 20,ProFee,0989,99458,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99460_3,"INIT NB EM PER DAY, HOSP",ProFee,0989,99460,,,,0,3.00,2.25,2.25,135.50,0.00,135.50,135.50,N/A
99461_3,"INIT NB EM PER DAY, NON-FAC",ProFee,0989,99461,,,,0,3.00,2.25,2.25,89.00,0.00,89.00,89.00,N/A
99462_3,"SBSQ NB EM PER DAY, HOSP",ProFee,0989,99462,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
99463_3,SAME DAY NB DISCHARGE,ProFee,0989,99463,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
99464_3,ATTENDANCE AT DELIVERY,ProFee,0989,99464,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
99465_3,NB RESUSCITATION,ProFee,0989,99465,,,,0,3.00,2.25,2.25,206.50,0.00,206.50,206.50,N/A
99466_3,PED CRIT CARE TRANSPORT,ProFee,0989,99466,,,,0,3.00,2.25,2.25,338.00,0.00,338.00,338.00,N/A
99467_3,PED CRIT CARE TRANSPORT ADDL,ProFee,0989,99467,,,,0,3.00,2.25,2.25,169.00,0.00,169.00,169.00,N/A
99468_3,"NEONATE CRIT CARE, INITIAL",ProFee,0989,99468,,,,0,3.00,2.25,2.25,1302.00,0.00,1302.00,1302.00,N/A
99469_3,"NEONATE CRIT CARE, SUBSQ",ProFee,0989,99469,,,,0,3.00,2.25,2.25,563.50,0.00,563.50,563.50,N/A
99471_3,"PED CRITICAL CARE, INITIAL",ProFee,0989,99471,,,,0,3.00,2.25,2.25,1127.00,0.00,1127.00,1127.00,N/A
99472_3,"PED CRITICAL CARE, SUBSQ",ProFee,0989,99472,,,,0,3.00,2.25,2.25,583.00,0.00,583.00,583.00,N/A
99473_3,SELF-MEAS BP PT EDUCAJ/TRAIN,ProFee,0989,99473,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99474_3,SELF-MEAS BP 2 READG BID 30D,ProFee,0989,99474,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
99475_3,"PED CRIT CARE AGE 2-5, INIT",ProFee,0989,99475,,,,0,3.00,2.25,2.25,793.50,0.00,793.50,793.50,N/A
99476_3,"PED CRIT CARE AGE 2-5, SUBSQ",ProFee,0989,99476,,,,0,3.00,2.25,2.25,489.00,0.00,489.00,489.00,N/A
99477_3,INIT DAY HOSP NEONATE CARE,ProFee,0989,99477,,,,0,3.00,2.25,2.25,494.00,0.00,494.00,494.00,N/A
99478_3,"IC, LBW INF < 1500 GM SUBSQ",ProFee,0989,99478,,,,0,3.00,2.25,2.25,194.00,0.00,194.00,194.00,N/A
99479_3,IC LBW INF 1500-2500 G SUBSQ,ProFee,0989,99479,,,,0,3.00,2.25,2.25,176.00,0.00,176.00,176.00,N/A
99480_3,IC INF PBW 2501-5000 G SUBSQ,ProFee,0989,99480,,,,0,3.00,2.25,2.25,169.50,0.00,169.50,169.50,N/A
99483_3,ASSMT & CARE PLN PT COG IMP,ProFee,0989,99483,,,,0,3.00,2.25,2.25,248.50,0.00,248.50,248.50,N/A
99484_3,CARE MGMT SVC BHVL HLTH COND,ProFee,0989,99484,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
99485_3,SUPRV INTERFACILTY TRANSPORT,ProFee,0989,99485,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
99486_3,SUPRV INTERFAC TRNSPORT ADDL,ProFee,0989,99486,,,,0,3.00,2.25,2.25,94.50,0.00,94.50,94.50,N/A
99487_3,CMPLX CHRON CARE W/O PT VSIT,ProFee,0989,99487,,,,0,3.00,2.25,2.25,74.00,0.00,74.00,74.00,N/A
99489_3,CMPLX CHRON CARE ADDL 30 MIN,ProFee,0989,99489,,,,0,3.00,2.25,2.25,37.00,0.00,37.00,37.00,N/A
99490_2,Chronic Care Management Services  At Least 20 Minu,ProFee,0989,99490,,,,0,74.00,55.50,45.50,55.50,0.00,45.50,45.50,N/A
99490_3,Chronic Care Management Services  At Least 20 Minu,ProFee,0989,99490,,,,0,74.00,55.50,45.50,55.50,0.00,45.50,45.50,N/A
99491_2,CHRNC CARE MGMT SVC 30 MIN,ProFee,0989,99491,,,,0,74.00,55.50,55.50,55.50,0.00,N/A,N/A,N/A
99491_3,CHRNC CARE MGMT SVC 30 MIN,ProFee,0989,99491,,,,0,74.00,55.50,55.50,55.50,0.00,N/A,N/A,N/A
99492_3,1ST PSYC COLLAB CARE MGMT,ProFee,0989,99492,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
99493_3,SBSQ PSYC COLLAB CARE MGMT,ProFee,0989,99493,,,,0,3.00,2.25,2.25,113.50,0.00,113.50,113.50,N/A
99494_3,1ST/SBSQ PSYC COLLAB CARE,ProFee,0989,99494,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
99495_3,TRANS CARE MGMT 14 DAY DISCH,ProFee,0989,99495,,,,0,3.00,2.25,2.25,156.00,0.00,156.00,156.00,N/A
99496_3,TRANS CARE MGMT 7 DAY DISCH,ProFee,0989,99496,,,,0,3.00,2.25,2.25,226.50,0.00,226.50,226.50,N/A
99497_2,Advance Care Planning first 30 mins,Inpatient,0521,99497,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
99497_2,Advance Care Planning first 30 mins,Outpatient,0521,99497,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,0.00,103.50
99497_3,Advance Care Planning first 30 mins,Inpatient,0521,99497,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,109.25,103.50
99497_3,Advance Care Planning first 30 mins,Outpatient,0521,99497,,,,0,115.00,86.25,86.25,109.25,103.50,109.25,0.00,103.50
99498_2,Advance Care Planning Including The Explanation An,Outpatient,0521,99498,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,0.00,90.90
99498_2,Advance Care Planning Including The Explanation An,Inpatient,0521,99498,,,,0,101.00,75.75,75.75,95.95,90.90,95.95,95.95,90.90
99498_3,Advance Care Planning Including The Explanation An,Inpatient,0521,99498,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,96.90,91.80
99498_3,Advance Care Planning Including The Explanation An,Outpatient,0521,99498,,,,0,102.00,76.50,76.50,96.90,91.80,96.90,0.00,91.80
99499_3,UNLISTED E&M SERVICE,Outpatient,0521,99499,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
99499_3,UNLISTED E&M SERVICE,Inpatient,0521,99499,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
99500_3,"HOME VISIT, PRENATAL",ProFee,0989,99500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99501_3,"HOME VISIT, POSTNATAL",ProFee,0989,99501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99502_3,"HOME VISIT, NB CARE",ProFee,0989,99502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99503_3,"HOME VISIT, RESP THERAPY",ProFee,0989,99503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99504_3,HOME VISIT MECH VENTILATOR,ProFee,0989,99504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99505_3,"HOME VISIT, STOMA CARE",ProFee,0989,99505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99506_3,"HOME VISIT, IM INJECTION",ProFee,0989,99506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99507_3,"HOME VISIT, CATH MAINTAIN",ProFee,0989,99507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99509_3,HOME VISIT DAY LIFE ACTIVITY,ProFee,0989,99509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99510_3,"HOME VISIT, SING/M/FAM COUNS",ProFee,0989,99510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99511_3,"HOME VISIT, FECAL/ENEMA MGMT",ProFee,0989,99511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99512_3,HOME VISIT FOR HEMODIALYSIS,ProFee,0989,99512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99600_3,HOME VISIT NOS,ProFee,0989,99600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99601_3,"HOME INFUSION/VISIT, 2 HRS",ProFee,0989,99601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99602_3,"HOME INFUSION, EACH ADDTL HR",ProFee,0989,99602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99605_3,"MTMS BY PHARM, NP, 15 MIN",ProFee,0989,99605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99606_3,"MTMS BY PHARM, EST, 15 MIN",ProFee,0989,99606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
99607_3,"MTMS BY PHARM, ADDL 15 MIN",ProFee,0989,99607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0021_3,Outside state ambulance serv,ProFee,0989,A0021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0080_3,Noninterest escort in non er,ProFee,0989,A0080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0090_3,Interest escort in non er,ProFee,0989,A0090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0100_3,Nonemergency transport taxi,ProFee,0989,A0100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0110_3,Nonemergency transport bus,ProFee,0989,A0110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0120_3,Noner transport mini-bus,ProFee,0989,A0120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0130_3,Noner transport wheelch van,ProFee,0989,A0130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0140_3,Nonemergency transport air,ProFee,0989,A0140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0160_3,Noner transport case worker,ProFee,0989,A0160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0170_3,Transport parking fees/tolls,ProFee,0989,A0170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0180_3,Noner transport lodgng recip,ProFee,0989,A0180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0190_3,Noner transport meals recip,ProFee,0989,A0190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0200_3,Noner transport lodgng escrt,ProFee,0989,A0200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0210_3,Noner transport meals escort,ProFee,0989,A0210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0225_3,Neonatal emergency transport,ProFee,0989,A0225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0380_3,Basic life support mileage,ProFee,0989,A0380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0382_3,Basic support routine suppls,ProFee,0989,A0382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0384_3,Bls defibrillation supplies,ProFee,0989,A0384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0390_3,Advanced life support mileag,ProFee,0989,A0390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0392_3,Als defibrillation supplies,ProFee,0989,A0392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0394_3,Als IV drug therapy supplies,ProFee,0989,A0394,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0396_3,Als esophageal intub suppls,ProFee,0989,A0396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0398_3,Als routine disposble suppls,ProFee,0989,A0398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0420_3,Ambulance waiting 1/2 hr,ProFee,0989,A0420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0422_3,Ambulance 02 life sustaining,ProFee,0989,A0422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0424_3,Extra ambulance attendant,ProFee,0989,A0424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0425_3,Ground mileage,ProFee,0989,A0425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0426_3,Als 1,ProFee,0989,A0426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0427_3,ALS1-emergency,ProFee,0989,A0427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0428_3,bls,ProFee,0989,A0428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0429_3,BLS-emergency,ProFee,0989,A0429,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0430_3,Fixed wing air transport,ProFee,0989,A0430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0431_3,Rotary wing air transport,ProFee,0989,A0431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0432_3,PI volunteer ambulance co,ProFee,0989,A0432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0433_3,als 2,ProFee,0989,A0433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0434_3,Specialty care transport,ProFee,0989,A0434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0435_3,Fixed wing air mileage,ProFee,0989,A0435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0436_3,Rotary wing air mileage,ProFee,0989,A0436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0800_3,Amb trans 7pm-7am,ProFee,0989,A0800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A0888_3,Noncovered ambulance mileage,ProFee,0989,A0888,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0998_3,Ambulance response/treatment,ProFee,0989,A0998,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A0999_3,Unlisted ambulance service,ProFee,0989,A0999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4206_3,1 CC sterile syringe&needle,ProFee,0989,A4206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4207_3,2 CC sterile syringe&needle,ProFee,0989,A4207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4208_3,3 CC sterile syringe&needle,ProFee,0989,A4208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4209_3,5+ CC sterile syringe&needle,ProFee,0989,A4209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4210_3,Nonneedle injection device,ProFee,0989,A4210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4211_3,Supp for self-adm injections,ProFee,0989,A4211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4212_3,Non coring needle or stylet,ProFee,0989,A4212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4213_3,20+ CC syringe only,ProFee,0989,A4213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4215_3,Sterile needle,ProFee,0989,A4215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4216_3,"Sterile water/saline, 10 ml",ProFee,0989,A4216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4217_3,"Sterile water/saline, 500 ml",ProFee,0989,A4217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4218_3,Sterile saline or water,ProFee,0989,A4218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4220_3,Infusion pump refill kit,ProFee,0989,A4220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4221_3,Maint drug infus cath per wk,ProFee,0989,A4221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4222_3,Infusion supplies with pump,ProFee,0989,A4222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4223_3,Infusion supplies w/o pump,ProFee,0989,A4223,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4224_3,Supply insulin inf cath/wk,ProFee,0989,A4224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4225_3,Sup/ext insulin inf pump syr,ProFee,0989,A4225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4226_3,Weekly supply maint cgs pump,ProFee,0989,A4226,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4230_3,Infus insulin pump non needl,ProFee,0989,A4230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4231_3,Infusion insulin pump needle,ProFee,0989,A4231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4232_3,Syringe w/needle insulin 3cc,ProFee,0989,A4232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4233_3,Alkalin batt for glucose mon,ProFee,0989,A4233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4234_3,J-cell batt for glucose mon,ProFee,0989,A4234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4235_3,Lithium batt for glucose mon,ProFee,0989,A4235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4236_3,Silvr oxide batt glucose mon,ProFee,0989,A4236,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4244_3,Alcohol or peroxide per pint,ProFee,0989,A4244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4245_3,Alcohol wipes per box,ProFee,0989,A4245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4246_3,Betadine/phisohex solution,ProFee,0989,A4246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4247_3,Betadine/iodine swabs/wipes,ProFee,0989,A4247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4248_3,Chlorhexidine antisept,ProFee,0989,A4248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4250_3,Urine reagent strips/tablets,ProFee,0989,A4250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4252_3,Blood ketone test or strip,ProFee,0989,A4252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4253_3,Blood glucose/reagent strips,ProFee,0989,A4253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4255_3,Glucose monitor platforms,ProFee,0989,A4255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4256_3,Calibrator solution/chips,ProFee,0989,A4256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4257_3,Replace Lensshield Cartridge,ProFee,0989,A4257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4258_3,Lancet device each,ProFee,0989,A4258,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4259_3,Lancets per box,ProFee,0989,A4259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4261_3,Cervical cap contraceptive,ProFee,0989,A4261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4262_3,Temporary tear duct plug,ProFee,0989,A4262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4263_3,Permanent tear duct plug,ProFee,0989,A4263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4264_3,Intratubal occlusion device,ProFee,0989,A4264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4265_3,Paraffin,ProFee,0989,A4265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4266_3,Diaphragm,ProFee,0989,A4266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4267_3,Male condom,ProFee,0989,A4267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4268_3,Female condom,ProFee,0989,A4268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4269_3,Spermicide,ProFee,0989,A4269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4270_3,Disposable endoscope sheath,ProFee,0989,A4270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4280_3,Brst prsths adhsv attchmnt,ProFee,0989,A4280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4281_3,Replacement breastpump tube,ProFee,0989,A4281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4282_3,Replacement breastpump adpt,ProFee,0989,A4282,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4283_3,Replacement breastpump cap,ProFee,0989,A4283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4284_3,Replcmnt breast pump shield,ProFee,0989,A4284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4285_3,Replcmnt breast pump bottle,ProFee,0989,A4285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4286_3,Replcmnt breastpump lok ring,ProFee,0989,A4286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4290_3,Sacral nerve stim test lead,ProFee,0989,A4290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4300_3,Cath impl vasc access portal,ProFee,0989,A4300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4301_3,Implantable access syst perc,ProFee,0989,A4301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4305_3,Drug delivery system >=50 ML,ProFee,0989,A4305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4306_3,Drug delivery system <=5 ML,ProFee,0989,A4306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4311_3,Catheter w/o bag 2-way latex,ProFee,0989,A4311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4312_3,Cath w/o bag 2-way silicone,ProFee,0989,A4312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4313_3,Catheter w/bag 3-way,ProFee,0989,A4313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4314_3,Cath w/drainage 2-way latex,ProFee,0989,A4314,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4315_3,Cath w/drainage 2-way silcne,ProFee,0989,A4315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4316_3,Cath w/drainage 3-way,ProFee,0989,A4316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4320_3,Irrigation tray,ProFee,0989,A4320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4321_3,Cath therapeutic irrig agent,ProFee,0989,A4321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4322_3,Irrigation syringe,ProFee,0989,A4322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4326_3,Male external catheter,ProFee,0989,A4326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4327_3,Fem urinary collect dev cup,ProFee,0989,A4327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4328_3,Fem urinary collect pouch,ProFee,0989,A4328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4330_3,Stool collection pouch,ProFee,0989,A4330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4331_3,Extension drainage tubing,ProFee,0989,A4331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4332_3,Lube sterile packet,ProFee,0989,A4332,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4333_3,Urinary cath anchor device,ProFee,0989,A4333,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4334_3,Urinary cath leg strap,ProFee,0989,A4334,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4335_3,Incontinence supply,ProFee,0989,A4335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4336_3,Urethral insert,ProFee,0989,A4336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4337_3,Incontinent rectal insert,ProFee,0989,A4337,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4338_3,Indwelling catheter latex,ProFee,0989,A4338,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4340_3,Indwelling catheter special,ProFee,0989,A4340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4344_3,Cath indw foley 2 way silicn,ProFee,0989,A4344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4346_3,Cath indw foley 3 way,ProFee,0989,A4346,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4348_3,Male ext cath extended wear,ProFee,0989,A4348,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4349_3,Disposable male external cat,ProFee,0989,A4349,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4352_3,Coude tip urinary catheter,ProFee,0989,A4352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4353_3,Intermittent urinary cath,ProFee,0989,A4353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4354_3,Cath insertion tray w/bag,ProFee,0989,A4354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4355_3,Bladder irrigation tubing,ProFee,0989,A4355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4356_3,Ext ureth clmp or compr dvc,ProFee,0989,A4356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4357_3,Bedside drainage bag,ProFee,0989,A4357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4358_3,Urinary leg or abdomen bag,ProFee,0989,A4358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4359_3,Urinary suspensory w/o leg b,ProFee,0989,A4359,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4360_3,Disposable ext urethral dev,ProFee,0989,A4360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4361_3,Ostomy face plate,ProFee,0989,A4361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4362_3,Solid skin barrier,ProFee,0989,A4362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4363_3,"Ostomy clamp, replacement",ProFee,0989,A4363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4364_3,"Adhesive, liquid or equal",ProFee,0989,A4364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4365_3,Adhesive remover wipes,ProFee,0989,A4365,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4366_3,Ostomy vent,ProFee,0989,A4366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4367_3,Ostomy belt,ProFee,0989,A4367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4368_3,Ostomy filter,ProFee,0989,A4368,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4369_3,Skin barrier liquid per oz,ProFee,0989,A4369,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4371_3,Skin barrier powder per oz,ProFee,0989,A4371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4372_3,Skin barrier solid 4x4 equiv,ProFee,0989,A4372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4373_3,Skin barrier with flange,ProFee,0989,A4373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4375_3,Drainable plastic pch w fcpl,ProFee,0989,A4375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4376_3,Drainable rubber pch w fcplt,ProFee,0989,A4376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4377_3,Drainable plstic pch w/o fp,ProFee,0989,A4377,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4378_3,Drainable rubber pch w/o fp,ProFee,0989,A4378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4379_3,Urinary plastic pouch w fcpl,ProFee,0989,A4379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4380_3,Urinary rubber pouch w fcplt,ProFee,0989,A4380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4381_3,Urinary plastic pouch w/o fp,ProFee,0989,A4381,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4382_3,Urinary hvy plstc pch w/o fp,ProFee,0989,A4382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4383_3,Urinary rubber pouch w/o fp,ProFee,0989,A4383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4384_3,Ostomy faceplt/silicone ring,ProFee,0989,A4384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4385_3,Ost skn barrier sld ext wear,ProFee,0989,A4385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4387_3,Ost clsd pouch w att st barr,ProFee,0989,A4387,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4388_3,Drainable pch w ex wear barr,ProFee,0989,A4388,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4389_3,Drainable pch w st wear barr,ProFee,0989,A4389,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4390_3,Drainable pch ex wear convex,ProFee,0989,A4390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4391_3,Urinary pouch w ex wear barr,ProFee,0989,A4391,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4392_3,Urinary pouch w st wear barr,ProFee,0989,A4392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4393_3,Urine pch w ex wear bar conv,ProFee,0989,A4393,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4394_3,Ostomy pouch liq deodorant,ProFee,0989,A4394,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4395_3,Ostomy pouch solid deodorant,ProFee,0989,A4395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4396_3,Peristomal hernia supprt blt,ProFee,0989,A4396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4397_3,Irrigation supply sleeve,ProFee,0989,A4397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4398_3,Ostomy irrigation bag,ProFee,0989,A4398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4399_3,Ostomy irrig cone/cath w brs,ProFee,0989,A4399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4400_3,Ostomy irrigation set,ProFee,0989,A4400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4402_3,Lubricant per ounce,ProFee,0989,A4402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4404_3,Ostomy ring each,ProFee,0989,A4404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4405_3,Nonpectin based ostomy paste,ProFee,0989,A4405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4406_3,Pectin based ostomy paste,ProFee,0989,A4406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4407_3,Ext wear ost skn barr <=4sq",ProFee,0989,A4407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4408_3,Ext wear ost skn barr >4sq",ProFee,0989,A4408,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4409_3,Ost skn barr w flng <=4 sq",ProFee,0989,A4409,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4410_3,Ost skn barr w flng >4sq",ProFee,0989,A4410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4411_3,Ost skn barr extnd =4sq,ProFee,0989,A4411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4412_3,Ost pouch drain high output,ProFee,0989,A4412,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4413_3,2 pc drainable ost pouch,ProFee,0989,A4413,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4414_3,Ostomy sknbarr w flng <=4sq",ProFee,0989,A4414,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4415_3,Ostomy skn barr w flng >4sq",ProFee,0989,A4415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4416_3,Ost pch clsd w barrier/filtr,ProFee,0989,A4416,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4417_3,Ost pch w bar/bltinconv/fltr,ProFee,0989,A4417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4418_3,Ost pch clsd w/o bar w filtr,ProFee,0989,A4418,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4419_3,Ost pch for bar w flange/flt,ProFee,0989,A4419,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4420_3,Ost pch clsd for bar w lk fl,ProFee,0989,A4420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4421_3,Ostomy supply misc,ProFee,0989,A4421,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4422_3,Ost pouch absorbent material,ProFee,0989,A4422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4423_3,Ost pch for bar w lk fl/fltr,ProFee,0989,A4423,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4424_3,Ost pch drain w bar & filter,ProFee,0989,A4424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4425_3,Ost pch drain for barrier fl,ProFee,0989,A4425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4426_3,Ost pch drain 2 piece system,ProFee,0989,A4426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4427_3,Ost pch drain/barr lk flng/f,ProFee,0989,A4427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4428_3,Urine ost pouch w faucet/tap,ProFee,0989,A4428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4429_3,Urine ost pouch w bltinconv,ProFee,0989,A4429,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4430_3,Ost urine pch w b/bltin conv,ProFee,0989,A4430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4431_3,Ost pch urine w barrier/tapv,ProFee,0989,A4431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4432_3,Os pch urine w bar/fange/tap,ProFee,0989,A4432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4433_3,Urine ost pch bar w lock fln,ProFee,0989,A4433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4434_3,Ost pch urine w lock flng/ft,ProFee,0989,A4434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4435_3,1pc ost pch drain hgh output,ProFee,0989,A4435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4450_2,Non-waterproof tape,ProFee,0989,A4450,,,,0,50.00,37.50,37.50,37.50,0.00,N/A,N/A,N/A
A4450_3,Non-waterproof tape,ProFee,0989,A4450,,,,0,52.00,39.00,39.00,39.00,0.00,N/A,N/A,N/A
A4452_3,Waterproof tape,ProFee,0989,A4452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4455_3,Adhesive remover per ounce,ProFee,0989,A4455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4456_3,"Adhesive remover, wipes",ProFee,0989,A4456,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4458_3,Reusable enema bag,ProFee,0989,A4458,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4459_3,"Manual pump enema, reusable",ProFee,0989,A4459,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4461_3,Surgicl dress hold non-reuse,ProFee,0989,A4461,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4462_3,Abdmnl drssng holder/binder,ProFee,0989,A4462,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4463_3,Surgical dress holder reuse,ProFee,0989,A4463,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4465_3,Non-elastic extremity binder,ProFee,0989,A4465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4466_3,Elastic garment/covering,ProFee,0989,A4467,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4467_3,Belt strap sleev grmnt cover,ProFee,0989,A4467,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4470_3,Gravlee jet washer,ProFee,0989,A4470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4480_3,Vabra aspirator,ProFee,0989,A4480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4481_3,Tracheostoma filter,ProFee,0989,A4481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4483_3,Moisture exchanger,ProFee,0989,A4483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4490_3,Above knee surgical stocking,ProFee,0989,A4490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4495_3,Thigh length surg stocking,ProFee,0989,A4495,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4500_3,Below knee surgical stocking,ProFee,0989,A4500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4510_3,Full length surg stocking,ProFee,0989,A4510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4520_3,Incontinence garment anytype,ProFee,0989,A4520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4553_3,"Nondisp underpads, all sizes",ProFee,0989,A4553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4554_3,Disposable underpads,ProFee,0989,A4554,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4555_3,Ca tx e-stim electr/transduc,ProFee,0989,A4555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4556_3,"Electrodes, pair",ProFee,0989,A4556,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4557_3,"Lead wires, pair",ProFee,0989,A4557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4558_3,Conductive paste or gel,ProFee,0989,A4558,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4559_3,Coupling gel or paste,ProFee,0989,A4559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4562_3,"Pessary, non rubber,any type",ProFee,0989,A4562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4563_3,Vag inser rectal control sys,ProFee,0989,A4563,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4566_3,Should sling/vest/abrestrain,ProFee,0989,A4566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4575_3,Hyperbaric o2 chamber disps,ProFee,0989,A4575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4595_3,TENS suppl 2 lead per month,ProFee,0989,A4595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4600_3,"Sleeve, inter limb comp dev",ProFee,0989,A4600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4601_3,"Lith ion batt, non-pros use",ProFee,0989,A4601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4602_3,Replace lithium battery 1.5v,ProFee,0989,A4602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4604_3,Tubing with heating element,ProFee,0989,A4604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4605_3,Trach suction cath close sys,ProFee,0989,A4605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4606_3,Oxygen probe used w oximeter,ProFee,0989,A4606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4608_3,Transtracheal oxygen cath,ProFee,0989,A4608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4611_3,Heavy duty battery,ProFee,0989,A4611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4612_3,Battery cables,ProFee,0989,A4612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4613_3,Battery charger,ProFee,0989,A4613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4614_3,Hand-held PEFR meter,ProFee,0989,A4614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4616_3,Tubing (oxygen) per foot,ProFee,0989,A4616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4617_3,Mouth piece,ProFee,0989,A4617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4618_3,Breathing circuits,ProFee,0989,A4618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4619_3,Face tent,ProFee,0989,A4619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4620_3,Variable concentration mask,ProFee,0989,A4620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4623_3,Tracheostomy inner cannula,ProFee,0989,A4623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4624_3,Tracheal suction tube,ProFee,0989,A4624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4625_3,Trach care kit for new trach,ProFee,0989,A4625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4626_3,Tracheostomy cleaning brush,ProFee,0989,A4626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4627_3,Spacer bag/reservoir,ProFee,0989,A4627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4628_3,Oropharyngeal suction cath,ProFee,0989,A4628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4629_3,Tracheostomy care kit,ProFee,0989,A4629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4630_3,Repl bat t.e.n.s. own by pt,ProFee,0989,A4630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4632_3,Infus pump rplcemnt battery,ProFee,0989,A4632,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A4633_3,Uvl replacement bulb,ProFee,0989,A4633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4634_3,Replacement bulb th lightbox,ProFee,0989,A4634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4635_3,Underarm crutch pad,ProFee,0989,A4635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4636_3,Handgrip for cane etc,ProFee,0989,A4636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4637_3,Repl tip cane/crutch/walker,ProFee,0989,A4637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4638_3,Repl batt pulse gen sys,ProFee,0989,A4638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4639_3,Infrared ht sys replcmnt pad,ProFee,0989,A4639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4640_3,Alternating pressure pad,ProFee,0989,A4640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4641_3,Diagnostic imaging agent,ProFee,0989,A4641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4642_3,Satumomab pendetide per dose,ProFee,0989,A4642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4648_3,Implantable tissue marker,ProFee,0989,A4648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4649_3,Surgical supplies,ProFee,0989,A4649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4650_3,Implant radiation dosimeter,ProFee,0989,A4650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4651_3,Calibrated microcap tube,ProFee,0989,A4651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4652_3,Microcapillary tube sealant,ProFee,0989,A4652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4653_3,PD catheter anchor belt,ProFee,0989,A4653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4657_3,Syringe w/wo needle,ProFee,0989,A4657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4660_3,Sphyg/bp app w cuff and stet,ProFee,0989,A4660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4663_3,Dialysis blood pressure cuff,ProFee,0989,A4663,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4670_3,"Automatic bp monitor, dial",ProFee,0989,A4670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4671_3,Disposable cycler set,ProFee,0989,A4671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4672_3,"Drainage ext line, dialysis",ProFee,0989,A4672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4673_3,Ext line w easy lock connect,ProFee,0989,A4673,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4674_3,"Chem/antisept solution, 8oz",ProFee,0989,A4674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4680_3,"Activated carbon filter, ea",ProFee,0989,A4680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4690_3,"Dialyzer, each",ProFee,0989,A4690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4706_3,Bicarbonate conc sol per gal,ProFee,0989,A4706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4707_3,Bicarbonate conc pow per pac,ProFee,0989,A4707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4708_3,Acetate conc sol per gallon,ProFee,0989,A4708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4709_3,Acid conc sol per gallon,ProFee,0989,A4709,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4714_3,Treated water per gallon,ProFee,0989,A4714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4719_3,Y set tubing,ProFee,0989,A4719,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4720_3,Dialysat sol fld vol > 249cc,ProFee,0989,A4720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4721_3,Dialysat sol fld vol > 999cc,ProFee,0989,A4721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4722_3,Dialys sol fld vol > 1999cc,ProFee,0989,A4722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4723_3,Dialys sol fld vol > 2999cc,ProFee,0989,A4723,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4724_3,Dialys sol fld vol > 3999cc,ProFee,0989,A4724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4725_3,Dialys sol fld vol > 4999cc,ProFee,0989,A4725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4726_3,Dialys sol fld vol > 5999cc,ProFee,0989,A4726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4728_3,"Dialysate solution, non-dex",ProFee,0989,A4728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4730_3,"Fistula cannulation set, ea",ProFee,0989,A4730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4736_3,"Topical anesthetic, per gram",ProFee,0989,A4736,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4737_3,Inj anesthetic per 10 ml,ProFee,0989,A4737,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4740_3,Shunt accessory,ProFee,0989,A4740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4750_3,Art or venous blood tubing,ProFee,0989,A4750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4755_3,Comb art/venous blood tubing,ProFee,0989,A4755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4760_3,"Dialysate sol test kit, each",ProFee,0989,A4760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4765_3,Dialysate conc pow per pack,ProFee,0989,A4765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4766_3,Dialysate conc sol add 10 ml,ProFee,0989,A4766,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4770_3,Blood collection tube/vacuum,ProFee,0989,A4770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4771_3,Serum clotting time tube,ProFee,0989,A4771,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4772_3,Blood glucose test strips,ProFee,0989,A4772,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4773_3,Occult blood test strips,ProFee,0989,A4773,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4774_3,Ammonia test strips,ProFee,0989,A4774,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4802_3,Protamine sulfate per 50 mg,ProFee,0989,A4802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4860_3,Disposable catheter tips,ProFee,0989,A4860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4870_3,Plumb/elec wk hm hemo equip,ProFee,0989,A4870,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4890_3,Repair/maint cont hemo equip,ProFee,0989,A4890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4911_3,Drain bag/bottle,ProFee,0989,A4911,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4913_3,Misc dialysis supplies noc,ProFee,0989,A4913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4918_3,Venous pressure clamp,ProFee,0989,A4918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4927_3,Non-sterile gloves,ProFee,0989,A4927,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4928_3,Surgical mask,ProFee,0989,A4928,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4929_3,"Tourniquet for dialysis, ea",ProFee,0989,A4929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4930_3,"Sterile, gloves per pair",ProFee,0989,A4930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4931_3,Reusable oral thermometer,ProFee,0989,A4931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A4932_3,Reusable rectal thermometer,ProFee,0989,A4932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5051_3,Pouch clsd w barr attached,ProFee,0989,A5051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5052_3,Clsd ostomy pouch w/o barr,ProFee,0989,A5052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5053_3,Clsd ostomy pouch faceplate,ProFee,0989,A5053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5054_3,Clsd ostomy pouch w/flange,ProFee,0989,A5054,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5055_3,Stoma cap,ProFee,0989,A5055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5056_3,1 pc ost pouch w filter,ProFee,0989,A5056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5057_3,1 pc ost pou w built-in conv,ProFee,0989,A5057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5061_3,Pouch drainable w barrier at,ProFee,0989,A5061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5062_3,Drnble ostomy pouch w/o barr,ProFee,0989,A5062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5063_3,Drain ostomy pouch w/flange,ProFee,0989,A5063,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5071_3,Urinary pouch w/barrier,ProFee,0989,A5071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5072_3,Urinary pouch w/o barrier,ProFee,0989,A5072,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5073_3,Urinary pouch on barr w/flng,ProFee,0989,A5073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5081_3,Continent stoma plug,ProFee,0989,A5081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5082_3,Continent stoma catheter,ProFee,0989,A5082,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5083_3,Stoma absorptive cover,ProFee,0989,A5083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5093_3,Ostomy accessory convex inse,ProFee,0989,A5093,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5102_3,Bedside drain btl w/wo tube,ProFee,0989,A5102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5105_3,Urinary suspensory,ProFee,0989,A5105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5112_3,Urinary leg bag,ProFee,0989,A5112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5113_3,Latex leg strap,ProFee,0989,A5113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5114_3,Foam/fabric leg strap,ProFee,0989,A5114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5120_3,"Skin barrier, wipe or swab",ProFee,0989,A5120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5121_3,Solid skin barrier 6x6,ProFee,0989,A5121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5122_3,Solid skin barrier 8x8,ProFee,0989,A5122,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5126_3,Disk/foam pad +or- adhesive,ProFee,0989,A5126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5131_3,Appliance cleaner,ProFee,0989,A5131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5200_3,Percutaneous catheter anchor,ProFee,0989,A5200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5500_3,Diab shoe for density insert,ProFee,0989,A5500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5501_3,Diabetic custom molded shoe,ProFee,0989,A5501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5503_3,Diabetic shoe w/roller/rockr,ProFee,0989,A5503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5504_3,Diabetic shoe with wedge,ProFee,0989,A5504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5505_3,Diab shoe w/metatarsal bar,ProFee,0989,A5505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5506_3,Diabetic shoe w/off set heel,ProFee,0989,A5506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5507_3,Modification diabetic shoe,ProFee,0989,A5507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5508_3,Diabetic deluxe shoe,ProFee,0989,A5508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5510_3,Compression form shoe insert,ProFee,0989,A5510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5512_3,Multi den insert direct form,ProFee,0989,A5512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5513_3,Multi den insert custom mold,ProFee,0989,A5513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A5514_3,Mult den insert dir carv/cam,ProFee,0989,A5514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6000_3,Wound warming wound cover,ProFee,0989,A6000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6010_3,Collagen based wound filler,ProFee,0989,A6010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6011_3,Collagen gel/paste wound fil,ProFee,0989,A6011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6021_3,Collagen dressing <=16 sq in,ProFee,0989,A6021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6022_3,Collagen drsg>6<=48 sq in,ProFee,0989,A6022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6023_3,Collagen dressing >48 sq in,ProFee,0989,A6023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6024_3,Collagen dsg wound filler,ProFee,0989,A6024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6025_3,"Silicone gel sheet, each",ProFee,0989,A6025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6154_3,Wound pouch each,ProFee,0989,A6154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6196_3,Alginate dressing <=16 sq in,ProFee,0989,A6196,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6197_3,Alginate drsg >16 <=48 sq in,ProFee,0989,A6197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6198_3,alginate dressing > 48 sq in,ProFee,0989,A6198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6199_3,Alginate drsg wound filler,ProFee,0989,A6199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6200_3,Compos drsg <=16 no border,ProFee,0989,A6200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A6201_3,Compos drsg >16<=48 no bdr,ProFee,0989,A6201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A6202_3,Compos drsg >48 no border,ProFee,0989,A6202,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A6203_3,Composite drsg <= 16 sq in,ProFee,0989,A6203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6204_3,Composite drsg >16<=48 sq in,ProFee,0989,A6204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6205_3,Composite drsg > 48 sq in,ProFee,0989,A6205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6206_3,Contact layer <= 16 sq in,ProFee,0989,A6206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6207_3,Contact layer >16<= 48 sq in,ProFee,0989,A6207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6208_3,Contact layer > 48 sq in,ProFee,0989,A6208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6209_3,Foam drsg <=16 sq in w/o bdr,ProFee,0989,A6209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6210_3,Foam drg >16<=48 sq in w/o b,ProFee,0989,A6210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6211_3,Foam drg > 48 sq in w/o brdr,ProFee,0989,A6211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6212_3,Foam drg <=16 sq in w/border,ProFee,0989,A6212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6213_3,Foam drg >16<=48 sq in w/bdr,ProFee,0989,A6213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6214_3,Foam drg > 48 sq in w/border,ProFee,0989,A6214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6215_3,Foam dressing wound filler,ProFee,0989,A6215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6216_3,Non-sterile gauze<=16 sq in,ProFee,0989,A6216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6217_3,Non-sterile gauze>16<=48 sq,ProFee,0989,A6217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6218_3,Non-sterile gauze > 48 sq in,ProFee,0989,A6218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6219_3,Gauze <= 16 sq in w/border,ProFee,0989,A6219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6220_3,Gauze >16 <=48 sq in w/bordr,ProFee,0989,A6220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6221_3,Gauze > 48 sq in w/border,ProFee,0989,A6221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6222_3,Gauze <=16 in no w/sal w/o b,ProFee,0989,A6222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6223_3,Gauze >16<=48 no w/sal w/o b,ProFee,0989,A6223,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6224_3,Gauze > 48 in no w/sal w/o b,ProFee,0989,A6224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6228_3,Gauze <= 16 sq in water/sal,ProFee,0989,A6228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6229_3,Gauze >16<=48 sq in watr/sal,ProFee,0989,A6229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6230_3,Gauze > 48 sq in water/salne,ProFee,0989,A6230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6231_3,Hydrogel dsg<=16 sq in,ProFee,0989,A6231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6232_3,Hydrogel dsg>16<=48 sq in,ProFee,0989,A6232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6233_3,Hydrogel dressing >48 sq in,ProFee,0989,A6233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6234_3,Hydrocolld drg <=16 w/o bdr,ProFee,0989,A6234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6235_3,Hydrocolld drg >16<=48 w/o b,ProFee,0989,A6235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6236_3,Hydrocolld drg > 48 in w/o b,ProFee,0989,A6236,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6238_3,Hydrocolld drg >16<=48 w/bdr,ProFee,0989,A6238,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6239_3,Hydrocolld drg > 48 in w/bdr,ProFee,0989,A6239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6240_3,Hydrocolld drg filler paste,ProFee,0989,A6240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6241_3,Hydrocolloid drg filler dry,ProFee,0989,A6241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6242_3,Hydrogel drg <=16 in w/o bdr,ProFee,0989,A6242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6243_3,Hydrogel drg >16<=48 w/o bdr,ProFee,0989,A6243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6244_3,Hydrogel drg >48 in w/o bdr,ProFee,0989,A6244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6245_3,Hydrogel drg <= 16 in w/bdr,ProFee,0989,A6245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6246_3,Hydrogel drg >16<=48 in w/b,ProFee,0989,A6246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6247_3,Hydrogel drg > 48 sq in w/b,ProFee,0989,A6247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6248_3,Hydrogel drsg gel filler,ProFee,0989,A6248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6250_3,Skin seal protect moisturizr,ProFee,0989,A6250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6251_3,Absorpt drg <=16 sq in w/o b,ProFee,0989,A6251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6252_3,Absorpt drg >16 <=48 w/o bdr,ProFee,0989,A6252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6253_3,Absorpt drg > 48 sq in w/o b,ProFee,0989,A6253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6254_3,Absorpt drg <=16 sq in w/bdr,ProFee,0989,A6254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6255_3,Absorpt drg >16<=48 in w/bdr,ProFee,0989,A6255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6256_3,Absorpt drg > 48 sq in w/bdr,ProFee,0989,A6256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6257_3,Transparent film <= 16 sq in,ProFee,0989,A6257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6258_3,Transparent film >16<=48 in,ProFee,0989,A6258,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6259_3,Transparent film > 48 sq in,ProFee,0989,A6259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6260_3,Wound cleanser any type/size,ProFee,0989,A6260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6261_3,Wound filler gel/paste /oz,ProFee,0989,A6261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6262_3,Wound filler dry form / gram,ProFee,0989,A6262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6266_3,Impreg gauze no h20/sal/yard,ProFee,0989,A6266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6402_3,Sterile gauze <= 16 sq in,ProFee,0989,A6402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6403_3,Sterile gauze>16 <= 48 sq in,ProFee,0989,A6403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6404_3,Sterile gauze > 48 sq in,ProFee,0989,A6404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6407_3,"Packing strips, non-impreg",ProFee,0989,A6407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6410_3,Sterile eye pad,ProFee,0989,A6410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6411_3,Non-sterile eye pad,ProFee,0989,A6411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6412_3,Occlusive eye patch,ProFee,0989,A6412,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6413_3,"Adhesive bandage, first-aid",ProFee,0989,A6413,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6441_3,Pad band w>=3" <5"/yd,ProFee,0989,A6441,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6442_3,Conform band n/s w<3"/yd,ProFee,0989,A6442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6443_3,Conform band n/s w>=3"<5"/yd,ProFee,0989,A6443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6444_3,Conform band n/s w>=5"/yd,ProFee,0989,A6444,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6445_3,Conform band s w <3"/yd,ProFee,0989,A6445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6446_3,Conform band s w>=3" <5"/yd,ProFee,0989,A6446,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6447_3,Conform band s w >=5"/yd,ProFee,0989,A6447,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6448_3,Lt compres band <3"/yd,ProFee,0989,A6448,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6449_3,Lt compres band >=3" <5"/yd,ProFee,0989,A6449,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6450_3,Lt compres band >=5"/yd,ProFee,0989,A6450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6451_3,Mod compres band w>=3"<5"/yd,ProFee,0989,A6451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6453_3,Self-adher band w <3"/yd,ProFee,0989,A6453,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6454_3,Self-adher band w>=3" <5"/yd,ProFee,0989,A6454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6455_3,Self-adher band >=5"/yd,ProFee,0989,A6455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6456_3,Zinc paste band w >=3"<5"/yd,ProFee,0989,A6456,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6457_3,Tubular dressing,ProFee,0989,A6457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6460_3,Synthetic drsg <= 16 sq in,ProFee,0989,A6460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6461_3,Synthetic drsg >16<=48 sq in,ProFee,0989,A6461,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6501_3,Compres burngarment bodysuit,ProFee,0989,A6501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6502_3,Compres burngarment chinstrp,ProFee,0989,A6502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6503_3,Compres burngarment facehood,ProFee,0989,A6503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6504_3,Cmprsburngarment glove-wrist,ProFee,0989,A6504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6505_3,Cmprsburngarment glove-elbow,ProFee,0989,A6505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6506_3,Cmprsburngrmnt glove-axilla,ProFee,0989,A6506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6507_3,Cmprs burngarment foot-knee,ProFee,0989,A6507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6508_3,Cmprs burngarment foot-thigh,ProFee,0989,A6508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6509_3,Compres burn garment jacket,ProFee,0989,A6509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6510_3,Compres burn garment leotard,ProFee,0989,A6510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6511_3,Compres burn garment panty,ProFee,0989,A6511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6512_3,"Compres burn garment, noc",ProFee,0989,A6512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6513_3,Compress burn mask face/neck,ProFee,0989,A6513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6530_3,Compression stocking BK18-30,ProFee,0989,A6530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6531_3,Compression stocking BK30-40,ProFee,0989,A6531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6532_3,Compression stocking BK40-50,ProFee,0989,A6532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6534_3,Gc stocking thighlngth 30-40,ProFee,0989,A6534,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6535_3,Gc stocking thighlngth 40-50,ProFee,0989,A6535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6536_3,Gc stocking full lngth 18-30,ProFee,0989,A6536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6537_3,Gc stocking full lngth 30-40,ProFee,0989,A6537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6538_3,Gc stocking full lngth 40-50,ProFee,0989,A6538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6539_3,Gc stocking waistlngth 18-30,ProFee,0989,A6539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6540_3,Gc stocking waistlngth 30-40,ProFee,0989,A6540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6541_3,Gc stocking waistlngth 40-50,ProFee,0989,A6541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6542_3,Gc stocking custom made,ProFee,0989,A6542,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A6543_3,Gc stocking lymphedema,ProFee,0989,A6543,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A6544_3,Gc stocking garter belt,ProFee,0989,A6544,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6545_3,Grad comp non-elastic BK,ProFee,0989,A6545,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6549_3,G compression stocking,ProFee,0989,A6549,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A6550_3,Neg pres wound ther drsg set,ProFee,0989,A6550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7000_3,Disposable canister for pump,ProFee,0989,A7000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7001_3,Nondisposable pump canister,ProFee,0989,A7001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7002_3,Tubing used w suction pump,ProFee,0989,A7002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7003_3,Nebulizer administration set,ProFee,0989,A7003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7004_3,Disposable nebulizer sml vol,ProFee,0989,A7004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7005_3,Nondisposable nebulizer set,ProFee,0989,A7005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7006_3,Filtered nebulizer admin set,ProFee,0989,A7006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7007_3,Lg vol nebulizer disposable,ProFee,0989,A7007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7008_3,Disposable nebulizer prefill,ProFee,0989,A7008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7009_3,Nebulizer reservoir bottle,ProFee,0989,A7009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7010_3,Disposable corrugated tubing,ProFee,0989,A7010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7011_3,Nondispos corrugated tubing,ProFee,0989,A7010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7012_3,Nebulizer water collec devic,ProFee,0989,A7012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7013_3,Disposable compressor filter,ProFee,0989,A7013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7014_3,Compressor nondispos filter,ProFee,0989,A7014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7015_3,Aerosol mask used w nebulize,ProFee,0989,A7015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7016_3,Nebulizer dome & mouthpiece,ProFee,0989,A7016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7017_3,Nebulizer not used w oxygen,ProFee,0989,A7017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7018_3,Water distilled w/nebulizer,ProFee,0989,A7018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7020_3,"Interface, cough stim device",ProFee,0989,A7020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7025_3,Replace chest compress vest,ProFee,0989,A7025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7026_3,Replace chst cmprss sys hose,ProFee,0989,A7026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7027_3,Combination oral/nasal mask,ProFee,0989,A7027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7028_3,Repl oral cushion combo mask,ProFee,0989,A7028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7029_3,Repl nasal pillow comb mask,ProFee,0989,A7029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7030_3,CPAP full face mask,ProFee,0989,A7030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7031_3,Replacement facemask interfa,ProFee,0989,A7031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7032_3,Replacement nasal cushion,ProFee,0989,A7032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7033_3,Replacement nasal pillows,ProFee,0989,A7033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7034_3,Nasal application device,ProFee,0989,A7034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7035_3,Pos airway press headgear,ProFee,0989,A7035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7036_3,Pos airway press chinstrap,ProFee,0989,A7036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7037_3,Pos airway pressure tubing,ProFee,0989,A7037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7038_3,Pos airway pressure filter,ProFee,0989,A7038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7039_3,"Filter, non disposable w pap",ProFee,0989,A7039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7040_3,One way chest drain valve,ProFee,0989,A7040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7041_3,Water seal drain container,ProFee,0989,A7041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7042_3,Implanted pleural catheter,ProFee,0989,A7042,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A7043_3,Vacuum drainagebottle/tubing,ProFee,0989,A7043,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A7044_3,PAP oral interface,ProFee,0989,A7044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7045_3,Repl exhalation port for PAP,ProFee,0989,A7045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7046_3,"Repl water chamber, PAP dev",ProFee,0989,A7046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7047_3,Resp suction oral interface,ProFee,0989,A7047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7048_3,Vacuum drain bottle/tube kit,ProFee,0989,A7048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7501_3,Tracheostoma valve w diaphra,ProFee,0989,A7501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7502_3,Replacement diaphragm/fplate,ProFee,0989,A7502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7503_3,HMES filter holder or cap,ProFee,0989,A7503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7504_3,Tracheostoma HMES filter,ProFee,0989,A7504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7505_3,HMES or trach valve housing,ProFee,0989,A7505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7506_3,HMES/trachvalve adhesivedisk,ProFee,0989,A7506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7507_3,Integrated filter & holder,ProFee,0989,A7507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7508_3,Housing & Integrated Adhesiv,ProFee,0989,A7508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7509_3,Heat & moisture exchange sys,ProFee,0989,A7509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7520_3,Trach/laryn tube non-cuffed,ProFee,0989,A7520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7521_3,Trach/laryn tube cuffed,ProFee,0989,A7521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7522_3,Trach/laryn tube stainless,ProFee,0989,A7522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7523_3,Tracheostomy shower protect,ProFee,0989,A7523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7524_3,Tracheostoma stent/stud/bttn,ProFee,0989,A7524,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7525_3,Tracheostomy mask,ProFee,0989,A7525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7526_3,Tracheostomy tube collar,ProFee,0989,A7526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A7527_3,Trach/laryn tube plug/stop,ProFee,0989,A7527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A8000_3,Soft protect helmet prefab,ProFee,0989,A8000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A8001_3,Hard protect helmet prefab,ProFee,0989,A8001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A8002_3,Soft protect helmet custom,ProFee,0989,A8002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A8003_3,Hard protect helmet custom,ProFee,0989,A8003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A8004_3,"Repl soft interface, helmet",ProFee,0989,A8004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9150_3,Misc/exper non-prescript dru,ProFee,0989,A9150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9152_3,Single vitamin nos,ProFee,0989,A9152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9153_3,Multi-vitamin nos,ProFee,0989,A9153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9155_3,Artificial saliva,ProFee,0989,A9155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9180_3,"Lice treatment, topical",ProFee,0989,A9180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9270_3,Non-covered item or service,ProFee,0989,A9270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9272_3,"Disp wound suct, drsg/access",ProFee,0989,A9272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9273_3,Hot/cold h2obot/cap/col/wrap,ProFee,0989,A9273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9274_3,Ext amb insulin delivery sys,ProFee,0989,A9274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9275_3,Disp home glucose monitor,ProFee,0989,A9275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9276_3,"Disposable sensor, CGM sys",ProFee,0989,A9276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9277_3,"External transmitter, CGM",ProFee,0989,A9277,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9278_3,"External receiver, CGM sys",ProFee,0989,A9278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9279_3,Monitoring feature/deviceNOC,ProFee,0989,A9279,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9280_3,"Alert device, noc",ProFee,0989,A9280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9281_3,Reaching/grabbing device,ProFee,0989,A9281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9282_3,Wig any type,ProFee,0989,A9282,,,,0,3.00,2.25,2.25,255.06,0.00,255.06,255.06,N/A
A9283_3,Foot press off load supp dev,ProFee,0989,A9283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9284_3,Non-electronic spirometer,ProFee,0989,A9284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9285_3,Inversion eversion cor devic,ProFee,0989,A9285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9286_3,"Any hygienic item, device",ProFee,0989,A9286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9300_3,Exercise equipment,ProFee,0989,A9300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9500_3,Technetium TC 99m sestamibi,ProFee,0989,A9500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9501_3,Technetium TC-99m teboroxime,ProFee,0989,A9501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9502_3,Technetium TC99M tetrofosmin,ProFee,0989,A9502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9503_3,Technetium TC 99m medronate,ProFee,0989,A9503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9504_3,Technetium tc 99m apcitide,ProFee,0989,A9504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9505_3,Thallous chloride TL 201/mci,ProFee,0989,A9505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9507_3,Indium/111 capromab pendetid,ProFee,0989,A9507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9508_3,Iobenguane sulfate I-131,ProFee,0989,A9508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9509_3,Iodine I-123 sod iodide mil,ProFee,0989,A9509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9510_3,Technetium TC99m Disofenin,ProFee,0989,A9510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9512_3,Technetiumtc99mpertechnetate,ProFee,0989,A9512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9513_3,Lutetium lu 177 dotatat ther,ProFee,0989,A9513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9515_3,Choline c-11,ProFee,0989,A9515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9516_3,I-123 sodium iodide capsule,ProFee,0989,A9516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9517_3,Th I131 so iodide cap millic,ProFee,0989,A9517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9520_3,Tc99 tilmanocept diag 0.5mci,ProFee,0989,A9520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9521_3,Technetiumtc-99m exametazine,ProFee,0989,A9521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9524_3,Iodinated I-131 serumalbumin,ProFee,0989,A9524,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9526_3,"Ammonia N-13, per dose",ProFee,0989,A9526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9527_3,Iodine I-125 sodium iodide,ProFee,0989,A9527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9528_3,Dx I131 so iodide cap millic,ProFee,0989,A9528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9529_3,Dx I131 so iodide sol millic,ProFee,0989,A9529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9530_3,Th I131 so iodide sol millic,ProFee,0989,A9530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9531_3,Dx I131 so iodide microcurie,ProFee,0989,A9531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9532_3,I-125 serum albumin micro,ProFee,0989,A9532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9535_3,"Injection, methylene blue",ProFee,0989,A9535,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9536_3,Tc99m depreotide,ProFee,0989,A9536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9537_3,Tc99m mebrofenin,ProFee,0989,A9537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9538_3,Tc99m pyrophosphate,ProFee,0989,A9538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9539_3,Tc99m pentetate,ProFee,0989,A9539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9540_3,Tc99m MAA,ProFee,0989,A9540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9541_3,Tc99m sulfur colloid,ProFee,0989,A9541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9542_3,"In111 ibritumomab, dx",ProFee,0989,A9542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9543_3,"Y90 ibritumomab, rx",ProFee,0989,A9543,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9544_3,"I131 tositumomab, dx",ProFee,0989,A9544,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9545_3,"I131 tositumomab, rx",ProFee,0989,A9545,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9546_3,Co57/58,ProFee,0989,A9546,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9547_3,In111 oxyquinoline,ProFee,0989,A9547,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9548_3,In111 pentetate,ProFee,0989,A9548,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9549_3,Tc99m arcitumomab,ProFee,0989,A9549,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9550_3,Tc99m gluceptate,ProFee,0989,A9550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9551_3,Tc99m succimer,ProFee,0989,A9551,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9552_3,F18 fdg,ProFee,0989,A9552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9553_3,Cr51 chromate,ProFee,0989,A9553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9554_3,"I125 iothalamate, dx",ProFee,0989,A9554,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9555_3,Rb82 rubidium,ProFee,0989,A9555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9556_3,Ga67 gallium,ProFee,0989,A9556,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9557_3,Tc99m bicisate,ProFee,0989,A9557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9558_3,Xe133 xenon 10mci,ProFee,0989,A9558,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9559_3,Co57 cyano,ProFee,0989,A9559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9560_3,Tc99m labeled rbc,ProFee,0989,A9560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9561_3,Tc99m oxidronate,ProFee,0989,A9561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9562_3,Tc99m mertiatide,ProFee,0989,A9562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9563_3,P32 Na phosphate,ProFee,0989,A9563,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9564_3,P32 chromic phosphate,ProFee,0989,A9564,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9565_3,In111 pentetreotide,ProFee,0989,A9565,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9566_3,Tc99m fanolesomab,ProFee,0989,A9566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9567_3,Technetium TC-99m aerosol,ProFee,0989,A9567,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9568_3,Technetium tc99m arcitumomab,ProFee,0989,A9568,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9569_3,Technetium TC-99m auto WBC,ProFee,0989,A9569,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9570_3,Indium In-111 auto WBC,ProFee,0989,A9570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9571_3,Indium IN-111 auto platelet,ProFee,0989,A9571,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9572_3,Indium In-111 pentetreotide,ProFee,0989,A9572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9575_3,Inj gadoterate meglumi 0.1ml,ProFee,0989,A9575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9576_3,Inj prohance multipack,ProFee,0989,A9576,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9577_3,Inj multihance,ProFee,0989,A9577,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9578_3,Inj multihance multipack,ProFee,0989,A9578,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9579_3,"Gad-base MR contrast NOS,1ml",ProFee,0989,A9579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9580_3,Sodium fluoride F-18,ProFee,0989,A9580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9581_3,Gadoxetate disodium inj,ProFee,0989,A9581,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9582_3,Iodine I-123 iobenguane,ProFee,0989,A9582,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9583_3,Gadofosveset trisodium inj,ProFee,0989,A9583,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9584_3,Iodine i-123 ioflupane,ProFee,0989,A9584,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9585_3,Gadobutrol injection,ProFee,0989,A9585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9586_3,Florbetapir f18,ProFee,0989,A9586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9587_3,Gallium ga-68,ProFee,0989,A9587,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9588_3,Fluciclovine f-18,ProFee,0989,A9588,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9589_3,Insti hexaminolevulinate hcl,ProFee,0989,A9589,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9590_3,Iodine i-131 iobenguane 1mci,ProFee,0989,A9590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9597_3,"Pet, dx, for tumor id, noc",ProFee,0989,A9597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9598_3,"Pet dx for non-tumor id, noc",ProFee,0989,A9598,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9599_3,Radioph dx b amyloid pet nos,ProFee,0989,A9599,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9600_3,Strontium-89 chloride,ProFee,0989,A9600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9604_3,Sm 153 lexidronam,ProFee,0989,A9604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9605_3,Samarium sm153 lexidronamm,ProFee,0989,A9605,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
A9606_3,Radium ra223 dichloride ther,ProFee,0989,A9606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9698_3,Non-rad contrast materialNOC,ProFee,0989,A9698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9699_3,Noc therapeutic radiopharm,ProFee,0989,A9699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9700_3,Echocardiography Contrast,ProFee,0989,A9700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9900_3,Supply/accessory/service,ProFee,0989,A9900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9901_3,Delivery/set up/dispensing,ProFee,0989,A9901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
A9999_3,"DME supply or accessory, nos",ProFee,0989,A9999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
ACOV_1,COVID RAPID IN HOUSE,Outpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
ACOV_1,COVID RAPID IN HOUSE,Inpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
ACRBDA_1,Acetylcholine Rec Binding AB,Inpatient,0300,83519,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
ACRBDA_1,Acetylcholine Rec Binding AB,Outpatient,0300,83519,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
B4034_3,Enter feed supkit syr by day,ProFee,0989,B4034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4035_3,Enteral feed supp pump per d,ProFee,0989,B4035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4036_3,Enteral feed sup kit grav by,ProFee,0989,B4036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4081_3,Enteral ng tubing w/ stylet,ProFee,0989,B4081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4082_3,Enteral ng tubing w/o stylet,ProFee,0989,B4082,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4083_3,Enteral stomach tube levine,ProFee,0989,B4083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4086_3,Gastrostomy/jejunostomy tube,ProFee,0989,B4086,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
B4087_3,"Gastro/jejuno tube, std",ProFee,0989,B4087,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4088_3,"Gastro/jejuno tube, low-pro",ProFee,0989,B4088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4100_3,Food thickener oral,ProFee,0989,B4100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4102_3,EF adult fluids and electro,ProFee,0989,B4102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4103_3,EF ped fluid and electrolyte,ProFee,0989,B4103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4104_3,Additive for enteral formula,ProFee,0989,B4104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4105_3,Enzyme cartridge enteral nut,ProFee,0989,B4105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4149_3,EF blenderized foods,ProFee,0989,B4149,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4150_3,EF complet w/intact nutrient,ProFee,0989,B4150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4152_3,EF calorie dense>/=1.5Kcal,ProFee,0989,B4152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4153_3,EF hydrolyzed/amino acids,ProFee,0989,B4153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4154_3,EF spec metabolic noninherit,ProFee,0989,B4154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4155_3,EF incomplete/modular,ProFee,0989,B4155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4157_3,EF special metabolic inherit,ProFee,0989,B4157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4158_3,EF ped complete intact nut,ProFee,0989,B4158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4159_3,EF ped complete soy based,ProFee,0989,B4159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4160_3,EF ped caloric dense>/=0.7kc,ProFee,0989,B4160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4161_3,EF ped hydrolyzed/amino acid,ProFee,0989,B4161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4162_3,EF ped specmetabolic inherit,ProFee,0989,B4162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4164_3,Parenteral 50% dextrose solu,ProFee,0989,B4164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4168_3,Parenteral sol amino acid 3.,ProFee,0989,B4168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4172_3,Parenteral sol amino acid 5.,ProFee,0989,B4172,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
B4176_3,Parenteral sol amino acid 7-,ProFee,0989,B4176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4178_3,Parenteral sol amino acid >,ProFee,0989,B4178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4180_3,Parenteral sol carb > 50%,ProFee,0989,B4180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4185_3,Parenteral sol 10 gm lipids,ProFee,0989,B4185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4187_3,"Omegaven, 10 grams lipids",ProFee,0989,B4187,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
B4189_3,Parenteral sol amino acid &,ProFee,0989,B4189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4193_3,Parenteral sol 52-73 gm prot,ProFee,0989,B4193,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4197_3,Parenteral sol 74-100 gm pro,ProFee,0989,B4197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4199_3,Parenteral sol > 100gm prote,ProFee,0989,B4199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4216_3,Parenteral nutrition additiv,ProFee,0989,B4216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4220_3,Parenteral supply kit premix,ProFee,0989,B4220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4222_3,Parenteral supply kit homemi,ProFee,0989,B4222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B4224_3,Parenteral administration ki,ProFee,0989,B4224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B5000_3,Parenteral sol renal-amirosy,ProFee,0989,B5000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B5100_3,Parenteral sol hepatic-fream,ProFee,0989,B5100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B5200_3,Parenteral sol stres-brnch c,ProFee,0989,B5200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B9000_3,Enter infusion pump w/o alrm,ProFee,0989,B9000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
B9002_3,Enteral infusion pump w/ ala,ProFee,0989,B9002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B9004_3,Parenteral infus pump portab,ProFee,0989,B9004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B9006_3,Parenteral infus pump statio,ProFee,0989,B9006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B9998_3,Enteral supp not otherwise c,ProFee,0989,B9998,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
B9999_3,Parenteral supp not othrws c,ProFee,0989,B9999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
BCAR_1,Beta Carotene,Outpatient,0300,82380,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
BCAR_1,Beta Carotene,Inpatient,0300,82380,,,,0,260.00,195.00,195.00,247.00,234.00,247.00,247.00,234.00
BHI_2,Behavior Health Integration,ProFee,0989,G0511,,,,0,89.00,66.75,39.50,66.75,0.00,39.50,39.50,N/A
BHI_3,Behavior Health Integration,ProFee,0989,G0511,,,,0,90.00,67.50,39.50,67.50,0.00,39.50,39.50,N/A
BIANKL_1,Bilateral Ankle Complete,Outpatient,0320,73610,,,,0,489.00,366.75,366.75,464.55,440.10,464.55,464.55,440.10
BIANKL_1,Bilateral Ankle Complete,Inpatient,0320,73610,,,,0,489.00,366.75,366.75,464.55,440.10,464.55,464.55,440.10
C1178_3,"BUSULFAN IV, 6 Mg",ProFee,0989,C1178,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1300_3,HYPERBARIC Oxygen,ProFee,0989,C1300,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1713_3,"Anchor/screw bn/bn,tis/bn",ProFee,0989,C1713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1714_3,"Cath, trans atherectomy, dir",ProFee,0989,C1714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1715_3,Brachytherapy needle,ProFee,0989,C1715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1716_3,"Brachytx source, Gold 198",ProFee,0989,C1716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1717_3,"Brachytx source, HDR Ir-192",ProFee,0989,C1717,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1718_3,"Brachytx source, Iodine 125",ProFee,0989,C1718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1719_3,"Brachytx sour,Non-HDR Ir-192",ProFee,0989,C1719,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1720_3,"Brachytx sour, Palladium 103",ProFee,0989,C1720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1721_3,"AICD, dual chamber",ProFee,0989,C1721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1722_3,"AICD, single chamber",ProFee,0989,C1722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1724_3,"Cath, trans atherec,rotation",ProFee,0989,C1724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1725_3,"Cath, translumin non-laser",ProFee,0989,C1725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1726_3,"Cath, bal dil, non-vascular",ProFee,0989,C1726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1727_3,"Cath, bal tis dis, non-vas",ProFee,0989,C1727,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1728_3,"Cath, brachytx seed adm",ProFee,0989,C1728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1729_3,"Cath, drainage",ProFee,0989,C1729,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1730_3,"Cath, EP, 19 or few elect",ProFee,0989,C1730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1731_3,"Cath, EP, 20 or more elec",ProFee,0989,C1731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1732_3,"Cath, EP, diag/abl, 3D/vect",ProFee,0989,C1732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1733_3,"Cath, EP, othr than cool-tip",ProFee,0989,C1733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1734_3,"Orth/devic/drug bn/bn,tis/bn",ProFee,0989,C1734,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1749_3,"Endo, colon, retro imaging",ProFee,0989,C1749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1750_3,"Cath, hemodialysis,long-term",ProFee,0989,C1750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1751_3,"Cath, inf, per/cent/midline",ProFee,0989,C1751,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1752_3,"Cath,hemodialysis,short-term",ProFee,0989,C1752,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1753_3,"Cath, intravas ultrasound",ProFee,0989,C1753,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1754_3,"Catheter, intradiscal",ProFee,0989,C1754,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1755_3,"Catheter, intraspinal",ProFee,0989,C1755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1756_3,"Cath, pacing, transesoph",ProFee,0989,C1756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1757_3,"Cath, thrombectomy/embolect",ProFee,0989,C1757,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1758_3,"Catheter, ureteral",ProFee,0989,C1758,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1759_3,"Cath, intra echocardiography",ProFee,0989,C1759,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1760_3,"Closure dev, vasc",ProFee,0989,C1760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1762_3,"Conn tiss, human(inc fascia)",ProFee,0989,C1762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1763_3,"Conn tiss, non-human",ProFee,0989,C1763,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1764_3,"Event recorder, cardiac",ProFee,0989,C1764,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1765_3,Adhesion barrier,ProFee,0989,C1765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1766_3,"Intro/sheath,strble,non-peel",ProFee,0989,C1766,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1767_3,"Generator, neurostim, imp",ProFee,0989,C1767,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1768_3,"Graft, vascular",ProFee,0989,C1768,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1769_3,Guide wire,ProFee,0989,C1769,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1770_3,"Imaging coil, MR, insertable",ProFee,0989,C1770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1771_3,"Rep dev, urinary, w/sling",ProFee,0989,C1771,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1772_3,"Infusion pump, programmable",ProFee,0989,C1772,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1773_3,"Ret dev, insertable",ProFee,0989,C1773,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1776_3,Joint device (implantable),ProFee,0989,C1776,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1777_3,"Lead, AICD, endo single coil",ProFee,0989,C1777,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1778_3,"Lead, neurostimulator",ProFee,0989,C1778,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1779_3,"Lead, pmkr, transvenous VDD",ProFee,0989,C1779,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1780_3,"Lens, intraocular (new tech)",ProFee,0989,C1780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1781_3,Mesh (implantable),ProFee,0989,C1781,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1782_3,Morcellator,ProFee,0989,C1782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1783_3,"Ocular imp, aqueous drain de",ProFee,0989,C1783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1784_3,"Ocular dev, intraop, det ret",ProFee,0989,C1784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1785_3,"Pmkr, dual, rate-resp",ProFee,0989,C1785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1786_3,"Pmkr, single, rate-resp",ProFee,0989,C1786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1787_3,"Patient progr, neurostim",ProFee,0989,C1787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1788_3,"Port, indwelling, imp",ProFee,0989,C1788,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1789_3,"Prosthesis, breast, imp",ProFee,0989,C1789,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1813_3,"Prosthesis, penile, inflatab",ProFee,0989,C1813,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1814_3,"Retinal tamp, silicone oil",ProFee,0989,C1814,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1815_3,"Pros, urinary sph, imp",ProFee,0989,C1815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1816_3,"Receiver/transmitter, neuro",ProFee,0989,C1816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1817_3,Septal defect imp sys,ProFee,0989,C1817,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1818_3,Integrated keratoprosthesis,ProFee,0989,C1818,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1819_3,Tissue local excision,ProFee,0989,C1819,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1820_3,Generator neuro rechg bat sy,ProFee,0989,C1820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1821_3,Interspinous implant,ProFee,0989,C1821,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1822_3,"Gen, neuro, hf, rechg bat",ProFee,0989,C1822,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1823_3,"Gen, neuro, trans sen/stim",ProFee,0989,C1823,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1824_3,"Generator, ccm, implant",ProFee,0989,C1824,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1830_3,Power bone marrow bx needle,ProFee,0989,C1830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1839_3,Iris prosthesis,ProFee,0989,C1839,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1840_3,Telescopic intraocular lens,ProFee,0989,C1840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1841_3,Retinal prosth int/ext comp,ProFee,0989,C1841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1842_3,"Retinal prosth, add-on",ProFee,0989,C1842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1874_3,"Stent, coated/cov w/del sys",ProFee,0989,C1874,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1875_3,"Stent, coated/cov w/o del sy",ProFee,0989,C1875,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1876_3,"Stent, non-coa/non-cov w/del",ProFee,0989,C1876,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1877_3,"Stent, non-coat/cov w/o del",ProFee,0989,C1877,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1878_3,Matrl for vocal cord,ProFee,0989,C1878,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1879_3,"Tissue marker, implantable",ProFee,0989,C1879,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C1880_3,Vena cava filter,ProFee,0989,C1880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1881_3,Dialysis access system,ProFee,0989,C1881,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1882_3,"AICD, other than sing/dual",ProFee,0989,C1882,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1883_3,"Adapt/ext, pacing/neuro lead",ProFee,0989,C1883,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1884_3,Embolization Protect syst,ProFee,0989,C1884,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1885_3,"Cath, translumin angio laser",ProFee,0989,C1885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1886_3,"Catheter, ablation",ProFee,0989,C1886,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1887_3,"Catheter, guiding",ProFee,0989,C1887,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1888_3,Endovas non-cardiac abl cath,ProFee,0989,C1888,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1889_3,"Implant/insert device, noc",ProFee,0989,C1889,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1890_3,No device w/dev-intensive px,ProFee,0989,C1890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1891_3,"Infusion pump,non-prog, perm",ProFee,0989,C1891,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1892_3,"Intro/sheath,fixed,peel-away",ProFee,0989,C1892,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1893_3,"Intro/sheath, fixed,non-peel",ProFee,0989,C1893,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1894_3,"Intro/sheath, non-laser",ProFee,0989,C1894,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1895_3,"Lead, AICD, endo dual coil",ProFee,0989,C1895,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1896_3,"Lead, AICD, non sing/dual",ProFee,0989,C1896,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1897_3,"Lead, neurostim test kit",ProFee,0989,C1897,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1898_3,"Lead, pmkr, other than trans",ProFee,0989,C1898,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1899_3,"Lead, pmkr/AICD combination",ProFee,0989,C1899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1900_3,"Lead, coronary venous",ProFee,0989,C1900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C1982_3,"Cath, pressure,valve-occlu",ProFee,0989,C1982,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C2596_3,"Probe, robotic, water-jet",ProFee,0989,C2596,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C2613_3,Lung bx plug w/del sys,ProFee,0989,C2613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2614_3,"Probe, perc lumb disc",ProFee,0989,C2614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2615_3,"Sealant, pulmonary, liquid",ProFee,0989,C2615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2616_3,"Brachytx source, Yttrium-90",ProFee,0989,C2616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2617_3,"Stent, non-cor, tem w/o del",ProFee,0989,C2617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2618_3,"Probe, cryoablation",ProFee,0989,C2618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2619_3,"Pmkr, dual, non rate-resp",ProFee,0989,C2619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2620_3,"Pmkr, single, non rate-resp",ProFee,0989,C2620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2621_3,"Pmkr, other than sing/dual",ProFee,0989,C2621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2622_3,"Prosthesis, penile, non-inf",ProFee,0989,C2622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2623_3,"Cath, translumin, drug-coat",ProFee,0989,C2623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2624_3,Wireless pressure sensor,ProFee,0989,C2624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2625_3,"Stent, non-cor, tem w/del sy",ProFee,0989,C2625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2626_3,"Infusion pump, non-prog,temp",ProFee,0989,C2626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2627_3,"Cath, suprapubic/cystoscopic",ProFee,0989,C2627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2628_3,"Catheter, occlusion",ProFee,0989,C2628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2629_3,"Intro/sheath, laser",ProFee,0989,C2629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2630_3,"Cath, EP, cool-tip",ProFee,0989,C2630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2631_3,"Rep dev, urinary, w/o sling",ProFee,0989,C2631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2632_3,"Brachytx sol, I-125, per mCi",ProFee,0989,C2632,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C2633_3,"Brachytx source, Cesium-131",ProFee,0989,C2633,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C2634_3,"Brachytx source, HA, I-125",ProFee,0989,C2634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2635_3,"Brachytx source, HA, P-103",ProFee,0989,C2635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2636_3,"Brachytx linear source, P-103",ProFee,0989,C2636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2637_3,"Brachytx, Ytterbium-169",ProFee,0989,C2637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2638_3,"Brachytx, stranded, I-125",ProFee,0989,C2638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2639_3,"Brachytx, non-stranded,I-125",ProFee,0989,C2639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2640_3,"Brachytx, stranded, P-103",ProFee,0989,C2640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2641_3,"Brachytx, non-stranded,P-103",ProFee,0989,C2641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2642_3,"Brachytx, stranded, C-131",ProFee,0989,C2642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2643_3,"Brachytx, non-stranded,C-131",ProFee,0989,C2643,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2644_3,Brachytx cesium-131 chloride,ProFee,0989,C2644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2645_3,"Brachytx planar, p-103",ProFee,0989,C2645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2698_3,"Brachytx, stranded, NOS",ProFee,0989,C2698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C2699_3,"Brachytx, non-stranded, NOS",ProFee,0989,C2699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5271_3,Low cost skin substitute app,ProFee,0989,C5271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5272_3,Low cost skin substitute app,ProFee,0989,C5272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5273_3,Low cost skin substitute app,ProFee,0989,C5273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5274_3,Low cost skin substitute app,ProFee,0989,C5274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5275_3,Low cost skin substitute app,ProFee,0989,C5275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5276_3,Low cost skin substitute app,ProFee,0989,C5276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5277_3,Low cost skin substitute app,ProFee,0989,C5277,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C5278_3,Low cost skin substitute app,ProFee,0989,C5278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8900_3,"MRA w/cont, abd",ProFee,0989,C8900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8901_3,"MRA w/o cont, abd",ProFee,0989,C8901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8902_3,"MRA w/o fol w/cont, abd",ProFee,0989,C8902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8903_3,"MRI w/cont, breast,  uni",ProFee,0989,C8903,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8904_3,"MRI w/o cont, breast, uni",ProFee,0989,77046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8905_3,"MRI w/o fol w/cont, brst, un",ProFee,0989,C8905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8906_3,"MRI w/cont, breast,  bi",ProFee,0989,C8906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8907_3,"MRI w/o cont, breast, bi",ProFee,0989,77047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8908_3,"MRI w/o fol w/cont, breast,",ProFee,0989,C8908,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8909_3,"MRA w/cont, chest",ProFee,0989,C8909,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8910_3,"MRA w/o cont, chest",ProFee,0989,C8910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8911_3,"MRA w/o fol w/cont, chest",ProFee,0989,C8911,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8912_3,"MRA w/cont, lwr ext",ProFee,0989,C8912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8913_3,"MRA w/o cont, lwr ext",ProFee,0989,C8913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8914_3,"MRA w/o fol w/cont, lwr ext",ProFee,0989,C8914,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8918_3,"MRA w/cont, pelvis",ProFee,0989,C8918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8919_3,"MRA w/o cont, pelvis",ProFee,0989,C8919,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8920_3,"MRA w/o fol w/cont, pelvis",ProFee,0989,C8920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8921_3,Comp transtho echo w/contr,ProFee,0989,C8921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8922_3,Limit transtho echo w/contr,ProFee,0989,C8922,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8923_3,2D com transtho echo w/contr,ProFee,0989,C8923,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8924_3,2D lim transtho echo w/contr,ProFee,0989,C8924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8925_3,"2D TEE w/contrast, int/rept",ProFee,0989,C8925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8926_3,"Cong TEE w/contr, int/rept",ProFee,0989,C8926,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8927_3,TEE w/contrast; monitor,ProFee,0989,C8927,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8928_3,2D transtho w/contr; stress,ProFee,0989,C8928,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8929_3,"TTE w or wo fol wcon,Doppler",ProFee,0989,C8929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8930_3,"TTE w or w/o contr, cont ECG",ProFee,0989,C8930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8931_3,"MRA, w/dye, spinal canal",ProFee,0989,C8931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8932_3,"MRA, w/o dye, spinal canal",ProFee,0989,C8932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8933_3,"MRA, w/o&w/dye, spinal canal",ProFee,0989,C8933,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8934_3,"MRA, w/dye, upper extremity",ProFee,0989,C8934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8935_3,"MRA, w/o dye, upper extr",ProFee,0989,C8935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8936_3,"MRA, w/o&w/dye, upper extr",ProFee,0989,C8936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8937_3,Cad breast mri,ProFee,0989,C8937,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C8950_3,"IV inf, tx/dx, up to 1 hr",ProFee,0989,C8950,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8951_3,"IV inf, tx/dx, each addl hr",ProFee,0989,C8951,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8952_3,"Tx, prophy, dx IV push",ProFee,0989,C8952,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8953_3,"Chemotx adm, IV push",ProFee,0989,C8953,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8954_3,"Chemotx adm, IV inf up to 1h",ProFee,0989,C8954,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8955_3,"Chemotx adm, IV inf, addl hr",ProFee,0989,C8955,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C8957_3,"Prolonged IV inf, req pump",ProFee,0989,C8957,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9003_3,"Palivizumab, per 50 mg",ProFee,0989,C9003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9014_3,"Injection, cerliponase alfa",ProFee,0989,J0567,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9015_3,"C-1 esterase, haegarda",ProFee,0989,J0599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9016_3,"Inj, triptorelin ext rel",ProFee,0989,J3316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9021_3,"Injection, obinutuzumab",ProFee,0989,C9021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9022_3,"Injection, elosulfase alfa",ProFee,0989,C9022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9023_3,Inj testosterone undecanoate,ProFee,0989,C9023,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9024_3,"Inj, daunorubicin-cytarabine",ProFee,0989,J9153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9025_3,"Injection, ramucirumab",ProFee,0989,J9308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9026_3,"Injection, vedolizumab",ProFee,0989,J3380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9027_3,"Injection, pembrolizumab",ProFee,0989,J9271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9028_3,Inj. inotuzumab ozogamicin,ProFee,0989,J9229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9029_3,"Injection, guselkumab",ProFee,0989,J1628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9030_3,Inj copanlisib,ProFee,0989,J9057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9031_3,"Lutetium lu 177 dotatate, tx",ProFee,0989,A9513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9032_3,Voretigene neparvovec-rzyl,ProFee,0989,J3398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9033_3,"Inj, akynzeo",ProFee,0989,J1454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9034_3,"Injection, dexamethasone 9%",ProFee,0989,C9034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9035_3,"Injection, aristada initio",ProFee,0989,C9035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9036_3,"Injection, patisiran",ProFee,0989,C9036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9037_3,"Injection, risperidone",ProFee,0989,C9037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9038_3,Inj mogamulizumab-kpkc,ProFee,0989,C9038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9039_3,"Injection, plazomicin",ProFee,0989,C9039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9040_3,"Injection, fremanezumab-vfrm",ProFee,0989,C9040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9041_3,"Inj, coagulation factor xa",ProFee,0989,J7169,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9042_3,"Inj., belrapzo 1 mg",ProFee,0989,C9042,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9043_3,"Injection, levoleucovorin",ProFee,0989,J0641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9044_3,"Injection, cemiplimab-rwlc",ProFee,0989,C9044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9045_3,Moxetumomab pasudotox-tdfk,ProFee,0989,C9045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9046_3,Cocaine hcl nasal solution,ProFee,0989,C9046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9047_3,"Injection, caplacizumab-yhdp",ProFee,0989,C9047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9048_3,Dexamethasone ophth insert,ProFee,0989,C9048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9049_3,"Injection, tagraxofusp-erzs",ProFee,0989,C9049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9050_3,"Injection, emapalumab-lzsg",ProFee,0989,C9050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9051_3,"Injection, omadacycline",ProFee,0989,C9051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9052_3,"Injection, ravulizumab-cwv",ProFee,0989,C9052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9054_3,"Injection, lefamulin",ProFee,0989,J0691,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9055_3,"Inj, brexanolone",ProFee,0989,C9055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9113_3,"Inj pantoprazole sodium, via",ProFee,0989,C9113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9121_3,"Injection, argatroban",ProFee,0989,C9121,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9132_3,"Kcentra, per i.u.",ProFee,0989,J7168,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9133_3,Factor ix recombinant,ProFee,0989,C9133,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9134_3,Factor xiii a-subunit recomb,ProFee,0989,C9134,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9135_3,Factor ix (alprolix),ProFee,0989,C9135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9136_3,Factor viii (eloctate),ProFee,0989,C9136,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9137_3,Adynovate factor viii recom,ProFee,0989,J7207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9138_3,Nuwiq factor viii recomb,ProFee,0989,J7209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9139_3,"Idelvion, 1 i.u.",ProFee,0989,J7202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9140_3,Afstyla factor viii recomb,ProFee,0989,J7210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9141_3,Factor viii pegylated-aucl,ProFee,0989,C9141,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9220_3,Sodium hyaluronate,ProFee,0989,C9220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9221_3,Graftjacket Reg Matrix,ProFee,0989,C9221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9222_3,Graftjacket SftTis,ProFee,0989,C9222,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9224_3,"Injection, galsulfase",ProFee,0989,C9224,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9225_3,Fluocinolone acetonide,ProFee,0989,C9225,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9237_3,"Inj, lanreotide acetate",ProFee,0989,C9237,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9238_3,"Inj, levetiracetam",ProFee,0989,C9238,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9239_3,"Inj, temsirolimus",ProFee,0989,C9239,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9240_3,"Injection, ixabepilone",ProFee,0989,C9240,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9245_3,"Injection, romiplostim",ProFee,0989,C9245,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9246_3,"Inj, gadoxetate disodium",ProFee,0989,C9246,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9247_3,"Inj, iobenguane, I-123, dx",ProFee,0989,C9247,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9248_3,"Inj, clevidipine butyrate",ProFee,0989,C9248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9250_3,Artiss fibrin sealant,ProFee,0989,C9250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9254_3,"Injection, lacosamide",ProFee,0989,C9254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9257_3,Bevacizumab injection,ProFee,0989,C9257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9270_3,Gammaplex IVIG,ProFee,0989,C9270,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9272_3,"Inj, denosumab",ProFee,0989,C9272,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9273_3,"Sipuleucel-T, per infusion",ProFee,0989,C9273,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9274_3,Crotalidae Poly Immune Fab,ProFee,0989,C9274,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9275_3,Hexaminolevulinate HCl,ProFee,0989,A9589,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9276_3,Cabazitaxel injection,ProFee,0989,C9276,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9277_3,"Lumizyme, 1 mg",ProFee,0989,C9277,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9278_3,Incobotulinumtoxin A,ProFee,0989,C9278,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9279_3,"Injection, ibuprofen",ProFee,0989,C9279,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9285_3,"Patch, lidocaine/tetracaine",ProFee,0989,C9285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9290_3,"Inj, bupivacaine liposome",ProFee,0989,C9290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9293_3,"Injection, glucarpidase",ProFee,0989,C9293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9349_3,"Puraply, puraply antimic",ProFee,0989,Q4172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9352_3,"Neuragen nerve guide, per cm",ProFee,0989,C9352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9353_3,"Neurawrap nerve protector,cm",ProFee,0989,C9353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9354_3,"Veritas collagen matrix, cm2",ProFee,0989,C9354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9355_3,"Neuromatrix nerve cuff, cm",ProFee,0989,C9355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9356_3,"TenoGlide tendon prot, cm2",ProFee,0989,C9356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9358_3,"SurgiMend, 0.5cm2",ProFee,0989,C9358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9359_3,"Implant, bone void filler",ProFee,0989,C9359,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9360_3,"SurgiMend, neonatal",ProFee,0989,C9360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9361_3,NeuroMend nerve wrap,ProFee,0989,C9361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9362_3,"Implnt,bon void filler-strip",ProFee,0989,C9362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9363_3,Integra Meshed Bil Wound Mat,ProFee,0989,C9363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9364_3,"Porcine implant, Permacol",ProFee,0989,C9364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9367_3,Endoform Dermal Template,ProFee,0989,C9367,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9399_3,Unclassified drugs or biolog,ProFee,0989,C9399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9407_3,"Iodine i-131 iobenguane, dx",ProFee,0989,A9590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9408_3,"Iodine i-131 iobenguane, tx",ProFee,0989,A9590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9441_3,"Inj, ferric carboxymaltose",ProFee,0989,C9441,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9442_3,"Injection, belinostat",ProFee,0989,J9032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9443_3,"Injection, dalbavancin",ProFee,0989,J0875,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9444_3,"Injection, oritavancin",ProFee,0989,J2407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9445_3,"C-1 esterase, ruconest",ProFee,0989,J0596,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9446_3,"Inj, tedizolid phosphate",ProFee,0989,J3090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9447_3,"Inj, phenylephrine ketorolac",ProFee,0989,J1097,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9448_3,Oral netupitant palonosetron,ProFee,0989,C9448,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9449_3,"Inj, blinatumomab",ProFee,0989,J9039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9450_3,Fluocinolone acetonide implt,ProFee,0989,J7313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9451_3,"Injection, peramivir",ProFee,0989,J2547,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9452_3,"Inj, ceftolozane/tazobactam",ProFee,0989,J0695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9453_3,"Injection, nivolumab",ProFee,0989,J9299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9454_3,"Inj, pasireotide long acting",ProFee,0989,J2502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9455_3,"Injection, siltuximab",ProFee,0989,J2860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9456_3,"Inj, isavuconazonium sulfate",ProFee,0989,J1833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9457_3,Lumason contrast agent,ProFee,0989,Q9950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9458_3,Florbetaben f18,ProFee,0989,Q9943,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9459_3,Flutemetamol f18,ProFee,0989,Q9982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9460_3,"Injection, cangrelor",ProFee,0989,C9460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9461_3,"Choline c 11, diagnostic",ProFee,0989,A9515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9462_3,"Injection, delafloxacin",ProFee,0989,C9462,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9463_3,"Injection, aprepitant",ProFee,0989,J0185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9464_3,"Injection, rolapitant",ProFee,0989,J2797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9465_3,"Injection, durolane",ProFee,0989,J7318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9466_3,"Injection, benralizumab",ProFee,0989,J0517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9467_3,Inj rituximab hyaluronidase,ProFee,0989,J9311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9468_3,"Inj, factor ix, rebinyn",ProFee,0989,J7203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9469_3,Inj triamcinolone acetonide,ProFee,0989,C9469,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9470_3,Aripiprazole lauroxil im,ProFee,0989,J1942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9471_3,"Hymovis, 1 mg",ProFee,0989,J7355,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9472_3,Inj talimogene laherparepvec,ProFee,0989,J9325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9473_3,"Injection, mepolizumab",ProFee,0989,J2182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9474_3,"Inj, irinotecan liposome",ProFee,0989,J9205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9475_3,"Injection, necitumumab",ProFee,0989,J9295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9476_3,"Injection, daratumumab",ProFee,0989,J9145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9477_3,"Injection, elotuzumab",ProFee,0989,J9176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9478_3,"Injection, sebelipase alfa",ProFee,0989,J2840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9479_3,"Instill, ciprofloxacin otic",ProFee,0989,J7342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9480_3,"Injection, trabectedin",ProFee,0989,J9352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9481_3,"Injection, reslizumab",ProFee,0989,J2786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9482_3,Sotalol hydrochloride iv,ProFee,0989,C9482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9483_3,"Injection, atezolizumab",ProFee,0989,J9022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9484_3,"Injection, eteplirsen",ProFee,0989,J1428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9485_3,"Injection, olaratumab",ProFee,0989,J9285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9486_3,"Inj, granisetron ext",ProFee,0989,J1627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9487_3,"Ustekinumab iv inj, 1 mg",ProFee,0989,J3358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9488_3,Conivaptan hcl,ProFee,0989,C9488,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9489_3,"Injection, nusinersen",ProFee,0989,J2326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9490_3,"Injection, bezlotoxumab",ProFee,0989,J0565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9491_3,"Injection, avelumab",ProFee,0989,J9023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9492_3,"Injection, durvalumab",ProFee,0989,J9173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9493_3,"Injection, edaravone",ProFee,0989,J1301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9494_3,"Injection, ocrelizumab",ProFee,0989,J2350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9497_3,"Loxapine, inhalation powder",ProFee,0989,J2062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9600_3,Perc drug-el cor stent sing,ProFee,0989,C9600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9601_3,Perc drug-el cor stent bran,ProFee,0989,C9601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9602_3,Perc d-e cor stent ather s,ProFee,0989,C9602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9603_3,Perc d-e cor stent ather br,ProFee,0989,C9603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9604_3,Perc d-e cor revasc t cabg s,ProFee,0989,C9604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9605_3,Perc d-e cor revasc t cabg b,ProFee,0989,C9605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9606_3,Perc d-e cor revasc w ami s,ProFee,0989,C9606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9607_3,Perc d-e cor revasc chro sin,ProFee,0989,C9607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9608_3,Perc d-e cor revasc chro add,ProFee,0989,C9608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9716_3,Radiofrequency energy to anu,ProFee,0989,C9716,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9723_3,Dyn IR Perf Img,ProFee,0989,C9723,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9724_3,EPS gast cardia plic,ProFee,0989,43210,,,,0,3.00,2.25,2.25,651.50,0.00,651.50,651.50,N/A
C9725_3,Place endorectal app,ProFee,0989,C9725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9726_3,Rxt breast appl place/remov,ProFee,0989,C9726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9727_3,Insert palate implants,ProFee,0989,C9727,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9728_3,"Place device/marker, non pro",ProFee,0989,C9728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9733_3,Non-ophthalmic fva,ProFee,0989,C9733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9734_3,"U/s trtmt, not leiomyomata",ProFee,0989,C9734,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9735_3,"Anoscopy, submucosal inj",ProFee,0989,C9735,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9737_3,Lap esoph augmentation,ProFee,0989,C9737,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9738_3,Blue light cysto imag agent,ProFee,0989,C9738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9739_3,Cystoscopy prostatic imp 1-3,ProFee,0989,C9739,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9740_3,Cysto impl 4 or more,ProFee,0989,C9740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9741_3,Impl pressure sensor w/angio,ProFee,0989,33289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9742_3,Laryngoscopy with injection,ProFee,0989,C9742,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9743_3,Bulking/spacer material impl,ProFee,0989,C9743,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9744_3,Abd us w/contrast,ProFee,0989,C9744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9745_3,Nasal endo eustachian tube,ProFee,0989,C9745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9746_3,Trans imp balloon cont,ProFee,0989,C9746,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9747_3,"Ablation, hifu, prostate",ProFee,0989,55880,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9748_3,Prostatic rf water vapor tx,ProFee,0989,53854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9749_3,Repair nasal stenosis w/imp,ProFee,0989,30468,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9750_3,Ins/rem-replace compl iims,ProFee,0989,0525T,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9751_3,"Microwave bronch, 3d, ebus",ProFee,0989,C9751,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9752_3,Intraosseous des lumb/sacrum,ProFee,0989,C9752,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9753_3,Intraosseous destruct add'l,ProFee,0989,C9753,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9754_3,"Perc av fistula, direct",ProFee,0989,G2170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9755_3,Rf magnetic-guide av fistula,ProFee,0989,G2171,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9756_3,Fluorescence lymph map w/icg,ProFee,0989,C9756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9757_3,Spine/lumbar disk surgery,ProFee,0989,C9757,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9758_3,Interatrial shunt ide,ProFee,0989,C9758,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
C9800_3,Dermal filler inj px/suppl,ProFee,0989,G0429,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
C9898_3,Inpnt stay radiolabeled item,ProFee,0989,C9898,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
C9899_3,"Inpt implant pros dev,no cov",ProFee,0989,C9899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
CCM_2,Chronic Care Management,ProFee,0989,G0511,,,,0,89.00,66.75,39.50,66.75,0.00,39.50,39.50,N/A
CCM_3,Chronic Care Management,ProFee,0989,G0511,,,,0,90.00,67.50,39.50,67.50,0.00,39.50,39.50,N/A
CONBK_2,CONTRACT BACK FIT TEST,ProFee,0989,,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
CONGP_2,CONTRACT JAMAR GRIP TEST,ProFee,0989,,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
CONGP_3,CONTRACT JAMAR GRIP TEST,ProFee,0989,,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
CONHP_2,CONTRACT H&P,ProFee,0989,CONHP,,,,0,90.00,67.50,67.50,67.50,N/A,N/A,N/A,N/A
CONHP_3,CONTRACT H&P,ProFee,0989,CONHP,,,,0,90.00,67.50,67.50,67.50,N/A,N/A,N/A,N/A
CONVS_2,CONTRACT VISION W/O H&P,ProFee,0989,,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
CONVS_3,CONTRACT VISION W/O H&P,ProFee,0989,,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
COVR_1,COVID Rapid In house,Outpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
COVR_1,COVID Rapid In house,Inpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
CSCF_1,Covid Sample Collection Fee,Inpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
CSCF_1,Covid Sample Collection Fee,Outpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
CVCL_1,Covid Sample Collection Fee,Outpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
CVCL_1,Covid Sample Collection Fee,Inpatient,0300,C9803,,,,0,37.00,27.75,27.75,35.15,33.30,35.15,35.15,33.30
E0100_3,Cane adjust/fixed with tip,ProFee,0989,E0100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0105_3,Cane adjust/fixed quad/3 pro,ProFee,0989,E0105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0110_3,Crutch forearm pair,ProFee,0989,E0110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0111_3,Crutch forearm each,ProFee,0989,E0111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0112_3,Crutch underarm pair wood,ProFee,0989,E0112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0113_3,Crutch underarm each wood,ProFee,0989,E0113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0114_3,Crutch underarm pair no wood,ProFee,0989,E0114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0116_3,Crutch underarm each no wood,ProFee,0989,E0116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0117_3,Underarm springassist crutch,ProFee,0989,E0117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0118_3,Crutch substitute,ProFee,0989,E0118,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0130_3,Walker rigid adjust/fixed ht,ProFee,0989,E0130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0135_3,Walker folding adjust/fixed,ProFee,0989,E0135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0140_3,Walker w trunk support,ProFee,0989,E0140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0141_3,Rigid wheeled walker adj/fix,ProFee,0989,E0141,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0143_3,Walker folding wheeled w/o s,ProFee,0989,E0143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0144_3,Enclosed walker w rear seat,ProFee,0989,E0144,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0147_3,Walker variable wheel resist,ProFee,0989,E0147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0148_3,Heavyduty walker no wheels,ProFee,0989,E0148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0149_3,Heavy duty wheeled walker,ProFee,0989,E0149,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0153_3,Forearm crutch platform atta,ProFee,0989,E0153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0154_3,Walker platform attachment,ProFee,0989,E0154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0155_3,"Walker wheel attachment,pair",ProFee,0989,E0155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0156_3,Walker seat attachment,ProFee,0989,E0156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0157_3,Walker crutch attachment,ProFee,0989,E0157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0158_3,Walker leg extenders set of4,ProFee,0989,E0158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0159_3,Brake for wheeled walker,ProFee,0989,E0159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0160_3,Sitz type bath or equipment,ProFee,0989,E0160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0161_3,Sitz bath/equipment w/faucet,ProFee,0989,E0161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0162_3,Sitz bath chair,ProFee,0989,E0162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0163_3,Commode chair stationry fxd,ProFee,0989,E0163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0164_3,Commode chair mobile fixed a,ProFee,0989,E0164,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0165_3,Commode chair stationry det,ProFee,0989,E0165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0166_3,Commode chair mobile detach,ProFee,0989,E0166,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0167_3,Commode chair pail or pan,ProFee,0989,E0167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0168_3,Heavyduty/wide commode chair,ProFee,0989,E0168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0170_3,Commode chair electric,ProFee,0989,E0170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0171_3,Commode chair non-electric,ProFee,0989,E0171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0172_3,Seat lift mechanism toilet,ProFee,0989,E0172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0175_3,Commode chair foot rest,ProFee,0989,E0175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0180_3,Press pad alternating w pump,ProFee,0989,E0180,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0181_3,Press pad alternating w/ pum,ProFee,0989,E0181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0182_3,Pressure pad alternating pum,ProFee,0989,E0182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0184_3,Dry pressure mattress,ProFee,0989,E0184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0185_3,Gel pressure mattress pad,ProFee,0989,E0185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0186_3,Air pressure mattress,ProFee,0989,E0186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0187_3,Water pressure mattress,ProFee,0989,E0187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0188_3,Synthetic sheepskin pad,ProFee,0989,E0188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0189_3,Lambswool sheepskin pad,ProFee,0989,E0189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0190_3,Positioning cushion,ProFee,0989,E0190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0191_3,Protector heel or elbow,ProFee,0989,E0191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0193_3,Powered air flotation bed,ProFee,0989,E0193,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0194_3,Air fluidized bed,ProFee,0989,E0194,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0196_3,Gel pressure mattress,ProFee,0989,E0196,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0197_3,Air pressure pad for mattres,ProFee,0989,E0197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0198_3,Water pressure pad for mattr,ProFee,0989,E0198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0199_3,Dry pressure pad for mattres,ProFee,0989,E0199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0200_3,Heat lamp without stand,ProFee,0989,E0200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0202_3,Phototherapy light w/ photom,ProFee,0989,E0202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0203_3,Therapeutic lightbox tabletp,ProFee,0989,E0203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0205_3,Heat lamp with stand,ProFee,0989,E0205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0210_3,Electric heat pad standard,ProFee,0989,E0210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0215_3,Electric heat pad moist,ProFee,0989,E0215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0217_3,Water circ heat pad w pump,ProFee,0989,E0217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0218_3,Water circ cold pad w pump,ProFee,0989,E0218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0220_3,Hot water bottle,ProFee,0989,E0220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0221_3,Infrared heating pad system,ProFee,0989,E0221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0225_3,Hydrocollator unit,ProFee,0989,E0225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0230_3,Ice cap or collar,ProFee,0989,E0230,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0231_3,Wound warming device,ProFee,0989,E0231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0232_3,Warming card for NWT,ProFee,0989,E0232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0235_3,Paraffin bath unit portable,ProFee,0989,E0235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0236_3,Pump for water circulating p,ProFee,0989,E0236,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0238_3,Heat pad non-electric moist,ProFee,0989,E0238,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0239_3,Hydrocollator unit portable,ProFee,0989,E0239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0240_3,Bath/shower chair,ProFee,0989,E0240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0241_3,Bath tub wall rail,ProFee,0989,E0241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0242_3,Bath tub rail floor,ProFee,0989,E0242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0243_3,Toilet rail,ProFee,0989,E0243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0244_3,Toilet seat raised,ProFee,0989,E0244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0245_3,Tub stool or bench,ProFee,0989,E0245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0246_3,Transfer tub rail attachment,ProFee,0989,E0246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0247_3,Trans bench w/wo comm open,ProFee,0989,E0247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0248_3,HDtrans bench w/wo comm open,ProFee,0989,E0248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0249_3,Pad water circulating heat u,ProFee,0989,E0249,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0250_3,Hosp bed fixed ht w/ mattres,ProFee,0989,E0250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0251_3,Hosp bed fixd ht w/o mattres,ProFee,0989,E0251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0255_3,Hospital bed var ht w/ mattr,ProFee,0989,E0255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0256_3,Hospital bed var ht w/o matt,ProFee,0989,E0256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0260_3,Hosp bed semi-electr w/ matt,ProFee,0989,E0260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0261_3,Hosp bed semi-electr w/o mat,ProFee,0989,E0261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0265_3,Hosp bed total electr w/ mat,ProFee,0989,E0265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0266_3,Hosp bed total elec w/o matt,ProFee,0989,E0266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0270_3,Hospital bed institutional t,ProFee,0989,E0270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0271_3,Mattress innerspring,ProFee,0989,E0271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0272_3,Mattress foam rubber,ProFee,0989,E0272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0273_3,Bed board,ProFee,0989,E0273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0274_3,Over-bed table,ProFee,0989,E0274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0275_3,Bed pan standard,ProFee,0989,E0275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0276_3,Bed pan fracture,ProFee,0989,E0276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0277_3,Powered pres-redu air mattrs,ProFee,0989,E0277,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0280_3,Bed cradle,ProFee,0989,E0280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0290_3,Hosp bed fx ht w/o rails w/m,ProFee,0989,E0290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0291_3,Hosp bed fx ht w/o rail w/o,ProFee,0989,E0291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0292_3,Hosp bed var ht w/o rail w/o,ProFee,0989,E0292,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0293_3,Hosp bed var ht w/o rail w/,ProFee,0989,E0293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0294_3,Hosp bed semi-elect w/ mattr,ProFee,0989,E0294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0295_3,Hosp bed semi-elect w/o matt,ProFee,0989,E0295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0296_3,Hosp bed total elect w/ matt,ProFee,0989,E0296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0297_3,Hosp bed total elect w/o mat,ProFee,0989,E0297,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0300_3,Enclosed ped crib hosp grade,ProFee,0989,E0300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0301_3,"HD hosp bed, 350-600 lbs",ProFee,0989,E0301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0302_3,Ex hd hosp bed > 600 lbs,ProFee,0989,E0302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0303_3,Hosp bed hvy dty xtra wide,ProFee,0989,E0303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0304_3,Hosp bed xtra hvy dty x wide,ProFee,0989,E0304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0305_3,Rails bed side half length,ProFee,0989,E0305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0310_3,Rails bed side full length,ProFee,0989,E0310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0315_3,Bed accessory brd/tbl/supprt,ProFee,0989,E0315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0316_3,Bed safety enclosure,ProFee,0989,E0316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0325_3,Urinal male jug-type,ProFee,0989,E0325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0326_3,Urinal female jug-type,ProFee,0989,E0326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0328_3,"Ped hospital bed, manual",ProFee,0989,E0328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0329_3,Ped hospital bed semi/elect,ProFee,0989,E0329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0350_3,Control unit bowel system,ProFee,0989,E0350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0352_3,Disposable pack w/bowel syst,ProFee,0989,E0352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0370_3,Air elevator for heel,ProFee,0989,E0370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0371_3,Nonpower mattress overlay,ProFee,0989,E0371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0372_3,Powered air mattress overlay,ProFee,0989,E0372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0373_3,Nonpowered pressure mattress,ProFee,0989,E0373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0424_3,Stationary compressed gas 02,ProFee,0989,E0424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0425_3,Gas system stationary compre,ProFee,0989,E0425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0430_3,Oxygen system gas portable,ProFee,0989,E0430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0431_3,Portable gaseous 02,ProFee,0989,E0431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0433_3,Portable liquid oxygen sys,ProFee,0989,E0433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0434_3,Portable liquid 02,ProFee,0989,E0434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0435_3,Oxygen system liquid portabl,ProFee,0989,E0435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0439_3,Stationary liquid 02,ProFee,0989,E0439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0440_3,Oxygen system liquid station,ProFee,0989,E0440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0441_3,"Oxygen contents, gaseous",ProFee,0989,E0441,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0442_3,"Oxygen contents, liquid",ProFee,0989,E0442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0443_3,"Portable 02 contents, gas",ProFee,0989,E0443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0444_3,"Portable 02 contents, liquid",ProFee,0989,E0444,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0445_3,Oximeter non-invasive,ProFee,0989,E0445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0446_3,"Topical Ox Deliver sys, nos",ProFee,0989,E0446,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0447_3,"Port o2 cont, liq over 4 lpm",ProFee,0989,E0447,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0450_3,Vol control vent invasiv int,ProFee,0989,E0465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0455_3,Oxygen tent excl croup/ped t,ProFee,0989,E0455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0457_3,Chest shell,ProFee,0989,E0457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0459_3,Chest wrap,ProFee,0989,E0459,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0460_3,Neg press vent portabl/statn,ProFee,0989,E0466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0461_3,Vol control vent noninv int,ProFee,0989,E0466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0462_3,Rocking bed w/ or w/o side r,ProFee,0989,E0462,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0463_3,Press supp vent invasive int,ProFee,0989,E0465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0464_3,Press supp vent noninv int,ProFee,0989,E0466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0465_3,Home vent invasive interface,ProFee,0989,E0465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0466_3,Home vent non-invasive inter,ProFee,0989,E0466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0467_3,Home vent multi-function,ProFee,0989,E0467,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0470_3,RAD w/o backup non-inv intfc,ProFee,0989,E0470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0471_3,RAD w/backup non inv intrfc,ProFee,0989,E0471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0472_3,RAD w backup invasive intrfc,ProFee,0989,E0472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0480_3,Percussor elect/pneum home m,ProFee,0989,E0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0481_3,Intrpulmnry percuss vent sys,ProFee,0989,E0481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0482_3,Cough stimulating device,ProFee,0989,E0482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0483_3,Chest compression gen system,ProFee,0989,E0483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0484_3,Non-elec oscillatory pep dvc,ProFee,0989,E0484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0485_3,Oral device/appliance prefab,ProFee,0989,E0485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0486_3,Oral device/appliance cusfab,ProFee,0989,E0486,,,,0,3.00,2.25,2.25,1290.00,0.00,1290.00,1290.00,N/A
E0487_3,Electronic spirometer,ProFee,0989,E0487,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0500_3,Ippb all types,ProFee,0989,E0500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0550_3,Humidif extens supple w ippb,ProFee,0989,E0550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0555_3,Humidifier for use w/ regula,ProFee,0989,E0555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0560_3,Humidifier supplemental w/ i,ProFee,0989,E0560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0561_3,Humidifier nonheated w PAP,ProFee,0989,E0561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0562_3,Humidifier heated used w PAP,ProFee,0989,E0562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0565_3,Compressor air power source,ProFee,0989,E0565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0570_3,Nebulizer with compression,ProFee,0989,E0570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0571_3,Aerosol compressor for svneb,ProFee,0989,E0571,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0572_3,Aerosol compressor adjust pr,ProFee,0989,E0572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0574_3,Ultrasonic generator w svneb,ProFee,0989,E0574,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0575_3,Nebulizer ultrasonic,ProFee,0989,E0575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0580_3,Nebulizer for use w/ regulat,ProFee,0989,E0580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0585_3,Nebulizer w/ compressor & he,ProFee,0989,E0585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0600_3,Suction pump portab hom modl,ProFee,0989,E0600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0601_3,Cont airway pressure device,ProFee,0989,E0601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0602_3,Manual breast pump,ProFee,0989,E0602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0603_3,Electric breast pump,ProFee,0989,E0603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0604_3,Hosp grade elec breast pump,ProFee,0989,E0604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0605_3,Vaporizer room type,ProFee,0989,E0605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0606_3,Drainage board postural,ProFee,0989,E0606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0607_3,Blood glucose monitor home,ProFee,0989,E0607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0610_3,Pacemaker monitr audible/vis,ProFee,0989,E0610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0615_3,Pacemaker monitr digital/vis,ProFee,0989,E0615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0616_3,Cardiac event recorder,ProFee,0989,E0616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0617_3,Automatic ext defibrillator,ProFee,0989,E0617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0618_3,Apnea monitor,ProFee,0989,E0618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0619_3,Apnea monitor w recorder,ProFee,0989,E0619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0620_3,Cap bld skin piercing laser,ProFee,0989,E0620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0621_3,Patient lift sling or seat,ProFee,0989,E0621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0625_3,Patient lift bathroom or toi,ProFee,0989,E0625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0627_3,Seat lift incorp lift-chair,ProFee,0989,E0627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0628_3,Seat lift for pt furn-electr,ProFee,0989,Q0078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0629_3,Seat lift for pt furn-non-el,ProFee,0989,E0629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0630_3,Patient lift hydraulic,ProFee,0989,E0630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0635_3,Patient lift electric,ProFee,0989,E0635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0636_3,PT support & positioning sys,ProFee,0989,E0636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0637_3,Sit-stand w seatlift,ProFee,0989,E0637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0638_3,Standing frame sys,ProFee,0989,E0638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0639_3,Moveable patient lift system,ProFee,0989,E0639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0640_3,Fixed patient lift system,ProFee,0989,E0640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0641_3,Multi-position stnd fram sys,ProFee,0989,E0641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0642_3,Dynamic standing frame,ProFee,0989,E0642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0650_3,Pneuma compresor non-segment,ProFee,0989,E0650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0651_3,Pneum compressor segmental,ProFee,0989,E0651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0652_3,Pneum compres w/cal pressure,ProFee,0989,E0652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0655_3,Pneumatic appliance half arm,ProFee,0989,E0655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0656_3,Segmental pneumatic trunk,ProFee,0989,E0656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0657_3,Segmental pneumatic chest,ProFee,0989,E0657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0660_3,Pneumatic appliance full leg,ProFee,0989,E0660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0665_3,Pneumatic appliance full arm,ProFee,0989,E0665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0666_3,Pneumatic appliance half leg,ProFee,0989,E0666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0667_3,Seg pneumatic appl full leg,ProFee,0989,E0667,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0668_3,Seg pneumatic appl full arm,ProFee,0989,E0668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0669_3,Seg pneumatic appli half leg,ProFee,0989,E0669,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0670_3,Seg pneum int legs/trunk,ProFee,0989,E0670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0671_3,Pressure pneum appl full leg,ProFee,0989,E0671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0672_3,Pressure pneum appl full arm,ProFee,0989,E0672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0673_3,Pressure pneum appl half leg,ProFee,0989,E0673,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0675_3,Pneumatic compression device,ProFee,0989,E0675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0676_3,Inter limb compress dev NOS,ProFee,0989,E0676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0691_3,Uvl pnl 2 sq ft or less,ProFee,0989,E0691,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0692_3,Uvl sys panel 4 ft,ProFee,0989,E0692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0693_3,Uvl sys panel 6 ft,ProFee,0989,E0693,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0694_3,Uvl md cabinet sys 6 ft,ProFee,0989,E0694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0700_3,Safety equipment,ProFee,0989,E0700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0701_3,Helmet w face guard prefab,ProFee,0989,E0701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0705_3,Transfer board or device,ProFee,0989,E0705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0710_3,Restraints any type,ProFee,0989,E0710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0720_3,Tens two lead,ProFee,0989,E0720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0730_3,Tens four lead,ProFee,0989,E0730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0731_3,Conductive garment for tens/,ProFee,0989,E0731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0740_3,Incontinence treatment systm,ProFee,0989,E0740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0744_3,Neuromuscular stim for scoli,ProFee,0989,E0744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0745_3,Neuromuscular stim for shock,ProFee,0989,E0745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0746_3,Electromyograph biofeedback,ProFee,0989,E0746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0747_3,Elec osteogen stim not spine,ProFee,0989,E0747,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0748_3,Elec osteogen stim spinal,ProFee,0989,E0748,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0749_3,Elec osteogen stim implanted,ProFee,0989,E0749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0755_3,Electronic salivary reflex s,ProFee,0989,E0755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0760_3,Osteogen ultrasound stimltor,ProFee,0989,E0760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0761_3,Nontherm electromgntc device,ProFee,0989,E0761,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0762_3,Trans elec jt stim dev sys,ProFee,0989,E0762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0764_3,Functional neuromuscularstim,ProFee,0989,E0764,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0765_3,Nerve stimulator for tx n&v,ProFee,0989,E0765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0766_3,Elec stim cancer treatment,ProFee,0989,E0766,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0769_3,Electric wound treatment dev,ProFee,0989,E0769,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0770_3,Functional electric stim NOS,ProFee,0989,E0770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0776_3,Iv pole,ProFee,0989,E0776,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0779_3,Amb infusion pump mechanical,ProFee,0989,E0779,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0780_3,Mech amb infusion pump <8hrs,ProFee,0989,E0780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0781_3,External ambulatory infus pu,ProFee,0989,E0781,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0782_3,Non-programble infusion pump,ProFee,0989,E0782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0783_3,Programmable infusion pump,ProFee,0989,E0783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0784_3,Ext amb infusn pump insulin,ProFee,0989,E0784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0785_3,Replacement impl pump cathet,ProFee,0989,E0785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0786_3,Implantable pump replacement,ProFee,0989,E0786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0787_3,Cgs dose adj insulin inf pmp,ProFee,0989,E0787,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0791_3,Parenteral infusion pump sta,ProFee,0989,E0791,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0830_3,Ambulatory traction device,ProFee,0989,E0830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0840_3,Tract frame attach headboard,ProFee,0989,E0840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0849_3,Cervical pneum trac equip,ProFee,0989,E0849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0850_3,Traction stand free standing,ProFee,0989,E0850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0855_3,Cervical traction equipment,ProFee,0989,E0855,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0856_3,Cervic collar w air bladder,ProFee,0989,E0856,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0860_3,Tract equip cervical tract,ProFee,0989,E0860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0870_3,Tract frame attach footboard,ProFee,0989,E0870,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0880_3,Trac stand free stand extrem,ProFee,0989,E0880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0890_3,Traction frame attach pelvic,ProFee,0989,E0890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0900_3,Trac stand free stand pelvic,ProFee,0989,E0900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0910_3,Trapeze bar attached to bed,ProFee,0989,E0910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0911_3,HD trapeze bar attach to bed,ProFee,0989,E0911,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0912_3,HD trapeze bar free standing,ProFee,0989,E0912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0920_3,Fracture frame attached to b,ProFee,0989,E0920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0930_3,Fracture frame free standing,ProFee,0989,E0930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0935_3,Exercise device passive moti,ProFee,0989,E0935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0936_3,"CPM device, other than knee",ProFee,0989,E0936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0940_3,Trapeze bar free standing,ProFee,0989,E0940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0941_3,Gravity assisted traction de,ProFee,0989,E0941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0942_3,Cervical head harness/halter,ProFee,0989,E0942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0944_3,Pelvic belt/harness/boot,ProFee,0989,E0944,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0945_3,Belt/harness extremity,ProFee,0989,E0945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0946_3,Fracture frame dual w cross,ProFee,0989,E0946,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0947_3,Fracture frame attachmnts pe,ProFee,0989,E0947,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0948_3,Fracture frame attachmnts ce,ProFee,0989,E0948,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0950_3,Tray,ProFee,0989,E0950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0951_3,Loop heel,ProFee,0989,E0951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0952_3,"Toe loop/holder, each",ProFee,0989,E0952,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0953_3,W/c lateral thigh/knee sup,ProFee,0989,E0953,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0954_3,"Foot box, any type each foot",ProFee,0989,E0954,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0955_3,Cushioned headrest,ProFee,0989,E0955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0956_3,W/c lateral trunk/hip suppor,ProFee,0989,E0956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0957_3,W/c medial thigh support,ProFee,0989,E0957,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0958_3,Whlchr att- conv 1 arm drive,ProFee,0989,E0958,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0959_3,Amputee adapter,ProFee,0989,E0959,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0960_3,W/c shoulder harness/straps,ProFee,0989,E0960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0961_3,Wheelchair brake extension,ProFee,0989,E0961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0966_3,Wheelchair head rest extensi,ProFee,0989,E0966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0967_3,Wheelchair hand rims,ProFee,0989,E0967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0968_3,Wheelchair commode seat,ProFee,0989,E0968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0969_3,Wheelchair narrowing device,ProFee,0989,E0969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0970_3,Wheelchair no. 2 footplates,ProFee,0989,E0970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0971_3,Wheelchair anti-tipping devi,ProFee,0989,E0971,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0973_3,W/Ch access det adj armrest,ProFee,0989,E0973,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0974_3,W/Ch access anti-rollback,ProFee,0989,E0974,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0977_3,Wheelchair wedge cushion,ProFee,0989,E0977,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0978_3,"W/C acc,saf belt pelv strap",ProFee,0989,E0978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0980_3,Wheelchair safety vest,ProFee,0989,E0980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0981_3,"Seat upholstery, replacement",ProFee,0989,E0981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0982_3,"Back upholstery, replacement",ProFee,0989,E0982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0983_3,Add pwr joystick,ProFee,0989,E0983,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0984_3,Add pwr tiller,ProFee,0989,E0984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0985_3,W/c seat lift mechanism,ProFee,0989,E0985,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0986_3,Man w/c push-rim pow assist,ProFee,0989,E0986,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0988_3,Lever-activated wheel drive,ProFee,0989,E0988,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0990_3,Whellchair elevating leg res,ProFee,0989,E0990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0992_3,Wheelchair solid seat insert,ProFee,0989,E0992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0994_3,Wheelchair arm rest,ProFee,0989,E0994,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0995_3,Wheelchair calf rest,ProFee,0989,E0995,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E0997_3,Wheelchair caster w/ a fork,ProFee,0989,E0997,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0998_3,Wheelchair caster w/o a fork,ProFee,0989,E0998,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E0999_3,Wheelchr pneumatic tire w/wh,ProFee,0989,E0999,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E1002_3,Pwr seat tilt,ProFee,0989,E1002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1003_3,Pwr seat recline,ProFee,0989,E1003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1004_3,Pwr seat recline mech,ProFee,0989,E1004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1005_3,Pwr seat recline pwr,ProFee,0989,E1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1006_3,Pwr seat combo w/o shear,ProFee,0989,E1006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1007_3,Pwr seat combo w/shear,ProFee,0989,E1007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1008_3,Pwr seat combo pwr shear,ProFee,0989,E1008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1009_3,Add mech leg elevation,ProFee,0989,E1009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1010_3,Add pwr leg elevation,ProFee,0989,E1010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1011_3,Ped wc modify width adjustm,ProFee,0989,E1011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1012_3,Ctr mount pwr elev leg rest,ProFee,0989,E1012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1014_3,Reclining back add ped w/c,ProFee,0989,E1014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1015_3,Shock absorber for man w/c,ProFee,0989,E1015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1016_3,Shock absorber for power w/c,ProFee,0989,E1016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1017_3,HD shck absrbr for hd man wc,ProFee,0989,E1017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1018_3,HD shck absrber for hd powwc,ProFee,0989,E1018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1020_3,Residual limb support system,ProFee,0989,E1020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1028_3,W/c manual swingaway,ProFee,0989,E1028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1029_3,W/c vent tray fixed,ProFee,0989,E1029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1030_3,W/c vent tray gimbaled,ProFee,0989,E1030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1031_3,Rollabout chair with casters,ProFee,0989,E1031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1035_3,Patient transfer system,ProFee,0989,E1035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1036_3,Patient transfer system >300,ProFee,0989,E1036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1037_3,"Transport chair, ped size",ProFee,0989,E1037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1038_3,Transport chair pt wt <250lb,ProFee,0989,E1038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1039_3,Transport chair pt wt>=250lb,ProFee,0989,E1039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1050_3,Whelchr fxd full length arms,ProFee,0989,E1050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1060_3,Wheelchair detachable arms,ProFee,0989,E1060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1070_3,Wheelchair detachable foot r,ProFee,0989,E1070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1083_3,Hemi-wheelchair fixed arms,ProFee,0989,E1083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1084_3,Hemi-wheelchair detachable a,ProFee,0989,E1084,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1085_3,Hemi-wheelchair fixed arms,ProFee,0989,E1085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1086_3,Hemi-wheelchair detachable a,ProFee,0989,E1086,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1087_3,Wheelchair lightwt fixed arm,ProFee,0989,E1087,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1088_3,Wheelchair lightweight det a,ProFee,0989,E1088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1089_3,Wheelchair lightwt fixed arm,ProFee,0989,E1089,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1090_3,Wheelchair lightweight det a,ProFee,0989,E1090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1092_3,Wheelchair wide w/ leg rests,ProFee,0989,E1092,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1093_3,Wheelchair wide w/ foot rest,ProFee,0989,E1093,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1100_3,Whchr s-recl fxd arm leg res,ProFee,0989,E1100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1110_3,Wheelchair semi-recl detach,ProFee,0989,E1110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1130_3,Whlchr stand fxd arm ft rest,ProFee,0989,E1130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1140_3,Wheelchair standard detach a,ProFee,0989,E1140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1150_3,Wheelchair standard w/ leg r,ProFee,0989,E1150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1160_3,Wheelchair fixed arms,ProFee,0989,E1160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1161_3,Manual adult wc w tiltinspac,ProFee,0989,E1161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1170_3,Whlchr ampu fxd arm leg rest,ProFee,0989,E1170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1171_3,Wheelchair amputee w/o leg r,ProFee,0989,E1171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1172_3,Wheelchair amputee detach ar,ProFee,0989,E1172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1180_3,Wheelchair amputee w/ foot r,ProFee,0989,E1180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1190_3,Wheelchair amputee w/ leg re,ProFee,0989,E1190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1195_3,Wheelchair amputee heavy dut,ProFee,0989,E1195,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1200_3,Wheelchair amputee fixed arm,ProFee,0989,E1200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1220_3,Whlchr special size/constrc,ProFee,0989,E1220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1221_3,Wheelchair spec size w foot,ProFee,0989,E1221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1222_3,Wheelchair spec size w/ leg,ProFee,0989,E1222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1223_3,Wheelchair spec size w foot,ProFee,0989,E1223,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1224_3,Wheelchair spec size w/ leg,ProFee,0989,E1224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1225_3,Manual semi-reclining back,ProFee,0989,E1225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1226_3,Manual fully reclining back,ProFee,0989,E1226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1227_3,Wheelchair spec sz spec ht a,ProFee,0989,E1227,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1228_3,Wheelchair spec sz spec ht b,ProFee,0989,E1228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1229_3,Pediatric wheelchair NOS,ProFee,0989,E1229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1230_3,Power operated vehicle,ProFee,0989,E1230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1231_3,Rigid ped w/c tilt-in-space,ProFee,0989,E1231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1232_3,Folding ped wc tilt-in-space,ProFee,0989,E1232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1233_3,Rig ped wc tltnspc w/o seat,ProFee,0989,E1233,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1234_3,Fld ped wc tltnspc w/o seat,ProFee,0989,E1234,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1235_3,Rigid ped wc adjustable,ProFee,0989,E1235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1236_3,Folding ped wc adjustable,ProFee,0989,E1236,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1237_3,Rgd ped wc adjstabl w/o seat,ProFee,0989,E1237,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1238_3,Fld ped wc adjstabl w/o seat,ProFee,0989,E1238,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1239_3,Ped power wheelchair NOS,ProFee,0989,E1239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1240_3,Whchr litwt det arm leg rest,ProFee,0989,E1240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1250_3,Wheelchair lightwt fixed arm,ProFee,0989,E1250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1260_3,Wheelchair lightwt foot rest,ProFee,0989,E1260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1270_3,Wheelchair lightweight leg r,ProFee,0989,E1270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1280_3,Whchr h-duty det arm leg res,ProFee,0989,E1280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1285_3,Wheelchair heavy duty fixed,ProFee,0989,E1285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1290_3,Wheelchair hvy duty detach a,ProFee,0989,E1290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1295_3,Wheelchair heavy duty fixed,ProFee,0989,E1295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1296_3,Wheelchair special seat heig,ProFee,0989,E1296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1297_3,Wheelchair special seat dept,ProFee,0989,E1297,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1298_3,Wheelchair spec seat depth/w,ProFee,0989,E1298,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1300_3,Whirlpool portable,ProFee,0989,E1300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1310_3,Whirlpool non-portable,ProFee,0989,E1310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1340_3,"Repair for DME, per 15 min",ProFee,0989,E1340,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E1352_3,O2 flow reg pos inspir press,ProFee,0989,E1352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1353_3,Oxygen supplies regulator,ProFee,0989,E1353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1354_3,"Wheeled cart, port cyl/conc",ProFee,0989,E1354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1355_3,Oxygen supplies stand/rack,ProFee,0989,E1355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1356_3,"Batt pack/cart, port conc",ProFee,0989,E1356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1357_3,"Battery charger, port conc",ProFee,0989,E1357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1358_3,"DC power adapter, port conc",ProFee,0989,E1358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1372_3,Oxy suppl heater for nebuliz,ProFee,0989,E1372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1390_3,Oxygen concentrator,ProFee,0989,E1390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1391_3,"Oxygen concentrator, dual",ProFee,0989,E1391,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1392_3,Portable oxygen concentrator,ProFee,0989,E1392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1399_3,Durable medical equipment mi,ProFee,0989,E1399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1405_3,O2/water vapor enrich w/heat,ProFee,0989,E1405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1406_3,O2/water vapor enrich w/o he,ProFee,0989,E1406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1500_3,Centrifuge,ProFee,0989,E1500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1510_3,Kidney dialysate delivry sys,ProFee,0989,E1510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1520_3,Heparin infusion pump,ProFee,0989,E1520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1530_3,Replacement air bubble detec,ProFee,0989,E1530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1540_3,Replacement pressure alarm,ProFee,0989,E1540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1550_3,Bath conductivity meter,ProFee,0989,E1550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1560_3,Replace blood leak detector,ProFee,0989,E1560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1570_3,Adjustable chair for esrd pt,ProFee,0989,E1570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1575_3,Transducer protect/fld bar,ProFee,0989,E1575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1580_3,Unipuncture control system,ProFee,0989,E1580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1590_3,Hemodialysis machine,ProFee,0989,E1590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1592_3,Auto interm peritoneal dialy,ProFee,0989,E1592,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1594_3,Cycler dialysis machine,ProFee,0989,E1594,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1600_3,Deli/install chrg hemo equip,ProFee,0989,E1600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1610_3,Reverse osmosis h2o puri sys,ProFee,0989,E1610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1615_3,Deionizer H2O puri system,ProFee,0989,E1615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1620_3,Replacement blood pump,ProFee,0989,E1620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1625_3,Water softening system,ProFee,0989,E1625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1630_3,Reciprocating peritoneal dia,ProFee,0989,E1630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1632_3,Wearable artificial kidney,ProFee,0989,E1632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1634_3,Peritoneal dialysis clamp,ProFee,0989,E1634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1635_3,Compact travel hemodialyzer,ProFee,0989,E1635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1636_3,Sorbent cartridges per 10,ProFee,0989,E1636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1637_3,"Hemostats for dialysis, each",ProFee,0989,E1637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1639_3,Dialysis scale,ProFee,0989,E1639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1699_3,Dialysis equipment noc,ProFee,0989,E1699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1700_3,Jaw motion rehab system,ProFee,0989,E1700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1701_3,Repl cushions for jaw motion,ProFee,0989,E1701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1702_3,Repl measr scales jaw motion,ProFee,0989,E1702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1800_3,Adjust elbow ext/flex device,ProFee,0989,E1800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1801_3,SPS elbow device,ProFee,0989,E1801,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1802_3,Adjst forearm pro/sup device,ProFee,0989,E1802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1805_3,Adjust wrist ext/flex device,ProFee,0989,E1805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1806_3,SPS wrist device,ProFee,0989,E1806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1810_3,Adjust knee ext/flex device,ProFee,0989,E1810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1811_3,SPS knee device,ProFee,0989,E1811,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1812_3,Knee ext/flex w act res ctrl,ProFee,0989,E1812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1815_3,Adjust ankle ext/flex device,ProFee,0989,E1815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1816_3,SPS ankle device,ProFee,0989,E1816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1818_3,SPS forearm device,ProFee,0989,E1818,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1820_3,Soft interface material,ProFee,0989,E1820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1821_3,Replacement interface SPSD,ProFee,0989,E1821,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1825_3,Adjust finger ext/flex devc,ProFee,0989,E1825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1830_3,Adjust toe ext/flex device,ProFee,0989,E1830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1831_3,Static str toe dev ext/flex,ProFee,0989,E1831,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1840_3,Adj shoulder ext/flex device,ProFee,0989,E1840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1841_3,Static str shldr dev rom adj,ProFee,0989,E1841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E1902_3,AAC non-electronic board,ProFee,0989,E1902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2000_3,Gastric suction pump hme mdl,ProFee,0989,E2000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2100_3,Bld glucose monitor w voice,ProFee,0989,E2100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2101_3,Bld glucose monitor w lance,ProFee,0989,E2101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2120_3,Pulse gen sys tx endolymp fl,ProFee,0989,E2120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2201_3,Man w/ch acc seat w>=20"<24",ProFee,0989,E2201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2202_3,Seat width 24-27 in,ProFee,0989,E2202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2203_3,Frame depth less than 22 in,ProFee,0989,E2203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2204_3,Frame depth 22 to 25 in,ProFee,0989,E2204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2205_3,"Manual wc accessory, handrim",ProFee,0989,E2205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2206_3,Complete wheel lock assembly,ProFee,0989,E2206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2207_3,Crutch and cane holder,ProFee,0989,E2207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2208_3,Cylinder tank carrier,ProFee,0989,E2208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2209_3,Arm trough each,ProFee,0989,E2209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2210_3,Wheelchair bearings,ProFee,0989,E2210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2211_3,Pneumatic propulsion tire,ProFee,0989,E2211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2212_3,Pneumatic prop tire tube,ProFee,0989,E2212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2213_3,Pneumatic prop tire insert,ProFee,0989,E2213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2214_3,Pneumatic caster tire each,ProFee,0989,E2214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2215_3,Pneumatic caster tire tube,ProFee,0989,E2215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2216_3,Foam filled propulsion tire,ProFee,0989,E2216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2217_3,Foam filled caster tire each,ProFee,0989,E2217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2218_3,Foam propulsion tire each,ProFee,0989,E2218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2219_3,Foam caster tire any size ea,ProFee,0989,E2219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2220_3,Solid propulsion tire each,ProFee,0989,E2220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2221_3,Solid caster tire each,ProFee,0989,E2221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2222_3,Solid caster integrated whl,ProFee,0989,E2222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2223_3,Valve replacement only each,ProFee,0989,E2223,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2224_3,Propulsion whl excludes tire,ProFee,0989,E2224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2225_3,Caster wheel excludes tire,ProFee,0989,E2225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2226_3,Caster fork replacement only,ProFee,0989,E2226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2227_3,Gear reduction drive wheel,ProFee,0989,E2227,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2228_3,"Mwc acc, wheelchair brake",ProFee,0989,E2228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2230_3,Manual standing system,ProFee,0989,E2230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2231_3,Solid seat support base,ProFee,0989,E2231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2291_3,Planar back for ped size wc,ProFee,0989,E2291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2292_3,Planar seat for ped size wc,ProFee,0989,E2292,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2293_3,Contour back for ped size wc,ProFee,0989,E2293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2294_3,Contour seat for ped size wc,ProFee,0989,E2294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2295_3,Ped dynamic seating frame,ProFee,0989,E2295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2300_3,Pwr seat elevation sys,ProFee,0989,E2300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2301_3,Pwr standing,ProFee,0989,E2301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2310_3,Electro connect btw control,ProFee,0989,E2310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2311_3,Electro connect btw 2 sys,ProFee,0989,E2311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2312_3,Mini-prop remote joystick,ProFee,0989,E2312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2313_3,"PWC harness, expand control",ProFee,0989,E2313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2320_3,Hand chin control,ProFee,0989,E2320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2321_3,Hand interface joystick,ProFee,0989,E2321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2322_3,Mult mech switches,ProFee,0989,E2322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2323_3,Special joystick handle,ProFee,0989,E2323,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2324_3,Chin cup interface,ProFee,0989,E2324,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2325_3,Sip and puff interface,ProFee,0989,E2325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2326_3,Breath tube kit,ProFee,0989,E2326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2327_3,Head control interface mech,ProFee,0989,E2327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2328_3,Head/extremity control inter,ProFee,0989,E2328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2329_3,Head control nonproportional,ProFee,0989,E2329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2330_3,Head control proximity switc,ProFee,0989,E2330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2331_3,Attendant control,ProFee,0989,E2331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2340_3,W/c wdth 20-23 in seat frame,ProFee,0989,E2340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2341_3,W/c wdth 24-27 in seat frame,ProFee,0989,E2341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2342_3,W/c dpth 20-21 in seat frame,ProFee,0989,E2342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2343_3,W/c dpth 22-25 in seat frame,ProFee,0989,E2343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2351_3,Electronic SGD interface,ProFee,0989,E2351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2358_3,Gr 34 nonsealed leadacid,ProFee,0989,E2358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2359_3,Gr34 sealed leadacid battery,ProFee,0989,E2359,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2360_3,22nf nonsealed leadacid,ProFee,0989,E2360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2361_3,22nf sealed leadacid battery,ProFee,0989,E2361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2362_3,Gr24 nonsealed leadacid,ProFee,0989,E2362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2363_3,Gr24 sealed leadacid battery,ProFee,0989,E2363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2364_3,U1nonsealed leadacid battery,ProFee,0989,E2364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2365_3,U1 sealed leadacid battery,ProFee,0989,E2365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2366_3,"Battery charger, single mode",ProFee,0989,E2366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2367_3,"Battery charger, dual mode",ProFee,0989,E2367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2368_3,Power wc motor replacement,ProFee,0989,E2368,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2369_3,Pwr wc gear box replacement,ProFee,0989,E2369,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2370_3,Pwr wc motor/gear box combo,ProFee,0989,E2370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2371_3,Gr27 sealed leadacid battery,ProFee,0989,E2371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2372_3,Gr27 non-sealed leadacid,ProFee,0989,E2372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2373_3,Hand/chin ctrl spec joystick,ProFee,0989,E2373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2374_3,Hand/chin ctrl std joystick,ProFee,0989,E2374,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2375_3,Non-expandable controller,ProFee,0989,E2375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2376_3,"Expandable controller, repl",ProFee,0989,E2376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2377_3,"Expandable controller, initl",ProFee,0989,E2377,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2378_3,Pw actuator replacement,ProFee,0989,E2378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2381_3,Pneum drive wheel tire,ProFee,0989,E2381,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2382_3,"Tube, pneum wheel drive tire",ProFee,0989,E2382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2383_3,"Insert, pneum wheel drive",ProFee,0989,E2383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2384_3,Pneumatic caster tire,ProFee,0989,E2384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2385_3,"Tube, pneumatic caster tire",ProFee,0989,E2385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2386_3,Foam filled drive wheel tire,ProFee,0989,E2386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2387_3,Foam filled caster tire,ProFee,0989,E2387,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2388_3,Foam drive wheel tire,ProFee,0989,E2388,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2389_3,Foam caster tire,ProFee,0989,E2389,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2390_3,Solid drive wheel tire,ProFee,0989,E2390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2391_3,Solid caster tire,ProFee,0989,E2391,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2392_3,"Solid caster tire, integrate",ProFee,0989,E2392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2393_3,"Valve, pneumatic tire tube",ProFee,0989,E2393,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2394_3,Drive wheel excludes tire,ProFee,0989,E2394,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2395_3,Caster wheel excludes tire,ProFee,0989,E2395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2396_3,Caster fork,ProFee,0989,E2396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2397_3,"Pwc acc, lith-based battery",ProFee,0989,E2397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2398_3,Wc dynamic pos back hardware,ProFee,0989,E2398,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2399_3,Noc interface,ProFee,0989,E2399,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2402_3,Neg press wound therapy pump,ProFee,0989,E2402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2500_3,SGD digitized pre-rec <=8min,ProFee,0989,E2500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2502_3,SGD prerec msg >8min <=20min,ProFee,0989,E2502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2504_3,SGD prerec msg>20min <=40min,ProFee,0989,E2504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2506_3,SGD prerec msg > 40 min,ProFee,0989,E2506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2508_3,SGD spelling phys contact,ProFee,0989,E2508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2510_3,SGD w multi methods msg/accs,ProFee,0989,E2510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2511_3,SGD sftwre prgrm for PC/PDA,ProFee,0989,E2511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2512_3,"SGD accessory, mounting sys",ProFee,0989,E2512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2599_3,SGD accessory noc,ProFee,0989,E2599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2601_3,Gen w/c cushion wdth < 22 in,ProFee,0989,E2601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2602_3,Gen w/c cushion wdth >=22 in,ProFee,0989,E2602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2603_3,Skin protect wc cus wd <22in,ProFee,0989,E2603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2604_3,Skin protect wc cus wd>=22in,ProFee,0989,E2604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2605_3,Position wc cush wdth <22 in,ProFee,0989,E2605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2606_3,Position wc cush wdth>=22 in,ProFee,0989,E2606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2607_3,Skin pro/pos wc cus wd <22in,ProFee,0989,E2607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2608_3,Skin pro/pos wc cus wd>=22in,ProFee,0989,E2608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2609_3,Custom fabricate w/c cushion,ProFee,0989,E2609,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2610_3,Powered w/c cushion,ProFee,0989,E2610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2611_3,Gen use back cush wdth <22in,ProFee,0989,E2611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2612_3,Gen use back cush wdth>=22in,ProFee,0989,E2612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2613_3,Position back cush wd <22in,ProFee,0989,E2613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2614_3,Position back cush wd>=22in,ProFee,0989,E2614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2615_3,Pos back post/lat wdth <22in,ProFee,0989,E2615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2616_3,Pos back post/lat wdth>=22in,ProFee,0989,E2616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2617_3,Custom fab w/c back cushion,ProFee,0989,E2617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2618_3,Wc acc solid seat supp base,ProFee,0989,E2618,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
E2619_3,Replace cover w/c seat cush,ProFee,0989,E2619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2620_3,WC planar back cush wd <22in,ProFee,0989,E2620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2621_3,WC planar back cush wd>=22in,ProFee,0989,E2621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2622_3,Adj skin pro w/c cus wd<22in,ProFee,0989,E2622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2623_3,Adj skin pro wc cus wd>=22in,ProFee,0989,E2623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2624_3,Adj skin pro/pos cus<22in,ProFee,0989,E2624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2625_3,Adj skin pro/pos wc cus>=22,ProFee,0989,E2625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2626_3,Seo mobile arm sup att to wc,ProFee,0989,E2626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2627_3,Arm supp att to wc rancho ty,ProFee,0989,E2627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2628_3,Mobile arm supports reclinin,ProFee,0989,E2628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2629_3,Friction dampening arm supp,ProFee,0989,E2629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2630_3,Monosuspension arm/hand supp,ProFee,0989,E2630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2631_3,Elevat proximal arm support,ProFee,0989,E2631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2632_3,Offset/lat rocker arm w/ela,ProFee,0989,E2632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E2633_3,Mobile arm support supinator,ProFee,0989,E2633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E8000_3,Posterior gait trainer,ProFee,0989,E8000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E8001_3,Upright gait trainer,ProFee,0989,E8001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
E8002_3,Anterior gait trainer,ProFee,0989,E8002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
FOB_1,Occult Blood FIT,Outpatient,0300,82274,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
FOB_1,Occult Blood FIT,Inpatient,0300,82274,,,,0,50.00,37.50,37.50,47.50,45.00,47.50,47.50,45.00
G0008_2,Admin influenza virus vac,Outpatient,0771,G0008,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
G0008_2,Admin influenza virus vac,Inpatient,0771,G0008,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
G0008_3,Admin influenza virus vac,Inpatient,0771,G0008,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
G0008_3,Admin influenza virus vac,Outpatient,0771,G0008,,,,0,74.00,55.50,55.50,70.30,66.60,70.30,70.30,66.60
G0009_2,Admin pneumococcal vaccine,Inpatient,0771,G0009,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
G0009_2,Admin pneumococcal vaccine,Outpatient,0771,G0009,,,,0,45.00,33.75,33.75,42.75,40.50,42.75,42.75,40.50
G0009_3,Admin pneumococcal vaccine,Inpatient,0771,G0009,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
G0009_3,Admin pneumococcal vaccine,Outpatient,0771,G0009,,,,0,47.00,35.25,35.25,44.65,42.30,44.65,44.65,42.30
G0010_3,Admin hepatitis b vaccine,Outpatient,0521,G0010,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
G0010_3,Admin hepatitis b vaccine,Inpatient,0521,G0010,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
G0027_3,Semen analysis,ProFee,0989,G0027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0068_3,Adm of infusion drug in home,ProFee,0989,G0068,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0069_3,Adm of immune drug in home,ProFee,0989,G0069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0070_3,Adm of chemo drug in home,ProFee,0989,G0070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0071_2,Comm svcs by rhc/fqhc 5 min,Outpatient,0521,G0071,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,0.00,62.10
G0071_2,Comm svcs by rhc/fqhc 5 min,Inpatient,0521,G0071,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
G0071_3,Comm svcs by rhc/fqhc 5 min,Inpatient,0521,G0071,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,65.55,62.10
G0071_3,Comm svcs by rhc/fqhc 5 min,Outpatient,0521,G0071,,,,0,69.00,51.75,51.75,65.55,62.10,65.55,0.00,62.10
G0076_3,Care manag h vst new pt 20 m,ProFee,0989,G0076,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0077_3,Care manag h vst new pt 30 m,ProFee,0989,G0077,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0078_3,Care manag h vst new pt 45 m,ProFee,0989,G0078,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0079_3,Care manag h vst new pt 60 m,ProFee,0989,G0079,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0080_3,Care manag h vst new pt 75 m,ProFee,0989,G0080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0081_3,Care man h v ext pt 20 mi,ProFee,0989,G0081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0082_3,Care man h v ext pt 30 m,ProFee,0989,G0082,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0083_3,Care man h v ext pt 45 m,ProFee,0989,G0083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0084_3,Care man h v ext pt 60 m,ProFee,0989,G0084,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0085_3,Care man h v ext pt 75 m,ProFee,0989,G0085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0086_3,Care man home care plan 30 m,ProFee,0989,G0086,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0087_3,Care man home care plan 60 m,ProFee,0989,G0087,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0101_2,CA screen;pelvic/breast exam,Outpatient,0771,G0101,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
G0101_2,CA screen;pelvic/breast exam,Inpatient,0771,G0101,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
G0101_3,CA screen;pelvic/breast exam,Outpatient,0771,G0101,,,,0,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
G0101_3,CA screen;pelvic/breast exam,Inpatient,0771,G0101,,,,0,8.00,6.00,6.00,7.60,7.20,7.60,7.60,7.20
G0102_3,Prostate ca screening; dre,ProFee,0989,G0102,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
G0103_3,"Psa, total screening",ProFee,0989,G0103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0104_3,CA screen;flexi sigmoidscope,ProFee,0989,G0104,,,,0,3.00,2.25,2.25,82.00,0.00,82.00,82.00,N/A
G0105_3,Colorectal scrn; hi risk ind,ProFee,0989,G0105,,,,0,3.00,2.25,2.25,271.50,0.00,271.50,271.50,N/A
G0106_3,Colon CA screen;barium enema,ProFee,0989,G0106,,,,0,3.00,2.25,2.25,70.00,0.00,70.00,70.00,N/A
G0108_3,Diab manage trn  per indiv,ProFee,0989,G0108,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
G0109_3,Diab manage trn ind/group,ProFee,0989,G0109,,,,0,3.00,2.25,2.25,20.50,0.00,20.50,20.50,N/A
G0117_3,Glaucoma scrn hgh risk direc,ProFee,0989,G0117,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
G0118_3,Glaucoma scrn hgh risk direc,ProFee,0989,G0118,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
G0120_3,Colon ca scrn; barium enema,ProFee,0989,G0120,,,,0,3.00,2.25,2.25,73.50,0.00,73.50,73.50,N/A
G0121_3,Colon ca scrn not hi rsk ind,ProFee,0989,G0121,,,,0,3.00,2.25,2.25,272.00,0.00,272.00,272.00,N/A
G0122_3,Colon ca scrn; barium enema,ProFee,0989,G0122,,,,0,3.00,2.25,2.25,70.50,0.00,70.50,70.50,N/A
G0123_3,Screen cerv/vag thin layer,ProFee,0989,G0123,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0124_2,Screen c/v thin layer by MD,ProFee,0989,G0124,,,,0,25.00,18.75,18.75,46.00,0.00,46.00,46.00,N/A
G0124_3,Screen c/v thin layer by MD,ProFee,0989,G0124,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
G0127_3,Trim nail(s),ProFee,0989,G0127,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
G0128_3,CORF skilled nursing service,ProFee,0989,G0128,,,,0,3.00,2.25,2.25,11.00,0.00,11.00,11.00,N/A
G0129_3,Partial hosp prog service,ProFee,0989,G0129,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0130_3,Single energy x-ray study,ProFee,0989,G0130,,,,0,3.00,2.25,2.25,16.00,0.00,16.00,16.00,N/A
G0141_3,"Scr c/v cyto,autosys and md",ProFee,0989,G0141,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
G0143_3,"Scr c/v cyto,thinlayer,rescr",ProFee,0989,G0143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0144_3,"Scr c/v cyto,thinlayer,rescr",ProFee,0989,G0144,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0145_3,"Scr c/v cyto,thinlayer,rescr",ProFee,0989,G0145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0147_3,"Scr c/v cyto, automated sys",ProFee,0989,G0147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0148_3,"Scr c/v cyto, autosys, rescr",ProFee,0989,G0148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0151_3,"HHCP-serv of pt,ea 15 min",ProFee,0989,G0151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0152_3,"HHCP-serv of ot,ea 15 min",ProFee,0989,G0152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0153_3,"HHCP-svs of s/l path,ea 15mn",ProFee,0989,G0153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0154_3,"HHCP-svs of rn,ea 15 min",ProFee,0989,G0154,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0155_3,"HHCP-svs of csw,ea 15 min",ProFee,0989,G0155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0156_3,"HHCP-svs of aide,ea 15 min",ProFee,0989,G0156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0157_3,HHC PT assistant ea 15,ProFee,0989,G0157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0158_3,HHC OT assistant ea 15,ProFee,0989,G0158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0159_3,HHC PT maint ea 15 min,ProFee,0989,G0159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0160_3,HHC Occup Therapy ea 15,ProFee,0989,G0160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0161_3,HHC SLP ea 15 min,ProFee,0989,G0161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0162_3,"HHC RN E&M plan svs, 15 min",ProFee,0989,G0162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0163_3,HHC LPN/RN obs/asses ea 15,ProFee,0989,G0163,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0164_3,HHC lis nurse train ea 15,ProFee,0989,G0164,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0166_3,"Extrnl counterpulse, per tx",ProFee,0989,G0166,,,,0,3.00,2.25,2.25,198.50,0.00,198.50,198.50,N/A
G0168_2,Wound closure by adhesive,Inpatient,0521,G0168,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,229.90,217.80
G0168_2,Wound closure by adhesive,Outpatient,0521,G0168,,,,0,242.00,181.50,181.50,229.90,217.80,229.90,0.00,217.80
G0168_3,Wound closure by adhesive,Inpatient,0521,G0168,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,226.10,214.20
G0168_3,Wound closure by adhesive,Outpatient,0521,G0168,,,,0,238.00,178.50,178.50,226.10,214.20,226.10,0.00,214.20
G0173_3,Linear acc stereo radsur com,ProFee,0989,G0173,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0175_3,"OPPS Service,sched team conf",ProFee,0989,G0175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0176_3,OPPS/PHP;activity therapy,ProFee,0989,G0176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0177_3,OPPS/PHP; train & educ serv,ProFee,0989,G0177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0179_3,MD recertification HHA PT,ProFee,0989,G0179,,,,0,3.00,2.25,2.25,59.00,0.00,59.00,59.00,N/A
G0180_3,MD certification HHA patient,ProFee,0989,G0180,,,,0,3.00,2.25,2.25,76.00,0.00,76.00,76.00,N/A
G0181_3,Home health care supervision,ProFee,0989,G0181,,,,0,3.00,2.25,2.25,153.00,0.00,153.00,153.00,N/A
G0182_3,Hospice care supervision,ProFee,0989,G0182,,,,0,3.00,2.25,2.25,153.50,0.00,153.50,153.50,N/A
G0186_3,"Dstry eye lesn,fdr vssl tech",ProFee,0989,G0186,,,,0,3.00,2.25,2.25,846.00,0.00,846.00,846.00,N/A
G0202_3,Screeningmammographydigital,ProFee,0989,77067,,,,0,3.00,2.25,2.25,54.00,0.00,54.00,54.00,N/A
G0204_3,Diagnosticmammographydigital,ProFee,0989,77066,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
G0206_3,Diagnosticmammographydigital,ProFee,0989,77065,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
G0219_3,PET img wholbod melano nonco,ProFee,0989,G0219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0235_3,PET not otherwise specified,ProFee,0989,G0235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0237_3,Therapeutic procd strg endur,ProFee,0989,G0237,,,,0,3.00,2.25,2.25,14.00,0.00,14.00,14.00,N/A
G0238_3,"Oth resp proc, indiv",ProFee,0989,G0238,,,,0,3.00,2.25,2.25,10.01,0.00,10.01,10.01,N/A
G0239_3,"Oth resp proc, group",ProFee,0989,G0239,,,,0,3.00,2.25,2.25,12.77,0.00,12.77,12.77,N/A
G0243_3,Multisour photon stero treat,ProFee,0989,G0243,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0245_3,Initial foot exam pt lops,ProFee,0989,G0245,,,,0,3.00,2.25,2.25,61.00,0.00,61.00,61.00,N/A
G0246_3,Followup eval of foot pt lop,ProFee,0989,G0246,,,,0,3.00,2.25,2.25,30.50,0.00,30.50,30.50,N/A
G0247_3,Routine footcare pt w lops,ProFee,0989,G0247,,,,0,3.00,2.25,2.25,33.00,0.00,33.00,33.00,N/A
G0248_3,Demonstrate use home inr mon,ProFee,0989,G0248,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
G0249_3,"Provide test material,equipm",ProFee,0989,G0249,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
G0250_3,MD review interpret of test,ProFee,0989,G0250,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
G0251_3,Linear acc based stero radio,ProFee,0989,G0251,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0252_3,PET imaging initial dx,ProFee,0989,G0252,,,,0,3.00,2.25,2.25,106.00,0.00,106.00,106.00,N/A
G0255_3,Current percep threshold tst,ProFee,0989,G0255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0257_3,Unsched dialysis ESRD pt hos,ProFee,0989,G0257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0259_3,Inject for sacroiliac joint,ProFee,0989,G0259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0260_3,Inj for sacroiliac jt anesth,ProFee,0989,G0260,,,,0,3.00,2.25,2.25,120.00,0.00,120.00,120.00,N/A
G0265_3,Cryopresevation Freeze+stora,ProFee,0989,G0265,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0266_3,Thawing + expansion froz cel,ProFee,0989,G0266,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0267_3,Bone marrow or psc harvest,ProFee,0989,G0267,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0268_3,Removal of impacted wax md,ProFee,0989,G0268,,,,0,3.00,2.25,2.25,48.00,0.00,48.00,48.00,N/A
G0269_3,Occlusive device in vein art,ProFee,0989,G0269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0270_3,MNT subs tx for change dx,ProFee,0989,G0270,,,,0,3.00,2.25,2.25,39.00,0.00,39.00,39.00,N/A
G0271_3,Group MNT 2 or more 30 mins,ProFee,0989,G0271,,,,0,3.00,2.25,2.25,21.50,0.00,21.50,21.50,N/A
G0275_3,"Renal angio, cardiac cath",ProFee,0989,G0275,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0276_3,Pild/placebo control clin tr,ProFee,0989,G0276,,,,0,3.00,2.25,2.25,570.50,0.00,570.50,570.50,N/A
G0277_3,"Hbot, full body chamber, 30m",ProFee,0989,G0277,,,,0,3.00,2.25,2.25,119.50,0.00,119.50,119.50,N/A
G0278_3,"Iliac art angio,cardiac cath",ProFee,0989,G0278,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
G0279_3,"Tomosynthesis, mammo",ProFee,0989,G0279,,,,0,3.00,2.25,2.25,42.50,0.00,42.50,42.50,N/A
G0281_3,Elec stim unattend for press,ProFee,0989,G0281,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
G0282_3,Elect stim wound care not pd,ProFee,0989,G0282,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0283_3,Elec stim other than wound,ProFee,0989,G0283,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
G0288_3,"Recon, CTA for surg plan",ProFee,0989,G0288,,,,0,3.00,2.25,2.25,51.50,0.00,51.50,51.50,N/A
G0289_3,"Arthro, loose body + chondro",ProFee,0989,G0289,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
G0290_3,"Drug-eluting stents, single",ProFee,0989,G0290,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0291_3,"Drug-eluting stents,each add",ProFee,0989,G0291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0293_3,"Non-cov surg proc,clin trial",ProFee,0989,G0293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0294_3,"Non-cov proc, clinical trial",ProFee,0989,G0294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0295_3,Electromagnetic therapy onc,ProFee,0989,G0295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0296_3,Visit to determ ldct elig,ProFee,0989,G0296,,,,0,3.00,2.25,2.25,37.50,0.00,37.50,37.50,N/A
G0297_3,Insert single chamber/cd,ProFee,0989,71271,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0298_3,Insert dual chamber/cd,ProFee,0989,G0298,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0299_3,Inser/repos single icd+leads,ProFee,0989,G0299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0300_3,Insert reposit lead dual+gen,ProFee,0989,G0300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0302_3,Pre-op service LVRS complete,ProFee,0989,G0302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0303_3,Pre-op service LVRS 10-15dos,ProFee,0989,G0303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0304_3,Pre-op service LVRS 1-9 dos,ProFee,0989,G0304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0305_3,Post op service LVRS min 6,ProFee,0989,G0305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0306_3,CBC/diffwbc w/o platelet,ProFee,0989,G0306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0307_3,CBC without platelet,ProFee,0989,G0307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0308_3,ESRD related svc 4+mo < 2yrs,ProFee,0989,G0308,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0309_3,ESRD related svc 2-3mo <2yrs,ProFee,0989,G0309,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0310_3,ESRD related svc 1 vst <2yrs,ProFee,0989,G0310,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0311_3,ESRD related svs 4+mo 2-11yr,ProFee,0989,G0311,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0312_3,ESRD relate svs 2-3 mo 2-11y,ProFee,0989,G0312,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0313_3,ESRD related svs 1 mon 2-11y,ProFee,0989,G0313,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0314_3,ESRD Relate svs 4+mo 12-19,ProFee,0989,G0314,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0315_3,ESRD related svs 2-3mo/12-19,ProFee,0989,G0315,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0316_3,ESRD related svs 1vis/12-19y,ProFee,0989,G0316,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0317_3,ESRD related svs 4+mo 20+yrs,ProFee,0989,G0317,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0318_3,ESRD related svs 2-3 mo 20+y,ProFee,0989,G0318,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0319_3,ESRD related svs 1visit 20+y,ProFee,0989,G0319,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0320_3,ESD related svs home undr 2,ProFee,0989,G0320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0321_3,ESRDrelatedsvs home mo 2-11y,ProFee,0989,G0321,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0322_3,ESRD related svs hom mo12-19,ProFee,0989,G0322,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0323_3,ESRD related svs home mo 20+,ProFee,0989,G0323,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0324_3,ESRD relate svs home/dy <2yr,ProFee,0989,G0324,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0325_3,ESRD relate home/day/ 2-11yr,ProFee,0989,G0325,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0326_3,ESRD relate home/dy 12-19yr,ProFee,0989,G0326,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0327_3,ESRD relate home/dy 20+yrs,ProFee,0989,G0327,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0328_3,Fecal blood scrn immunoassay,ProFee,0989,G0328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0329_3,Electromagntic tx for ulcers,ProFee,0989,G0329,,,,0,3.00,2.25,2.25,15.50,0.00,15.50,15.50,N/A
G0332_3,Preadmin IV immunoglobulin,ProFee,0989,G0332,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0333_3,Dispense fee initial 30 day,ProFee,0989,G0333,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0337_3,Hospice evaluation preelecti,ProFee,0989,G0337,,,,0,3.00,2.25,2.25,102.50,0.00,102.50,102.50,N/A
G0339_3,"Robot lin-radsurg com, first",ProFee,0989,G0339,,,,0,3.00,2.25,2.25,3328.00,0.00,3328.00,3328.00,N/A
G0340_3,Robt lin-radsurg fractx 2-5,ProFee,0989,G0340,,,,0,3.00,2.25,2.25,2627.50,0.00,2627.50,2627.50,N/A
G0341_3,Percutaneous islet celltrans,ProFee,0989,G0341,,,,0,3.00,2.25,2.25,539.50,0.00,539.50,539.50,N/A
G0342_3,Laparoscopy islet cell trans,ProFee,0989,G0342,,,,0,3.00,2.25,2.25,1012.00,0.00,1012.00,1012.00,N/A
G0343_3,Laparotomy islet cell transp,ProFee,0989,G0343,,,,0,3.00,2.25,2.25,1668.50,0.00,1668.50,1668.50,N/A
G0344_3,Initial preventive exam,ProFee,0989,G0344,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0364_3,Bone marrow aspirate &biopsy,ProFee,0989,G0364,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0365_3,Vessel mapping hemo access,ProFee,0989,G0365,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
G0366_3,EKG for initial prevent exam,ProFee,0989,G0366,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0367_3,EKG tracing for initial prev,ProFee,0989,G0367,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0368_3,EKG interpret & report preve,ProFee,0989,G0368,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0372_2,MD service required for PMD,Outpatient,0521,G0372,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,0.00,36.00
G0372_2,MD service required for PMD,Inpatient,0521,G0372,,,,0,40.00,30.00,30.00,38.00,36.00,38.00,38.00,36.00
G0372_3,MD service required for PMD,Inpatient,0521,G0372,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,39.90,37.80
G0372_3,MD service required for PMD,Outpatient,0521,G0372,,,,0,42.00,31.50,31.50,39.90,37.80,39.90,0.00,37.80
G0375_3,Smoke/Tobacco counseling 3-10,ProFee,0989,G0375,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0376_3,Smoke/Tobacco counseling > 10,ProFee,0989,G0376,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0377_3,Administra Part D vaccine,ProFee,0989,G0377,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0378_3,Hospital observation per hr,ProFee,0989,G0378,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0379_3,Direct admit hospital observ,ProFee,0989,G0379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0380_3,Lev 1 hosp type B ED visit,ProFee,0989,G0380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0381_3,Lev 2 hosp type B ED visit,ProFee,0989,G0381,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0382_3,Lev 3 hosp type B ED visit,ProFee,0989,G0382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0383_3,Lev 4 hosp type B ED visit,ProFee,0989,G0383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0384_3,Lev 5 hosp type B ED visit,ProFee,0989,G0384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0389_3,Ultrasound exam AAA screen,ProFee,0989,76706,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
G0390_3,Trauma Respons w/hosp criti,ProFee,0989,G0390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0392_3,AV fistula or graft arterial,ProFee,0989,G0392,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0393_3,AV fistula or graft venous,ProFee,0989,G0393,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0394_3,"Blood occult test,colorectal",ProFee,0989,G0394,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0396_3,Alcohol/subs interv 15-30mn,ProFee,0989,G0396,,,,0,3.00,2.25,2.25,47.50,0.00,47.50,47.50,N/A
G0397_3,Alcohol/subs interv >30 min,ProFee,0989,G0397,,,,0,3.00,2.25,2.25,94.00,0.00,94.00,94.00,N/A
G0398_3,Home sleep test/type 2 Porta,ProFee,0989,G0398,,,,0,3.00,2.25,2.25,115.00,0.00,115.00,115.00,N/A
G0399_3,Home sleep test/type 3 Porta,ProFee,0989,G0399,,,,0,3.00,2.25,2.25,106.50,0.00,106.50,106.50,N/A
G0400_3,Home sleep test/type 4 Porta,ProFee,0989,G0400,,,,0,3.00,2.25,2.25,91.00,0.00,91.00,91.00,N/A
G0402_3,Initial preventive exam,Inpatient,0521,G0402,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
G0402_3,Initial preventive exam,Outpatient,0521,G0402,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
G0403_3,EKG for initial prevent exam,ProFee,0989,G0403,,,,0,3.00,2.25,2.25,24.00,0.00,24.00,24.00,N/A
G0404_3,EKG tracing for initial prev,ProFee,0989,G0404,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
G0405_3,EKG interpret & report preve,ProFee,0989,G0405,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
G0406_3,Telhealth inpt consult 15min,ProFee,0989,G0406,,,,0,3.00,2.25,2.25,54.50,0.00,54.50,54.50,N/A
G0407_3,Telheath inpt consult 25min,ProFee,0989,G0407,,,,0,3.00,2.25,2.25,102.00,0.00,102.00,102.00,N/A
G0408_3,Telhealth inpt consult 35min,ProFee,0989,G0408,,,,0,3.00,2.25,2.25,146.50,0.00,146.50,146.50,N/A
G0409_3,CORF related serv 15 mins ea,ProFee,0989,G0409,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0410_3,Grp psych partial hosp 45-50,ProFee,0989,G0410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0411_3,Inter active grp psych parti,ProFee,0989,G0411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0412_3,Open tx iliac spine uni/bil,ProFee,0989,G0412,,,,0,3.00,2.25,2.25,1035.50,0.00,1035.50,1035.50,N/A
G0413_3,Pelvic ring fracture uni/bil,ProFee,0989,G0413,,,,0,3.00,2.25,2.25,1536.00,0.00,1536.00,1536.00,N/A
G0414_3,Pelvic ring fx treat int fix,ProFee,0989,G0414,,,,0,3.00,2.25,2.25,1442.00,0.00,1442.00,1442.00,N/A
G0415_3,Open tx post pelvic fxcture,ProFee,0989,G0415,,,,0,3.00,2.25,2.25,1978.00,0.00,1978.00,1978.00,N/A
G0416_3,Sat biopsy prostate 1-20 spc,ProFee,0989,G0416,,,,0,3.00,2.25,2.25,259.50,0.00,259.50,259.50,N/A
G0417_3,Sat biopsy prostate 21-40,ProFee,0989,G0417,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0418_3,Sat biopsy prostate 41-60,ProFee,0989,G0418,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0419_3,Sat biopsy prostate: >60,ProFee,0989,G0419,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0420_3,Ed svc CKD ind per session,ProFee,0989,G0420,,,,0,3.00,2.25,2.25,154.00,0.00,154.00,154.00,N/A
G0421_3,Ed svc CKD grp per session,ProFee,0989,G0421,,,,0,3.00,2.25,2.25,35.50,0.00,35.50,35.50,N/A
G0422_3,Intens cardiac rehab w/exerc,ProFee,0989,G0422,,,,0,3.00,2.25,2.25,162.00,0.00,162.00,162.00,N/A
G0423_3,Intens cardiac rehab no exer,ProFee,0989,G0423,,,,0,3.00,2.25,2.25,162.00,0.00,162.00,162.00,N/A
G0424_3,Pulmonary rehab w exer,ProFee,0989,G0424,,,,0,3.00,2.25,2.25,20.00,0.00,20.00,20.00,N/A
G0425_3,Inpt telehealth consult 30m,ProFee,0989,G0425,,,,0,3.00,2.25,2.25,141.00,0.00,141.00,141.00,N/A
G0426_3,Inpt telehealth consult 50m,ProFee,0989,G0426,,,,0,3.00,2.25,2.25,191.00,0.00,191.00,191.00,N/A
G0427_3,Inpt telehealth con 70/>m,ProFee,0989,G0427,,,,0,3.00,2.25,2.25,285.00,0.00,285.00,285.00,N/A
G0428_3,Collagen Meniscus Implant,ProFee,0989,G0428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0429_3,Dermal filler injection(s),ProFee,0989,G0429,,,,0,3.00,2.25,2.25,101.50,0.00,101.50,101.50,N/A
G0431_3,Drug screen multip class,ProFee,0989,G0431,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0432_3,EIA HIV-1/HIV-2 screen,ProFee,0989,G0432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0433_3,ELISA HIV-1/HIV-2 screen,ProFee,0989,G0433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0434_3,Drug screen multi drug class,ProFee,0989,G0434,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0435_3,Oral HIV-1/HIV-2 screen,ProFee,0989,G0435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0436_3,Tobacco-use counsel 3-10 min,ProFee,0989,99406,,,,0,3.00,2.25,2.25,17.50,0.00,17.50,17.50,N/A
G0437_3,Tobacco-use counsel>10min,ProFee,0989,99407,,,,0,3.00,2.25,2.25,36.50,0.00,36.50,36.50,N/A
G0438_2,"PPPS, initial visit",Inpatient,0521,G0438,,,,0,379.00,284.25,284.25,360.05,341.10,360.05,360.05,341.10
G0438_2,"PPPS, initial visit",Outpatient,0521,G0438,,,,0,379.00,284.25,284.25,360.05,341.10,360.05,0.00,341.10
G0438_3,"PPPS, initial visit",Inpatient,0521,G0438,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
G0438_3,"PPPS, initial visit",Outpatient,0521,G0438,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
G0439_2,"PPPS, subseq visit",Inpatient,0521,G0439,,,,0,317.00,237.75,237.75,301.15,285.30,301.15,301.15,285.30
G0439_2,"PPPS, subseq visit",Outpatient,0521,G0439,,,,0,317.00,237.75,237.75,301.15,285.30,301.15,0.00,285.30
G0439_3,"PPPS, subseq visit",Outpatient,0521,G0439,,,,0,311.00,233.25,233.25,295.45,279.90,295.45,0.00,279.90
G0439_3,"PPPS, subseq visit",Inpatient,0521,G0439,,,,0,311.00,233.25,233.25,295.45,279.90,295.45,295.45,279.90
G0440_3,Skin/dermal subs init 25or<,ProFee,0989,G0440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0441_3,Skin/dermal subs each additi,ProFee,0989,G0441,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0442_3,Annual alcohol screen 15 min,ProFee,0989,G0442,,,,0,3.00,2.25,2.25,13.50,0.00,13.50,13.50,N/A
G0443_2,Brief alcohol misuse counsel,Inpatient,0521,G0443,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,61.75,58.50
G0443_2,Brief alcohol misuse counsel,Outpatient,0521,G0443,,,,0,65.00,48.75,48.75,61.75,58.50,61.75,0.00,58.50
G0443_3,Brief alcohol misuse counsel,Inpatient,0521,G0443,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
G0443_3,Brief alcohol misuse counsel,Outpatient,0521,G0443,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
G0444_2,"annual depression screening, 15 minutes",Inpatient,0521,G0444,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
G0444_2,"annual depression screening, 15 minutes",Outpatient,0521,G0444,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,0.00,22.50
G0444_3,"annual depression screening, 15 minutes",Outpatient,0521,G0444,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,0.00,22.50
G0444_3,"annual depression screening, 15 minutes",Inpatient,0521,G0444,,,,0,25.00,18.75,18.75,23.75,22.50,23.75,23.75,22.50
G0445_3,High inten beh couns std 30m,ProFee,0989,G0445,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
G0446_3,Intens behave ther cardio dx,ProFee,0989,G0446,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
G0447_3,Behavior counsel obesity 15m,ProFee,0989,G0447,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
G0448_3,Place perm pacing cardiovert,ProFee,0989,G0448,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0451_3,Devlopment test interpt&rep,ProFee,0989,G0451,,,,0,3.00,2.25,2.25,14.50,0.00,14.50,14.50,N/A
G0452_3,Molecular pathology interpr,ProFee,0989,G0452,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
G0453_3,Cont intraop neuro monitor,ProFee,0989,G0453,,,,0,3.00,2.25,2.25,46.50,0.00,46.50,46.50,N/A
G0454_3,Md document visit by npp,ProFee,0989,G0454,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
G0455_3,Fecal microbiota prep instil,ProFee,0989,G0455,,,,0,3.00,2.25,2.25,105.50,0.00,105.50,105.50,N/A
G0456_3,Neg pre wound <=50 sq cm,ProFee,0989,G0456,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0457_3,Neg pres wound >50 sq cm,ProFee,0989,G0457,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0458_3,Ldr prostate brachy comp rat,ProFee,0989,G0458,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0459_3,Telehealth inpt pharm mgmt,ProFee,0989,G0459,,,,0,3.00,2.25,2.25,58.00,0.00,58.00,58.00,N/A
G0460_3,Autologous prp for ulcers,ProFee,0989,G0460,,,,0,3.00,2.25,2.25,176.50,0.00,176.50,176.50,N/A
G0461_3,Immunohisto/cyto chem 1st st,ProFee,0989,G0461,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0462_3,Immunohisto/cyto chem add,ProFee,0989,G0462,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0463_3,Hospital outpt clinic visit,ProFee,0989,G0463,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0464_3,"Colorec ca scr, sto bas dna",ProFee,0989,G0464,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0466_2,New Patient (IPPE) Visit,ProFee,0989,G0466,,,,0,164.00,123.00,123.00,123.00,0.00,N/A,N/A,N/A
G0466_3,New Patient (IPPE) Visit,ProFee,0989,G0466,,,,0,163.00,122.25,122.25,122.25,0.00,N/A,N/A,N/A
G0467_2,Established Patient (IPPE) Visit,Outpatient,0521,G0467,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,0.00,147.60
G0467_2,Established Patient (IPPE) Visit,Inpatient,0521,G0467,,,,0,164.00,123.00,123.00,155.80,147.60,155.80,155.80,147.60
G0467_3,Established Patient (IPPE) Visit,Outpatient,0521,G0467,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,0.00,146.70
G0467_3,Established Patient (IPPE) Visit,Inpatient,0521,G0467,,,,0,163.00,122.25,122.25,154.85,146.70,154.85,154.85,146.70
G0468_2,IPPE OR AWV,ProFee,0989,G0468,,,,0,164.00,123.00,123.00,123.00,0.00,N/A,N/A,N/A
G0468_3,IPPE OR AWV,ProFee,0989,G0468,,,,0,163.00,122.25,122.25,122.25,0.00,N/A,N/A,N/A
G0469_3,"Fqhc visit, mh new pt",ProFee,0989,G0469,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0470_3,"Fqhc visit, mh estab pt",ProFee,0989,G0470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0471_3,Ven blood coll snf/hha,ProFee,0989,G0471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0472_3,Hep c screen high risk/other,ProFee,0989,G0472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0473_3,Group behave couns 2-10,ProFee,0989,G0473,,,,0,3.00,2.25,2.25,16.50,0.00,16.50,16.50,N/A
G0475_3,Hiv combination assay,ProFee,0989,G0475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0476_3,Hpv combo assay ca screen,ProFee,0989,G0476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0477_3,Drug test presump optical,ProFee,0989,80305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0478_3,Drug test presump opt inst,ProFee,0989,80306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0479_3,Drug test presump not opt,ProFee,0989,80307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0480_3,Drug test def 1-7 classes,ProFee,0989,G0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0481_3,Drug test def 8-14 classes,ProFee,0989,G0481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0482_3,Drug test def 15-21 classes,ProFee,0989,G0482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0483_3,Drug test def 22+ classes,ProFee,0989,G0483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0490_3,"Home visit rn, lpn by rhc/fq",ProFee,0989,G0490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0491_3,Dialysis acu kidney no esrd,ProFee,0989,G0491,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0492_3,Md/oth eval acut kid no esrd,ProFee,0989,G0492,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0493_3,Rn care ea 15 min hh/hospice,ProFee,0989,G0493,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0494_3,Lpn care ea 15min hh/hospice,ProFee,0989,G0494,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0495_3,Rn care train/edu in hh,ProFee,0989,G0495,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0496_3,Lpn care train/edu in hh,ProFee,0989,G0496,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0498_3,Chemo extend iv infus w/pump,ProFee,0989,G0498,,,,0,3.00,2.25,2.25,290.00,0.00,290.00,290.00,N/A
G0499_3,Hepb screen high risk indiv,ProFee,0989,G0499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0500_3,Mod sedat endo service >5yrs,ProFee,0989,G0500,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
G0501_3,Resource-inten svc during ov,ProFee,0989,G0501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0502_3,"Init psych care manag, 70min",ProFee,0989,99492,,,,0,3.00,2.25,2.25,125.50,0.00,125.50,125.50,N/A
G0503_3,"Subseq  psych care man,60mi",ProFee,0989,G0503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0504_3,Init/sub psych care add 30 m,ProFee,0989,99494,,,,0,3.00,2.25,2.25,60.50,0.00,60.50,60.50,N/A
G0505_3,Cog/func assessment  outpt,ProFee,0989,99483,,,,0,3.00,2.25,2.25,248.50,0.00,248.50,248.50,N/A
G0506_3,Comp asses care plan ccm svc,ProFee,0989,G0506,,,,0,3.00,2.25,2.25,64.50,0.00,64.50,64.50,N/A
G0507_3,Care manage serv minimum 20,ProFee,0989,99484,,,,0,3.00,2.25,2.25,45.50,0.00,45.50,45.50,N/A
G0508_3,Crit care telehea consult 60,ProFee,0989,G0508,,,,0,3.00,2.25,2.25,283.50,0.00,283.50,283.50,N/A
G0509_3,Crit care telehea consult 50,ProFee,0989,G0509,,,,0,3.00,2.25,2.25,274.00,0.00,274.00,274.00,N/A
G0512_3,Rural Health Clinic Or Federally Qualified Health,ProFee,0989,G0512,,,,0,3.00,2.25,2.25,86.00,0.00,86.00,86.00,N/A
G0513_3,"Prolong prev svcs, first 30m",ProFee,0989,G0513,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
G0514_3,"Prolong prev svcs, addl 30m",ProFee,0989,G0514,,,,0,3.00,2.25,2.25,86.50,0.00,86.50,86.50,N/A
G0515_3,Cognitive skills development,ProFee,0989,G0515,,,,0,3.00,2.25,2.25,27.95,0.00,27.95,27.95,N/A
G0516_3,"Insert drug del implant, >=4",ProFee,0989,G0516,,,,0,3.00,2.25,2.25,154.50,0.00,154.50,154.50,N/A
G0517_3,Remove drug implant,ProFee,0989,G0517,,,,0,3.00,2.25,2.25,175.50,0.00,175.50,175.50,N/A
G0518_3,Remove w insert drug implant,ProFee,0989,G0518,,,,0,3.00,2.25,2.25,284.50,0.00,284.50,284.50,N/A
G0659_3,Drug test def simple all cl,ProFee,0989,G0659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0908_3,Hgb > 12 g/dl,ProFee,0989,G0908,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0909_3,Hbg not doc,ProFee,0989,G0909,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0910_3,Hgb <= 12 g/dl,ProFee,0989,G0910,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0913_3,Improve visual funct,ProFee,0989,G0913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0914_3,Survey not complete,ProFee,0989,G0914,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0915_3,No improve visual funct,ProFee,0989,G0915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0916_3,Satisfy with care,ProFee,0989,G0916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0917_3,Satisfy survey not complete,ProFee,0989,G0917,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0918_3,No satisfy with care,ProFee,0989,G0918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G0919_3,Flu immunize not avail,ProFee,0989,G0919,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0920_3,Type loc act doc,ProFee,0989,G0920,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0921_3,Doc pt reas no assess,ProFee,0989,G0921,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G0922_3,Type loc act not doc,ProFee,0989,G0922,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1000_3,Cdsm applied pathways,ProFee,0989,G1000,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1001_3,Cdsm evicore,ProFee,0989,G1001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1002_3,Cdsm medcurrent,ProFee,0989,G1002,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1003_3,Cdsm medicalis,ProFee,0989,G1003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1004_3,Cdsm ndsc,ProFee,0989,G1004,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1005_3,Cdsm nia,ProFee,0989,G1005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1006_3,Cdsm test approp,ProFee,0989,G1006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1007_3,Cdsm aim,ProFee,0989,G1007,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1008_3,Cdsm cranberry pk,ProFee,0989,G1008,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1009_3,Cdsm sage health,ProFee,0989,G1009,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1010_3,Cdsm stanson,ProFee,0989,G1010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G1011_3,Cdsm qualified nos,ProFee,0989,G1011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2000_3,Blinded conv. tx mdd clin tr,ProFee,0989,G2000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2001_3,Post d/c h vst new pt 20 m,ProFee,0989,G2001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2002_3,Post-d/c h vst new pt 30 m,ProFee,0989,G2002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2003_3,Post-d/c h vst new pt 45 m,ProFee,0989,G2003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2004_3,Post-d/c h vst new pt 60 m,ProFee,0989,G2004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2005_3,Post-d/c h vst new pt 75 m,ProFee,0989,G2005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2006_3,Post-d/c h vst ext pt 20 m,ProFee,0989,G2006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2007_3,Post-d/c h vst ext pt 30 m,ProFee,0989,G2007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2008_3,Post-d/c h vst ext pt 45 m,ProFee,0989,G2008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2009_3,Post-d/c h vst ext pt 60 m,ProFee,0989,G2009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2010_3,Remot image submit by pt,ProFee,0989,G2010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2011_3,Alcohol/sub abuse assess,ProFee,0989,G2011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2012_3,Brief check in by md/qhp,ProFee,0989,G2012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2013_3,Post-d/c h vst ext pt 75 m,ProFee,0989,G2013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2014_3,Post-d/c care plan overs 30m,ProFee,0989,G2014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2015_3,Post-d/c care plan overs 60m,ProFee,0989,G2015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G2021_3,Hea care pract tx in place,ProFee,0989,G2021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2022_3,"Benef refuses service, mod",ProFee,0989,G2022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2025_2,Telehealth Visit,Inpatient,0521,G2025,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
G2025_2,Telehealth Visit,Outpatient,0521,G2025,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,0.00,118.80
G2025_3,Telehealth Visit,Outpatient,0521,G2025,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,0.00,118.80
G2025_3,Telehealth Visit,Inpatient,0521,G2025,,,,0,132.00,99.00,99.00,125.40,118.80,125.40,125.40,118.80
G2058_3,Ccm add 20min,ProFee,0989,G2058,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2061_3,Qual nonmd est pt 5-10m,ProFee,0989,G2061,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2062_3,Qual nonmd est pt 11-20m,ProFee,0989,G2062,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2063_3,Qual nonmd est pt 21>min,ProFee,0989,G2063,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2064_3,Md mang high risk dx 30,ProFee,0989,G2064,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2065_3,Clin mang h risk dx 30,ProFee,0989,G2065,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2066_3,Inter devc remote 30d,ProFee,0989,G2066,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2067_3,Med assist tx meth wk,ProFee,0989,G2067,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2068_3,Med assist tx bupre oral,ProFee,0989,G2068,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2069_3,Med assist tx inject,ProFee,0989,G2069,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2070_3,Med assist tx implant,ProFee,0989,G2070,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2071_3,Med tx remove implant,ProFee,0989,G2071,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2072_3,Med tx insert/remove imp,ProFee,0989,G2072,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2073_3,Med tx naltrexone,ProFee,0989,G2073,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2074_3,Med assist tx no drug,ProFee,0989,G2074,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2075_3,Med tx meds nos,ProFee,0989,G2075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2076_3,Intake act w/med exam,ProFee,0989,G2076,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2077_3,Periodic assessment,ProFee,0989,G2077,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2078_3,Take-home meth,ProFee,0989,G2078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2079_3,Take-hom buprenorphine,ProFee,0989,G2079,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2080_3,Add 30 mins counsel,ProFee,0989,G2080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2081_3,Pt 66+ snp or ltc pos > 90d,ProFee,0989,G2081,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2082_3,Visit esketamine 56m or less,ProFee,0989,G2082,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2083_3,"Visit esketamine, > 56m",ProFee,0989,G2083,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2086_3,Off base opioid tx 70min,ProFee,0989,G2086,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2087_3,"Off base opioid tx, 60 m",ProFee,0989,G2087,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2088_3,"Off base opioid tx, add30",ProFee,0989,G2088,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2089_3,A1c level 7 to 9%,ProFee,0989,G2089,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2090_3,Pt 66+ frailty and med dem,ProFee,0989,G2090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2091_3,Pt 66+ frailty and adv ill,ProFee,0989,G2091,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2092_3,Ace arb arni,ProFee,0989,G2092,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2093_3,Med doc rsn no ace arn arni,ProFee,0989,G2093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2094_3,Pt rsn no ace arn arni,ProFee,0989,G2094,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2095_3,Sys rsn no ace arn arni,ProFee,0989,G2095,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2096_3,No rsn ace arb arni,ProFee,0989,G2096,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2097_3,Child dx uri 3d of other dx,ProFee,0989,G2097,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2098_3,Pt 66+ frailty and med dem,ProFee,0989,G2098,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2099_3,Pt 66+ frailty and adv ill,ProFee,0989,G2099,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2100_3,Pt 66+ frailty and med dem,ProFee,0989,G2100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2101_3,Pt 66+ frailty and adv ill,ProFee,0989,G2101,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2102_3,Dil retinal eye exam,ProFee,0989,G2102,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2103_3,7 stereo photos interpret,ProFee,0989,G2103,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2104_3,Eye img valid w/7 stereo,ProFee,0989,G2104,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2105_3,Pt 66+ lt ints > 90,ProFee,0989,G2105,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2106_3,Pt 66+ lt ints > 90,ProFee,0989,G2106,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2107_3,Pt 66+ frailty and adv ill,ProFee,0989,G2107,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2108_3,Pt 66+ lt ints > 90,ProFee,0989,G2108,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2109_3,Pt 66+ frailty and med dem,ProFee,0989,G2109,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2110_3,Pt 66+ frailty and adv ill,ProFee,0989,G2110,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2112_3,Pred<=5 mg ra glu <6m,ProFee,0989,G2112,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2113_3,"Pred>5 mg >6m, no chg da",ProFee,0989,G2113,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2114_3,Pt 66-80 frailty and med dem,ProFee,0989,G2114,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2115_3,Pt 66+ frailty and med dem,ProFee,0989,G2115,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2116_3,Pt 66+ frailty and adv ill,ProFee,0989,G2116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2117_3,Pt 66-80 frailty and adv ill,ProFee,0989,G2117,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2118_3,Pt 81+ frailty,ProFee,0989,G2118,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2119_3,Calc vitd opt,ProFee,0989,G2119,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2120_3,No calc vitd opt,ProFee,0989,G2120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2121_3,Psy dep anx ap and icd asse,ProFee,0989,G2121,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2122_3,Psy/dep/anx/apandicd noasse,ProFee,0989,G2122,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2123_3,Pt 66-80 frailty med dem,ProFee,0989,G2123,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2124_3,Pt 66-80 frailty adv ill,ProFee,0989,G2124,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2125_3,Pt 81+ frailty,ProFee,0989,G2125,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2126_3,Pt 66+ frailty adv ill,ProFee,0989,G2126,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2127_3,Pt 66+ frailty med dem,ProFee,0989,G2127,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2128_3,No aspirin med rsn,ProFee,0989,G2128,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2129_3,No bp outpt,ProFee,0989,G2129,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2130_3,Pt 66+ lt inst > 90,ProFee,0989,G2130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2131_3,Pt 81+ frailty,ProFee,0989,G2131,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2132_3,Pt 66-80 frailty and med dem,ProFee,0989,G2132,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2133_3,Pt 66-80 frailty and adv ill,ProFee,0989,G2133,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2134_3,Pt 66+ frailty and med dem,ProFee,0989,G2134,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2135_3,Pt 66+ frailty and adv ill,ProFee,0989,G2135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2136_3,Bk pain vas 6-20wk = 3,ProFee,0989,G2136,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2137_3,Bk pain vas 6-20wk > 3,ProFee,0989,G2137,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2138_3,Bk pain vas 9-15mo = 3,ProFee,0989,G2138,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2139_3,Bk pain vas 9-20mo > 3,ProFee,0989,G2139,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2140_3,Leg pain vas 6-20wk = 3,ProFee,0989,G2140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2141_3,Leg pain vas 6-20wk > 3,ProFee,0989,G2141,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2142_3,Fs odi 9-15mo postop<= 22,ProFee,0989,G2142,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2143_3,Fs odi 9-15mo > 22,ProFee,0989,G2143,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2144_3,Fs odi 6-20wk postop > 22,ProFee,0989,G2144,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2145_3,Fsodi 6-20wk >22 or chg 30pt,ProFee,0989,G2145,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2146_3,Leg pain vas 9-15mo <= 3,ProFee,0989,G2146,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2147_3,Leg pain vas 9-15mo > 3,ProFee,0989,G2147,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2148_3,Mpm used,ProFee,0989,G2148,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2149_3,No mpm med rsn,ProFee,0989,G2149,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2150_3,No mpm,ProFee,0989,G2150,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2151_3,Dx degen neuro,ProFee,0989,G2151,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2152_3,Res change sc =0,ProFee,0989,G2152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2153_3,Hosp dur meas pd,ProFee,0989,G2153,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2154_3,Td 9 yrs start end meas,ProFee,0989,G2154,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2155_3,Hist contraindications,ProFee,0989,G2155,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2156_3,No prior td or hx contra,ProFee,0989,G2156,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2157_3,Pneum vacc 12 mo 60+,ProFee,0989,G2157,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2158_3,Pneum vacc adv rx,ProFee,0989,G2158,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2159_3,No pneum vacc 12 mo 60+,ProFee,0989,G2159,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2160_3,Herpzos 50+,ProFee,0989,G2160,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2161_3,Adv rx zos,ProFee,0989,G2161,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2162_3,No herpzos 50+,ProFee,0989,G2162,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2163_3,Infl vacc 07/01 to 06/30,ProFee,0989,G2163,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2164_3,Adv rx infl vacc,ProFee,0989,G2164,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2165_3,No infl vacc 07/01 to 06/30,ProFee,0989,G2165,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2166_3,No pt adm dx no neck fs prom,ProFee,0989,G2166,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G2167_3,Res change sc < 0,ProFee,0989,G2167,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G3001_3,"Admin + supply, tositumomab",ProFee,0989,G3001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6001_3,Echo guidance radiotherapy,ProFee,0989,G6001,,,,0,3.00,2.25,2.25,43.00,0.00,43.00,43.00,N/A
G6002_3,Stereoscopic x-ray guidance,ProFee,0989,G6002,,,,0,3.00,2.25,2.25,29.00,0.00,29.00,29.00,N/A
G6003_3,Radiation treatment delivery,ProFee,0989,G6003,,,,0,3.00,2.25,2.25,281.00,0.00,281.00,281.00,N/A
G6004_3,Radiation treatment delivery,ProFee,0989,G6004,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
G6005_3,Radiation treatment delivery,ProFee,0989,G6005,,,,0,3.00,2.25,2.25,208.00,0.00,208.00,208.00,N/A
G6006_3,Radiation treatment delivery,ProFee,0989,G6006,,,,0,3.00,2.25,2.25,208.50,0.00,208.50,208.50,N/A
G6007_3,Radiation treatment delivery,ProFee,0989,G6007,,,,0,3.00,2.25,2.25,422.00,0.00,422.00,422.00,N/A
G6008_3,Radiation treatment delivery,ProFee,0989,G6008,,,,0,3.00,2.25,2.25,288.50,0.00,288.50,288.50,N/A
G6009_3,Radiation treatment delivery,ProFee,0989,G6009,,,,0,3.00,2.25,2.25,287.50,0.00,287.50,287.50,N/A
G6010_3,Radiation treatment delivery,ProFee,0989,G6010,,,,0,3.00,2.25,2.25,285.50,0.00,285.50,285.50,N/A
G6011_3,Radiation treatment delivery,ProFee,0989,G6011,,,,0,3.00,2.25,2.25,401.00,0.00,401.00,401.00,N/A
G6012_3,Radiation treatment delivery,ProFee,0989,G6012,,,,0,3.00,2.25,2.25,381.50,0.00,381.50,381.50,N/A
G6013_3,Radiation treatment delivery,ProFee,0989,G6013,,,,0,3.00,2.25,2.25,381.50,0.00,381.50,381.50,N/A
G6014_3,Radiation treatment delivery,ProFee,0989,G6014,,,,0,3.00,2.25,2.25,382.00,0.00,382.00,382.00,N/A
G6015_3,Radiation tx delivery imrt,ProFee,0989,G6015,,,,0,3.00,2.25,2.25,498.00,0.00,498.00,498.00,N/A
G6016_3,Delivery comp imrt,ProFee,0989,G6016,,,,0,3.00,2.25,2.25,496.50,0.00,496.50,496.50,N/A
G6017_3,Intrafraction track motion,ProFee,0989,G6017,,,,0,3.00,2.25,2.25,76.50,0.00,76.50,76.50,N/A
G6018_3,Ileoscopy w/stent,ProFee,0989,G6018,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6019_3,Colonoscopy lesion removal,ProFee,0989,G6019,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6020_3,Colonoscopy w/stent,ProFee,0989,G6020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6021_3,Unlisted px small intestine,ProFee,0989,G6021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6022_3,Sigmoidoscopy w/ablate tumr,ProFee,0989,G6022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6023_3,Sigmoidoscopy w/stent,ProFee,0989,G6023,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6024_3,Lesion removal colonoscopy,ProFee,0989,G6024,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6025_3,Colonoscopy w/stent,ProFee,0989,G6025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6027_3,Anoscopy hra w/spec collect,ProFee,0989,G6027,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6028_3,Anoscopy hra w/biopsy,ProFee,0989,G6028,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6030_3,Assay of amitriptyline,ProFee,0989,G6030,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6031_3,Assay of benzodiazepines,ProFee,0989,G6031,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6032_3,Assay of desipramine,ProFee,0989,G6032,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6034_3,Assay of doxepin,ProFee,0989,G6034,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6035_3,Assay of gold,ProFee,0989,G0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G6036_3,Assay of imipramine,ProFee,0989,G6036,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6037_3,Assay of nortiptyline,ProFee,0989,G6037,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6038_3,Assay of salicylate,ProFee,0989,G6038,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6039_3,Assay of acetaminophen,ProFee,0989,G6039,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6040_3,Assay of ethanol,ProFee,0989,G6040,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6041_3,Assay of urine alkaloids,ProFee,0989,G6041,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6042_3,Assay of amphetamines,ProFee,0989,G6042,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6043_3,Assay of barbiturates,ProFee,0989,G6043,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6044_3,Assay of cocaine,ProFee,0989,G6044,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6045_3,Assay of dihydrocodeinone,ProFee,0989,G6045,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6046_3,Assay of dihydromorphinone,ProFee,0989,G6046,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6047_3,Assay of dihydrotestosterone,ProFee,0989,G6047,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6048_3,Assay of dimethadione,ProFee,0989,G6048,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6049_3,Asssay of epiandrosterone,ProFee,0989,G6049,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6050_3,Assay of ethchlorvynol,ProFee,0989,G6050,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6051_3,Assay of flurazepam,ProFee,0989,G6051,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6052_3,Assay of meprobamate,ProFee,0989,G6052,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6053_3,Assay of methadone,ProFee,0989,G6053,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6054_3,Assay of methsuximide,ProFee,0989,G6054,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6055_3,Assay of nicotine,ProFee,0989,G6055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6056_3,Assay of opiates,ProFee,0989,G6056,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6057_3,Assay of phenothiazine,ProFee,0989,G6057,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G6058_3,Drug confirmation,ProFee,0989,G6058,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8006_3,AMI pt recd aspirin at arriv,ProFee,0989,G8006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8007_3,AMI pt did not receiv aspiri,ProFee,0989,G8007,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8008_3,AMI pt ineligible for aspiri,ProFee,0989,G8008,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8009_3,AMI pt recd Bblock at arr,ProFee,0989,G8009,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8010_3,AMI pt did not rec bblock,ProFee,0989,G8010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8011_3,AMI pt inelig Bbloc at arriv,ProFee,0989,G8011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8012_3,Pneum pt recv antibiotic 4 h,ProFee,0989,G8012,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8013_3,Pneum pt w/o antibiotic 4 hr,ProFee,0989,G8013,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8014_3,Pneum pt not elig antibiotic,ProFee,0989,G8014,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8015_3,Diabetic pt w/ HBA1c>9%,ProFee,0989,G8015,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8016_3,Diabetic pt w/ HBA1c<or=9%,ProFee,0989,G8016,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8017_3,DM pt inelig for HBA1c measu,ProFee,0989,G8017,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8018_3,Care not provided for HbA1c,ProFee,0989,G8018,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8019_3,Diabetic pt w/LDL>= 100mg/dl,ProFee,0989,G8019,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8020_3,Diab pt w/LDL< 100mg/dl,ProFee,0989,G8020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8021_3,Diab pt inelig for LDL meas,ProFee,0989,G8021,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8022_3,Care not provided for LDL,ProFee,0989,G8022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8023_3,DM pt w BP>=140/80,ProFee,0989,G8023,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8024_3,Diabetic pt wBP<140/80,ProFee,0989,G8024,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8025_3,Diabetic pt inelig for BP me,ProFee,0989,G8025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8026_3,Diabet pt w no care re BP me,ProFee,0989,G8026,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8027_3,HF p w/LVSD on ACE-I/ARB,ProFee,0989,G8027,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8028_3,HF pt w/LVSD not on ACE-I/AR,ProFee,0989,G8028,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8029_3,HF pt not elig for ACE-I/ARB,ProFee,0989,G8029,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8030_3,HF pt w/LVSD on Bblocker,ProFee,0989,G8030,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8031_3,HF pt w/LVSD not on Bblocker,ProFee,0989,G8031,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8032_3,HF pt not elig for Bblocker,ProFee,0989,G8032,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8033_3,PMI-CAD pt on Bblocker,ProFee,0989,G8033,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8034_3,PMI-CAD pt not on Bblocker,ProFee,0989,G8034,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8035_3,PMI-CAD pt inelig Bblocker,ProFee,0989,G8035,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8036_3,AMI-CAD pt doc on antiplatel,ProFee,0989,G8036,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8037_3,AMI-CAD pt not docu on antip,ProFee,0989,G8037,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8038_3,AMI-CAD inelig antiplate mea,ProFee,0989,G8038,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8039_3,CAD pt w/LDL>100mg/dl,ProFee,0989,G8039,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8040_3,CAD pt w/LDL<or=100mg/dl,ProFee,0989,G8040,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8041_3,CAD pt not eligible for LDL,ProFee,0989,G8041,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8051_3,Osteoporosis assess,ProFee,0989,G8051,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8052_3,Osteopor pt not assess,ProFee,0989,G8052,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8053_3,Pt inelig for osteopor meas,ProFee,0989,G8053,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8054_3,Falls assess not docum 12 mo,ProFee,0989,G8054,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8055_3,Falls assess w/ 12 mon,ProFee,0989,G8055,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8056_3,Not elig for falls assessmen,ProFee,0989,G8056,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8057_3,Hearing assess receive,ProFee,0989,G8057,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8058_3,Pt w/o hearing assess,ProFee,0989,G8058,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8059_3,Pt inelig for hearing assess,ProFee,0989,G8059,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8060_3,Urinary incont pt assess,ProFee,0989,G8060,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8061_3,Pt not assess for urinary in,ProFee,0989,G8061,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8062_3,Pt not elig for urinary inco,ProFee,0989,G8062,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8075_3,ESRD pt w/ dialy of URR>=65%,ProFee,0989,G8075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8076_3,ESRD pt w/ dialy of URR<65%,ProFee,0989,G8076,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8077_3,ESRD pt not elig for URR/KtV,ProFee,0989,G8077,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8078_3,ESRD pt w/Hct>or=33,ProFee,0989,G8078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8079_3,ESRD pt w/Hct<33,ProFee,0989,G8079,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8080_3,ESRD pt inelig for HCT/Hgb,ProFee,0989,G8080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8081_3,ESRD pt w/ auto AV fistula,ProFee,0989,G8081,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8082_3,ESRD pt w other fistula,ProFee,0989,G8082,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8085_3,ESRD PT inelig auto AV FISTU,ProFee,0989,G8085,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8093_3,COPD pt rec smoking cessat,ProFee,0989,G8093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8094_3,COPD pt w/o smoke cessat int,ProFee,0989,G8094,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8099_3,Osteopo pt given Ca+VitD sup,ProFee,0989,G8099,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8100_3,Osteop pt inelig for Ca+VitD,ProFee,0989,G8100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8103_3,New dx osteo pt w/antiresorp,ProFee,0989,G8103,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8104_3,Osteo pt inelig for antireso,ProFee,0989,G8104,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8106_3,Bone dens meas test perf,ProFee,0989,G8106,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8107_3,Bone dens meas test inelig,ProFee,0989,G8107,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8108_3,Pt receiv influenza vacc,ProFee,0989,G8108,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8109_3,Pt w/o influenza vacc,ProFee,0989,G8109,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8110_3,Pt inelig for influenza vacc,ProFee,0989,G8110,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8111_3,Pt receiv mammogram,ProFee,0989,G8111,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8112_3,Pt not doc mammogram,ProFee,0989,G8112,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8113_3,Pt ineligible mammography,ProFee,0989,G8113,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8114_3,Care not provided for mamogr,ProFee,0989,G8114,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8115_3,Pt receiv pneumo vacc,ProFee,0989,G8115,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8116_3,Pt did not rec pneumo vacc,ProFee,0989,G8116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8117_3,Pt was inelig for pneumo vac,ProFee,0989,G8117,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8126_3,Pt treat w/antidepress12wks,ProFee,0989,G8126,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8127_3,Pt not treat w/antidepres12w,ProFee,0989,G8127,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8128_3,Pt inelig for antidepres med,ProFee,0989,G8128,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8129_3,Pt treat w/antidepres for 6m,ProFee,0989,G8129,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8130_3,Pt not treat w/antidepres 6m,ProFee,0989,G8130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8131_3,Pt inelig for antidepres med,ProFee,0989,G8131,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8152_3,Pt w/AB 1 hr prior to incisi,ProFee,0989,G8152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8153_3,Pt not doc for AB 1 hr prior,ProFee,0989,G8153,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8154_3,Pt ineligi for AB therapy,ProFee,0989,G8154,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8155_3,Pt recd thromboemb prophylax,ProFee,0989,G8155,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8156_3,Pt did not rec thromboembo,ProFee,0989,G8156,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8157_3,Pt ineligi for thrombolism,ProFee,0989,G8157,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8158_3,Pt recd CABG w/ IMA,ProFee,0989,G8158,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8159_3,Pt w/CABG w/o IMA,ProFee,0989,G8159,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8160_3,Pt inelig for CABG w/IMA,ProFee,0989,G8160,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8161_3,Iso CABG pt rec preop bblock,ProFee,0989,G8161,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8162_3,Iso CABG pt w/o preop Bblock,ProFee,0989,G8162,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8163_3,Iso CABG pt inelig for preo,ProFee,0989,G8163,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8164_3,Iso CABG pt w/prolng intub,ProFee,0989,G8164,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8165_3,Iso CABG pt w/o prolng intub,ProFee,0989,G8165,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8166_3,Iso CABG req surg rexpo,ProFee,0989,G8166,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8167_3,Iso CABG w/o surg explo,ProFee,0989,G8167,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8170_3,CEA/ext bypass pt on aspirin,ProFee,0989,G8170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8171_3,Pt w/carot endarct/ext bypas,ProFee,0989,G8171,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8172_3,CEA/ext bypass pt not on asp,ProFee,0989,G8172,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8182_3,CAD pt care not prov LDL,ProFee,0989,G8182,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8183_3,HF/atrial fib pt on warfarin,ProFee,0989,G8183,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8184_3,HF/atrial fib pt inelig warf,ProFee,0989,G8184,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8185_3,Osteoarth pt w/ assess pain,ProFee,0989,G8185,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8186_3,Osteoarth pt inelig assess,ProFee,0989,G8186,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8193_3,Antibio not doc prior surg,ProFee,0989,G8193,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8196_3,Antibio not docum prior surg,ProFee,0989,G8196,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8200_3,Cefazolin not docum prophy,ProFee,0989,G8200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8204_3,MD not doc order to d/c anti,ProFee,0989,G8204,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8209_3,Clinician did not doc,ProFee,0989,G8209,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8214_3,Clini not doc order VTE,ProFee,0989,G8214,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8217_3,Pt not received DVT proph,ProFee,0989,G8217,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8219_3,Received DVT proph day 2,ProFee,0989,G8219,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8220_3,Pt not rec DVT proph day 2,ProFee,0989,G8220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8221_3,Pt inelig for DVT proph,ProFee,0989,G8221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8223_3,Pt not doc for presc antipla,ProFee,0989,G8223,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8226_3,Pt no prescr anticoa at D/C,ProFee,0989,G8226,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8231_3,Pt not doc for admin t-PA,ProFee,0989,G8231,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8234_3,Pt not doc dysphagia screen,ProFee,0989,G8234,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8238_3,Pt not doc to rec rehab serv,ProFee,0989,G8238,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8240_3,Inter carotid stenosis30-99%,ProFee,0989,G8240,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8243_3,Pt not doc MRI/CT w/o lesion,ProFee,0989,G8243,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8246_3,Pt inelig hx w new/chg mole,ProFee,0989,G8246,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8248_3,Pt w/one alarm symp not doc,ProFee,0989,G8248,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8251_3,"Pt not doc w/Barretts, endo",ProFee,0989,G8251,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8254_3,Pt w/no doc order for barium,ProFee,0989,G8254,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8257_3,Pt not doc rev meds D/C,ProFee,0989,G8257,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8260_3,Pt not doc to have dec maker,ProFee,0989,G8260,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8263_3,Pt not doc assess urinary in,ProFee,0989,G8263,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8266_3,Pt not doc charc urin incon,ProFee,0989,G8266,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8268_3,Pt not doc rec care urin inc,ProFee,0989,G8268,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8271_3,Pt no doc screen fall,ProFee,0989,G8271,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8274_3,Clini not doc pres/abs alarm,ProFee,0989,G8274,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8276_3,Pt not doc mole change,ProFee,0989,G8276,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8279_3,Pt not doc rec PE,ProFee,0989,G8279,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8282_3,Pt not doc to rec couns,ProFee,0989,G8282,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8285_3,Pt did not rec pres osteo,ProFee,0989,G8285,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8289_3,Pt not doc rec Ca/Vit D,ProFee,0989,G8289,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8293_3,COPD pt w/o spir results,ProFee,0989,G8293,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8296_3,COPD pt not doc bronch ther,ProFee,0989,G8296,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8298_3,Pt doc optic nerve eval,ProFee,0989,G8298,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8299_3,Pt not doc optic nerv eval,ProFee,0989,G8299,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8302_3,Pt doc w/ target IOP,ProFee,0989,G8302,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8303_3,Pt not doc w/ IOP,ProFee,0989,G8303,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8304_3,Clin doc pt inelig IOP,ProFee,0989,G8304,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8305_3,Clin not prov care POAG,ProFee,0989,G8305,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8306_3,POAG w/ IOP rec care plan,ProFee,0989,G8306,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8307_3,POAG w/ IOP no care plan,ProFee,0989,G8307,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8308_3,POAG w/ IOP not doc plan,ProFee,0989,G8308,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8310_3,Pt not doc rec antiox,ProFee,0989,G8310,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8314_3,Pt not doc to rec mac exam,ProFee,0989,G8314,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8318_3,Pt doc not have visual func,ProFee,0989,G8318,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8322_3,Pt not doc pre axial leng,ProFee,0989,G8322,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8326_3,Pt not doc rec fundus exam,ProFee,0989,G8326,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8330_3,Pt not doc rec dilated mac,ProFee,0989,G8330,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8334_3,Doc of macular not giv MD,ProFee,0989,G8334,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8338_3,Clin not doc pt test osteo,ProFee,0989,G8338,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8341_3,Pt not doc for DEXA,ProFee,0989,G8341,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8345_3,Pt not doc have DEXA,ProFee,0989,G8345,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8351_3,Pt not doc ECG,ProFee,0989,G8351,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8354_3,Pt not rec aspirin prior ER,ProFee,0989,G8354,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8357_3,Pt not doc to have ECG,ProFee,0989,G8357,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8360_3,Pt not doc vital signs recor,ProFee,0989,G8360,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8362_3,Pt not doc 02 SAT assess,ProFee,0989,G8362,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8365_3,Pt not doc mental status,ProFee,0989,G8365,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8367_3,Pt not doc have empiric AB,ProFee,0989,G8367,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8370_3,Asthma pt w survey not docum,ProFee,0989,G8370,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8371_3,Chemother not rec stg3 colon,ProFee,0989,G8371,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8372_3,Chemother rec stg3 colon ca,ProFee,0989,G8372,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8373_3,Chemo plan documen prior che,ProFee,0989,G8373,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8374_3,Chemo plan not doc prior che,ProFee,0989,G8374,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8375_3,CLL pt w/o doc flow cytometr,ProFee,0989,G8375,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8376_3,Brst ca pt inelig tamoxifen,ProFee,0989,G8376,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8377_3,MD doc colon ca pt inelig ch,ProFee,0989,G8377,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8378_3,MD doc pt inelig radiation,ProFee,0989,G8378,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8379_3,Doc radiat tx recom 12mo ov,ProFee,0989,G8379,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8380_3,Pt w stgIC-3Brst ca not rec,ProFee,0989,G8380,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8381_3,Pt w stgIC-3Brst ca rec tam,ProFee,0989,G8381,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8382_3,MM pt w/o doc IV bisphophon,ProFee,0989,G8382,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8383_3,No doc radiation rec 12mo ov,ProFee,0989,G8383,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8384_3,Base cytogen test MDS notper,ProFee,0989,G8384,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8385_3,Diabet pt no do Hgb A1c 12m,ProFee,0989,G8385,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8386_3,Diabet pt nodoc LDLiprotei,ProFee,0989,G8386,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8387_3,ESRD pt w Hct/Hgb not docume,ProFee,0989,G8387,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8388_3,ESRD pt w URR/Ktv notdoc eli,ProFee,0989,G8388,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8389_3,MDS pt no doc FE st prio EPO,ProFee,0989,G8389,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8390_3,Diabetic w/o document BP 12m,ProFee,0989,G8390,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8391_3,Pt w asthma no doc med or tx,ProFee,0989,G8391,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8395_3,LVEF>=40% doc normal or mild,ProFee,0989,G8395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8396_3,LVEF not performed,ProFee,0989,G8396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8397_3,Dil macula/fundus exam/w doc,ProFee,0989,G8397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8398_3,Dil macular/fundus not perfo,ProFee,0989,G8398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8399_3,Pt w/DXA document or order,ProFee,0989,G8399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8400_3,Pt w/DXA no document or orde,ProFee,0989,G8400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8401_3,Pt inelig osteo screen measu,ProFee,0989,G8401,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8402_3,Smoke preven interven counse,ProFee,0989,G8402,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8403_3,Smoke preven nocounsel,ProFee,0989,G8403,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8404_3,Low extemity neur exam docum,ProFee,0989,G8404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8405_3,Low extemity neur not perfor,ProFee,0989,G8405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8406_3,Pt inelig lower extrem neuro,ProFee,0989,G8406,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8407_3,ABI documented,ProFee,0989,G8407,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8408_3,ABI not documented,ProFee,0989,G8408,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8409_3,Pt inelig for ABI measure,ProFee,0989,G8409,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8410_3,Eval on foot documented,ProFee,0989,G8410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8415_3,Eval on foot not performed,ProFee,0989,G8415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8416_3,Pt inelig footwear evaluatio,ProFee,0989,G8416,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8417_3,BMI >=30 calcuate w/followup,ProFee,0989,G8417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8418_3,BMI < 22 calcuate w/followup,ProFee,0989,G8418,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8419_3,BMI>=30or<22 cal no followup,ProFee,0989,G8419,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8420_3,BMI<30 and >=22 calc & docu,ProFee,0989,G8420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8421_3,BMI not calculated,ProFee,0989,G8421,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8422_3,Pt inelig BMI calculation,ProFee,0989,G8422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8423_3,Pt screen flu vac & counsel,ProFee,0989,G8423,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8424_3,Flu vaccine not screen,ProFee,0989,G8424,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8425_3,Flu vaccine screen not curre,ProFee,0989,G8425,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8426_3,Pt not approp screen & counc,ProFee,0989,G8426,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8427_3,Doc meds verified w/pt or re,ProFee,0989,G8427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8428_3,Meds document w/o verifica,ProFee,0989,G8428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8429_3,Incomplete doc pt on meds,ProFee,0989,G8429,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8430_3,Pt inelig med check,ProFee,0989,G8430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8431_3,Clin depression screen doc,ProFee,0989,G8431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8432_3,Clin depression screen not d,ProFee,0989,G8432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8433_3,Pt inelig for depression scr,ProFee,0989,G8433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8434_3,Cognitive impairment screen,ProFee,0989,G8434,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8435_3,Cognitive screen not documen,ProFee,0989,G8435,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8436_3,Pt inelig for cognitive impa,ProFee,0989,G8436,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8437_3,Tx plan develop & document,ProFee,0989,G8437,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8438_3,Tx plan develop & not docum,ProFee,0989,G8438,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8439_3,Pt inelig for co-develp tx p,ProFee,0989,G8439,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8440_3,Pain assessment document,ProFee,0989,G8440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8441_3,No document of pain assess,ProFee,0989,G8441,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8442_3,Pt inelig pain assessment,ProFee,0989,G8442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8443_3,Prescription by E-Prescrib s,ProFee,0989,G8443,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8445_3,Prescrip not gen at encounte,ProFee,0989,G8445,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8446_3,Some prescrib handwritten or,ProFee,0989,G8446,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8447_3,Pt visit doc using CCHIT cer,ProFee,0989,G8447,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8448_3,Pt visit docum w/non-CCHIT c,ProFee,0989,G8448,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8449_3,Pt not doc w/EMR due to syst,ProFee,0989,G8449,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8450_3,Beta-bloc rx pt w/abn lvef,ProFee,0989,G8450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8451_3,Pt w/abn lvef inelig b-bloc,ProFee,0989,G8451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8452_3,Pt w/abn lvef b-bloc no rx,ProFee,0989,G8452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8453_3,Tob use cess int counsel,ProFee,0989,G8453,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8454_3,Tob use cess int no counsel,ProFee,0989,G8454,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8455_3,Current tobacco smoker,ProFee,0989,G8455,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8456_3,Smokeless tobacco user,ProFee,0989,G8456,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8457_3,Tobacco non-user,ProFee,0989,G8457,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8458_3,Pt inelig geno no antvir tx,ProFee,0989,G8458,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8459_3,Doc pt rec antivir treat,ProFee,0989,G8459,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8460_3,Pt inelig RNA no antvir tx,ProFee,0989,G8460,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8461_3,Pt rec antivir treat hep c,ProFee,0989,G8461,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8462_3,Pt inelig couns no antvir tx,ProFee,0989,G8462,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8463_3,Pt rec antiviral treat doc,ProFee,0989,G8463,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8464_3,Pt inelig; lo to no dter rsk,ProFee,0989,G8464,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8465_3,High risk recurrence pro ca,ProFee,0989,G8465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8466_3,Pt inelig suic; MDD remis,ProFee,0989,G8466,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8467_3,New dx init/rec episode MDD,ProFee,0989,G8467,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8468_3,ACE/ARB rx pt w/abn lvef,ProFee,0989,G8468,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8469_3,Pt w/abn lvef inelig ACE/ARB,ProFee,0989,G8469,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8470_3,Pt w/ normal lvef,ProFee,0989,G8470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8471_3,LVEF not performed/doc,ProFee,0989,G8471,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8472_3,ACE/ARB no rx pt w/abn lvef,ProFee,0989,G8472,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8473_3,ACE/ARB thxpy rx'd,ProFee,0989,G8473,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8474_3,ACE/ARB not rx'd; doc reas,ProFee,0989,G8474,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8475_3,ACE/ARB thxpy not rx'd,ProFee,0989,G8475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8476_3,BP sys <130 and dias <80,ProFee,0989,G8476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8477_3,BP sys>=130 and/or dias >=80,ProFee,0989,G8477,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8478_3,BP not performed/doc,ProFee,0989,G8478,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8479_3,MD rx'd ACE/ARB thxpy,ProFee,0989,G8479,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8480_3,Pt inelig ACE/ARB thxpy,ProFee,0989,G8480,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8481_3,MD not rx'd ACE/ARB thxpy,ProFee,0989,G8481,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8482_3,Flu immunize order/admin,ProFee,0989,G8482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8483_3,Flu imm no ord/admin doc rea,ProFee,0989,G8483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8484_3,Flu immunize no order/admin,ProFee,0989,G8484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8485_3,"Report, Diabetes measures",ProFee,0989,G8485,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8486_3,"Report, Prev Care Measures",ProFee,0989,G8486,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8487_3,Report CKD Measures,ProFee,0989,G8487,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8488_3,Report ESRD Measures,ProFee,0989,G8488,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8489_3,CAD measures grp,ProFee,0989,G8489,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8490_3,RA measures grp,ProFee,0989,G8490,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8491_3,HIV/AIDS measures grp,ProFee,0989,G8491,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8492_3,Prev Care measures grp,ProFee,0989,G8492,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8493_3,Back pain measures grp,ProFee,0989,G8493,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8494_3,DM meas qual act perform,ProFee,0989,G8494,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8495_3,CKD meas qual act perform,ProFee,0989,G8495,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8496_3,PC meas qual act perform,ProFee,0989,G8496,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8497_3,CABG meas qual act perform,ProFee,0989,G8497,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8498_3,CAD meas qual act perform,ProFee,0989,G8498,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8499_3,RA meas qual act perform,ProFee,0989,G8499,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8500_3,HIV meas qual act perform,ProFee,0989,G8500,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8501_3,Perio meas qual act perform,ProFee,0989,G8501,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8502_3,BP meas qual act perform,ProFee,0989,G8502,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8503_3,Doc proph antibx w/in 1 hr,ProFee,0989,G8503,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8504_3,Doc ord pro antbx w/in 1 hr,ProFee,0989,G8504,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8505_3,No doc proph antibx w/in 1hr,ProFee,0989,G8505,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8506_3,Pt rec ACE/ARB,ProFee,0989,G8506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8507_3,Pt inelig pt verif meds,ProFee,0989,G8507,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8508_3,Pt inelig; pain asses no f/u,ProFee,0989,G8508,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8509_3,Pain assess no f/u pln doc,ProFee,0989,G8509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8510_3,Pt inelig neg scrn depres,ProFee,0989,G8510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8511_3,Clin depres scrn no f/u doc,ProFee,0989,G8511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8512_3,Pain sev quant present,ProFee,0989,G8512,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8513_3,ABI meas & doc,ProFee,0989,G8513,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8514_3,PT inelig; ABI measure,ProFee,0989,G8514,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8515_3,No ABI measurement,ProFee,0989,G8515,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8516_3,Scrn fal rsk >2 fal or w/inj,ProFee,0989,G8516,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8517_3,Scrn fall rsk; <2 falls,ProFee,0989,G8517,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8518_3,Clin stg b/f lun/eso ca surg,ProFee,0989,G8518,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8519_3,Pt in; clin ca stg b/f surg,ProFee,0989,G8519,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8520_3,Clin stg b/f surg not doc,ProFee,0989,G8520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8521_3,Antplt recd 48 hrs & disch,ProFee,0989,G8521,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8522_3,Pt inelig; antiplt therapy,ProFee,0989,G8522,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8523_3,Antplt not recd reas no spec,ProFee,0989,G8523,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8524_3,Patch closure conv CEA,ProFee,0989,G8524,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8525_3,No patch closure CEA,ProFee,0989,G8525,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8526_3,No patch closure conv CEA,ProFee,0989,G8526,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8527_3,Doc ord antimic prophy,ProFee,0989,G8527,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8528_3,Pt inelig; proph antibiot,ProFee,0989,G8528,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8529_3,No doc ord antimic prophy,ProFee,0989,G8529,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8530_3,Auto AV fistula recd,ProFee,0989,G8530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8531_3,Pt inelig; auto AV fistula,ProFee,0989,G8531,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8532_3,No auto AV fistula; no reas,ProFee,0989,G8532,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8533_3,Partic in clin data base reg,ProFee,0989,G8533,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8534_3,Doc elder mal scrn f/u plan,ProFee,0989,G8534,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8535_3,Pt inelig no eld mal scrn,ProFee,0989,G8535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8536_3,No doc elder mal scrn,ProFee,0989,G8536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8537_3,Pt inelig eldmal scrn no f/u,ProFee,0989,G8537,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8538_3,Eld mal scrn no f/u pln,ProFee,0989,G8538,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8539_3,Cur funct assess & care pln,ProFee,0989,G8539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8540_3,Pt inelig funct assess,ProFee,0989,G8540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8541_3,No doc cur funct assess,ProFee,0989,G8541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8542_3,Pt inelig func asses no pln,ProFee,0989,G8542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8543_3,Cur funct asses; no care pln,ProFee,0989,G8543,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8544_3,CABG measures grp,ProFee,0989,G8544,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8545_3,HepC measures grp,ProFee,0989,G8545,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8546_3,CAP measures grp,ProFee,0989,G8546,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8547_3,IVD measures grp,ProFee,0989,G8547,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8548_3,HF measures grp,ProFee,0989,G8548,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8549_3,HepC MG qual act perform,ProFee,0989,G8549,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8550_3,CAP MG qual act perform,ProFee,0989,G8550,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8551_3,HF MG qual act perform,ProFee,0989,G8551,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8552_3,IVD MG qual act perform,ProFee,0989,G8552,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8553_3,1 Rx via qualified eRx sys,ProFee,0989,G8553,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8556_3,Ref to doc otolog eval,ProFee,0989,G8556,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8557_3,Pt inelig ref otolog eval,ProFee,0989,G8557,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8558_3,No ref to doc otolog eval,ProFee,0989,G8558,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8559_3,Pt ref doc oto eval,ProFee,0989,G8559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8560_3,Pt hx act drain prev 90 days,ProFee,0989,G8560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8561_3,Pt inelig for ref oto eval,ProFee,0989,G8561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8562_3,Pt no hx act drain 90 d,ProFee,0989,G8562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8563_3,Pt no ref oto reas no spec,ProFee,0989,G8563,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8564_3,Pt ref oto eval,ProFee,0989,G8564,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8565_3,Ver doc hear loss,ProFee,0989,G8565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8566_3,Pt inelig ref oto eval,ProFee,0989,G8566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8567_3,Pt no doc hear loss,ProFee,0989,G8567,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8568_3,Pt no ref otolo no spec,ProFee,0989,G8568,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8569_3,Prol intubation req,ProFee,0989,G8569,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8570_3,No prol intub req,ProFee,0989,G8570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8571_3,Ster wd ifx 30 d postop,ProFee,0989,G8571,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8572_3,No ster wd ifx,ProFee,0989,G8572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8573_3,Stk/CVA CABG,ProFee,0989,G8573,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8574_3,No strk/CVA CABG,ProFee,0989,G8574,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8575_3,Postop ren insuf,ProFee,0989,G8575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8576_3,No postop ren insuf,ProFee,0989,G8576,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8577_3,Reop req bld grft oth,ProFee,0989,G8577,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8578_3,No reop req bld grft oth,ProFee,0989,G8578,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8579_3,Antplt med disch,ProFee,0989,G8579,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8580_3,Antplt med contraind,ProFee,0989,G8580,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8581_3,no antplt med disch,ProFee,0989,G8581,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8582_3,Bblock disch,ProFee,0989,G8582,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8583_3,Bblock contraind,ProFee,0989,G8583,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8584_3,No bblock disch,ProFee,0989,G8584,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8585_3,Antilipid treat disch,ProFee,0989,G8585,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8586_3,Antlip disch contra,ProFee,0989,G8586,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8587_3,No antlipid treat disch,ProFee,0989,G8587,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8588_3,Sys BP <140,ProFee,0989,G8588,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8589_3,Sys BP >= 140,ProFee,0989,G8589,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8590_3,Dia BP < 90,ProFee,0989,G8590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8591_3,Dia BP >= 90,ProFee,0989,G8591,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8592_3,No BP measure,ProFee,0989,G8592,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8593_3,Lipid pn results,ProFee,0989,G8593,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8594_3,No lipid prof perf,ProFee,0989,G8594,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8595_3,Ldl < 100,ProFee,0989,G8595,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8596_3,No LDL perf,ProFee,0989,G8596,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8597_3,Ldl >= 100,ProFee,0989,G8597,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8598_3,Asp therp used,ProFee,0989,G8598,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8599_3,No asp therp used,ProFee,0989,G8599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8600_3,tPA initi w/in 3 hrs,ProFee,0989,G8600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8601_3,No elig tPA init w/in 3 hrs,ProFee,0989,G8601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8602_3,No tPA init w/in 3 hrs,ProFee,0989,G8602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8603_3,Spok lang comp score,ProFee,0989,G8603,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8604_3,No high score spok lang,ProFee,0989,G8604,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8605_3,No spok lang comp score,ProFee,0989,G8605,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8606_3,Attention score,ProFee,0989,G8606,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8607_3,No high score attention,ProFee,0989,G8607,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8608_3,No attention score,ProFee,0989,G8608,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8609_3,Memory score,ProFee,0989,G8609,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8610_3,No high score memory,ProFee,0989,G8610,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8611_3,No memory score,ProFee,0989,G8611,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8612_3,Moto speech score,ProFee,0989,G8612,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8613_3,No high score moto speech,ProFee,0989,G8613,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8614_3,No moto speech score,ProFee,0989,G8614,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8615_3,Reading score,ProFee,0989,G8615,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8616_3,No high score reading,ProFee,0989,G8616,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8617_3,No reading score,ProFee,0989,G8617,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8618_3,Spok lang exp score,ProFee,0989,G8618,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8619_3,No high score spok lang exp,ProFee,0989,G8619,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8620_3,No spok lang exp score,ProFee,0989,G8620,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8621_3,Writing score,ProFee,0989,G8621,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8622_3,No high score writing,ProFee,0989,G8622,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8623_3,No writing score,ProFee,0989,G8623,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8624_3,Swallowing score,ProFee,0989,G8624,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8625_3,No high score swallowing,ProFee,0989,G8625,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8626_3,No swallowing score,ProFee,0989,G8626,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8627_3,Surg proc w/in 30 days,ProFee,0989,G8627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8628_3,No surg proc w/in 30 days,ProFee,0989,G8628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8629_3,Doc antibio order b/4 surg,ProFee,0989,G8629,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8630_3,Doc antibio given b/4 surg,ProFee,0989,G8630,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8631_3,Pt no elg 4 order antbi give,ProFee,0989,G8631,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8632_3,Doc no antibi order b/4 surg,ProFee,0989,G8632,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8633_3,Pharm ther osteo rx,ProFee,0989,G8633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8634_3,Pt no elg phar ther osteo,ProFee,0989,G8634,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8635_3,No pharm ther osteo rx,ProFee,0989,G8635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8636_3,Flu immun admin/prev rec,ProFee,0989,G8636,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8637_3,Pt no elg receiv flu immun,ProFee,0989,G8637,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8638_3,Flu immun no admin/prev rec,ProFee,0989,G8638,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8639_3,Flu immun admin or prev rec,ProFee,0989,G8639,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8640_3,Pt no elg rec flu immun,ProFee,0989,G8640,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8641_3,Flu immun not admin/pre rec,ProFee,0989,G8641,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8642_3,Hrdshp rural w/o internet,ProFee,0989,G8642,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8643_3,Hrdshp w/o suff pharm w/eRx,ProFee,0989,G8643,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8644_3,EP no prescribe priv,ProFee,0989,G8644,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8645_3,Asthma measures grp,ProFee,0989,G8645,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8646_3,Asthma MG qual act perform,ProFee,0989,G8646,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8647_3,Fun stat score knee >= 0,ProFee,0989,G8647,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8648_3,Fun stat score knee < 0,ProFee,0989,G8648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8649_3,Fun stat score knee pt noelg,ProFee,0989,G8649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8650_3,Fun stat score knee not done,ProFee,0989,G8650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8651_3,Fun stat score hip >= 0,ProFee,0989,G8651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8652_3,Fun stat score hip < 0,ProFee,0989,G8652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8653_3,Fun stat score hip pt no elg,ProFee,0989,G8653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8654_3,Fun stat score hip not done,ProFee,0989,G8654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8655_3,Fun stat score LE >= 0,ProFee,0989,G8655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8656_3,Fun stat score LE < 0,ProFee,0989,G8656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8657_3,Fun stat score LE pt no elg,ProFee,0989,G8657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8658_3,Fun stat score LE not done,ProFee,0989,G8658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8659_3,Fun stat score LS >= 0,ProFee,0989,G8659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8660_3,Fun stat score LS < 0,ProFee,0989,G8660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8661_3,Fun stat score LS pt no elg,ProFee,0989,G8661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8662_3,Fun stat score LS not done,ProFee,0989,G8662,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8663_3,Fun stat score shdl >=0,ProFee,0989,G8663,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8664_3,Fun stat score shdl < 0,ProFee,0989,G8664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8665_3,Fun stat score shdl pt no el,ProFee,0989,G8665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8666_3,Fun stat score shdl not done,ProFee,0989,G8666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8667_3,Fun stat score UE >=0,ProFee,0989,G8667,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8668_3,Fun stat score UE < 0,ProFee,0989,G8668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8669_3,Fun stat score UE pt no elg,ProFee,0989,G8669,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8670_3,Fun stat score UE not done,ProFee,0989,G8670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8671_3,Fun stat score neck/TS >=0,ProFee,0989,G8671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8672_3,Fun stat score neck/TS < 0,ProFee,0989,G8672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8673_3,Fun stat scor nek/TS pt no e,ProFee,0989,G8673,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8674_3,Fun stat scor nek/TS not don,ProFee,0989,G8674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8675_3,BP Syst >= 140 mmHg,ProFee,0989,G8675,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8676_3,BP Diast >= 90 mmHg,ProFee,0989,G8676,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8677_3,BP Syst < 130 mmHg,ProFee,0989,G8677,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8678_3,BP Syst >=130 - 139 mmHg,ProFee,0989,G8678,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8679_3,BP Diast < 80 mmHg,ProFee,0989,G8679,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8680_3,BP Diast 80-89 mmHg,ProFee,0989,G8680,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8681_3,Pt hosp w/HF,ProFee,0989,G8681,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8682_3,LVG test perf,ProFee,0989,G8682,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8683_3,Pt not elig for LVF test,ProFee,0989,G8683,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8684_3,Pt not hosp w/HF,ProFee,0989,G8684,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8685_3,LVF test not perf,ProFee,0989,G8685,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8686_3,Toba smkr curr or 2 hand exp,ProFee,0989,G8686,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8687_3,No tob smkr cur no 2 hnd exp,ProFee,0989,G8687,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8688_3,Smkls tob cur; no 2 hnd exp,ProFee,0989,G8688,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8689_3,Toba use not assess,ProFee,0989,G8689,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8690_3,Curr toba smkr or 2 hand exp,ProFee,0989,G8690,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8691_3,No cur tob smkr no 2 hnd exp,ProFee,0989,G8691,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8692_3,Curr smkls tob; no 2 hnd exp,ProFee,0989,G8692,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8693_3,Tobacco no assess,ProFee,0989,G8693,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8694_3,Lvef <40%,ProFee,0989,G8694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8696_3,Antithromb thx presc,ProFee,0989,G8696,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8697_3,Antithromb no presc doc reas,ProFee,0989,G8697,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8698_3,Antithromb no presc no reas,ProFee,0989,G8698,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8699_3,Rehab ordered disch,ProFee,0989,G8699,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8700_3,Rehab not indicated disch,ProFee,0989,G8700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8701_3,Rehab not ordered,ProFee,0989,G8701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8702_3,Antiobiotics 4 hr prior surg,ProFee,0989,G8702,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8703_3,Antibiotics not prior surg,ProFee,0989,G8703,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8704_3,Ecg performed,ProFee,0989,G8704,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8705_3,Med reas no ecg,ProFee,0989,G8705,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8706_3,Pt reas no ecg,ProFee,0989,G8706,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8707_3,Ecg not performed,ProFee,0989,G8707,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8708_3,Antibiotic not pres,ProFee,0989,G8708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8709_3,Pt presc doc med rsn id uri,ProFee,0989,G8709,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8710_3,Pt pres antibiotic,ProFee,0989,G8710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8711_3,Pres antibiotic,ProFee,0989,G8711,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8712_3,Not pres antibiotic,ProFee,0989,G8712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8713_3,Spkt/v great 1.2 kt/v,ProFee,0989,G8713,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8714_3,Hemodialysis 3 times week,ProFee,0989,G8714,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8717_3,Less 1.2 kt/v,ProFee,0989,G8717,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8718_3,Great 1.7 kt/v per week,ProFee,0989,G8718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8720_3,Less 1.7 kt/v per week,ProFee,0989,G8720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8721_3,"Pt, pn, hist grade doc",ProFee,0989,G8721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8722_3,"Med reas pt, pn, not doc",ProFee,0989,G8722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8723_3,Spec sit not prim tumor,ProFee,0989,G8723,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8724_3,"Pt, pn, hist grade not doc",ProFee,0989,G8724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8725_3,Lipid profile perf doc,ProFee,0989,G8725,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8726_3,Doc reas no lipid profile,ProFee,0989,G8726,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8728_3,Lipid profile not perf,ProFee,0989,G8728,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8730_3,Pain doc pos and plan,ProFee,0989,G8730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8731_3,Pain neg no plan,ProFee,0989,G8731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8732_3,No doc of pain,ProFee,0989,G8732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8733_3,Doc pos elder mal scrn plan,ProFee,0989,G8733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8734_3,Doc neg elder mal no plan,ProFee,0989,G8734,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8735_3,Eld mal scrn pos no plan,ProFee,0989,G8735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8736_3,Ldl-c <100mg/dl,ProFee,0989,G8736,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8737_3,Ldl-c >=100mg/dl,ProFee,0989,G8737,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8738_3,Lvef < 40%,ProFee,0989,G8738,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8739_3,Lvef >= 40%,ProFee,0989,G8739,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8740_3,Lvef not perfrmd,ProFee,0989,G8740,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8749_3,No signs melanoma,ProFee,0989,G8749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8751_3,Smkg status not assess,ProFee,0989,G8751,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8752_3,Sys bp less 140,ProFee,0989,G8752,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8753_3,Sys bp > or = 140,ProFee,0989,G8753,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8754_3,Dias bp less 90,ProFee,0989,G8754,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8755_3,Dias bp > or = 90,ProFee,0989,G8755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8756_3,No bp measure doc,ProFee,0989,G8756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8757_3,Copd mg qual act perform,ProFee,0989,G8757,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8758_3,Ibd mg qual act perform,ProFee,0989,G8758,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8759_3,Osa mg qual act perform,ProFee,0989,G8759,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8761_3,Dementia mg qual act perform,ProFee,0989,G8761,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8762_3,Pd mg qual act perform,ProFee,0989,G8762,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8763_3,Hyperten mg qual act perform,ProFee,0989,G8763,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8764_3,Car prev mg qual act perform,ProFee,0989,G8764,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8765_3,Cataract mg qual act perform,ProFee,0989,G8765,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8767_3,Lipid panel res doc rev,ProFee,0989,G8767,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8768_3,Doc med reas no lipid profle,ProFee,0989,G8768,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8769_3,Lipid profile not perform,ProFee,0989,G8769,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8770_3,Urine protein test doc rev,ProFee,0989,G8770,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8771_3,Doc dx ckd,ProFee,0989,G8771,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8772_3,Doc med reas no urine protn,ProFee,0989,G8772,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8773_3,No urine protein test,ProFee,0989,G8773,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8774_3,Serum creatinine doc rev,ProFee,0989,G8774,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8775_3,Doc med reas no serum crtn,ProFee,0989,G8775,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8776_3,No serum creatinine test,ProFee,0989,G8776,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8777_3,Diabetes screen,ProFee,0989,G8777,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8778_3,Doc med reas no diabete scrn,ProFee,0989,G8778,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8779_3,No diabetes screen,ProFee,0989,G8779,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8780_3,Counsel diet phys activity,ProFee,0989,G8780,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8781_3,Doc med reas no counsel diet,ProFee,0989,G8781,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8782_3,No counsel diet phys act,ProFee,0989,G8782,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8783_3,Bp scrn perf rec interval,ProFee,0989,G8783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8784_3,Pt no elig for bp assess,ProFee,0989,G8784,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8785_3,Bp scrn no perf at interval,ProFee,0989,G8785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8797_3,Specimen site not esophagus,ProFee,0989,G8797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8798_3,Specimen site not prostate,ProFee,0989,G8798,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8806_3,Perf ultrsnd to lct preg doc,ProFee,0989,G8806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8807_3,No ta tv ultrasnd,ProFee,0989,G8807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8808_3,"Ultrasound not perf, rng",ProFee,0989,G8808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8809_3,Rh-immunoglobulin order,ProFee,0989,G8809,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8810_3,Doc reas no rh-immuno,ProFee,0989,G8810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8811_3,No rh-immunoglobulin order,ProFee,0989,G8811,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8815_3,Doc reas no statin therapy,ProFee,0989,G8815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8816_3,Statin med pres at disch,ProFee,0989,G8816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8817_3,Doc reas no statin med disch,ProFee,0989,G8817,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8818_3,Pt disch to home by day#7,ProFee,0989,G8818,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8825_3,Pt not disch to home day#7,ProFee,0989,G8825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8826_3,Pt disch home day #2 evar,ProFee,0989,G8826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8833_3,Pt not disch home day#2 evar,ProFee,0989,G8833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8834_3,Pt disch home day #2 cea,ProFee,0989,G8834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8838_3,Not disch home by day #2,ProFee,0989,G8838,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8839_3,Sleep apnea assess,ProFee,0989,G8839,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8840_3,Doc reas no sleep apnea,ProFee,0989,G8840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8841_3,No sleep apnea assess,ProFee,0989,G8841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8842_3,Ahi or rdi initial dx,ProFee,0989,G8842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8843_3,Doc reas no ahi or rdi,ProFee,0989,G8843,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8844_3,No ahi or rdi initial dx,ProFee,0989,G8844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8845_3,Pos airway press prescribed,ProFee,0989,G8845,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8846_3,Mod or severe osa,ProFee,0989,G8846,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8848_3,Mild osa,ProFee,0989,G8848,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8849_3,Doc reas no pos air press,ProFee,0989,G8849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8850_3,No pap prescribed,ProFee,0989,G8850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8851_3,Adhere pos air press therapy,ProFee,0989,G8851,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8852_3,Pos air press prescribe,ProFee,0989,G8852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8853_3,Pos air press not prescribe,ProFee,0989,G8853,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8854_3,Reas no adhere pos air pres,ProFee,0989,G8854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8855_3,Pos air press adhere no perf,ProFee,0989,G8855,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8856_3,Ref for oto eval,ProFee,0989,G8856,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8857_3,No elig ref for oto eval,ProFee,0989,G8857,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8858_3,Not ref for oto eval,ProFee,0989,G8858,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8859_3,Corticosteroids 10mg 60 days,ProFee,0989,G8859,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8860_3,Corticosteroid 10 mg 60 days,ProFee,0989,G8860,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8861_3,Dxa ordered for osteo,ProFee,0989,G8861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8862_3,No corticostrd 10mg 60 days,ProFee,0989,G8862,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8863_3,No assess bone loss,ProFee,0989,G8863,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8864_3,Pneumococcal vaccine admin,ProFee,0989,G8864,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8865_3,Doc med reas no pneumococcal,ProFee,0989,G8865,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8866_3,Doc pt reas no pneumococcal,ProFee,0989,G8866,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8867_3,No pneumococcal admin,ProFee,0989,G8867,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8868_3,1st course antitnf,ProFee,0989,G8868,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8869_3,Doc immune hep b antitnf,ProFee,0989,G8869,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8870_3,Hepb admin 1st antitnf,ProFee,0989,G8870,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8871_3,No 1st antitnf,ProFee,0989,G8871,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8872_3,Intraop image confirm excise,ProFee,0989,G8872,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8873_3,Specimen not intraop image,ProFee,0989,G8873,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8874_3,Tissue not image intraop,ProFee,0989,G8874,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8875_3,Breast cancer dx min invsive,ProFee,0989,G8875,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8876_3,Doc reas no min inv dx,ProFee,0989,G8876,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8877_3,No brst cncr dx min invasive,ProFee,0989,G8877,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8878_3,Sent lymph node biopsy,ProFee,0989,G8878,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8879_3,Node neg inv brst cncr,ProFee,0989,G8879,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8880_3,Sen lym p node biop not perf,ProFee,0989,G8880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8881_3,Brst cncr stage > t1n0m0,ProFee,0989,G8881,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8882_3,No sent lymph node biopsy,ProFee,0989,G8882,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8883_3,"Rev, comm, track, doc biopsy",ProFee,0989,G8883,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8884_3,Doc reas biopsy not review,ProFee,0989,G8884,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8885_3,"No rev, comm, track biopsy",ProFee,0989,G8885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8886_3,Bp under control,ProFee,0989,G8886,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8887_3,Doc med reas bp not control,ProFee,0989,G8887,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8888_3,Bp not under control,ProFee,0989,G8888,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8889_3,No doc bp,ProFee,0989,G8889,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8890_3,Ldl-c under control,ProFee,0989,G8890,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8891_3,Doc med reas no ldl-c contrl,ProFee,0989,G8891,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8892_3,Doc med reas no ldl-c test,ProFee,0989,G8892,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8893_3,Ldl-c not under control,ProFee,0989,G8893,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8894_3,Ldl-c not performed,ProFee,0989,G8894,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8895_3,Antrom prescribe,ProFee,0989,G8895,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8896_3,Doc med reas no antihtrom,ProFee,0989,G8896,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8897_3,Antithrom not prescribe,ProFee,0989,G8897,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8898_3,Copd measures group,ProFee,0989,G8898,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8899_3,Inflammatory bowel dis mg,ProFee,0989,G8899,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8900_3,Obstructive sleep apnea mg,ProFee,0989,G8900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8902_3,Dementia measures group,ProFee,0989,G8902,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8903_3,Parkinson's disease mg,ProFee,0989,G8903,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8904_3,Hypertension mg,ProFee,0989,G8904,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8905_3,Cardiovascular prevention mg,ProFee,0989,G8905,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8906_3,Cataract measures group,ProFee,0989,G8906,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8907_3,Pt doc no events on discharg,ProFee,0989,G8907,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8908_3,Pt doc w burn prior to d/c,ProFee,0989,G8908,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8909_3,Pt doc no burn prior to d/c,ProFee,0989,G8909,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8910_3,Pt doc to have fall in asc,ProFee,0989,G8910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8911_3,Pt doc no fall in asc,ProFee,0989,G8911,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8912_3,Pt doc with wrong event,ProFee,0989,G8912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8913_3,Pt doc no wrong event,ProFee,0989,G8913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8914_3,Pt trans to hosp post d/c,ProFee,0989,G8914,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8915_3,Pt not trans to hosp at d/c,ProFee,0989,G8915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8916_3,Pt w iv ab given on time,ProFee,0989,G8916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8917_3,Pt w iv ab not given on time,ProFee,0989,G8917,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8918_3,Pt w/o preop order iv ab pro,ProFee,0989,G8918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8923_3,Lvef < 40% or lvsd,ProFee,0989,G8923,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8924_3,"Spir fev1/fvc<70%,fev<60%",ProFee,0989,G8924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8925_3,Spir fev1/fvc>=60% & no copd,ProFee,0989,G8925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8926_3,Spiro no perf or doc,ProFee,0989,G8926,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8927_3,Adj chem pres ajcc iii,ProFee,0989,G8927,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8928_3,Adj chem not pres rsn spec,ProFee,0989,G8928,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8929_3,Adj cmo not pres rsn not gvn,ProFee,0989,G8929,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8930_3,Assess of dep @ initial eval,ProFee,0989,G8930,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8931_3,Asses of dep not documented,ProFee,0989,G8931,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8932_3,Suicd rsk assessed init eval,ProFee,0989,G8932,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8933_3,Suicide risk not assessed,ProFee,0989,G8933,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8934_3,Lvef <40% or dep lv sys fcn,ProFee,0989,G8934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8935_3,Rx ace or arb therapy,ProFee,0989,G8935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8936_3,Pt not eligible ace/arb,ProFee,0989,G8936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8937_3,No rx ace/arb therapy,ProFee,0989,G8937,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8938_3,Bmi doc onl fup nt doc,ProFee,0989,G8938,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8939_3,"Pain as doc positive, no f/u",ProFee,0989,G8939,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8940_3,"Scr dep pos, no plan done",ProFee,0989,G8940,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8941_3,Eld maltreatment doc as pos,ProFee,0989,G8941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8942_3,Doc fcn/care plan w/30 days,ProFee,0989,G8942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8943_3,Ldlc not pres w/i 12 mo prir,ProFee,0989,G8943,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8944_3,Ajcc mel cnr stg 0 - iic,ProFee,0989,G8944,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8946_3,Mibm but no dx of breast ca,ProFee,0989,G8946,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8947_3,1 or more neuropsych,ProFee,0989,G8947,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8948_3,No neuropsych symptoms,ProFee,0989,G8948,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8949_3,Doc pt reas on counsel diet,ProFee,0989,G8949,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8950_3,"Pre-htn or htn doc, f/u indc",ProFee,0989,G8950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8951_3,"Pre-htn/htn doc, no pt f/u",ProFee,0989,G8951,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8952_3,"Pre-htn/htn, no f/u, not gvn",ProFee,0989,G8952,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8953_3,Oncology mg qual act perform,ProFee,0989,G8953,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8955_3,Most recent assess vol mgmt,ProFee,0989,G8955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8956_3,Pt rcv hedia outpt dyls fac,ProFee,0989,G8956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8957_3,Pt no hedia in outpt fac,ProFee,0989,G8957,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8958_3,Assess vol mgmt not doc,ProFee,0989,G8958,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8959_3,Clin tx mdd comm to tx clin,ProFee,0989,G8959,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8960_3,Clin tx mdd not comm,ProFee,0989,G8960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8961_3,Csit lowrisk surg pts preop,ProFee,0989,G8961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8962_3,Csit on pt any reas 30 days,ProFee,0989,G8962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8963_3,Csi per asx pt w/pci 2 yrs,ProFee,0989,G8963,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8964_3,Csi any other than pci 2 yr,ProFee,0989,G8964,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8965_3,Csit perf on low chd rsk,ProFee,0989,G8965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8966_3,Csit perf sx or high chd rsk,ProFee,0989,G8966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8967_3,Warf or other fda drug presc,ProFee,0989,G8967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8968_3,Doc med not presb,ProFee,0989,G8968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8969_3,Doc pt rsn no presc warf/fda,ProFee,0989,G8969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8970_3,No rsk fac or 1 mod risk te,ProFee,0989,G8970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8971_3,Warfrn or othr antcog no rx,ProFee,0989,G8971,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8972_3,1>=risk or>= mod risk for te,ProFee,0989,G8972,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8973_3,Mst rcnt hbb < 10g/dl,ProFee,0989,G8973,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8974_3,Hgb not doc rns not gvn,ProFee,0989,G8974,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8975_3,"Hgb <10g/dl, med rsn",ProFee,0989,G8975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8976_3,Hgb >= 10 g/dl,ProFee,0989,G8976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8977_3,Oncology measures grp,ProFee,0989,G8977,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G8978_3,Mobility current status,ProFee,0989,G8978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8979_3,Mobility goal status,ProFee,0989,G8979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8980_3,Mobility d/c status,ProFee,0989,G8980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8981_3,Body pos current status,ProFee,0989,G8981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8982_3,Body pos goal status,ProFee,0989,G8982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8983_3,Body pos d/c status,ProFee,0989,G8983,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8984_3,Carry current status,ProFee,0989,G8984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8985_3,Carry goal status,ProFee,0989,G8985,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8986_3,Carry d/c status,ProFee,0989,G8986,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8987_3,Self care current status,ProFee,0989,G8987,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8988_3,Self care goal status,ProFee,0989,G8988,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8989_3,Self care d/c status,ProFee,0989,G8989,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8990_3,Other pt/ot current status,ProFee,0989,G8990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8991_3,Other pt/ot goal status,ProFee,0989,G8991,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8992_3,Other pt/ot  d/c status,ProFee,0989,G8992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8993_3,Sub pt/ot current status,ProFee,0989,G8993,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8994_3,Sub pt/ot goal status,ProFee,0989,G8994,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8995_3,Sub pt/ot d/c status,ProFee,0989,G8995,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8996_3,Swallow current status,ProFee,0989,G8996,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8997_3,Swallow goal status,ProFee,0989,G8997,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8998_3,Swallow d/c status,ProFee,0989,G8998,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G8999_3,Motor speech current status,ProFee,0989,G8999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9001_3,"MCCD, initial rate",ProFee,0989,G9001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9002_3,"MCCD,maintenance rate",ProFee,0989,G9002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9003_3,"MCCD, risk adj hi, initial",ProFee,0989,G9003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9004_3,"MCCD, risk adj lo, initial",ProFee,0989,G9004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9005_3,"MCCD, risk adj, maintenance",ProFee,0989,G9005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9006_3,"MCCD, Home monitoring",ProFee,0989,G9006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9007_3,"MCCD, sch team conf",ProFee,0989,G9007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9008_3,"Mccd,phys coor-care ovrsght",ProFee,0989,G9008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9009_3,"MCCD, risk adj, level 3",ProFee,0989,G9009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9010_3,"MCCD, risk adj, level 4",ProFee,0989,G9010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9011_3,"MCCD, risk adj, level 5",ProFee,0989,G9011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9012_3,Other Specified Case Mgmt,ProFee,0989,G9012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9013_3,ESRD demo bundle level I,ProFee,0989,G9013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9014_3,ESRD demo bundle-level II,ProFee,0989,G9014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9016_3,Demo-smoking cessation coun,ProFee,0989,G9016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9017_3,Amantadine HCL 100mg oral,ProFee,0989,G9017,,,,0,3.00,2.25,1.50,2.25,0.00,1.50,1.50,N/A
G9018_3,"Zanamivir,inhalation pwd 10m",ProFee,0989,G9018,,,,0,3.00,2.25,2.25,8.00,0.00,8.00,8.00,N/A
G9019_3,Oseltamivir phosphate 75mg,ProFee,0989,G9019,,,,0,3.00,2.25,2.25,8.50,0.00,8.50,8.50,N/A
G9020_3,Rimantadine HCL 100mg oral,ProFee,0989,G9020,,,,0,3.00,2.25,2.25,2.50,0.00,2.50,2.50,N/A
G9033_3,Amantadine HCL oral brand,ProFee,0989,G9033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9034_3,Zanamivir powder via inhaler,ProFee,0989,G9034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9035_3,Oseltamivir phosphate 75mg o,ProFee,0989,G9035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9036_3,Rimantadine HCL 100mg,ProFee,0989,G9036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9041_3,Low vision serv occupational,ProFee,0989,G9041,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9042_3,Low vision orient/mobility,ProFee,0989,G9042,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9043_3,Low vision rehab therapist,ProFee,0989,G9043,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9044_3,Low vision rehab teacher,ProFee,0989,G9044,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9050_3,Oncology work-up evaluation,ProFee,0989,G9050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9051_3,Oncology treatment decision,ProFee,0989,G9051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9052_3,Onc surveillance for disease,ProFee,0989,G9052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9053_3,Onc expectant management pt,ProFee,0989,G9053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9054_3,Onc supervision palliative,ProFee,0989,G9054,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9055_3,Onc visit unspecified NOS,ProFee,0989,G9055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9056_3,Onc prac mgmt adheres guide,ProFee,0989,G9056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9057_3,Onc pract mgmt differs guide,ProFee,0989,G9057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9058_3,Onc prac mgmt disagree w/gui,ProFee,0989,G9058,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9059_3,Onc prac mgmt pt opt alterna,ProFee,0989,G9059,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9060_3,Onc prac mgmt dif pt comorb,ProFee,0989,G9060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9061_3,Onc prac cond noadd by guide,ProFee,0989,G9061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9062_3,Onc prac guide differs nos,ProFee,0989,G9062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9063_3,Onc dx nsclc stgI no dx prog,ProFee,0989,G9063,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9064_3,Onc dx nsclc stg2 no dx prog,ProFee,0989,G9064,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9065_3,Onc dx nsclc stg3A nodx prog,ProFee,0989,G9065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9066_3,Onc dx nsclc stg3B-4 metasta,ProFee,0989,G9066,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9067_3,Onc dx nsclc dx unknown nos,ProFee,0989,G9067,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9068_3,Onc dx nsclc/sclc limited,ProFee,0989,G9068,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9069_3,Onc dx sclc/nsclc ext at dx,ProFee,0989,G9069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9070_3,Onc dx sclc/nsclc ext unknwn,ProFee,0989,G9070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9071_3,Onc dx brst stg1 2B no dx pr,ProFee,0989,G9071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9072_3,Onc dx brst stg1-2 noprogres,ProFee,0989,G9072,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9073_3,Onc dx brst stg3-w/progres,ProFee,0989,G9073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9074_3,Onc dx brst stg3-noprogress,ProFee,0989,G9074,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9075_3,Onc dx brst metastic/ recur,ProFee,0989,G9075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9076_3,Onc dx brst unknown NOS,ProFee,0989,G9076,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9077_3,Onc dx prostate T1no progres,ProFee,0989,G9077,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9078_3,Onc dx prostate T2no progres,ProFee,0989,G9078,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9079_3,Onc dx prostate T3b-T4noprog,ProFee,0989,G9079,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9080_3,Onc dx prostate w/rise PSA,ProFee,0989,G9080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9081_3,Onc dx prostate mets no cast,ProFee,0989,G9081,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9082_3,Onc dx prostate castrate met,ProFee,0989,G9082,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9083_3,Onc dx prostate unknown NOS,ProFee,0989,G9083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9084_3,"Onc dx colon t1-3,n1-2,no pr",ProFee,0989,G9084,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9085_3,"Onc dx colon T4, N0 w/o prog",ProFee,0989,G9085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9086_3,Onc dx colon T1-4 no dx prog,ProFee,0989,G9086,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9087_3,Onc dx colon radiolg evid dx,ProFee,0989,G9087,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9088_3,Onc dx colon m1/mets w/o rad,ProFee,0989,G9088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9089_3,Onc dx colon extent unknown,ProFee,0989,G9089,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9090_3,Onc dx rectal T1-2 no progr,ProFee,0989,G9090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9091_3,Onc dx rectal T3 N0 no prog,ProFee,0989,G9091,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9092_3,"Onc dx rectal T1-3,N1-2noprg",ProFee,0989,G9092,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9093_3,"Onc dx rectal T4,N,M0 no prg",ProFee,0989,G9093,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9094_3,Onc dx rectal M1 w/mets prog,ProFee,0989,G9094,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9095_3,Onc dx rectal extent unknwn,ProFee,0989,G9095,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9096_3,Onc dx esophag T1-T3 noprog,ProFee,0989,G9096,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9097_3,Onc dx esophageal T4 no prog,ProFee,0989,G9097,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9098_3,Onc dx esophageal mets recur,ProFee,0989,G9098,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9099_3,Onc dx esophageal unknown,ProFee,0989,G9099,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9100_3,Onc dx gastric no recurrence,ProFee,0989,G9100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9101_3,Onc dx gastric p R1-R2noprog,ProFee,0989,G9101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9102_3,Onc dx gastric unresectable,ProFee,0989,G9102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9103_3,Onc dx gastric recurrent,ProFee,0989,G9103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9104_3,Onc dx gastric unknown NOS,ProFee,0989,G9104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9105_3,Onc dx pancreatc p R0 res no,ProFee,0989,G9105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9106_3,Onc dx pancreatc p R1/R2 no,ProFee,0989,G9106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9107_3,Onc dx pancreatic unresectab,ProFee,0989,G9107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9108_3,Onc dx pancreatic unknwn NOS,ProFee,0989,G9108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9109_3,Onc dx head/neck T1-T2no prg,ProFee,0989,G9109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9110_3,Onc dx head/neck T3-4 noprog,ProFee,0989,G9110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9111_3,Onc dx head/neck M1 mets rec,ProFee,0989,G9111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9112_3,Onc dx head/neck ext unknown,ProFee,0989,G9112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9113_3,Onc dx ovarian stg1A-B no pr,ProFee,0989,G9113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9114_3,Onc dx ovarian stg1A-B or 2,ProFee,0989,G9114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9115_3,Onc dx ovarian stg3/4 noprog,ProFee,0989,G9115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9116_3,Onc dx ovarian recurrence,ProFee,0989,G9116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9117_3,Onc dx ovarian unknown NOS,ProFee,0989,G9117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9118_3,Onc dx NHL stg 1-2 not relap,ProFee,0989,G9118,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9119_3,Onc dx NHL stg 3-4 not relap,ProFee,0989,G9119,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9120_3,Onc dx NHL trans to lg Bcell,ProFee,0989,G9120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9121_3,Onc NHLstg 1-2 no relap no,ProFee,0989,G9121,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9122_3,Onc dx NHL stg 3/4no relap,ProFee,0989,G9122,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9123_3,Onc dx NHL lge Bcell relap,ProFee,0989,G9123,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9124_3,Onc dx NHL relapse/refractor,ProFee,0989,G9124,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9125_3,Onc dx NHL stg unknown,ProFee,0989,G9125,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9126_3,Onc dx ovarian stg IA/B,ProFee,0989,G9126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9127_3,Onc dx multi myeloma stage I,ProFee,0989,G9127,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9128_3,Onc dx mult myeloma stg2 hig,ProFee,0989,G9128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9129_3,Onc dx mult myeloma unkwn op,ProFee,0989,G9129,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9130_3,Onc dx multi myeloma unknown,ProFee,0989,G9130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9131_3,Onc dx brst unknown NOS,ProFee,0989,G9131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9132_3,Onc dx prostate mets no cast,ProFee,0989,G9132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9133_3,Onc dx prostate clinical met,ProFee,0989,G9133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9134_3,Onc NHLstg 1-2 no relap no,ProFee,0989,G9134,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9135_3,Onc dx NHL stg 3-4 not relap,ProFee,0989,G9135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9136_3,Onc dx NHL trans to lg Bcell,ProFee,0989,G9136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9137_3,Onc dx NHL relapse/refractor,ProFee,0989,G9137,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9138_3,Onc dx NHL stg unknown,ProFee,0989,G9138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9139_3,Onc dx CML dx status unknown,ProFee,0989,G9139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9140_3,Frontier extended stay demo,ProFee,0989,G9140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9143_3,Warfarin respon genetic test,ProFee,0989,G9143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9147_3,Outpt IV insulin tx any mea,ProFee,0989,G9147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9148_2,National Committee For Quality Assurance - Level 1,Inpatient,0522,G9148,,,,0,346.00,259.50,259.50,328.70,311.40,328.70,328.70,311.40
G9148_2,National Committee For Quality Assurance - Level 1,Outpatient,0522,G9148,,,,0,346.00,259.50,259.50,328.70,311.40,328.70,0.00,N/A
G9148_3,National Committee For Quality Assurance - Level 1,Outpatient,0522,G9148,,,,0,346.00,259.50,259.50,328.70,311.40,328.70,0.00,N/A
G9148_3,National Committee For Quality Assurance - Level 1,Inpatient,0522,G9148,,,,0,346.00,259.50,259.50,328.70,311.40,328.70,328.70,311.40
G9149_3,National Committee For Quality Assurance - Level 2,ProFee,0989,G9149,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9150_3,National Committee For Quality Assurance - Level 3,ProFee,0989,G9150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9151_3,Mapcp demo state,ProFee,0989,G9151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9152_3,Mapcp demo community,ProFee,0989,G9152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9153_3,Mapcp demo physician,ProFee,0989,G9153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9156_3,Evaluation for wheelchair,ProFee,0989,G9156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9157_3,Transesoph doppl cardiac mon,ProFee,0989,G9157,,,,0,3.00,2.25,2.25,137.50,0.00,137.50,137.50,N/A
G9158_3,Motor speech d/c status,ProFee,0989,G9158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9159_3,Lang comp current status,ProFee,0989,G9159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9160_3,Lang comp goal status,ProFee,0989,G9160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9161_3,Lang comp d/c status,ProFee,0989,G9161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9162_3,Lang express current status,ProFee,0989,G9162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9163_3,Lang express goal status,ProFee,0989,G9163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9164_3,Lang express d/c status,ProFee,0989,G9164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9165_3,Atten current status,ProFee,0989,G9165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9166_3,Atten goal status,ProFee,0989,G9166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9167_3,Atten d/c status,ProFee,0989,G9167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9168_3,Memory current status,ProFee,0989,G9168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9169_3,Memory goal status,ProFee,0989,G9169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9170_3,Memory d/c status,ProFee,0989,G9170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9171_3,Voice current status,ProFee,0989,G9171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9172_3,Voice goal status,ProFee,0989,G9172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9173_3,Voice d/c status,ProFee,0989,G9173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9174_3,Speech lang current status,ProFee,0989,G9174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9175_3,Speech lang goal status,ProFee,0989,G9175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9176_3,Speech lang d/c status,ProFee,0989,G9176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9186_3,Motor speech goal status,ProFee,0989,G9186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9187_3,Bpci home visit,ProFee,0989,G9187,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
G9188_3,Beta not given no reason,ProFee,0989,G9188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9189_3,Beta pres or already taking,ProFee,0989,G9189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9190_3,Medical reason for no beta,ProFee,0989,G9190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9191_3,Pt reason for no beta,ProFee,0989,G9191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9192_3,System reason for no beta,ProFee,0989,G9192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9193_3,Doc not eligible for dep med,ProFee,0989,G9193,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9194_3,Mdd pt treated for 180d,ProFee,0989,G9194,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9195_3,Mdd pt not treated for 180d,ProFee,0989,G9195,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9196_3,Med reason for no ceph,ProFee,0989,G9196,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9197_3,Order for ceph,ProFee,0989,G9197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9198_3,No order for ceph no reason,ProFee,0989,G9198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9199_3,Doc reason for no vte,ProFee,0989,G9199,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9200_3,No reason for no vte,ProFee,0989,G9200,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9201_3,Vte given upon admission,ProFee,0989,G9201,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9202_3,Hep c aby pos,ProFee,0989,G9202,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9203_3,Hep c rna done prior to med,ProFee,0989,G9203,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9204_3,No reason for no hep c rna,ProFee,0989,G9204,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9205_3,Hep c antiviral started,ProFee,0989,G9205,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9206_3,Hep c therapy started,ProFee,0989,G9206,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9207_3,Hep c genotype prior to med,ProFee,0989,G9207,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9208_3,No reason for no hep c geno,ProFee,0989,G9208,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9209_3,Hep c rna 4to12 wk after med,ProFee,0989,G9209,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9210_3,No hepc rna after med docrsn,ProFee,0989,G9210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9211_3,No hepc rna after med no rsn,ProFee,0989,G9211,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9212_3,Doc of dsm-iv init eval,ProFee,0989,G9212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9213_3,No doc of dsm-iv,ProFee,0989,G9213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9214_3,Cd4 count documented,ProFee,0989,G9214,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9215_3,No cd4 count no reason,ProFee,0989,G9215,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9216_3,No pcp proph at dx no reason,ProFee,0989,G9216,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9217_3,No pcp proph low cd4 norsn,ProFee,0989,G9217,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9218_3,No pcp prop low at cd4 norsn,ProFee,0989,G9218,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9219_3,No oder pjp for med reason,ProFee,0989,G9219,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9220_3,No order for pjp for medrsn,ProFee,0989,G9220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9221_3,Pjp proph prescribed,ProFee,0989,G9221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9222_3,Pjp proph ordered low cd4,ProFee,0989,G9222,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9223_3,Pjp proph ordered cd4 low,ProFee,0989,G9223,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9224_3,Medrsn no foot exam,ProFee,0989,G9224,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9225_3,Norsn no foot exam,ProFee,0989,G9225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9226_3,3 comp foot exam completed,ProFee,0989,G9226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9227_3,"Foa doc, care plan not doc",ProFee,0989,G9227,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9228_3,Gc chl syp documented,ProFee,0989,G9228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9229_3,Ptrsn no gc chl syp test,ProFee,0989,G9229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9230_3,Norsn for gc chl syp test,ProFee,0989,G9230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9231_3,Doc esrd dia trans preg,ProFee,0989,G9231,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9232_3,Ptrsn no comm comorbid,ProFee,0989,G9232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9233_3,Tkr composite,ProFee,0989,G9233,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9234_3,Tkr intent,ProFee,0989,G9234,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9235_3,Gs mg composite,ProFee,0989,G9235,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9236_3,Op rad mg composite,ProFee,0989,G9236,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9237_3,Gs mg intent,ProFee,0989,G9237,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9238_3,Op rad mg intent,ProFee,0989,G9238,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9239_3,Doc rsn hemod & cath acc,ProFee,0989,G9239,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9240_3,Doc pt w cath maint dia,ProFee,0989,G9240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9241_3,Doc pt w out cath maint dia,ProFee,0989,G9241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9242_3,Doc viral load >=200,ProFee,0989,G9242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9243_3,Doc viral load <200,ProFee,0989,G9243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9244_3,Antiviral not ordered,ProFee,0989,G9244,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9245_3,Antiviral ordered,ProFee,0989,G9245,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9246_3,No med visit in 24mo,ProFee,0989,G9246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9247_3,1 med visit in 24mo,ProFee,0989,G9247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9248_3,No med visit 6mo,ProFee,0989,G9248,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9249_3,Med visit w in 6mo,ProFee,0989,G9249,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9250_3,Doc of pain comfort 48hr,ProFee,0989,G9250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9251_3,Doc no pain comfort 48hr,ProFee,0989,G9251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9252_3,Neo detect scrn colo,ProFee,0989,G9252,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9253_3,No neo detect scrn colo,ProFee,0989,G9253,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9254_3,Doc pt dischg >2d,ProFee,0989,G9254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9255_3,Doc pt dischg <=2d,ProFee,0989,G9255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9256_3,Doc of pat death after cas,ProFee,0989,G9256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9257_3,Doc of pat stroke after cas,ProFee,0989,G9257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9258_3,Doc of pat stroke after cea,ProFee,0989,G9258,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9259_3,Survive/no stroke post cas,ProFee,0989,G9259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9260_3,Doc of pat death after cea,ProFee,0989,G9260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9261_3,Survive/no stroke post cea,ProFee,0989,G9261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9262_3,Doc of death post-aaa repair,ProFee,0989,G9262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9263_3,Doc of disch post-aaa repair,ProFee,0989,G9263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9264_3,Doc rsn hemod w/cath >=90d,ProFee,0989,G9264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9265_3,Doc cath >90d for maint dia,ProFee,0989,G9265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9266_3,Norsn pt cath >=90d,ProFee,0989,G9266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9267_3,Doc comp or mort w in 30d,ProFee,0989,G9267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9268_3,Doc comp or mort w in 90d,ProFee,0989,G9268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9269_3,Doc no comp or mort w in 30d,ProFee,0989,G9269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9270_3,Doc no comp or mort w in 90d,ProFee,0989,G9270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9271_3,Ldl under 100,ProFee,0989,G9271,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9272_3,Ldl 100 and over,ProFee,0989,G9272,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9273_3,Sys<140 and dia<90,ProFee,0989,G9273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9274_3,Bp out of nrml limits,ProFee,0989,G9274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9275_3,Doc of non tobacco user,ProFee,0989,G9275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9276_3,Doc of tobacco user,ProFee,0989,G9276,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9277_3,Doc daily aspirin or contra,ProFee,0989,G9277,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9278_3,Doc no daily aspirin,ProFee,0989,G9278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9279_3,Pne scrn done doc vac done,ProFee,0989,G9279,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9280_3,Pne not given norsn,ProFee,0989,G9280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9281_3,Pne scrn done doc not ind,ProFee,0989,G9281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9282_3,Doc medrsn no histo type,ProFee,0989,G9282,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9283_3,Hist type doc on report,ProFee,0989,G9283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9284_3,No hist type doc on report,ProFee,0989,G9284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9285_3,Site not small cell lung ca,ProFee,0989,G9285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9286_3,Antibio rx w in 10d of sympt,ProFee,0989,G9286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9287_3,No antibio w in 10d of sympt,ProFee,0989,G9287,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9288_3,Doc medrsn no hist type rpt,ProFee,0989,G9288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9289_3,Doc type nsm lung ca,ProFee,0989,G9289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9290_3,No doc type nsm lung ca,ProFee,0989,G9290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9291_3,Not nsm lung ca,ProFee,0989,G9291,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9292_3,Medrsn no pt category,ProFee,0989,G9292,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9293_3,No pt category on report,ProFee,0989,G9293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9294_3,Pt cat and thck on report,ProFee,0989,G9294,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9295_3,Non cutaneous loc,ProFee,0989,G9295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9296_3,Doc share dec prior proc,ProFee,0989,G9296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9297_3,No doc share dec prior proc,ProFee,0989,G9297,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9298_3,Eval risk vte card 30d prior,ProFee,0989,G9298,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9299_3,No eval riskk vte card prior,ProFee,0989,G9299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9300_3,Doc medrsn no compl antibio,ProFee,0989,G9300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9301_3,Doc compl inf antibio,ProFee,0989,G9301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9302_3,Norsn incomp inf antibio,ProFee,0989,G9302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9303_3,Norsn no pros info op rpt,ProFee,0989,G9303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9304_3,Pros info op rpt,ProFee,0989,G9304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9305_3,No interv req for leak,ProFee,0989,G9305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9306_3,Interv req for leak,ProFee,0989,G9306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9307_3,No ret for surg w in 30d,ProFee,0989,G9307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9308_3,Unpl ret or w/compl w/in 30d,ProFee,0989,G9308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9309_3,No unplnd hosp readm in 30d,ProFee,0989,G9309,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9310_3,Unplnd hosp readm in 30d,ProFee,0989,G9310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9311_3,No surg site infection,ProFee,0989,G9311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9312_3,Surgical site infection,ProFee,0989,G9312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9313_3,Amoxic not presc as 1st line,ProFee,0989,G9313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9314_3,Norsn not first line amox,ProFee,0989,G9314,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9315_3,Doc first line amox,ProFee,0989,G9315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9316_3,Doc comm risk calc,ProFee,0989,G9316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9317_3,No doc comm risk calc,ProFee,0989,G9317,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9318_3,Image std nomenclature,ProFee,0989,G9318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9319_3,Image not std nomenclature,ProFee,0989,G9319,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9320_3,Medrsn no std nomenclature,ProFee,0989,G9320,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9321_3,Doc count of ct in 12mo,ProFee,0989,G9321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9322_3,No doc count of ct in 12mo,ProFee,0989,G9322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9323_3,Mdrsn no doc cnt of ct,ProFee,0989,G9323,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9324_3,Not all data norsn,ProFee,0989,G9324,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9325_3,Medrsn no ct rpt to reg,ProFee,0989,G9325,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9326_3,"Ct done no rad ds index, nrg",ProFee,0989,G9326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9327_3,Ct done rad ds index,ProFee,0989,G9327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9328_3,Medrsn no dicom format doc,ProFee,0989,G9328,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9329_3,Norsn no dicom format doc,ProFee,0989,G9329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9340_3,Dicom format doc on rpt,ProFee,0989,G9340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9341_3,Srch for ct w in 12 mos,ProFee,0989,G9341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9342_3,No srch for ct in 12mo norsn,ProFee,0989,G9342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9343_3,Medrsn no dicom srch,ProFee,0989,G9343,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9344_3,Sysrsn no dicom srch,ProFee,0989,G9344,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9345_3,Follow up pulm nod,ProFee,0989,G9345,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9346_3,No follow up pulm nod,ProFee,0989,G9346,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9347_3,No follow up pulm nod norsn,ProFee,0989,G9347,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9348_3,Doc rsn for ord ct scan,ProFee,0989,G9348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9349_3,Ct within 28 days,ProFee,0989,G9349,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9350_3,No doc sinus ct 28d or dx,ProFee,0989,G9350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9351_3,Doc >1 sinus ct w 90d dx,ProFee,0989,G9351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9352_3,Not >1 sinus ct w 90d dx,ProFee,0989,G9352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9353_3,Medrsn >1 sinus ct w 90d dx,ProFee,0989,G9353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9354_3,1 or no ct sinus w/in 90d dx,ProFee,0989,G9354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9355_3,No early ind/delivery,ProFee,0989,G9355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9356_3,Early ind/delivery,ProFee,0989,G9356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9357_3,Pp eval/edu perf,ProFee,0989,G9357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9358_3,Pp eval/edu not perf,ProFee,0989,G9358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9359_3,Neg mgd pos tb notact,ProFee,0989,G9359,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9360_3,No doc of neg or man pos tb,ProFee,0989,G9360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9361_3,Doc rsn elect c-sec/induct,ProFee,0989,G9361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9362_3,Mac or pnb w/o genanes >60m,ProFee,0989,G9362,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9363_3,Mac or pnb w/o genanes <60m,ProFee,0989,G9363,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9364_3,Sinus caus bac inx,ProFee,0989,G9364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9365_3,1high risk med ord,ProFee,0989,G9365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9366_3,1high risk no ord,ProFee,0989,G9366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9367_3,>= 2 same hi-rsk med ord,ProFee,0989,G9367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9368_3,>= 2 same hi-rsk med not ord,ProFee,0989,G9368,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9369_3,Fill 2 rx antipsych,ProFee,0989,G9369,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9370_3,Not fill 2 rx antipsych,ProFee,0989,G9370,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9376_3,Contd ret attach at 6mth f/u,ProFee,0989,G9376,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9377_3,No ret attach after 6mt,ProFee,0989,G9377,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9378_3,Contd ret attach f/u vis,ProFee,0989,G9378,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9379_3,No acheive flat ret 6mth,ProFee,0989,G9379,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9380_3,Off assis eol iss,ProFee,0989,G9380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9381_3,Doc med reas no offer eol,ProFee,0989,G9381,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9382_3,No off assis eol,ProFee,0989,G9382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9383_3,Recd scrn hcv infec,ProFee,0989,G9383,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9384_3,Doc med rsn no hcv scrn,ProFee,0989,G9384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9385_3,Doc pt reas not rec hcv srn,ProFee,0989,G9385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9386_3,Scrn hcv infec not recd,ProFee,0989,G9386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9389_3,Unpln rup post cap,ProFee,0989,G9389,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9390_3,No unpln rup post cap,ProFee,0989,G9390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9391_3,Achv refrac +1d,ProFee,0989,G9391,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9392_3,Not achv refrac +1d,ProFee,0989,G9392,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9393_3,Ini phq9 >9 remiss <5,ProFee,0989,G9393,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9394_3,"Dx bipol, death, nhres, hosp",ProFee,0989,G9394,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9395_3,Ini phq9 >9 no remiss >=5,ProFee,0989,G9395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9396_3,Ini phq9 >9 not assess,ProFee,0989,G9396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9399_3,Doc disc tx choices,ProFee,0989,G9399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9400_3,Doc reas no disc tx opt,ProFee,0989,G9400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9401_3,No disc tx choices,ProFee,0989,G9401,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9402_3,Recd f/u w/in 30d disch,ProFee,0989,G9402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9403_3,Doc reas no 30 day f/u,ProFee,0989,G9403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9404_3,No 30 day f/u,ProFee,0989,G9404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9405_3,Recd f/u w/in 7d dc,ProFee,0989,G9405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9406_3,Doc reas no 7d f/u,ProFee,0989,G9406,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9407_3,No 7d f/u,ProFee,0989,G9407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9408_3,Card tamp w/in 30d,ProFee,0989,G9408,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9409_3,No card tamp e/in 30d,ProFee,0989,G9409,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9410_3,Admit w/in 180d req remov,ProFee,0989,G9410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9411_3,No admit w/in 180d req remov,ProFee,0989,G9411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9412_3,Admit w/in 180d req surg rev,ProFee,0989,G9412,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9413_3,No admit req surg rev,ProFee,0989,G9413,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9414_3,1dose menig vac btwn 11 & 13,ProFee,0989,G9414,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9415_3,No 1dose meni vac btwn 11&13,ProFee,0989,G9415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9416_3,Pt 1 tdap betw 10-13 yrs,ProFee,0989,G9416,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9417_3,Pt not 1 tdap betw 10-13 yrs,ProFee,0989,G9417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9418_3,Lungcx bx rpt docs class,ProFee,0989,G9418,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9419_3,Med reas not incl histo type,ProFee,0989,G9419,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9420_3,Spec site no lung,ProFee,0989,G9420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9421_3,Lung cx bx rpt no doc class,ProFee,0989,G9421,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9422_3,Rpt doc class histo type,ProFee,0989,G9422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9423_3,Med reas rpt no histo type,ProFee,0989,G9423,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9424_3,Site no lung or lung cx,ProFee,0989,G9424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9425_3,Spec rpt no doc class histo,ProFee,0989,G9425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9426_3,Impr med time edarr pain med,ProFee,0989,G9426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9427_3,No impro med time pain med,ProFee,0989,G9427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9428_3,Patho rpt incl pt ctg,ProFee,0989,G9428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9429_3,Doc med rsn no pt cat,ProFee,0989,G9429,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9430_3,Spec site no cutaneous,ProFee,0989,G9430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9431_3,Patho rpt no pt ctg,ProFee,0989,G9431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9432_3,Asth controlled,ProFee,0989,G9432,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9433_3,"Death, nhres, hospice",ProFee,0989,G9433,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9434_3,Asth not controlled,ProFee,0989,G9434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9435_3,Asp presc disch,ProFee,0989,G9435,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9436_3,Asp not presc doc reas,ProFee,0989,G9436,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9437_3,Asp not presc disch,ProFee,0989,G9437,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9438_3,P2y inhib presc,ProFee,0989,G9438,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9439_3,P2y inhib not presc doc reas,ProFee,0989,G9439,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9440_3,P2y inhib not presc,ProFee,0989,G9440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9441_3,Statin presc disch,ProFee,0989,G9441,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9442_3,Statin not presc doc reas,ProFee,0989,G9442,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9443_3,Statin not presc disch,ProFee,0989,G9443,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9448_3,Born 1945-1965,ProFee,0989,G9448,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9449_3,Hx bld transf b/f 1992,ProFee,0989,G9449,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9450_3,Hx injec drug use,ProFee,0989,G9450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9451_3,1x scrn hcv infect,ProFee,0989,G9451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9452_3,Doc med reas no scrn hcv,ProFee,0989,G9452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9453_3,Pt reas no hcv infect,ProFee,0989,G9453,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9454_3,No scr hcv inf 12 mth rp,ProFee,0989,G9454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9455_3,"Abd imag w/us, ct or mri",ProFee,0989,G9455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9456_3,Doc med pt reas no hcc scrn,ProFee,0989,G9456,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9457_3,Pt no abd img no doc rsn,ProFee,0989,G9457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9458_3,Tob user recd cess interv,ProFee,0989,G9458,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9459_3,Tob non-user,ProFee,0989,G9459,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9460_3,No tob assess or cess inter,ProFee,0989,G9460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9463_3,Sinusitis intent,ProFee,0989,G9463,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9464_3,Sinusitis comp,ProFee,0989,G9464,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9465_3,Aoe intent,ProFee,0989,G9465,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9466_3,Aoe comp,ProFee,0989,G9466,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9467_3,Recd cortico >=10mg/day >60d,ProFee,0989,G9467,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9468_3,No recd cortico>=10mg/d >60d,ProFee,0989,G9468,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9469_3,Rec cortico>90d or 1rx 900mg,ProFee,0989,G9469,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9470_3,No rec cortico>60d 1rx 600mg,ProFee,0989,G9470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9471_3,W/in 2yr dxa not order,ProFee,0989,G9471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9472_3,No dxa no med hx no rv sx,ProFee,0989,G9472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9473_3,Chap services at hospice,ProFee,0989,G9473,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9474_3,Diet counsel at hospice,ProFee,0989,G9474,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9475_3,Other counselor at hospice,ProFee,0989,G9475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9476_3,Volun service at hospice,ProFee,0989,G9476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9477_3,Care coord at hospice,ProFee,0989,G9477,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9478_3,Othe therapist at hospice,ProFee,0989,G9478,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9479_3,Pharmacist at hospice,ProFee,0989,G9479,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9480_3,Admission to mccm,ProFee,0989,G9480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9481_3,Remote e/m new pt 10mins,ProFee,0989,G9481,,,,0,3.00,2.25,2.25,26.50,0.00,26.50,26.50,N/A
G9482_3,Remote e/m new pt 20mins,ProFee,0989,G9482,,,,0,3.00,2.25,2.25,50.50,0.00,50.50,50.50,N/A
G9483_3,Remote e/m new pt 30mins,ProFee,0989,G9483,,,,0,3.00,2.25,2.25,78.50,0.00,78.50,78.50,N/A
G9484_3,Remote e/m new pt 45mins,ProFee,0989,G9484,,,,0,3.00,2.25,2.25,132.50,0.00,132.50,132.50,N/A
G9485_3,Remote e/m new pt 60mins,ProFee,0989,G9485,,,,0,3.00,2.25,2.25,173.00,0.00,173.00,173.00,N/A
G9486_3,Remote e/m est. pt 10mins,ProFee,0989,G9486,,,,0,3.00,2.25,2.25,26.00,0.00,26.00,26.00,N/A
G9487_3,Remote e/m est. pt 15mins,ProFee,0989,G9487,,,,0,3.00,2.25,2.25,52.00,0.00,52.00,52.00,N/A
G9488_3,Remote e/m est. pt 25mins,ProFee,0989,G9488,,,,0,3.00,2.25,2.25,80.00,0.00,80.00,80.00,N/A
G9489_3,Remote e/m est. pt 40mins,ProFee,0989,G9489,,,,0,3.00,2.25,2.25,113.00,0.00,113.00,113.00,N/A
G9490_3,Cmmi mod home visit,ProFee,0989,G9490,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
G9496_3,Doc rsn no adeno/neopl detec,ProFee,0989,G9496,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9497_3,Rec inst no smoke day surg,ProFee,0989,G9497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9498_3,Abx reg prescribed,ProFee,0989,G9498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9499_3,No start/rec antvir tx hep c,ProFee,0989,G9499,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9500_3,Rad expos ind/exp tm doc,ProFee,0989,G9500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9501_3,Rad expos ind/exp tm no doc,ProFee,0989,G9501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9502_3,Med reas no perf foot exam,ProFee,0989,G9502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9503_3,Pt tk tams hcl,ProFee,0989,G9503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9504_3,Doc rsn hep b stat not asses,ProFee,0989,G9504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9505_3,Abx pres w/in 10 dys of symp,ProFee,0989,G9505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9506_3,Bio imm resp mod presc,ProFee,0989,G9506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9507_3,Doc reas on statin or contra,ProFee,0989,G9507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9508_3,Doc pt not on statin,ProFee,0989,G9508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9509_3,Adit mdd dys rem 12 mnths,ProFee,0989,G9509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9510_3,Remis12m not phq-9 score <5,ProFee,0989,G9510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9511_3,Idx evt dte phq>9 doc 12 mo,ProFee,0989,G9511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9512_3,Indiv pdc > 0.8,ProFee,0989,G9512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9513_3,Indiv pdc not > 0.8,ProFee,0989,G9513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9514_3,Req ret or w/in 90d of surg,ProFee,0989,G9514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9515_3,"No reas, no ret or w/in 90d",ProFee,0989,G9515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9516_3,Impr vis acuit w/in 90d,ProFee,0989,G9516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9517_3,No impr vis acuit w/in 90d,ProFee,0989,G9517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9518_3,Doc active inj drug use,ProFee,0989,G9518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9519_3,Final ref +/- 1.0 w/in 90d,ProFee,0989,G9519,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9520_3,Refract not +/- 1.0 w/in 90d,ProFee,0989,G9520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9521_3,Er and ip hosp <2 in 12 mos,ProFee,0989,G9521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9522_3,Er/ip hosp =/>2 in 12 mos,ProFee,0989,G9522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9523_3,D/c hemo or perit dialysis,ProFee,0989,G9523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9524_3,Refer to hospice,ProFee,0989,G9524,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9525_3,Doc pt reas no hospice refer,ProFee,0989,G9525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9526_3,"No reason, no refer hospice",ProFee,0989,G9526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9529_3,Minor blunt trauma w/head ct,ProFee,0989,G9529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9530_3,Pt mbht hd ct ord ec prov,ProFee,0989,G9530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9531_3,Pt doc,ProFee,0989,G9531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9532_3,Pt hd ct ord,ProFee,0989,G9532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9533_3,Indic for head ct not valid,ProFee,0989,G9533,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9534_3,Adv brain image not ordered,ProFee,0989,G9534,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9535_3,Normal neuro exam,ProFee,0989,G9535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9536_3,Doc med reas adv brain image,ProFee,0989,G9536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9537_3,Doc sysm rsn img hd,ProFee,0989,G9537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9538_3,Adv brain image ordered,ProFee,0989,G9538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9539_3,Intent pot remv time placemt,ProFee,0989,G9539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9540_3,Pt alive 3 mos post proc,ProFee,0989,G9540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9541_3,Filter rem 3 mon plmt,ProFee,0989,G9541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9542_3,Doc reass appr remo filt 3ms,ProFee,0989,G9542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9543_3,Doc 2x re-assess filt remov,ProFee,0989,G9543,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9544_3,No filt remov w/in 3mos plcm,ProFee,0989,G9544,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9547_3,Cys ren les or adren,ProFee,0989,G9547,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9548_3,No f/u rec image study,ProFee,0989,G9548,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9549_3,Doc med rsn for f/u imag,ProFee,0989,G9549,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9550_3,Imag rec,ProFee,0989,G9550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9551_3,Imag no les,ProFee,0989,G9551,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9552_3,Inc thyr node <1.0 in rpt,ProFee,0989,G9552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9553_3,Prior thyroid dise dx,ProFee,0989,G9553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9554_3,Ct/cta/mri/a chst foll rec,ProFee,0989,G9554,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9555_3,Doc med rsn for follup image,ProFee,0989,G9555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9556_3,Ct/cta/mri/a no follup imag,ProFee,0989,G9556,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9557_3,Ct/cta/mri/a no thyr <1.0cm,ProFee,0989,G9557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9558_3,Tx beta-lactam abx therapy,ProFee,0989,G9558,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9559_3,Doc med reas no abx therapy,ProFee,0989,G9559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9560_3,"No beta-lactam abx ther, rng",ProFee,0989,G9560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9561_3,Presc opiates >6 wks,ProFee,0989,G9561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9562_3,Foll-up eval q3mo opiod tx,ProFee,0989,G9562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9563_3,No f/u eval q3mo opiod tx,ProFee,0989,G9563,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9572_3,Phq-scr >9 doc in 12m time,ProFee,0989,G9572,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9573_3,Adl pt md or dys rem 6 mon,ProFee,0989,G9573,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9574_3,Adl pt md dys no rem 6 mon,ProFee,0989,G9574,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9577_3,Presc opiates >6 wks,ProFee,0989,G9577,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9578_3,Doc opioid tx 1x during ther,ProFee,0989,G9578,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9579_3,No doc opioid tx 1x at ther,ProFee,0989,G9579,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9580_3,Door to punc time <2hrs,ProFee,0989,G9580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9581_3,"Md doc, door to punc tm >2hr",ProFee,0989,G9581,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9582_3,"Door to punc time >2hr, nrg",ProFee,0989,G9582,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9583_3,Presc opiates >6 wks,ProFee,0989,G9583,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9584_3,Eval opioid use instr/pt int,ProFee,0989,G9584,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9585_3,No eval opi use instr/intv,ProFee,0989,G9585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9593_3,Low pecarn ped head trauma,ProFee,0989,G9593,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9594_3,Pt mbht hd ct ord ec prov,ProFee,0989,G9594,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9595_3,Doc shnt/tum/coag,ProFee,0989,G9595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9596_3,Ped pt hd ct ord,ProFee,0989,G9596,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9597_3,No low pecarn ped head traum,ProFee,0989,G9597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9598_3,Aor ane 5.5-5.9 cm max diam,ProFee,0989,G9598,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9599_3,Aor ane >=6.0 cm max diam,ProFee,0989,G9599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9600_3,Symp aaa urgent repair,ProFee,0989,G9600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9601_3,Pt dchg home post op day 7,ProFee,0989,G9601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9602_3,Pt no dchg home postop day 7,ProFee,0989,G9602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9603_3,Pt surv improv bsline tx,ProFee,0989,G9603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9604_3,Pt surv results not avail,ProFee,0989,G9604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9605_3,Surv score no improv w/tx,ProFee,0989,G9605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9606_3,Intraop cyst eval trac inj,ProFee,0989,G9606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9607_3,Doc med rsn not perf cystosc,ProFee,0989,G9607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9608_3,Intraop cyst eval not done,ProFee,0989,G9608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9609_3,Doc order anti-plat,ProFee,0989,G9609,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9610_3,Doc md rsn no antipla,ProFee,0989,G9610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9611_3,No doc order anti-plat rng,ProFee,0989,G9611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9612_3,Phodoc 2 mr cec lndmk,ProFee,0989,G9612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9613_3,Doc post surg anatomy,ProFee,0989,G9613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9614_3,Photodoc < 2 cec lndmk,ProFee,0989,G9614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9615_3,Pre-op asst doc,ProFee,0989,G9615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9616_3,Doc rsn no preop assmt,ProFee,0989,G9616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9617_3,"Pre-op asst not doc, rng",ProFee,0989,G9617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9618_3,Doc scr uter mal or us/samp,ProFee,0989,G9618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9619_3,Doc rsn no scr uter malig,ProFee,0989,G9619,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9620_3,No scr utr malig/us/samp rng,ProFee,0989,G9620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9621_3,Scr unheal etoh w/counsel,ProFee,0989,G9621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9622_3,No unheal etoh user,ProFee,0989,G9622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9623_3,Doc med rsn no scr etoh use,ProFee,0989,G9623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9624_3,Pt not scrn or no counseling,ProFee,0989,G9624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9625_3,Pt bl srg 30 day pst srg,ProFee,0989,G9625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9626_3,Med rsn no rpt baldder inj,ProFee,0989,G9626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9627_3,Pt no bl srg 30 day pst srg,ProFee,0989,G9627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9628_3,Pt bwli srg 30 day pst srg,ProFee,0989,G9628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9629_3,Med rsn no rpt bowel inj,ProFee,0989,G9629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9630_3,Pt no bwli srg 30 day srg,ProFee,0989,G9630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9631_3,Pt ui srg 30 day pst srg,ProFee,0989,G9631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9632_3,Med rsn for no rpt uret inj,ProFee,0989,G9632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9633_3,Pt no ui srg 30 day pst srg,ProFee,0989,G9633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9634_3,Qual life tool 2x same/impr,ProFee,0989,G9634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9635_3,No doc rsn do qual life assm,ProFee,0989,G9635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9636_3,No life asst 2x same/decr,ProFee,0989,G9636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9637_3,Doc >1 dose reduc tech,ProFee,0989,G9637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9638_3,No doc >1 dose reduc tech,ProFee,0989,G9638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9639_3,Amp no reqd in48h ieler proc,ProFee,0989,G9639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9640_3,Doc plan hybrid/stage proc,ProFee,0989,G9640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9641_3,Amp reqd w/in 48h ieler proc,ProFee,0989,G9641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9642_3,Current smoker,ProFee,0989,G9642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9643_3,Elective surgery,ProFee,0989,G9643,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9644_3,No smok b/4 anes day of surg,ProFee,0989,G9644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9645_3,Had smoke b/4 anes day surg,ProFee,0989,G9645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9646_3,Pt w/90d mrs 0-2,ProFee,0989,G9646,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9647_3,No mrs score in 90d followup,ProFee,0989,G9647,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9648_3,Pt w/90d mrs >2,ProFee,0989,G9648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9649_3,Psor as doc spc bm,ProFee,0989,G9649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9650_3,Doc pt no ther chg or contra,ProFee,0989,G9650,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9651_3,Psor as doc no spc bm,ProFee,0989,G9651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9652_3,Pt tx sys bio med psori 6mth,ProFee,0989,G9652,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9653_3,Pt no tx sys bio rx 6 mths,ProFee,0989,G9653,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9654_3,Mon anesth care,ProFee,0989,G9654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9655_3,Toc tool incl key elem,ProFee,0989,G9655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9656_3,Pt trans from anest to pacu,ProFee,0989,G9656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9657_3,Toc dur aneth to icu,ProFee,0989,G9657,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9658_3,Toc tool incl elem not used,ProFee,0989,G9658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9659_3,>85y no hx colo ca/rsn scope,ProFee,0989,G9659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9660_3,Doc med rsn scope pt >85y,ProFee,0989,G9660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9661_3,>85y scope othr rsn,ProFee,0989,G9661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9662_3,Prior dx/active clin ascvd,ProFee,0989,G9662,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9663_3,Fast/dir ldl <= 190 mg/dl,ProFee,0989,G9663,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9664_3,Taking statin or rec'd order,ProFee,0989,G9664,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9665_3,No statin/no order statin,ProFee,0989,G9665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9666_3,Fas/dir ldl 70-189mg/dl mst,ProFee,0989,G9666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9667_3,Doc med rsn no stat tx/presc,ProFee,0989,G9667,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9669_3,Intend rpt mult chr msr grp,ProFee,0989,G9669,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9670_3,Qty act mcc mg perf,ProFee,0989,G9670,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9671_3,Intend rpt dia retin msr grp,ProFee,0989,G9671,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9672_3,Qty act diab retin mg perf,ProFee,0989,G9672,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9673_3,Intend rpt card prev msr grp,ProFee,0989,G9673,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9674_3,Pt w/clin ascvd dx,ProFee,0989,G9674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9675_3,Pt w/fast/dir lab ldl-c >190,ProFee,0989,G9675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9676_3,40-75y w/type 1/2 w/ldl-c rs,ProFee,0989,G9676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9677_3,Qty act card prev mg perf,ProFee,0989,G9677,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
G9678_3,Oncology care model service,ProFee,0989,G9678,,,,0,3.00,2.25,2.25,222.50,0.00,222.50,222.50,N/A
G9679_3,Acute care pneumonia,ProFee,0989,G9679,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9680_3,Acute care congestive heart,ProFee,0989,G9680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9681_3,Acute care chronic obstruct,ProFee,0989,G9681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9682_3,Acute care skin infection,ProFee,0989,G9682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9683_3,Acute fluid/electro disorder,ProFee,0989,G9683,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9684_3,Acute care urinary tract inf,ProFee,0989,G9684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9685_3,Acute nursing facility care,ProFee,0989,G9685,,,,0,3.00,2.25,2.25,287.00,0.00,287.00,287.00,N/A
G9686_3,Nursing facility conference,ProFee,0989,G9686,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
G9687_3,Hospice anytime msmt per,ProFee,0989,G9687,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9688_3,Pt w/hosp anytime msmt per,ProFee,0989,G9688,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9689_3,Inpt elect carotid intervent,ProFee,0989,G9689,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9690_3,Pt in hos,ProFee,0989,G9690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9691_3,Pt hosp dur msmt period,ProFee,0989,G9691,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9692_3,Hosp recd by pt dur msmt per,ProFee,0989,G9692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9693_3,Pt use hosp during msmt per,ProFee,0989,G9693,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9694_3,Hosp srv used pt in msmt per,ProFee,0989,G9694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9695_3,Long act inhal bronchdil pre,ProFee,0989,G9695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9696_3,Med rsn no presc bronchdil,ProFee,0989,G9696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9697_3,Pt rsn no presc bronchdil,ProFee,0989,G9697,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9698_3,Sys rsn no presc bronchdil,ProFee,0989,G9698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9699_3,Long inhal bronchdil no pres,ProFee,0989,G9699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9700_3,Pt is w/hosp during msmt per,ProFee,0989,G9700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9701_3,Child anbx 30 prior dx estab,ProFee,0989,G9701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9702_3,Pt use hosp during msmt per,ProFee,0989,G9702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9703_3,Child anbx 30 prior dx phary,ProFee,0989,G9703,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9704_3,Ajcc br ca stg i: t1 mic/t1a,ProFee,0989,G9704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9705_3,Ajcc br ca stg ib,ProFee,0989,G9705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9706_3,Low recur prost ca,ProFee,0989,G9706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9707_3,Pt had hosp dur msmt per,ProFee,0989,G9707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9708_3,Bilat mast/hx bi /unilat mas,ProFee,0989,G9708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9709_3,Hosp srv used pt in msmt per,ProFee,0989,G9709,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9710_3,Pt prov hosp srv msmt per,ProFee,0989,G9710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9711_3,Pt hx tot col or colon ca,ProFee,0989,G9711,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9712_3,Doc med rsn presc anbx,ProFee,0989,G9712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9713_3,Pt use hosp during msmt per,ProFee,0989,G9713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9714_3,Pt is w/hosp during msmt per,ProFee,0989,G9714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9715_3,Pt w/hosp anytime msmt per,ProFee,0989,G9715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9716_3,Bmi doc onl fup not cmpltd,ProFee,0989,G9716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9717_3,Doc pt dx dep/bp f/u nt req,ProFee,0989,G9717,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9718_3,Hospice anytime msmt per,ProFee,0989,G9718,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9719_3,Pt not ambul/immob/wc,ProFee,0989,G9719,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9720_3,Hospice anytime msmt per,ProFee,0989,G9720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9721_3,Pt not ambul/immob/wc,ProFee,0989,G9721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9722_3,Doc hx renal fail or cr+ >4,ProFee,0989,G9722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9723_3,Hosp recd by pt dur msmt per,ProFee,0989,G9723,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9724_3,Pt w/doc use anticoag mst yr,ProFee,0989,G9724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9725_3,Pt w/hosp anytime msmt per,ProFee,0989,G9725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9726_3,Refused to participate,ProFee,0989,G9726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9727_3,Pt unable cmplt knee fs prom,ProFee,0989,G9727,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9728_3,Refused to participate,ProFee,0989,G9728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9729_3,Pt unbl cmplt hip fs prom,ProFee,0989,G9729,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9730_3,Refused to participate,ProFee,0989,G9730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9731_3,Pt unbl cmplt ft/ank fs prom,ProFee,0989,G9731,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9732_3,Refused to participate,ProFee,0989,G9732,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9733_3,Pt unbl cmplt lb fs prom,ProFee,0989,G9733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9734_3,Refused to participate,ProFee,0989,G9734,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9735_3,Pt unbl cmplt shld fs prom,ProFee,0989,G9735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9736_3,Refused to participate,ProFee,0989,G9736,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9737_3,Pt unbl cmplt ewh fs prom,ProFee,0989,G9737,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9738_3,Refused to participate,ProFee,0989,G9738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9739_3,Pt unbl cmplt go fs prom,ProFee,0989,G9739,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9740_3,Hosp srv to pt dur msmt per,ProFee,0989,G9740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9741_3,Pt w/hosp anytime msmt per,ProFee,0989,G9741,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9742_3,Psych sympt assessed,ProFee,0989,G9742,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9743_3,"Psych symp not assessed, rns",ProFee,0989,G9743,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9744_3,Pt not eli d/t act dig htn,ProFee,0989,G9744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9745_3,Doc rsn no hbp scrn or f/u,ProFee,0989,G9745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9746_3,"Mit sten, valve or trans af",ProFee,0989,G9746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9747_3,Pall dialysis with catheter,ProFee,0989,G9747,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9748_3,App transpl lvg kidney donor,ProFee,0989,G9748,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9749_3,Pall dialysis with catheter,ProFee,0989,G9749,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9750_3,App transpl lvg kidney donor,ProFee,0989,G9750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9751_3,Pt died w/in 24 mos rpt time,ProFee,0989,G9751,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9752_3,Urgent surgery,ProFee,0989,G9752,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9753_3,"Doc no dicom, ct other fac",ProFee,0989,G9753,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9754_3,Incid pulm nodule,ProFee,0989,G9754,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9755_3,Doc med rsn no fllw up,ProFee,0989,G9755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9756_3,Surg proc w/silicone oil,ProFee,0989,G9756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9757_3,Surg proc w/silicone oil,ProFee,0989,G9757,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9758_3,Pt in hos,ProFee,0989,G9758,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9759_3,Hx preop post cap rup,ProFee,0989,G9759,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9760_3,Pt w/hosp anytime msmt per,ProFee,0989,G9760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9761_3,Pt w/hosp anytime msmt per,ProFee,0989,G9761,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9762_3,Pt had >= 2-3 hpv vaccines,ProFee,0989,G9762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9763_3,Pt not have 2-3 hpv vaccines,ProFee,0989,G9763,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9764_3,Pt treatd w/oral syst or bio,ProFee,0989,G9764,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9765_3,Doc pat declined therapy,ProFee,0989,G9765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9766_3,Cva stroke dx tx transf fac,ProFee,0989,G9766,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9767_3,Hosp new dx cva consid evst,ProFee,0989,G9767,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9768_3,Pt w/hosp anytime msmt per,ProFee,0989,G9768,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9769_3,Bn den 2yr/got ost med/ther,ProFee,0989,G9769,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9770_3,Perip nerve block,ProFee,0989,G9770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9771_3,"Anes end, 1 temp >35.5(95.9)",ProFee,0989,G9771,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9772_3,Doc med rsn no temp >= 35.5,ProFee,0989,G9772,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9773_3,1 bod temp >=35.5,ProFee,0989,G9773,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9774_3,Pt had hyst,ProFee,0989,G9774,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9775_3,Recd 2 anti-emet pre/intraop,ProFee,0989,G9775,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9776_3,Doc med rsn no proph antiem,ProFee,0989,G9776,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9777_3,Pt no antiemet pre/intraop,ProFee,0989,G9777,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9778_3,Pts dx w/pregn,ProFee,0989,G9778,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9779_3,Pts breastfeeding,ProFee,0989,G9779,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9780_3,Pts dx w/rhabdomyolysis,ProFee,0989,G9780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9781_3,Doc rsn no statin,ProFee,0989,G9781,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9782_3,Hx dx fam/pure hypercholes,ProFee,0989,G9782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9783_3,"Doc dx dm, fast <70, no stat",ProFee,0989,G9783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9784_3,Path/derm prov 2nd biop opin,ProFee,0989,G9784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9785_3,Path report sent,ProFee,0989,G9785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9786_3,Path report not sent,ProFee,0989,G9786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9787_3,Pt alive,ProFee,0989,G9787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9788_3,Most rct bp </= 140/90,ProFee,0989,G9788,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9789_3,"Record bp ip, er, urg/self",ProFee,0989,G9789,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9790_3,Most rct bp >/= 140/90,ProFee,0989,G9790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9791_3,Most rct tob stat free,ProFee,0989,G9791,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9792_3,Most rct tob stat not free,ProFee,0989,G9792,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9793_3,Pt on daily asa/antiplat,ProFee,0989,G9793,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9794_3,Doc med rsn no daily aspirin,ProFee,0989,G9794,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9795_3,Pt no daily asa/antiplat,ProFee,0989,G9795,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9796_3,Pt not currently on statin,ProFee,0989,G9796,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9797_3,Pt currently on statin,ProFee,0989,G9797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9798_3,D/c ami btw 7/1-6/30 meas pd,ProFee,0989,G9798,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9799_3,Med disp evt indic hx asth,ProFee,0989,G9799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9800_3,Pt id intol/alleg beta-block,ProFee,0989,G9800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9801_3,Nonacut transf from inpt,ProFee,0989,G9801,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9802_3,Pt w/hosp anytime msmt per,ProFee,0989,G9802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9803_3,Pt presc 135 day trmt,ProFee,0989,G9803,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9804_3,Pt not presc 135 day trmt,ProFee,0989,G9804,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9805_3,Pt w/hosp anytime msmt per,ProFee,0989,G9805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9806_3,Pt recd cerv cyto/hpv,ProFee,0989,G9806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9807_3,Pt no recd cerv cyto/hpv,ProFee,0989,G9807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9808_3,Pt no asthm cont med mst per,ProFee,0989,G9808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9809_3,Pt w/hosp anytime msmt per,ProFee,0989,G9809,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9810_3,Pdc 75% w/asth cont med,ProFee,0989,G9810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9811_3,No pdc 75% w/asth cont med,ProFee,0989,G9811,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9812_3,Pt died during inpt/30d aft,ProFee,0989,G9812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9813_3,Pt not died w/in 30d of proc,ProFee,0989,G9813,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9814_3,Death during index hosp,ProFee,0989,G9814,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9815_3,Death not during index hosp,ProFee,0989,G9815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9816_3,Death <30 day post discharge,ProFee,0989,G9816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9817_3,No death 30-days post-disch,ProFee,0989,G9817,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9818_3,Doc sex activity,ProFee,0989,G9818,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9819_3,Pt w/hosp anytime msmt per,ProFee,0989,G9819,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9820_3,Doc chlam scr test w/follow,ProFee,0989,G9820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9821_3,No doc chlam scr ts w/follow,ProFee,0989,G9821,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9822_3,Endo abl proc yr prev ind dt,ProFee,0989,G9822,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9823_3,Endo smpl/hyst bx res doc,ProFee,0989,G9823,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9824_3,Endo smpl/hyst bx res no doc,ProFee,0989,G9824,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9825_3,"Her-2 neg,undoc/unkn",ProFee,0989,G9825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9826_3,Transf pract aft init chemo,ProFee,0989,G9826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9827_3,Her-2 targ ther no init tx,ProFee,0989,G9827,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9828_3,Her-2 targ ther dur init tx,ProFee,0989,G9828,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9829_3,Breast adj chemo admin,ProFee,0989,G9829,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9830_3,Her-2 pos,ProFee,0989,G9830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9831_3,Ajcc stg brt ca dx ii or iii,ProFee,0989,G9831,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9832_3,"Brt ca dx i, no t1/t1a/t1b",ProFee,0989,G9832,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9833_3,Transf pract aft init chemo,ProFee,0989,G9833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9834_3,Pt met dis at dx,ProFee,0989,G9834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9835_3,Trastuz given w/in 12 mos dx,ProFee,0989,G9835,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9836_3,Rsn no trast given doc,ProFee,0989,G9836,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9837_3,Trastuz not in 12 mos dx,ProFee,0989,G9837,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9838_3,Pt met dis at dx,ProFee,0989,G9838,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9839_3,Anti-egfr mon anti ther,ProFee,0989,G9839,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9840_3,Gene testing performed,ProFee,0989,G9840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9841_3,Gene testing not performed,ProFee,0989,G9841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9842_3,Pt met dis at dx,ProFee,0989,G9842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9843_3,Kras or nras gene mutation,ProFee,0989,G9843,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9844_3,Pt no recd anti-egfr ther,ProFee,0989,G9844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9845_3,Pt recd anti-egfr ther,ProFee,0989,G9845,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9846_3,Pt died from cancer,ProFee,0989,G9846,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9847_3,Pt recd chemo last 14d life,ProFee,0989,G9847,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9848_3,Pt no chemo last 14d life,ProFee,0989,G9848,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9849_3,Pt died from cancer,ProFee,0989,G9849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9850_3,1/more ed last 30d life,ProFee,0989,G9850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9851_3,1/no ed visit last 30d life,ProFee,0989,G9851,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9852_3,Pt died from cancer,ProFee,0989,G9852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9853_3,Icu stay last 30d life,ProFee,0989,G9853,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9854_3,No icu stay last 30d life,ProFee,0989,G9854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9855_3,Pt died from cancer,ProFee,0989,G9855,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9856_3,Pt no hospice,ProFee,0989,G9856,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9857_3,Pt admit hospice,ProFee,0989,G9857,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9858_3,Pt enroll hospice,ProFee,0989,G9858,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9859_3,Pt died from cancer,ProFee,0989,G9859,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9860_3,Pt less 3d hospice,ProFee,0989,G9860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9861_3,Pt more than 3d hospice,ProFee,0989,G9861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9862_3,Doc rsn no 10 yr follow,ProFee,0989,G9862,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9868_3,Next gen aco model <10min,ProFee,0989,G9868,,,,0,3.00,2.25,2.25,40.00,0.00,40.00,40.00,N/A
G9869_3,Next gen aco model 10-20min,ProFee,0989,G9869,,,,0,3.00,2.25,2.25,53.50,0.00,53.50,53.50,N/A
G9870_3,Next gen aco model >20min,ProFee,0989,G9870,,,,0,3.00,2.25,2.25,67.00,0.00,67.00,67.00,N/A
G9873_3,1 em core session,ProFee,0989,G9873,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
G9874_3,4 em core sessions,ProFee,0989,G9874,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
G9875_3,9 em core sessions,ProFee,0989,G9875,,,,0,3.00,2.25,2.25,125.00,0.00,125.00,125.00,N/A
G9876_3,2 em core ms mo 7-9 no wl,ProFee,0989,G9876,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
G9877_3,2 em core ms mo 10-12 no wl,ProFee,0989,G9877,,,,0,3.00,2.25,2.25,21.00,0.00,21.00,21.00,N/A
G9878_3,2 em core ms mo 7-9 wl,ProFee,0989,G9878,,,,0,3.00,2.25,2.25,83.50,0.00,83.50,83.50,N/A
G9879_3,2 em core ms mo 10-12 wl,ProFee,0989,G9879,,,,0,3.00,2.25,2.25,83.50,0.00,83.50,83.50,N/A
G9880_3,Em 5 percent wl,ProFee,0989,G9880,,,,0,3.00,2.25,2.25,222.00,0.00,222.00,222.00,N/A
G9881_3,Em 9 percent wl,ProFee,0989,G9881,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
G9882_3,2 em ongoing ms mo 13-15 wl,ProFee,0989,G9882,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
G9883_3,2 em ongoing ms mo 16-18 wl,ProFee,0989,G9883,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
G9884_3,2 em ongoing ms mo 19-21 wl,ProFee,0989,G9884,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
G9885_3,2 em ongoing ms mo 22-24 wl,ProFee,0989,G9885,,,,0,3.00,2.25,2.25,69.50,0.00,69.50,69.50,N/A
G9890_3,Em bridge payment,ProFee,0989,G9890,,,,0,3.00,2.25,2.25,34.50,0.00,34.50,34.50,N/A
G9891_3,Em session reporting,ProFee,0989,G9891,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9892_3,Doc pt rsn no dil mac exam,ProFee,0989,G9892,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9893_3,No mac exam,ProFee,0989,G9893,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9894_3,Adr dep thrpy prescribed,ProFee,0989,G9894,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9895_3,Doc med rsn no adr dep thrpy,ProFee,0989,G9895,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9896_3,Doc pt rsn no adr dep thrpy,ProFee,0989,G9896,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9897_3,Pt nt prsc adr dep thrpy rng,ProFee,0989,G9897,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9898_3,Pt 66+ snp or ltc pos,ProFee,0989,G9898,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9899_3,Scrn mam perf rslts doc,ProFee,0989,G9899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9900_3,Scrn mam perf rslts not doc,ProFee,0989,G9900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9901_3,Pt 66+ snp or ltc pos,ProFee,0989,G9901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9902_3,Pt scrn tbco and id as user,ProFee,0989,G9902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9903_3,Pt scrn tbco id as non user,ProFee,0989,G9903,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9904_3,Doc med rsn no tbco scrn,ProFee,0989,G9904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9905_3,No pt tbco scrn rng,ProFee,0989,G9905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9906_3,Pt recv tbco cess interv,ProFee,0989,G9906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9907_3,Doc med rsn no tbco interv,ProFee,0989,G9907,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9908_3,No pt tbco cess interv rng,ProFee,0989,G9908,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9909_3,Doc med rsn no tbco interv,ProFee,0989,G9909,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9910_3,Pt 66+ snp or ltc pos,ProFee,0989,G9910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9911_3,Node neg pre/post syst ther,ProFee,0989,G9911,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9912_3,Hbv status assesed and int,ProFee,0989,G9912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9913_3,No hbv status assesd and int,ProFee,0989,G9913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9914_3,Pt receiving anti-tnf agent,ProFee,0989,G9914,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9915_3,No documntd hbv results rcd,ProFee,0989,G9915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9916_3,Funct status past 12 months,ProFee,0989,G9916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9917_3,Adv dem crgvr limited,ProFee,0989,G9917,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9918_3,"No funct stat perf, rsn nos",ProFee,0989,G9918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9919_3,Scrn nd pos nd prov of rec,ProFee,0989,G9919,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9920_3,Scrning perf and negative,ProFee,0989,G9920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9921_3,No or part scrn nd rng or os,ProFee,0989,G9921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9922_3,Sfty cncrns scrn nd mit recs,ProFee,0989,G9922,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9923_3,Safty cncrns scrn and neg,ProFee,0989,G9923,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9924_3,Doc med rsn no scrn or recs,ProFee,0989,G9924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9925_3,No scrn prov rsn nos,ProFee,0989,G9925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9926_3,Sfty cncrns scrn but no recs,ProFee,0989,G9926,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9927_3,Doc no warf /fda  pt trial,ProFee,0989,G9927,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9928_3,No warf or fda drug presc,ProFee,0989,G9928,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9929_3,Trs/rev af,ProFee,0989,G9929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9930_3,Com care,ProFee,0989,G9930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9931_3,No chad or chad scr 0 or 1,ProFee,0989,G9931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9932_3,Doc pt rsn no tb scrn recrds,ProFee,0989,G9932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9933_3,Canc detectd during col scrn,ProFee,0989,G9933,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9934_3,Doc rsn not detecting cancer,ProFee,0989,G9934,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9935_3,Canc not detectd during srcn,ProFee,0989,G9935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9936_3,Pmh plyp/neo co/rect/jun/ans,ProFee,0989,G9936,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9937_3,Dig or surv colsco,ProFee,0989,G9937,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9938_3,Pt 66+ snp or ltc pos,ProFee,0989,G9938,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9939_3,Same path/derm perf biopsy,ProFee,0989,G9939,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9940_3,Doc reas no statin therapy,ProFee,0989,G9940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9941_3,Pre and post vas wthn 3 mos,ProFee,0989,G9941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9942_3,Adtl spine proc on same date,ProFee,0989,G9942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9943_3,Bk pn nt msr vas scl pre/pst,ProFee,0989,G9943,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9944_3,Vas 3 mon pre and 1 yr post,ProFee,0989,G9944,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9945_3,Pt w/cancer  scoliosis,ProFee,0989,G9945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9946_3,Bk pain no vas,ProFee,0989,G9946,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9947_3,Pre and post vas wthn 3 mos,ProFee,0989,G9947,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9948_3,Adtl spine proc on same date,ProFee,0989,G9948,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9949_3,Leg pain no vas,ProFee,0989,G9949,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9954_3,Pt >2 rsk fac post-op vomit,ProFee,0989,G9954,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9955_3,Inhlnt anesth only for induc,ProFee,0989,G9955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9956_3,Combo thrpy of >= 2 prophly,ProFee,0989,G9956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9957_3,Doc med rsn no combo thrpy,ProFee,0989,G9957,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9958_3,No combo prohpyl thrp for pt,ProFee,0989,G9958,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9959_3,Systemic antimicro not presc,ProFee,0989,G9959,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9960_3,Med rsn sys antimi nt rx,ProFee,0989,G9960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9961_3,Systemic antimicro presc,ProFee,0989,G9961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9962_3,Embolization doc separatly,ProFee,0989,G9962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9963_3,Embolization not doc separat,ProFee,0989,G9963,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9964_3,Pt recv >=1 well-chld visit,ProFee,0989,G9964,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9965_3,No well-chld vist recv by pt,ProFee,0989,G9965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9966_3,"Scrn, inter, report child",ProFee,0989,G9966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9967_3,"No scrn, inter, reprt child",ProFee,0989,G9967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9968_3,Pt refrd 2 pvdr/spclst in pp,ProFee,0989,G9968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9969_3,Pvdr rfrd pt rprt rcvd,ProFee,0989,G9969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9970_3,Pvdr rfrd pt no rprt rcvd,ProFee,0989,G9970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9974_3,Mac exam perf,ProFee,0989,G9974,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9975_3,Doc med rsn no dil mac exam,ProFee,0989,G9975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
G9978_3,Remote e/m new pt 10mins,ProFee,0989,G9978,,,,0,3.00,2.25,2.25,38.00,0.00,38.00,38.00,N/A
G9979_3,Remote e/m new pt 20mins,ProFee,0989,G9979,,,,0,3.00,2.25,2.25,71.50,0.00,71.50,71.50,N/A
G9980_3,Remote e/m new pt 30 mins,ProFee,0989,G9980,,,,0,3.00,2.25,2.25,108.50,0.00,108.50,108.50,N/A
G9981_3,Remote e/m new pt 45mins,ProFee,0989,G9981,,,,0,3.00,2.25,2.25,183.00,0.00,183.00,183.00,N/A
G9982_3,Remote e/m new pt 60mins,ProFee,0989,G9982,,,,0,3.00,2.25,2.25,239.00,0.00,239.00,239.00,N/A
G9983_3,Remote e/m est. pt 10mins,ProFee,0989,G9983,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
G9984_3,Remote e/m est. pt  15mins,ProFee,0989,G9984,,,,0,3.00,2.25,2.25,72.50,0.00,72.50,72.50,N/A
G9985_3,Remote e/m est. pt 25mins,ProFee,0989,G9985,,,,0,3.00,2.25,2.25,111.00,0.00,111.00,111.00,N/A
G9986_3,Remote e/m est. pt 40mins,ProFee,0989,G9986,,,,0,3.00,2.25,2.25,157.00,0.00,157.00,157.00,N/A
G9987_3,Bpci advanced in home visit,ProFee,0989,G9987,,,,0,3.00,2.25,2.25,63.50,0.00,63.50,63.50,N/A
H0001_3,Alcohol and/or drug assess,ProFee,0989,H0001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0002_3,Alcohol and/or drug screenin,ProFee,0989,H0002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0003_3,Alcohol and/or drug screenin,ProFee,0989,H0003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0004_3,Alcohol and/or drug services,ProFee,0989,H0004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0005_3,Alcohol and/or drug services,ProFee,0989,H0005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0006_3,Alcohol and/or drug services,ProFee,0989,H0006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0007_3,Alcohol and/or drug services,ProFee,0989,H0007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0008_3,Alcohol and/or drug services,ProFee,0989,H0008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0009_3,Alcohol and/or drug services,ProFee,0989,H0009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0010_3,Alcohol and/or drug services,ProFee,0989,H0010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0011_3,Alcohol and/or drug services,ProFee,0989,H0011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0012_3,Alcohol and/or drug services,ProFee,0989,H0012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0013_3,Alcohol and/or drug services,ProFee,0989,H0013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0014_3,Alcohol and/or drug services,ProFee,0989,H0014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0015_3,Alcohol and/or drug services,ProFee,0989,H0015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0016_3,Alcohol and/or drug services,ProFee,0989,H0016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0017_3,Alcohol and/or drug services,ProFee,0989,H0017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0018_3,Alcohol and/or drug services,ProFee,0989,H0018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0019_3,Alcohol and/or drug services,ProFee,0989,H0019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0020_3,Alcohol and/or drug services,ProFee,0989,H0020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0021_3,Alcohol and/or drug training,ProFee,0989,H0021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0022_3,Alcohol and/or drug interven,ProFee,0989,H0022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0023_3,Alcohol and/or drug outreach,ProFee,0989,H0023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0024_3,Alcohol and/or drug preventi,ProFee,0989,H0024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0025_3,Alcohol and/or drug preventi,ProFee,0989,H0025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0026_3,Alcohol and/or drug preventi,ProFee,0989,H0026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0027_3,Alcohol and/or drug preventi,ProFee,0989,H0027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0028_3,Alcohol and/or drug preventi,ProFee,0989,H0028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0029_3,Alcohol and/or drug preventi,ProFee,0989,H0029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0030_3,Alcohol and/or drug hotline,ProFee,0989,H0030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0031_3,MH health assess by non-md,ProFee,0989,H0031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0032_3,MH svc plan dev by non-md,ProFee,0989,H0032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0033_3,Oral med adm direct observe,ProFee,0989,H0033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0034_3,Med trng & support per 15min,ProFee,0989,H0034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0035_3,MH partial hosp tx under 24h,ProFee,0989,H0035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0036_3,Comm psy face-face per 15min,ProFee,0989,H0036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0037_3,Comm psy sup tx pgm per diem,ProFee,0989,H0037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0038_3,Self-help/peer svc per 15min,ProFee,0989,H0038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0039_3,Asser com tx face-face/15min,ProFee,0989,H0039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0040_3,Assert comm tx pgm per diem,ProFee,0989,H0040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0041_3,Fos c chld non-ther per diem,ProFee,0989,H0041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0042_3,Fos c chld non-ther per mon,ProFee,0989,H0042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0043_3,"Supported housing, per diem",ProFee,0989,H0043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0044_3,"Supported housing, per month",ProFee,0989,H0044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0045_3,Respite not-in-home per diem,ProFee,0989,H0045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0046_3,"Mental health service, nos",ProFee,0989,H0046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0047_3,Alcohol/drug abuse svc nos,ProFee,0989,H0047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0048_3,Spec coll non-blood:a/d test,ProFee,0989,H0048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0049_3,Alcohol/drug screening,ProFee,0989,H0049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H0050_3,Alcohol/drug service 15 min,ProFee,0989,H0050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1000_3,Prenatal care atrisk assessm,ProFee,0989,H1000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1001_3,Antepartum management,ProFee,0989,H1001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1002_3,Carecoordination prenatal,ProFee,0989,H1002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1003_3,Prenatal at risk education,ProFee,0989,H1003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1004_3,Follow up home visit/prental,ProFee,0989,H1004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1005_3,Prenatalcare enhanced srv pk,ProFee,0989,H1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1010_3,Nonmed family planning ed,ProFee,0989,H1010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H1011_3,Family assessment,ProFee,0989,H1011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2000_3,Comp multidisipln evaluation,ProFee,0989,H2000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2001_3,Rehabilitation program 1/2 d,ProFee,0989,H2001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2010_3,Comprehensive med svc 15 min,ProFee,0989,H2010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2011_3,"Crisis interven svc, 15 min",ProFee,0989,H2011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2012_3,"Behav hlth day treat, per hr",ProFee,0989,H2012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2013_3,"Psych hlth fac svc, per diem",ProFee,0989,H2013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2014_3,"Skills train and dev, 15 min",ProFee,0989,H2014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2015_3,"Comp comm supp svc, 15 min",ProFee,0989,H2015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2016_3,"Comp comm supp svc, per diem",ProFee,0989,H2016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2017_3,"Psysoc rehab svc, per 15 min",ProFee,0989,H2017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2018_3,"Psysoc rehab svc, per diem",ProFee,0989,H2018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2019_3,"Ther behav svc, per 15 min",ProFee,0989,H2019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2020_3,"Ther behav svc, per diem",ProFee,0989,H2020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2021_3,"Com wrap-around sv, 15 min",ProFee,0989,H2021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2022_3,"Com wrap-around sv, per diem",ProFee,0989,H2022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2023_3,"Supported employ, per 15 min",ProFee,0989,H2023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2024_3,"Supported employ, per diem",ProFee,0989,H2024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2025_3,"Supp maint employ, 15 min",ProFee,0989,H2025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2026_3,"Supp maint employ, per diem",ProFee,0989,H2026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2027_3,"Psychoed svc, per 15 min",ProFee,0989,H2027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2028_3,"Sex offend tx svc, 15 min",ProFee,0989,H2028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2029_3,"Sex offend tx svc, per diem",ProFee,0989,H2029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2030_3,"MH clubhouse svc, per 15 min",ProFee,0989,H2030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2031_3,"MH clubhouse svc, per diem",ProFee,0989,H2031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2032_3,"Activity therapy, per 15 min",ProFee,0989,H2032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2033_3,Multisys ther/juvenile 15min,ProFee,0989,H2033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2034_3,"A/D halfway house, per diem",ProFee,0989,H2034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2035_3,"A/D tx program, per hour",ProFee,0989,H2035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2036_3,"A/D tx program, per diem",ProFee,0989,H2036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
H2037_3,"Dev delay prev dp ch, 15 min",ProFee,0989,H2037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
ICOV_1,COVID RAPID IN HOUSE,Inpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
ICOV_1,COVID RAPID IN HOUSE,Outpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
J0120_3,Tetracyclin injection,ProFee,0989,J0120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0121_3,"Inj., omadacycline, 1 mg",ProFee,0989,J0121,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0122_3,"Inj., eravacycline, 1 mg",ProFee,0989,J0122,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0128_3,Abarelix injection,ProFee,0989,J0128,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0129_3,Abatacept injection,ProFee,0989,J0129,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0130_3,Abciximab injection,ProFee,0989,J0130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0131_3,Acetaminophen injection,ProFee,0989,J0131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0132_3,Acetylcysteine injection,ProFee,0989,J0132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0133_3,Acyclovir injection,ProFee,0989,J0133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0135_3,Adalimumab injection,ProFee,0989,J0135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0150_3,Injection adenosine 6 MG,ProFee,0989,J0150,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0151_3,Inj adenosine diag 1mg,ProFee,0989,J0151,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0152_3,Adenosine injection,ProFee,0989,J0152,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0153_3,Adenosine inj 1mg,ProFee,0989,J0153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0170_3,Adrenalin epinephrin inject,ProFee,0989,J0170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0171_2,Adrenalin epinephrine inject,Outpatient,0521,J0171,,,,0,21.00,15.75,15.75,19.95,18.90,19.95,0.00,18.90
J0171_2,Adrenalin epinephrine inject,Inpatient,0521,J0171,,,,0,21.00,15.75,15.75,19.95,18.90,19.95,19.95,18.90
J0171_3,Adrenalin epinephrine inject,Outpatient,0521,J0171,,,,0,24.00,18.00,18.00,22.80,21.60,22.80,0.00,21.60
J0171_3,Adrenalin epinephrine inject,Inpatient,0521,J0171,,,,0,24.00,18.00,18.00,22.80,21.60,22.80,22.80,21.60
J0178_3,Aflibercept injection,ProFee,0989,J0178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0179_3,"Inj, brolucizumab-dbll, 1 mg",ProFee,0989,J0179,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0180_3,Agalsidase beta injection,ProFee,0989,J0180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0185_3,"Inj., aprepitant, 1 mg",ProFee,0989,J0185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0190_3,Inj biperiden lactate/5 mg,ProFee,0989,J0190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0200_3,Alatrofloxacin mesylate,ProFee,0989,J0200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0202_3,"Injection, alemtuzumab",ProFee,0989,J0202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0205_3,Alglucerase injection,ProFee,0989,J0205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0207_3,Amifostine,ProFee,0989,J0207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0210_3,Methyldopate hcl injection,ProFee,0989,J0210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0215_3,Alefacept,ProFee,0989,J0215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0220_3,Aglucosidase alfa injection,ProFee,0989,J0220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0221_3,Lumizyme injection,ProFee,0989,J0221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0222_3,"Inj., patisiran, 0.1 mg",ProFee,0989,J0222,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0256_3,Alpha 1 proteinase inhibitor,ProFee,0989,J0256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0257_3,Glassia injection,ProFee,0989,J0257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0270_3,Alprostadil for injection,ProFee,0989,J0270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0275_3,Alprostadil urethral suppos,ProFee,0989,J0275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0278_3,Amikacin sulfate injection,ProFee,0989,J0278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0280_3,Aminophyllin 250 MG inj,ProFee,0989,J0280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0282_3,Amiodarone HCl,ProFee,0989,J0282,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0285_3,Amphotericin B,ProFee,0989,J0285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0287_3,Amphotericin b lipid complex,ProFee,0989,J0287,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0288_3,Ampho b cholesteryl sulfate,ProFee,0989,J0288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0289_3,Amphotericin b liposome inj,ProFee,0989,J0289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0290_3,Ampicillin 500 MG inj,ProFee,0989,J0290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0291_3,"Inj., plazomicin, 5 mg",ProFee,0989,J0291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0295_3,Ampicillin sodium per 1.5 gm,ProFee,0989,J0295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0300_3,Amobarbital 125 MG inj,ProFee,0989,J0300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0330_3,Succinycholine chloride inj,ProFee,0989,J0330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0348_3,Anadulafungin injection,ProFee,0989,J0348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0350_3,Injection anistreplase 30 u,ProFee,0989,J0350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0360_3,Hydralazine hcl injection,ProFee,0989,J0360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0364_3,Apomorphine hydrochloride,ProFee,0989,J0364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0365_3,"Aprotonin, 10,000 kiu",ProFee,0989,J0365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0380_3,Inj metaraminol bitartrate,ProFee,0989,J0380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0390_3,Chloroquine injection,ProFee,0989,J0390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0395_3,Arbutamine HCl injection,ProFee,0989,J0395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0400_3,Aripiprazole injection,ProFee,0989,J0400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0401_3,Inj aripiprazole ext rel 1mg,ProFee,0989,J0401,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0456_3,Azithromycin,ProFee,0989,J0456,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0460_3,Atropine sulfate injection,ProFee,0989,J0460,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0461_3,Atropine sulfate injection,ProFee,0989,J0461,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0470_3,Dimecaprol injection,ProFee,0989,J0470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0475_3,Baclofen 10 MG injection,ProFee,0989,J0475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0476_3,Baclofen intrathecal trial,ProFee,0989,J0476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0480_3,Basiliximab,ProFee,0989,J0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0485_3,Belatacept injection,ProFee,0989,J0485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0490_3,Belimumab injection,ProFee,0989,J0490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0500_3,Dicyclomine injection,ProFee,0989,J0500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0515_3,Inj benztropine mesylate,ProFee,0989,J0515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0517_3,"Inj., benralizumab, 1 mg",ProFee,0989,J0517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0520_3,Bethanechol chloride inject,ProFee,0989,J0520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0530_3,Penicillin g benzathine inj,ProFee,0989,J0530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0540_3,Penicillin g benzathine inj,ProFee,0989,J0540,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0550_3,Penicillin g benzathine inj,ProFee,0989,J0550,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0558_3,PenG benzathine/procaine inj,ProFee,0989,J0558,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0560_3,Penicillin g benzathine inj,ProFee,0989,J0560,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0565_3,"Inj, bezlotoxumab, 10 mg",ProFee,0989,J0565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0567_3,"Inj., cerliponase alfa 1 mg",ProFee,0989,J0567,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0570_3,Penicillin g benzathine inj,ProFee,0989,J0570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0571_3,Buprenorphine oral 1mg,ProFee,0989,J0571,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0572_3,Bupren/nal up to 3mg bupreno,ProFee,0989,J0572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0573_3,Bupren/nal 3.1 to 6mg bupren,ProFee,0989,J0573,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0574_3,Bupren/nal 6.1 to 10mg bupre,ProFee,0989,J0574,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0575_3,Bupren/nal over 10mg bupreno,ProFee,0989,J0575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0580_3,Penicillin g benzathine inj,ProFee,0989,J0580,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0583_3,Bivalirudin,ProFee,0989,J0583,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0584_3,"Injection, burosumab-twza 1m",ProFee,0989,J0584,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0585_3,Botulinum toxin a per unit,ProFee,0989,J0585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0586_3,AbobotulinumtoxinA,ProFee,0989,J0586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0587_3,Botulinum toxin type B,ProFee,0989,J0587,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0588_3,Incobotulinumtoxin a,ProFee,0989,J0588,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0592_3,Buprenorphine hydrochloride,ProFee,0989,J0592,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0593_3,"Inj., lanadelumab-flyo, 1 mg",ProFee,0989,J0593,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0594_3,Busulfan injection,ProFee,0989,J0594,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0596_3,"Injection, ruconest",ProFee,0989,J0596,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0597_3,"C-1 esterase, berinert",ProFee,0989,J0597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0598_3,"C-1 esterase, cinryze",ProFee,0989,J0598,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0599_3,"Inj., haegarda 10 units",ProFee,0989,J0599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0600_3,Edetate calcium disodium inj,ProFee,0989,J0600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0604_3,"Cinacalcet, esrd on dialysis",ProFee,0989,J0604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0606_3,"Inj, etelcalcetide, 0.1 mg",ProFee,0989,J0606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0610_3,Calcium gluconate injection,ProFee,0989,J0610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0620_3,Calcium glycer & lact/10 ML,ProFee,0989,J0620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0630_3,Calcitonin salmon injection,ProFee,0989,J0630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0636_3,Inj calcitriol per 0.1 mcg,ProFee,0989,J0636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0637_3,Caspofungin acetate,ProFee,0989,J0637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0638_3,Canakinumab injection,ProFee,0989,J0638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0640_3,Leucovorin calcium injection,ProFee,0989,J0640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0641_3,Levoleucovorin injection,ProFee,0989,J0641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0642_3,"Injection, khapzory, 0.5 mg",ProFee,0989,J0642,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0670_3,Inj mepivacaine HCL/10 ml,ProFee,0989,J0670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0690_3,Cefazolin sodium injection,ProFee,0989,J0690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0692_3,Cefepime HCl for injection,ProFee,0989,J0692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0694_3,Cefoxitin sodium injection,ProFee,0989,J0694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0695_3,Inj ceftolozane tazobactam,ProFee,0989,J0695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0696_2,"Ceftriaxone sodium, 250 mg",Outpatient,0251,J0696,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
J0696_2,"Ceftriaxone sodium, 250 mg",Inpatient,0251,J0696,,,,0,29.00,21.75,21.75,27.55,26.10,27.55,27.55,26.10
J0696_3,"Ceftriaxone sodium, 250 mg",Outpatient,0251,J0696,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
J0696_3,"Ceftriaxone sodium, 250 mg",Inpatient,0251,J0696,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
J0697_3,Sterile cefuroxime injection,ProFee,0989,J0697,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0698_3,Cefotaxime sodium injection,ProFee,0989,J0698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0702_3,Betamethasone acet&sod phosp,ProFee,0989,J0702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0704_3,Betamethasone sod phosp/4 MG,ProFee,0989,J0704,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0706_3,Caffeine citrate injection,ProFee,0989,J0706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0710_3,Cephapirin sodium injection,ProFee,0989,J0710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0712_3,Ceftaroline fosamil inj,ProFee,0989,J0712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0713_3,Inj ceftazidime per 500 mg,ProFee,0989,J0713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0714_3,Ceftazidime and avibactam,ProFee,0989,J0714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0715_3,Ceftizoxime sodium / 500 MG,ProFee,0989,J0715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0716_3,Centruroides immune f(ab),ProFee,0989,J0716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0717_3,Certolizumab pegol inj 1mg,ProFee,0989,J0717,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0718_3,Certolizumab pegol inj,ProFee,0989,J0718,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0720_3,Chloramphenicol sodium injec,ProFee,0989,J0720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0725_3,Chorionic gonadotropin/1000u,ProFee,0989,J0725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0735_3,Clonidine hydrochloride,ProFee,0989,J0735,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0740_3,Cidofovir injection,ProFee,0989,J0740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0743_3,Cilastatin sodium injection,ProFee,0989,J0743,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0744_3,Ciprofloxacin iv,ProFee,0989,J0744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0745_3,Inj codeine phosphate /30 MG,ProFee,0989,J0745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0760_3,Colchicine injection,ProFee,0989,J0760,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0770_3,Colistimethate sodium inj,ProFee,0989,J0770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0775_3,"Collagenase, clost hist inj",ProFee,0989,J0775,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0795_3,Corticorelin ovine triflutal,ProFee,0989,J0795,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0833_3,Cosyntropin injection NOS,ProFee,0989,J0834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0834_3,Cosyntropin cortrosyn inj,ProFee,0989,J0834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0835_3,Inj cosyntropin per 0.25 MG,ProFee,0989,J0835,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0840_3,Crotalidae poly immune fab,ProFee,0989,J0840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0841_3,Inj crotalidae im f(ab')2 eq,ProFee,0989,J0841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0850_3,Cytomegalovirus imm IV /vial,ProFee,0989,J0850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0875_3,"Injection, dalbavancin",ProFee,0989,J0875,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0878_3,Daptomycin injection,ProFee,0989,J0878,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0881_3,"Darbepoetin alfa, non-esrd",ProFee,0989,J0881,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0882_3,"Darbepoetin alfa, esrd use",ProFee,0989,J0882,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0883_3,Argatroban nonesrd use 1mg,ProFee,0989,J0883,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0884_3,Argatroban esrd dialysis 1mg,ProFee,0989,J0884,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0885_3,"Epoetin alfa, non-esrd",ProFee,0989,J0885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0886_3,"Epoetin alfa, esrd",ProFee,0989,Q4081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0887_3,Epoetin beta esrd use,ProFee,0989,J0887,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0888_3,Epoetin beta non esrd,ProFee,0989,J0888,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0890_3,Peginesatide injection,ProFee,0989,J0890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0894_3,Decitabine injection,ProFee,0989,J0894,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0895_3,Deferoxamine mesylate inj,ProFee,0989,J0895,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0897_3,Denosumab injection,ProFee,0989,J0897,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0900_3,Testosterone enanthate inj,ProFee,0989,J0900,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J0945_3,Brompheniramine maleate inj,ProFee,0989,J0945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J0970_3,Estradiol valerate injection,ProFee,0989,J0970,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1000_3,Depo-estradiol cypionate inj,ProFee,0989,J1000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1020_3,Methylprednisolone 20 MG inj,ProFee,0989,J1020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1030_2,Methylprednisolone 40 MG inj,ProFee,0989,J1030,,,,0,24.00,18.00,18.00,18.00,0.00,N/A,N/A,N/A
J1030_3,Methylprednisolone 40 MG inj,ProFee,0989,J1030,,,,0,27.00,20.25,20.25,20.25,0.00,N/A,N/A,N/A
J1050_3,Medroxyprogesterone Acetate 1mg,Outpatient,0636,J1050,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1050_3,Medroxyprogesterone Acetate 1mg,Inpatient,0636,J1050,,,,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1051_1,Medroxyprogesterone Acetate,Inpatient,0636,J1051,,,05485-4000-00,1,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1051_1,Medroxyprogesterone Acetate,Outpatient,0636,J1051,,,05485-4000-00,1,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1051_2,Medroxyprogesterone inj,Inpatient,0521,J1051,,,05485-4000-00,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1051_2,Medroxyprogesterone inj,Outpatient,0521,J1051,,,05485-4000-00,0,113.00,84.75,84.75,107.35,101.70,107.35,0.00,101.70
J1051_3,Medroxyprogesterone inj,Inpatient,0521,J1051,,,05485-4000-00,0,113.00,84.75,84.75,107.35,101.70,107.35,107.35,101.70
J1051_3,Medroxyprogesterone inj,Outpatient,0521,J1051,,,05485-4000-00,0,113.00,84.75,84.75,107.35,101.70,107.35,0.00,101.70
J1056_3,MA/EC contraceptiveinjection,ProFee,0989,J1056,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1060_3,Testosterone cypionate 1 ML,ProFee,0989,J1060,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1071_3,testosterone cypionate 1mg,ProFee,0989,J1071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1094_3,Inj dexamethasone acetate,Outpatient,0636,J1094,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
J1094_3,Inj dexamethasone acetate,Inpatient,0636,J1094,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
J1095_3,"Injection, dexamethasone 9%",ProFee,0989,J1095,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1096_3,Dexametha opth insert 0.1 mg,ProFee,0989,J1096,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1097_3,Phenylep ketorolac opth soln,ProFee,0989,J1097,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1100_2,Dexamethasone sod phos 1mg,Inpatient,0636,J1100,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1100_2,Dexamethasone sod phos 1mg,Outpatient,0636,J1100,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1100_3,Dexamethasone sod phos 1mg,Outpatient,0636,J1100,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1100_3,Dexamethasone sod phos 1mg,Inpatient,0636,J1100,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1110_3,Inj dihydroergotamine mesylt,ProFee,0989,J1110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1120_3,Acetazolamid sodium injectio,ProFee,0989,J1120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1130_3,Inj diclofenac sodium 0.5mg,ProFee,0989,J1130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1160_3,Digoxin injection,ProFee,0989,J1160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1162_3,Digoxin immune fab (ovine),ProFee,0989,J1162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1165_3,Phenytoin sodium injection,ProFee,0989,J1165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1180_3,Dyphylline injection,ProFee,0989,J1180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1190_3,Dexrazoxane HCl injection,ProFee,0989,J1190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1200_2,Diphenhydramine hcl U2 50mg,ProFee,0989,J1200,,,,0,20.00,15.00,15.00,15.00,0.00,N/A,N/A,N/A
J1200_3,Diphenhydramine hcl U2 50mg,ProFee,0989,J1200,,,,0,23.00,17.25,17.25,17.25,0.00,N/A,N/A,N/A
J1205_3,Chlorothiazide sodium inj,ProFee,0989,J1205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1212_3,Dimethyl sulfoxide 50% 50 ML,ProFee,0989,J1212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1230_3,Methadone injection,ProFee,0989,J1230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1240_3,Dimenhydrinate injection,ProFee,0989,J1240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1245_3,Dipyridamole injection,ProFee,0989,J1245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1250_3,Inj dobutamine HCL/250 mg,ProFee,0989,J1250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1260_3,Dolasetron mesylate,ProFee,0989,J1260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1265_3,Dopamine injection,ProFee,0989,J1265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1267_3,Doripenem injection,ProFee,0989,J1267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1270_3,"Injection, doxercalciferol",ProFee,0989,J1270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1290_3,Ecallantide injection,ProFee,0989,J1290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1300_3,Eculizumab injection,ProFee,0989,J1300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1301_3,"Injection, edaravone, 1 mg",ProFee,0989,J1301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1303_3,"Inj., ravulizumab-cwvz 10 mg",ProFee,0989,J1303,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1320_3,Amitriptyline injection,ProFee,0989,J1320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1322_3,"Elosulfase alfa, injection",ProFee,0989,J1322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1324_3,Enfuvirtide injection,ProFee,0989,J1324,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1325_3,Epoprostenol injection,ProFee,0989,J1325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1327_3,Eptifibatide injection,ProFee,0989,J1327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1330_3,Ergonovine maleate injection,ProFee,0989,J1330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1335_3,Ertapenem injection,ProFee,0989,J1335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1364_3,Erythro lactobionate /500 MG,ProFee,0989,J1364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1390_3,Estradiol valerate 20 MG inj,ProFee,0989,J1390,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1410_3,Inj estrogen conjugate 25 MG,ProFee,0989,J1410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1428_3,"Inj, eteplirsen, 10 mg",ProFee,0989,J1428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1430_3,Ethanolamine oleate 100 mg,ProFee,0989,J1430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1435_3,Injection estrone per 1 MG,ProFee,0989,J1435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1436_3,Etidronate disodium inj,ProFee,0989,J1436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1438_3,Etanercept injection,ProFee,0989,J1438,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1439_3,Inj ferric carboxymaltos 1mg,ProFee,0989,J1439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1440_3,Filgrastim 300 mcg injection,ProFee,0989,J1440,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1441_3,Filgrastim 480 mcg injection,ProFee,0989,J1441,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1442_3,Inj filgrastim excl biosimil,ProFee,0989,J1442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1443_3,Inj ferric pyrophosphate cit,ProFee,0989,J1443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1444_3,Fe pyro cit pow 0.1 mg iron,ProFee,0989,J1444,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1446_3,"Inj, tbo-filgrastim, 5 mcg",ProFee,0989,J1447,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1447_3,Inj tbo filgrastim 1 microg,ProFee,0989,J1447,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1450_3,Fluconazole,ProFee,0989,J1450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1451_3,"Fomepizole, 15 mg",ProFee,0989,J1451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1452_3,Intraocular Fomivirsen na,ProFee,0989,J1452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1453_3,Fosaprepitant injection,ProFee,0989,J1453,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1454_3,"Inj fosnetupitant, palonoset",ProFee,0989,J1454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1455_3,Foscarnet sodium injection,ProFee,0989,J1455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1457_3,Gallium nitrate injection,ProFee,0989,J1457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1458_3,Galsulfase injection,ProFee,0989,J1458,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1459_3,Inj IVIG privigen 500 mg,ProFee,0989,J1459,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1460_3,Gamma globulin 1 CC inj,ProFee,0989,J1460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1470_3,Gamma globulin 2 CC inj,ProFee,0989,J1470,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1480_3,Gamma globulin 3 CC inj,ProFee,0989,J1480,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1490_3,Gamma globulin 4 CC inj,ProFee,0989,J1490,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1500_3,Gamma globulin 5 CC inj,ProFee,0989,J1500,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1510_3,Gamma globulin 6 CC inj,ProFee,0989,J1510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1520_3,Gamma globulin 7 CC inj,ProFee,0989,J1520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1530_3,Gamma globulin 8 CC inj,ProFee,0989,J1530,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1540_3,Gamma globulin 9 CC inj,ProFee,0989,J1540,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1550_3,Gamma globulin 10 CC inj,ProFee,0989,J1550,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1555_3,"Inj cuvitru, 100 mg",ProFee,0989,J1555,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1556_3,"Inj, imm glob bivigam, 500mg",ProFee,0989,J1556,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1557_3,Gammaplex injection,ProFee,0989,J1557,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1559_3,Hizentra injection,ProFee,0989,J1559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1560_3,Gamma globulin > 10 CC inj,ProFee,0989,J1560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1561_3,Gamunex injection,ProFee,0989,J1561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1562_3,"Vivaglobin, inj",ProFee,0989,J1562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1565_3,RSV-ivig,ProFee,0989,J1565,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1566_3,"Immune globulin, powder",ProFee,0989,J1566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1567_3,"Immune globulin, liquid",ProFee,0989,J1567,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1568_3,Octagam injection,ProFee,0989,J1568,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1569_3,Gammagard liquid injection,ProFee,0989,J1569,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1570_3,Ganciclovir sodium injection,ProFee,0989,J1570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1571_3,HepaGam B IM injection,ProFee,0989,J1571,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1572_3,Flebogamma injection,ProFee,0989,J1572,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1573_3,"Hepagam B intravenous, inj",ProFee,0989,J1573,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1575_3,Hyqvia 100mg immuneglobulin,ProFee,0989,J1575,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1580_3,Garamycin gentamicin inj,ProFee,0989,J1580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1590_3,Gatifloxacin injection,ProFee,0989,J1590,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1595_3,Injection glatiramer acetate,ProFee,0989,J1595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1599_3,"Ivig non-lyophilized, NOS",ProFee,0989,J1599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1600_3,Gold sodium thiomaleate inj,ProFee,0989,J1600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1602_3,Golimumab for iv use 1mg,ProFee,0989,J1602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1620_3,Gonadorelin hydroch/ 100 mcg,ProFee,0989,J1620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1626_3,Granisetron HCl injection,ProFee,0989,J1626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1627_3,"Inj, granisetron, xr, 0.1 mg",ProFee,0989,J1627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1628_3,"Inj., guselkumab, 1 mg",ProFee,0989,J1628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1631_3,Haloperidol decanoate inj,ProFee,0989,J1631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1640_3,"Hemin, 1 mg",ProFee,0989,J1640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1642_3,Inj heparin sodium per 10 u,ProFee,0989,J1642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1645_3,Dalteparin sodium,ProFee,0989,J1645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1652_3,Fondaparinux sodium,ProFee,0989,J1652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1655_3,Tinzaparin sodium injection,ProFee,0989,J1655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1670_3,Tetanus immune globulin inj,ProFee,0989,J1670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1675_3,Histrelin acetate,ProFee,0989,J1675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1680_3,Human fibrinogen conc inj,ProFee,0989,J1680,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1700_3,Hydrocortisone acetate inj,ProFee,0989,J1700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1710_3,Hydrocortisone sodium ph inj,ProFee,0989,J1710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1720_3,Hydrocortisone sodium succ i,ProFee,0989,J1720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1725_3,Hydroxyprogesterone caproate,ProFee,0989,J1729,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1726_3,"Makena, 10 mg",ProFee,0989,J1726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1729_3,Inj hydroxyprogst capoat nos,ProFee,0989,J1729,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1730_3,Diazoxide injection,ProFee,0989,J1730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1740_3,Ibandronate sodium injection,ProFee,0989,J1740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1741_3,Ibuprofen injection,ProFee,0989,J1741,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1742_3,Ibutilide fumarate injection,ProFee,0989,J1742,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1743_3,Idursulfase injection,ProFee,0989,J1743,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1744_3,Icatibant injection,ProFee,0989,J1744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1745_3,Infliximab injection,ProFee,0989,J1745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1746_3,"Inj., ibalizumab-uiyk, 10 mg",ProFee,0989,J1746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1750_3,Inj iron dextran,ProFee,0989,J1750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1751_3,Iron dextran 165 injection,ProFee,0989,J1751,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1752_3,Iron dextran 267 injection,ProFee,0989,J1752,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1756_3,Iron sucrose injection,ProFee,0989,J1756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1785_3,Injection imiglucerase /unit,ProFee,0989,J1785,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1786_3,Imuglucerase injection,ProFee,0989,J1786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1790_3,Droperidol injection,ProFee,0989,J1790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1800_3,Propranolol injection,ProFee,0989,J1800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1810_3,Droperidol/fentanyl inj,ProFee,0989,J1810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1817_3,Insulin for insulin pump use,ProFee,0989,J1817,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1825_3,Interferon beta-1a,ProFee,0989,J1825,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1826_3,Interferon Beta-1A inj,ProFee,0989,J1826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1830_3,Interferon beta-1b / .25 MG,ProFee,0989,J1830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1833_3,"Injection, isavuconazonium",ProFee,0989,J1833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1835_3,Itraconazole injection,ProFee,0989,J1835,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1840_3,Kanamycin sulfate 500 MG inj,ProFee,0989,J1840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1850_3,Kanamycin sulfate 75 MG inj,ProFee,0989,J1850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1885_2,Ketorolac tromethamine 15MG,Outpatient,0636,J1885,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1885_2,Ketorolac tromethamine 15MG,Inpatient,0636,J1885,,,,0,7.00,5.25,5.25,6.65,6.30,6.65,6.65,6.30
J1885_3,Ketorolac tromethamine 15MG,Outpatient,0636,J1885,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
J1885_3,Ketorolac tromethamine 15MG,Inpatient,0636,J1885,,,,0,20.00,15.00,15.00,19.00,18.00,19.00,19.00,18.00
J1890_3,Cephalothin sodium injection,ProFee,0989,J1890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1930_3,Lanreotide injection,ProFee,0989,J1930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1931_3,Laronidase injection,ProFee,0989,J1931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1942_3,Aripiprazole lauroxil 1mg,ProFee,0989,J1942,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1943_3,"Inj., aristada initio, 1 mg",ProFee,0989,J1943,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1944_3,Aripirazole lauroxil 1 mg,ProFee,0989,J1944,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J1945_3,Lepirudin,ProFee,0989,J1945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1950_3,Leuprolide acetate /3.75 MG,ProFee,0989,J1950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1953_3,Levetiracetam injection,ProFee,0989,J1953,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1955_3,Inj levocarnitine per 1 gm,ProFee,0989,J1955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1956_3,Levofloxacin injection,ProFee,0989,J1956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1960_3,Levorphanol tartrate inj,ProFee,0989,J1960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1980_3,Hyoscyamine sulfate inj,ProFee,0989,J1980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J1990_3,Chlordiazepoxide injection,ProFee,0989,J1990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2001_3,Lidocaine injection,ProFee,0989,J2001,,,04094-4276-16,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2010_3,Lincomycin injection,ProFee,0989,J2010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2020_3,Linezolid injection,ProFee,0989,J2020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2060_3,Lorazepam injection,ProFee,0989,J2060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2062_3,Loxapine for inhalation 1 mg,ProFee,0989,J2062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2150_3,Mannitol injection,ProFee,0989,J2150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2170_3,Mecasermin injection,ProFee,0989,J2170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2175_3,Meperidine hydrochl /100 MG,ProFee,0989,J2175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2180_3,Meperidine/promethazine inj,ProFee,0989,J2180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2182_3,"Injection, mepolizumab, 1mg",ProFee,0989,J2182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2185_3,Meropenem,ProFee,0989,J2185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2186_3,"Inj., meropenem, vaborbactam",ProFee,0989,J2186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2210_3,Methylergonovin maleate inj,ProFee,0989,J2210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2212_3,Methylnaltrexone injection,ProFee,0989,J2212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2248_3,Micafungin sodium injection,ProFee,0989,J2248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2260_3,Inj milrinone lactate / 5 MG,ProFee,0989,J2260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2265_3,Minocycline hydrochloride,ProFee,0989,J2265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2271_3,Morphine so4 injection 100mg,ProFee,0989,J2271,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2274_3,Inj morphine pf epid ithc,ProFee,0989,J2274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2275_3,Morphine sulfate injection,ProFee,0989,J2275,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2278_3,Ziconotide injection,ProFee,0989,J2278,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2280_3,"Inj, moxifloxacin 100 mg",ProFee,0989,J2280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2300_3,Inj nalbuphine hydrochloride,ProFee,0989,J2300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2310_3,Inj naloxone hydrochloride,ProFee,0989,J2310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2315_3,"Naltrexone, depot form",ProFee,0989,J2315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2320_3,Nandrolone decanoate 50 MG,ProFee,0989,J2320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2321_3,Nandrolone decanoate 100 MG,ProFee,0989,J2321,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2322_3,Nandrolone decanoate 200 MG,ProFee,0989,J2322,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2323_3,Natalizumab injection,ProFee,0989,J2323,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2325_3,Nesiritide injection,ProFee,0989,J2325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2326_3,"Inj, nusinersen, 0.1mg",ProFee,0989,J2326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2350_3,"Injection, ocrelizumab, 1 mg",ProFee,0989,J2350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2353_3,"Octreotide injection, depot",ProFee,0989,J2353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2354_3,"Octreotide inj, non-depot",ProFee,0989,J2354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2355_3,Oprelvekin injection,ProFee,0989,J2355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2357_3,Omalizumab injection,ProFee,0989,J2357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2358_3,Olanzapine long-acting inj,ProFee,0989,J2358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2360_3,Orphenadrine injection,ProFee,0989,J2360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2370_3,Phenylephrine hcl injection,ProFee,0989,J2370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2400_3,Chloroprocaine hcl injection,ProFee,0989,J2400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2405_1,ONDANSETRON,Outpatient,0636,J2405,,,23155-5484-25,1,11.80,8.85,8.85,11.21,10.62,11.21,11.21,10.62
J2405_1,ONDANSETRON,Inpatient,0636,J2405,,,23155-5484-25,1,11.80,8.85,8.85,11.21,10.62,11.21,11.21,10.62
J2405_2,Ondansetron hcl injection,Inpatient,0521,J2405,,,23155-5484-25,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
J2405_2,Ondansetron hcl injection,Outpatient,0521,J2405,,,23155-5484-25,0,16.00,12.00,12.00,15.20,14.40,15.20,0.00,14.40
J2405_3,Ondansetron hcl injection,Inpatient,0521,J2405,,,23155-5484-25,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
J2405_3,Ondansetron hcl injection,Outpatient,0521,J2405,,,23155-5484-25,0,16.00,12.00,12.00,15.20,14.40,15.20,0.00,14.40
J2407_3,"Injection, oritavancin",ProFee,0989,J2407,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2410_3,Oxymorphone hcl injection,ProFee,0989,J2410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2425_3,Palifermin injection,ProFee,0989,J2425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2426_3,Paliperidone palmitate inj,ProFee,0989,J2426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2430_3,Pamidronate disodium /30 MG,ProFee,0989,J2430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2440_3,Papaverin hcl injection,ProFee,0989,J2440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2460_3,Oxytetracycline injection,ProFee,0989,J2460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2469_3,Palonosetron HCl,ProFee,0989,J2469,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2501_3,Paricalcitol,ProFee,0989,J2501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2502_3,"Inj, pasireotide long acting",ProFee,0989,J2502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2503_3,Pegaptanib sodium injection,ProFee,0989,J2503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2504_3,"Pegademase bovine, 25 iu",ProFee,0989,J2504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2505_3,"Injection, pegfilgrastim 6mg",ProFee,0989,J2506,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2507_3,Pegloticase injection,ProFee,0989,J2507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2510_3,Penicillin g procaine inj,ProFee,0989,J2510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2513_3,Pentastarch 10% solution,ProFee,0989,J2513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2515_3,Pentobarbital sodium inj,ProFee,0989,J2515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2540_3,Penicillin g potassium inj,ProFee,0989,J2540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2543_3,Piperacillin/tazobactam,ProFee,0989,J2543,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2545_3,Pentamidine isethionte/300mg,ProFee,0989,J2545,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2547_3,"Injection, peramivir",ProFee,0989,J2547,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2550_1,Phenergan,Inpatient,0636,J2550,,,00641-6208-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J2550_1,Phenergan,Outpatient,0636,J2550,,,00641-6208-01,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J2550_1{2},Promethazine HCL,Outpatient,0636,J2550,,,00641-6208-01,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J2550_1{2},Promethazine HCL,Inpatient,0636,J2550,,,00641-6208-01,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J2550_2,Promethazine hcl U2 50mg,Inpatient,0521,J2550,,,00641-6208-01,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J2550_2,Promethazine hcl U2 50mg,Outpatient,0521,J2550,,,00641-6208-01,0,11.00,8.25,8.25,10.45,9.90,10.45,0.00,9.90
J2550_3,Promethazine hcl U2 50mg,Inpatient,0521,J2550,,,00641-6208-01,0,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
J2550_3,Promethazine hcl U2 50mg,Outpatient,0521,J2550,,,00641-6208-01,0,14.00,10.50,10.50,13.30,12.60,13.30,0.00,12.60
J2560_3,Phenobarbital sodium inj,ProFee,0989,J2560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2562_3,Plerixafor injection,ProFee,0989,J2562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2590_3,Oxytocin injection,ProFee,0989,J2590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2597_3,Inj desmopressin acetate,ProFee,0989,J2597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2650_3,Prednisolone acetate inj,ProFee,0989,J2650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2670_3,Totazoline hcl injection,ProFee,0989,J2670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2680_3,Fluphenazine decanoate 25 MG,ProFee,0989,J2680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2690_3,Procainamide hcl injection,ProFee,0989,J2690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2700_3,Oxacillin sodium injeciton,ProFee,0989,J2700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2704_3,"Inj, propofol, 10 mg",ProFee,0989,J2704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2710_3,Neostigmine methylslfte inj,ProFee,0989,J2710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2720_3,Inj protamine sulfate/10 MG,ProFee,0989,J2720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2724_3,Protein C concentrate,ProFee,0989,J2724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2725_3,Inj protirelin per 250 mcg,ProFee,0989,J2725,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2730_3,Pralidoxime chloride inj,ProFee,0989,J2730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2760_3,Phentolaine mesylate inj,ProFee,0989,J2760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2765_2,Metoclopramide hcl injection,ProFee,0989,J2765,,,,0,24.00,18.00,18.00,18.00,0.00,N/A,N/A,N/A
J2765_3,Metoclopramide hcl injection,ProFee,0989,J2765,,,,0,27.00,20.25,20.25,20.25,0.00,N/A,N/A,N/A
J2770_3,Quinupristin/dalfopristin,ProFee,0989,J2770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2778_3,Ranibizumab injection,ProFee,0989,J2778,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2780_3,Ranitidine hydrochloride inj,ProFee,0989,J2780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2783_3,Rasburicase,ProFee,0989,J2783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2785_3,Regadenoson injection,ProFee,0989,J2785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2786_3,"Injection, reslizumab, 1mg",ProFee,0989,J2786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2787_3,Riboflavin 5'phos opth<=3ml,ProFee,0989,J2787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2788_3,Rho d immune globulin 50 mcg,ProFee,0989,J2788,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2790_3,Rho d immune globulin inj,ProFee,0989,J2790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2791_3,Rhophylac injection,ProFee,0989,J2791,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2792_3,"Rho(D) immune globulin h, sd",ProFee,0989,J2792,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2793_3,Rilonacept injection,ProFee,0989,J2793,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2794_3,"Risperidone, long acting",ProFee,0989,J2794,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2795_3,Ropivacaine HCl injection,ProFee,0989,J2795,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2796_3,Romiplostim injection,ProFee,0989,J2796,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2797_3,"Inj., rolapitant, 0.5 mg",ProFee,0989,J2797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2798_3,"Inj., perseris, 0.5 mg",ProFee,0989,J2798,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2800_3,Methocarbamol injection,ProFee,0989,J2800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2805_3,Sincalide injection,ProFee,0989,J2805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2810_3,Inj theophylline per 40 MG,ProFee,0989,J2810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2820_3,Sargramostim injection,ProFee,0989,J2820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2840_3,Inj sebelipase alfa 1 mg,ProFee,0989,J2840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2850_3,Inj secretin synthetic human,ProFee,0989,J2850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2860_3,"Injection, siltuximab",ProFee,0989,J2860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2910_3,Aurothioglucose injeciton,ProFee,0989,J2910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2912_3,Sodium chloride injection,ProFee,0989,J2912,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J2916_3,Na ferric gluconate complex,ProFee,0989,J2916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2920_2,Methylprednisolone injection Up To 40 mg,Inpatient,0636,J2920,,,00090-0047-03,0,24.00,18.00,18.00,22.80,21.60,22.80,22.80,21.60
J2920_2,Methylprednisolone injection Up To 40 mg,Outpatient,0636,J2920,,,00090-0047-03,0,24.00,18.00,18.00,22.80,21.60,22.80,22.80,21.60
J2920_3,Methylprednisolone injection Up To 40 mg,Outpatient,0636,J2920,,,00090-0047-03,0,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
J2920_3,Methylprednisolone injection Up To 40 mg,Inpatient,0636,J2920,,,00090-0047-03,0,27.00,20.25,20.25,25.65,24.30,25.65,25.65,24.30
J2930_1,Methylprednisolone Vial 125 MG,Outpatient,0636,J2930,,,00009-0047-22,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
J2930_1,Methylprednisolone Vial 125 MG,Inpatient,0636,J2930,,,00009-0047-22,1,36.00,27.00,27.00,34.20,32.40,34.20,34.20,32.40
J2930_2,Methylprednisolone U2 125mg,ProFee,0989,J2930,,,00009-0047-22,0,36.00,27.00,27.00,27.00,0.00,N/A,N/A,N/A
J2930_3,Methylprednisolone U2 125mg,ProFee,0989,J2930,,,00009-0047-22,0,36.00,27.00,27.00,27.00,0.00,N/A,N/A,N/A
J2940_3,Somatrem injection,ProFee,0989,J2940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2941_3,Somatropin injection,ProFee,0989,J2941,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2950_3,Promazine hcl injection,ProFee,0989,J2950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2993_3,Reteplase injection,ProFee,0989,J2993,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2995_3,Inj streptokinase /250000 IU,ProFee,0989,J2995,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J2997_3,Alteplase recombinant,ProFee,0989,J2997,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3000_3,Streptomycin injection,ProFee,0989,J3000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3010_3,Fentanyl citrate injeciton,ProFee,0989,J3010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3031_3,"Inj., fremanezumab-vfrm 1 mg",ProFee,0989,J3031,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3060_3,"Inj, taliglucerase alfa 10 u",ProFee,0989,J3060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3070_3,Pentazocine injection,ProFee,0989,J3070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3090_3,Inj tedizolid phosphate,ProFee,0989,J3090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3095_3,Televancin injection,ProFee,0989,J3095,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3100_3,Tenecteplase injection,ProFee,0989,J3100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3101_3,Tenecteplase injection,ProFee,0989,J3101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3105_3,Terbutaline sulfate inj,ProFee,0989,J3105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3110_3,Teriparatide injection,ProFee,0989,J3110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3111_3,Inj. romosozumab-aqqg 1 mg,ProFee,0989,J3111,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3120_3,Testosterone enanthate inj,ProFee,0989,J3120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3121_3,Inj testostero enanthate 1mg,ProFee,0989,J3121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3130_3,Testosterone enanthate inj,ProFee,0989,J3130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3140_3,Testosterone suspension inj,ProFee,0989,J3140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3145_3,Testosterone undecanoate 1mg,ProFee,0989,J3145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3150_3,Testosteron propionate inj,ProFee,0989,J3150,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3230_3,Chlorpromazine hcl injection,ProFee,0989,J3230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3240_3,Thyrotropin injection,ProFee,0989,J3240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3243_3,Tigecycline injection,ProFee,0989,J3243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3245_3,"Inj., tildrakizumab, 1 mg",ProFee,0989,J3245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3246_3,Tirofiban HCl,ProFee,0989,J3246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3250_3,Trimethobenzamide hcl inj,ProFee,0989,J3250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3260_3,Tobramycin sulfate injection,ProFee,0989,J3260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3262_3,Tocilizumab injection,ProFee,0989,J3262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3265_3,Injection torsemide 10 mg/ml,ProFee,0989,J3265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3280_3,Thiethylperazine maleate inj,ProFee,0989,J3280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3285_3,Treprostinil injection,ProFee,0989,J3285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3300_3,Triamcinolone A inj PRS-free,ProFee,0989,J3300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3301_2,Triamcinolone acet 10mg,Outpatient,0521,J3301,,,07012-1165-51,0,11.00,8.25,8.25,10.45,9.90,10.45,0.00,9.90
J3301_2,Triamcinolone acet 10mg,Inpatient,0521,J3301,,,07012-1165-51,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J3301_3,Triamcinolone acet 10mg,Outpatient,0521,J3301,,,07012-1165-51,0,14.00,10.50,10.50,13.30,12.60,13.30,0.00,12.60
J3301_3,Triamcinolone acet 10mg,Inpatient,0521,J3301,,,07012-1165-51,0,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
J3302_3,Triamcinolone diacetate inj,ProFee,0989,J3302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3303_3,Triamcinolone hexacetonl inj,ProFee,0989,J3303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3304_3,Inj triamcinolone ace xr 1mg,ProFee,0989,J3304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3305_3,Inj trimetrexate glucoronate,ProFee,0989,J3305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3310_3,Perphenazine injeciton,ProFee,0989,J3310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3315_3,Triptorelin pamoate,ProFee,0989,J3315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3316_3,"Inj., triptorelin xr 3.75 mg",ProFee,0989,J3316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3320_3,Spectinomycn di-hcl inj,ProFee,0989,J3320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3350_3,Urea injection,ProFee,0989,J3350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3355_3,"Urofollitropin, 75 iu",ProFee,0989,J3355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3357_3,Ustekinumab injection,ProFee,0989,J3357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3358_3,"Ustekinumab, iv inject, 1 mg",ProFee,0989,J3358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3364_3,Urokinase 5000 IU injection,ProFee,0989,J3364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3365_3,"Urokinase 250,000 IU inj",ProFee,0989,J3365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3370_3,Vancomycin hcl injection,ProFee,0989,J3370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3380_3,"Injection, vedolizumab",ProFee,0989,J3380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3385_3,Velaglucerase alfa,ProFee,0989,J3385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3396_3,Verteporfin injection,ProFee,0989,J3396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3397_3,"Inj., vestronidase alfa-vjbk",ProFee,0989,J3397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3398_3,Inj luxturna 1 billion vec g,ProFee,0989,J3398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3400_3,Triflupromazine hcl inj,ProFee,0989,J3400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3411_1,Thiamine HCL,Inpatient,0636,J3411,,,63323-0013-01,1,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
J3411_1,Thiamine HCL,Outpatient,0636,J3411,,,63323-0013-01,1,22.00,16.50,16.50,20.90,19.80,20.90,20.90,19.80
J3415_3,Pyridoxine hcl 100 mg,ProFee,0989,J3415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3420_2,Vitamin b12 U2 1000mcg,Outpatient,0521,J3420,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,0.00,9.90
J3420_2,Vitamin b12 U2 1000mcg,Inpatient,0521,J3420,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J3420_3,Vitamin b12 U2 1000mcg,Inpatient,0521,J3420,,,,0,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
J3420_3,Vitamin b12 U2 1000mcg,Outpatient,0521,J3420,,,,0,14.00,10.50,10.50,13.30,12.60,13.30,0.00,12.60
J3465_3,"Injection, voriconazole",ProFee,0989,J3465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3470_3,Hyaluronidase injection,ProFee,0989,J3470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3471_3,"Ovine, up to 999 USP units",ProFee,0989,J3471,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3472_3,"Ovine, 1000 USP units",ProFee,0989,J3472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3473_3,Hyaluronidase recombinant,ProFee,0989,J3473,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3475_3,Inj magnesium sulfate,ProFee,0989,J3475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3480_3,Inj potassium chloride,ProFee,0989,J3480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3485_3,Zidovudine,ProFee,0989,J3485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3486_3,Ziprasidone mesylate,ProFee,0989,J3486,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3487_3,Zoledronic acid,ProFee,0989,J3487,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3488_3,Reclast injection,ProFee,0989,J3488,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J3489_3,Zoledronic acid 1mg,ProFee,0989,J3489,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3490_3,Drugs unclassified injection,ProFee,0989,J3490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3520_3,Edetate disodium per 150 mg,ProFee,0989,J3520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3530_3,Nasal vaccine inhalation,ProFee,0989,J3530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3535_3,Metered dose inhaler drug,ProFee,0989,J3535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3570_3,Laetrile amygdalin vit B17,ProFee,0989,J3570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3590_3,Unclassified biologics,ProFee,0989,J3590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J3591_3,Esrd on dialysi drug/bio noc,ProFee,0989,J3591,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7030_3,Normal saline solution infus,ProFee,0989,J7030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7040_3,Normal saline solution infus,ProFee,0989,J7040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7042_3,5% dextrose/normal saline,ProFee,0989,J7042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7050_3,Normal saline solution infus,ProFee,0989,J7050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7070_3,D5w infusion,ProFee,0989,J7070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7100_3,Dextran 40 infusion,ProFee,0989,J7100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7110_3,Dextran 75 infusion,ProFee,0989,J7110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7121_3,5% dextrose in lac ringers,ProFee,0989,J7121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7130_3,Hypertonic saline solution,ProFee,0989,J7130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7131_3,Hypertonic saline sol,ProFee,0989,J7131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7170_3,"Inj., emicizumab-kxwh 0.5 mg",ProFee,0989,J7170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7175_3,"Inj, factor x, (human), 1iu",ProFee,0989,J7175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7177_3,"Inj., fibryga, 1 mg",ProFee,0989,J7177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7178_3,Inj human fibrinogen con nos,ProFee,0989,J7178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7179_3,Vonvendi inj 1 iu vwf:rco,ProFee,0989,J7179,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7180_3,Factor xiii anti-hem factor,ProFee,0989,J7180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7181_3,Factor xiii recomb a-subunit,ProFee,0989,J7181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7182_3,Factor viii recomb novoeight,ProFee,0989,J7182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7183_3,Wilate injection,ProFee,0989,J7183,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7184_3,Wilate injection,ProFee,0989,J7184,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7185_3,Xyntha inj,ProFee,0989,J7185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7186_3,Antihemophilic viii/vwf comp,ProFee,0989,J7186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7187_3,"Humate-P, inj",ProFee,0989,J7187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7188_3,Inj Vonwillebrand factor iu,ProFee,0989,J7188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7189_3,Factor viia,ProFee,0989,J7189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7190_3,Factor viii,ProFee,0989,J7190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7191_3,Factor VIII (porcine),ProFee,0989,J7191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7192_3,Factor viii recombinant,ProFee,0989,J7192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7193_3,Factor IX non-recombinant,ProFee,0989,J7193,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7194_3,Factor ix complex,ProFee,0989,J7194,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7195_3,Factor IX recombinant,ProFee,0989,J7195,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7196_3,Antithrombin recombinant,ProFee,0989,J7196,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7197_3,Antithrombin iii injection,ProFee,0989,J7197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7198_3,Anti-inhibitor,ProFee,0989,J7198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7199_3,Hemophilia clot factor noc,ProFee,0989,J7199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7200_3,Factor ix recombinan rixubis,ProFee,0989,J7200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7201_3,Factor ix alprolix recomb,ProFee,0989,J7201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7202_3,Factor ix idelvion inj,ProFee,0989,J7202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7203_3,Factor ix recomb gly rebinyn,ProFee,0989,J7203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7205_3,Factor viii fc fusion recomb,ProFee,0989,J7205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7207_3,Factor viii pegylated recomb,ProFee,0989,J7207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7208_3,Inj. jivi 1 iu,ProFee,0989,J7208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7209_3,Factor viii nuwiq recomb 1iu,ProFee,0989,J7209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7210_3,"Inj, afstyla, 1 i.u.",ProFee,0989,J7210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7211_3,"Inj, kovaltry, 1 i.u.",ProFee,0989,J7211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7296_3,"Kyleena, 19.5 mg",ProFee,0989,J7296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7297_3,"Liletta, 52 mg",ProFee,0989,J7297,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7298_3,"Mirena, 52 mg",ProFee,0989,J7298,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7300_3,Intraut copper contraceptive,ProFee,0989,J7300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7301_3,"Skyla, 13.5 mg",ProFee,0989,J7301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7302_3,Levonorgestrel iu contracept,ProFee,0989,J7302,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7303_3,Contraceptive vaginal ring,ProFee,0989,J7303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7304_3,Contraceptive hormone patch,ProFee,0989,J7304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7306_3,Levonorgestrel implant sys,ProFee,0989,J7306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7307_3,Etonogestrel implant system,ProFee,0989,J7307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7308_3,Aminolevulinic acid hcl top,ProFee,0989,J7308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7309_3,"Methyl aminolevulinate, top",ProFee,0989,J7309,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7310_3,Ganciclovir long act implant,ProFee,0989,J7310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7311_3,Fluocinolone acetonide implt,ProFee,0989,J7311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7312_3,Dexamethasone intra implant,ProFee,0989,J7312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7313_3,"Inj., iluvien, 0.01 mg",ProFee,0989,J7313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7314_3,"Inj., yutiq, 0.01 mg",ProFee,0989,J7314,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7315_3,Ophthalmic mitomycin,ProFee,0989,J7315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7316_3,"Inj, ocriplasmin, 0.125 mg",ProFee,0989,J7316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7317_3,Sodium hyaluronate injection,ProFee,0989,J7317,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7318_3,"Inj, durolane 1 mg",ProFee,0989,J7318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7320_3,Hylan G-F 20 injection,ProFee,0989,J7320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7321_3,Hyalgan/supartz inj per dose,ProFee,0989,J7321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7322_3,Synvisc inj per dose,ProFee,0989,J7322,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7323_3,Euflexxa inj per dose,ProFee,0989,J7323,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7324_3,Orthovisc inj per dose,ProFee,0989,J7324,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7326_3,Gel-one,ProFee,0989,J7326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7327_3,Monovisc inj per dose,ProFee,0989,J7327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7328_3,Gelsyn-3 injection 0.1 mg,ProFee,0989,J7328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7329_3,"Inj, trivisc 1 mg",ProFee,0989,J7329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7330_3,Cultured chondrocytes implnt,ProFee,0989,J7330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7331_3,"Synojoynt, inj., 1 mg",ProFee,0989,J7331,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7332_3,"Inj., triluron, 1 mg",ProFee,0989,J7332,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7335_3,Capsaicin 8% patch,ProFee,0989,J7335,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7336_3,Capsaicin 8% patch,ProFee,0989,J7336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7340_3,Metabolic active D/E tissue,ProFee,0989,J7340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7341_3,"Non-human, metabolic tissue",ProFee,0989,J7341,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7342_3,Metabolically active tissue,ProFee,0989,J7342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7343_3,Nonmetabolic act d/e tissue,ProFee,0989,J7343,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7344_3,Nonmetabolic active tissue,ProFee,0989,J7344,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7345_3,"Aminolevulinic acid, 10% gel",ProFee,0989,J7345,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7346_3,Injectable human tissue,ProFee,0989,J7346,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7347_3,Integra matrix tissue,ProFee,0989,J7347,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7348_3,Tissuemend tissue,ProFee,0989,J7348,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7349_3,Primatrix tissue,ProFee,0989,J7349,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7350_3,Injectable human tissue,ProFee,0989,J7350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7401_3,Mometasone furoate sinus imp,ProFee,0989,J7401,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7500_3,Azathioprine oral 50mg,ProFee,0989,J7500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7501_3,Azathioprine parenteral,ProFee,0989,J7501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7502_3,Cyclosporine oral 100 mg,ProFee,0989,J7502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7503_3,Tacrol envarsus ex rel oral,ProFee,0989,J7503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7504_3,Lymphocyte immune globulin,ProFee,0989,J7504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7505_3,Monoclonal antibodies,ProFee,0989,J7505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7506_3,Prednisone oral,ProFee,0989,J7512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7507_3,Tacrolimus oral per 1 MG,ProFee,0989,J7507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7508_3,Tacrol astagraf ex rel oral,ProFee,0989,J7508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7510_3,Prednisolone oral per 5 mg,ProFee,0989,J7510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7511_3,Antithymocyte globuln rabbit,ProFee,0989,J7511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7512_3,Prednisone ir or dr oral 1mg,ProFee,0989,J7512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7513_3,"Daclizumab, parenteral",ProFee,0989,J7513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7515_3,Cyclosporine oral 25 mg,ProFee,0989,J7515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7516_3,Cyclosporin parenteral 250mg,ProFee,0989,J7516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7517_3,Mycophenolate mofetil oral,ProFee,0989,J7517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7518_3,Mycophenolic acid,ProFee,0989,J7518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7520_3,"Sirolimus, oral",ProFee,0989,J7520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7525_3,Tacrolimus injection,ProFee,0989,J7525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7527_3,Oral everolimus,ProFee,0989,J7527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7599_3,Immunosuppressive drug noc,ProFee,0989,J7599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7602_3,Albuterol inh non-comp con,ProFee,0989,J7602,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7603_3,Albuterol inh non-comp u d,ProFee,0989,J7603,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J7604_3,Acetylcysteine comp unit,ProFee,0989,J7604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7605_3,Arformoterol non-comp unit,ProFee,0989,J7605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7606_3,"Formoterol fumarate, inh",ProFee,0989,J7606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7607_3,Levalbuterol comp con,ProFee,0989,J7607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7608_3,Acetylcysteine inh sol u d,ProFee,0989,J7608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7609_2,Albuterol comp unit,Outpatient,0521,J7609,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,0.00,9.90
J7609_2,Albuterol comp unit,Inpatient,0521,J7609,,,,0,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J7609_3,Albuterol comp unit,Outpatient,0521,J7609,,,,0,14.00,10.50,10.50,13.30,12.60,13.30,0.00,12.60
J7609_3,Albuterol comp unit,Inpatient,0521,J7609,,,,0,14.00,10.50,10.50,13.30,12.60,13.30,13.30,12.60
J7610_3,Albuterol comp con,ProFee,0989,J7610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7611_3,Albuterol concentrated form,ProFee,0989,J7611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7612_3,Levalbuterol concentrated,ProFee,0989,J7612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7613_3,Albuterol unit dose,ProFee,0989,J7613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7614_3,Levalbuterol unit dose,ProFee,0989,J7614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7615_3,Levalbuterol comp unit,ProFee,0989,J7615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7620_1,Albuterol,Inpatient,0636,J7620,,,00487-0201-01,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
J7620_1,Albuterol,Outpatient,0636,J7620,,,00487-0201-01,1,10.00,7.50,7.50,9.50,9.00,9.50,9.50,9.00
J7620_2,Albuterol/Ipratropium Bromide non-compounded,ProFee,0989,J7620,,,00487-0201-01,0,10.00,7.50,7.50,7.50,0.00,N/A,N/A,N/A
J7620_3,Albuterol/Ipratropium Bromide non-compounded,ProFee,0989,J7620,,,00487-0201-01,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7622_3,Beclomethasone inhalatn sol,ProFee,0989,J7622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7624_3,Betamethasone inhalation sol,ProFee,0989,J7624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7626_3,Budesonide inhalation sol,ProFee,0989,J7626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7627_3,"Budesonide, compounded",ProFee,0989,J7627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7628_3,Bitolterol mes inhal sol con,ProFee,0989,J7628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7629_3,Bitolterol mes inh sol u d,ProFee,0989,J7629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7631_3,Cromolyn sodium inh sol u d,ProFee,0989,J7631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7632_3,Cromolyn sodium comp unit,ProFee,0989,J7632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7633_3,Budesonide concentrated sol,ProFee,0989,J7633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7634_3,Budesonide comp con,ProFee,0989,J7634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7635_3,Atropine inhal sol con,ProFee,0989,J7635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7636_3,Atropine inhal sol unit dose,ProFee,0989,J7636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7637_3,Dexamethasone inhal sol con,ProFee,0989,J7637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7638_3,Dexamethasone inhal sol u d,ProFee,0989,J7638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7639_3,Dornase alpha inhal sol u d,ProFee,0989,J7639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7640_3,Formoterol injection,ProFee,0989,J7640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7641_3,"Flunisolide, inhalation sol",ProFee,0989,J7641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7642_3,Glycopyrrolate inhal sol con,ProFee,0989,J7642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7643_3,Glycopyrrolate inhal sol u d,ProFee,0989,J7643,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7644_3,Ipratropium brom inh sol u d,ProFee,0989,J7644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7645_3,Ipratropium bromide comp,ProFee,0989,J7645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7647_3,Isoetharine comp con,ProFee,0989,J7647,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7648_3,Isoetharine hcl inh sol con,ProFee,0989,J7648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7649_3,Isoetharine hcl inh sol u d,ProFee,0989,J7649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7650_3,Isoetharine comp unit,ProFee,0989,J7650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7657_3,Isoproterenol comp con,ProFee,0989,J7657,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7658_3,Isoproterenolhcl inh sol con,ProFee,0989,J7658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7659_3,Isoproterenol hcl inh sol ud,ProFee,0989,J7659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7660_3,Isoproterenol comp unit,ProFee,0989,J7660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7665_3,Mannitol for inhaler,ProFee,0989,J7665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7667_3,Metaproterenol comp con,ProFee,0989,J7667,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7668_3,Metaproterenol inh sol con,ProFee,0989,J7668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7669_3,Metaproterenol inh sol u d,ProFee,0989,J7669,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7670_3,Metaproterenol comp unit,ProFee,0989,J7670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7674_3,"Methacholine chloride, neb",ProFee,0989,J7674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7676_3,Pentamidine comp unit dose,ProFee,0989,J7676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7677_3,Revefenacin inh non-com 1mcg,ProFee,0989,J7677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7680_3,Terbutaline so4 inh sol con,ProFee,0989,J7680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7681_3,Terbutaline so4 inh sol u d,ProFee,0989,J7681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7682_3,Tobramycin inhalation sol,ProFee,0989,J7682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7683_3,Triamcinolone inh sol con,ProFee,0989,J7683,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7684_3,Triamcinolone inh sol u d,ProFee,0989,J7684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7685_3,Tobramycin comp unit,ProFee,0989,J7685,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7686_3,"Treprostinil, non-comp unit",ProFee,0989,J7686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7699_3,Inhalation solution for DME,ProFee,0989,J7699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7799_3,Non-inhalation drug for DME,ProFee,0989,J7799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J7999_3,"Compounded drug, noc",ProFee,0989,J7999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8498_3,Antiemetic rectal/supp NOS,ProFee,0989,J8498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8499_1,Clonidine 0.1mg,Inpatient,0636,J8499,,,00904-5980-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_1,Clonidine 0.1mg,Outpatient,0636,J8499,,,00904-5980-61,1,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_1{2},Acetaminophen,Inpatient,0636,J8499,,,00904-5980-61,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_1{2},Acetaminophen,Outpatient,0636,J8499,,,00904-5980-61,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_1{3},Lorazpam,Outpatient,0636,J8499,,,00904-5980-61,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_1{3},Lorazpam,Inpatient,0636,J8499,,,00904-5980-61,2,11.00,8.25,8.25,10.45,9.90,10.45,10.45,9.90
J8499_2,Lorazepam,ProFee,0989,J8499,,,00904-5980-61,0,11.00,8.25,8.25,8.25,0.00,N/A,N/A,N/A
J8499_3,Lorazepam,ProFee,0989,J8499,,,00904-5980-61,0,11.00,8.25,8.25,8.25,0.00,N/A,N/A,N/A
J8501_3,Oral aprepitant,ProFee,0989,J8501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8510_3,Oral busulfan,ProFee,0989,J8510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8515_3,"Cabergoline, oral 0.25mg",ProFee,0989,J8515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8520_3,"Capecitabine, oral, 150 mg",ProFee,0989,J8520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8521_3,"Capecitabine, oral, 500 mg",ProFee,0989,J8521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8530_3,Cyclophosphamide oral 25 MG,ProFee,0989,J8530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8540_1,Dexamethasone Rd,Outpatient,0636,J8540,,,06332-3165-16,4,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
J8540_1,Dexamethasone Rd,Inpatient,0636,J8540,,,06332-3165-16,4,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
J8540_2,Oral dexamethasone,ProFee,0989,J8540,,,06332-3165-16,0,16.00,12.00,12.00,12.00,0.00,N/A,N/A,N/A
J8540_3,Oral dexamethasone,ProFee,0989,J8540,,,06332-3165-16,0,16.00,12.00,12.00,12.00,0.00,N/A,N/A,N/A
J8560_3,Etoposide oral 50 MG,ProFee,0989,J8560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8562_3,Oral fludarabine phosphate,ProFee,0989,J8562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8565_3,Gefitinib oral,ProFee,0989,J8565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8597_3,Antiemetic drug oral NOS,ProFee,0989,J8597,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8600_3,Melphalan oral 2 MG,ProFee,0989,J8600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8610_3,Methotrexate oral 2.5 MG,ProFee,0989,J8610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8650_3,Nabilone oral,ProFee,0989,J8650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8655_3,"Oral netupitant, palonosetro",ProFee,0989,J8655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8670_3,"Rolapitant, oral, 1mg",ProFee,0989,J8670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8700_3,Temozolomide,ProFee,0989,J8700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8705_3,Topotecan oral,ProFee,0989,J8705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J8999_3,Oral prescription drug chemo,ProFee,0989,J8999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9000_3,Doxorubic hcl 10 MG vl chemo,ProFee,0989,J9000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9001_3,Doxorubicin hcl liposome inj,ProFee,0989,J9001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9010_3,Alemtuzumab injection,ProFee,0989,J0202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9015_3,Aldesleukin/single use vial,ProFee,0989,J9015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9017_3,Arsenic trioxide,ProFee,0989,J9017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9019_3,Erwinaze injection,ProFee,0989,J9019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9020_3,Asparaginase injection,ProFee,0989,J9020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9022_3,"Inj, atezolizumab,10 mg",ProFee,0989,J9022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9023_3,"Injection, avelumab, 10 mg",ProFee,0989,J9023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9025_3,Azacitidine injection,ProFee,0989,J9025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9027_3,Clofarabine injection,ProFee,0989,J9027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9030_3,Bcg live intravesical 1mg,ProFee,0989,J9030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9031_3,Bcg live intravesical vac,ProFee,0989,J9031,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9032_3,"Injection, belinostat, 10mg",ProFee,0989,J9032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9033_3,Bendamustine injection,ProFee,0989,J9033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9034_3,"Inj., bendeka 1 mg",ProFee,0989,J9034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9035_3,Bevacizumab injection,ProFee,0989,J9035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9036_3,Inj. belrapzo/bendamustine,ProFee,0989,J9036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9039_3,"Injection, blinatumomab",ProFee,0989,J9039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9040_3,Bleomycin sulfate injection,ProFee,0989,J9040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9041_3,Bortezomib injection,ProFee,0989,J9041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9042_3,Brentuximab vedotin inj,ProFee,0989,J9042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9043_3,Cabazitaxel injection,ProFee,0989,J9043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9044_3,"Inj, bortezomib, nos, 0.1 mg",ProFee,0989,J9044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9045_3,Carboplatin injection,ProFee,0989,J9045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9047_3,"Injection, carfilzomib, 1 mg",ProFee,0989,J9047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9050_3,Carmus bischl nitro inj,ProFee,0989,J9050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9055_3,Cetuximab injection,ProFee,0989,J9055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9057_3,"Inj., copanlisib, 1 mg",ProFee,0989,J9057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9060_3,Cisplatin 10 MG injection,ProFee,0989,J9060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9062_3,Cisplatin 50 MG injection,ProFee,0989,J9062,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9065_3,Inj cladribine per 1 MG,ProFee,0989,J9065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9070_3,Cyclophosphamide 100 MG inj,ProFee,0989,J9070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9080_3,Cyclophosphamide 200 MG inj,ProFee,0989,J9080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9090_3,Cyclophosphamide 500 MG inj,ProFee,0989,J9090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9091_3,Cyclophosphamide 1.0 grm inj,ProFee,0989,J9091,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9092_3,Cyclophosphamide 2.0 grm inj,ProFee,0989,J9092,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9093_3,Cyclophosphamide lyophilized,ProFee,0989,J9093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9094_3,Cyclophosphamide lyophilized,ProFee,0989,J9094,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9095_3,Cyclophosphamide lyophilized,ProFee,0989,J9095,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9096_3,Cyclophosphamide lyophilized,ProFee,0989,J9096,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9097_3,Cyclophosphamide lyophilized,ProFee,0989,J9097,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9098_3,Cytarabine liposome,ProFee,0989,J9098,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9100_3,Cytarabine hcl 100 MG inj,ProFee,0989,J9100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9110_3,Cytarabine hcl 500 MG inj,ProFee,0989,J9110,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9118_3,Inj. calaspargase pegol-mknl,ProFee,0989,J9118,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9119_3,"Inj., cemiplimab-rwlc, 1 mg",ProFee,0989,J9119,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9120_3,Dactinomycin actinomycin d,ProFee,0989,J9120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9130_3,Dacarbazine 100 mg inj,ProFee,0989,J9130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9140_3,Dacarbazine 200 MG inj,ProFee,0989,J9140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9145_3,"Injection, daratumumab 10 mg",ProFee,0989,J9145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9150_3,Daunorubicin,ProFee,0989,J9150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9151_3,Daunorubicin citrate liposom,ProFee,0989,J9151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9153_3,"Inj daunorubicin, cytarabine",ProFee,0989,J9153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9155_3,Degarelix injection,ProFee,0989,J9155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9160_3,"Denileukin diftitox, 300 mcg",ProFee,0989,J9160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9165_3,Diethylstilbestrol injection,ProFee,0989,J9165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9170_3,Docetaxel,ProFee,0989,J9170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9171_3,Docetaxel injection,ProFee,0989,J9171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9173_3,"Inj., durvalumab, 10 mg",ProFee,0989,J9173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9175_3,Elliotts b solution per ml,ProFee,0989,J9175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9176_3,"Injection, elotuzumab, 1mg",ProFee,0989,J9176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9178_3,"Inj, epirubicin hcl, 2 mg",ProFee,0989,J9178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9179_3,Eribulin mesylate injection,ProFee,0989,J9179,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9181_3,Etoposide 10 MG inj,ProFee,0989,J9181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9182_3,Etoposide 100 MG inj,ProFee,0989,J9182,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9185_3,Fludarabine phosphate inj,ProFee,0989,J9185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9190_3,Fluorouracil injection,ProFee,0989,J9190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9199_3,"Injection, infugem, 200 mg",ProFee,0989,J9198,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9200_3,Floxuridine injection,ProFee,0989,J9200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9201_3,Gemcitabine HCl,ProFee,0989,J9201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9202_3,Goserelin acetate implant,ProFee,0989,J9202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9203_3,Gemtuzumab ozogamicin 0.1 mg,ProFee,0989,J9203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9204_3,"Inj mogamulizumab-kpkc, 1 mg",ProFee,0989,J9204,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9205_3,Inj irinotecan liposome 1 mg,ProFee,0989,J9205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9206_3,Irinotecan injection,ProFee,0989,J9206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9207_3,Ixabepilone injection,ProFee,0989,J9207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9208_3,Ifosfomide injection,ProFee,0989,J9208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9209_3,Mesna injection,ProFee,0989,J9209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9210_3,"Inj., emapalumab-lzsg, 1 mg",ProFee,0989,J9210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9211_3,Idarubicin hcl injection,ProFee,0989,J9211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9212_3,Interferon alfacon-1,ProFee,0989,J9212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9213_3,Interferon alfa-2a inj,ProFee,0989,J9213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9214_3,Interferon alfa-2b inj,ProFee,0989,J9214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9215_3,Interferon alfa-n3 inj,ProFee,0989,J9215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9216_3,Interferon gamma 1-b inj,ProFee,0989,J9216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9217_3,Leuprolide acetate suspnsion,ProFee,0989,J9217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9218_3,Leuprolide acetate injeciton,ProFee,0989,J9218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9219_3,Leuprolide acetate implant,ProFee,0989,J9219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9225_3,Histrelin implant,ProFee,0989,J9225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9226_3,Supprelin LA implant,ProFee,0989,J9226,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9228_3,Ipilimumab injection,ProFee,0989,J9228,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9229_3,Inj inotuzumab ozogam 0.1 mg,ProFee,0989,J9229,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9230_3,Mechlorethamine hcl inj,ProFee,0989,J9230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9245_3,Inj melphalan hydrochl 50 MG,ProFee,0989,J9245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9250_3,Methotrexate sodium inj,ProFee,0989,J9250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9260_3,Methotrexate sodium inj,ProFee,0989,J9260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9261_3,Nelarabine injection,ProFee,0989,J9261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9262_3,"Inj, omacetaxine mep, 0.01mg",ProFee,0989,J9262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9263_3,Oxaliplatin,ProFee,0989,J9263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9264_3,Paclitaxel injection,ProFee,0989,J9264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9265_3,Paclitaxel injection,ProFee,0989,J9265,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9266_3,Pegaspargase/singl dose vial,ProFee,0989,J9266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9267_3,Paclitaxel injection,ProFee,0989,J9267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9268_3,Pentostatin injection,ProFee,0989,J9268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9269_3,Inj. tagraxofusp-erzs 10 mcg,ProFee,0989,J9269,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9270_3,Plicamycin (mithramycin) inj,ProFee,0989,J9270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9271_3,Inj pembrolizumab,ProFee,0989,J9271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9280_3,Mitomycin 5 MG inj,ProFee,0989,J9280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9285_3,"Inj, olaratumab, 10 mg",ProFee,0989,J9285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9290_3,Mitomycin 20 MG inj,ProFee,0989,J9290,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9291_3,Mitomycin 40 MG inj,ProFee,0989,J9291,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9293_3,Mitoxantrone hydrochl / 5 MG,ProFee,0989,J9293,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9295_3,"Injection, necitumumab, 1 mg",ProFee,0989,J9295,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9299_3,"Injection, nivolumab",ProFee,0989,J9299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9300_3,Gemtuzumab ozogamicin,ProFee,0989,J9203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9301_3,Obinutuzumab inj,ProFee,0989,J9301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9302_3,Ofatumumab injection,ProFee,0989,J9302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9303_3,Panitumumab injection,ProFee,0989,J9303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9305_3,Pemetrexed injection,ProFee,0989,J9305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9306_3,"Injection, pertuzumab, 1 mg",ProFee,0989,J9306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9307_3,Pralatrexate injection,ProFee,0989,J9307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9308_3,"Injection, ramucirumab",ProFee,0989,J9308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9309_3,"Inj, polatuzumab vedotin 1mg",ProFee,0989,J9309,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9310_3,Rituximab cancer treatment,ProFee,0989,J9312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9311_3,"Inj rituximab, hyaluronidase",ProFee,0989,J9311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9312_3,"Inj., rituximab, 10 mg",ProFee,0989,J9312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9313_3,"Inj., lumoxiti, 0.01 mg",ProFee,0989,J9313,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9315_3,Romidepsin injection,ProFee,0989,J9315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9320_3,Streptozocin injection,ProFee,0989,J9320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9325_3,Inj talimogene laherparepvec,ProFee,0989,J9325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9328_3,Temozolomide injection,ProFee,0989,J9328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9330_3,Temsirolimus injection,ProFee,0989,J9330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9340_3,Thiotepa injection,ProFee,0989,J9340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9350_3,Topotecan,ProFee,0989,J9350,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9351_3,Topotecan injection,ProFee,0989,J9351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9352_3,Injection trabectedin 0.1mg,ProFee,0989,J9352,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9354_3,"Inj, ado-trastuzumab emt 1mg",ProFee,0989,J9354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9355_3,Trastuzumab,ProFee,0989,J9355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9356_3,"Inj. herceptin hylecta, 10mg",ProFee,0989,J9356,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9357_3,"Valrubicin, 200 mg",ProFee,0989,J9357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9360_3,Vinblastine sulfate inj,ProFee,0989,J9360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9370_3,Vincristine sulfate 1 MG inj,ProFee,0989,J9370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9371_3,"Inj, vincristine sul lip 1mg",ProFee,0989,J9371,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9375_3,Vincristine sulfate 2 MG inj,ProFee,0989,J9375,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9380_3,Vincristine sulfate 5 MG inj,ProFee,0989,J9380,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
J9390_3,Vinorelbine tartrate/10 mg,ProFee,0989,J9390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9395_3,"Injection, Fulvestrant",ProFee,0989,J9395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9400_3,"Inj, ziv-aflibercept, 1mg",ProFee,0989,J9400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9600_3,Porfimer sodium,ProFee,0989,J9600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
J9999_3,Chemotherapy drug,ProFee,0989,J9999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0001_3,Standard wheelchair,ProFee,0989,K0001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0002_3,Stnd hemi (low seat) whlchr,ProFee,0989,K0002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0003_3,Lightweight wheelchair,ProFee,0989,K0003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0004_3,High strength ltwt whlchr,ProFee,0989,K0004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0005_3,Ultralightweight wheelchair,ProFee,0989,K0005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0006_3,Heavy duty wheelchair,ProFee,0989,K0006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0007_3,Extra heavy duty wheelchair,ProFee,0989,K0007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0008_3,Cstm manual wheelchair/base,ProFee,0989,K0008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0009_3,Other manual wheelchair/base,ProFee,0989,K0009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0010_3,Stnd wt frame power whlchr,ProFee,0989,K0010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0011_3,Stnd wt pwr whlchr w control,ProFee,0989,K0011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0012_3,Ltwt portbl power whlchr,ProFee,0989,K0012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0013_3,Custom power whlchr base,ProFee,0989,K0013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0014_3,Other power whlchr base,ProFee,0989,K0014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0015_3,Detach non-adjus hght armrst,ProFee,0989,K0015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0017_3,Detach adjust armrest base,ProFee,0989,K0017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0018_3,Detach adjust armrst upper,ProFee,0989,K0018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0019_3,Arm pad each,ProFee,0989,K0019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0020_3,Fixed adjust armrest pair,ProFee,0989,K0020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0037_3,High mount flip-up footrest,ProFee,0989,K0037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0038_3,Leg strap each,ProFee,0989,K0038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0039_3,Leg strap h style each,ProFee,0989,K0039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0040_3,Adjustable angle footplate,ProFee,0989,K0040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0041_3,Large size footplate each,ProFee,0989,K0041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0042_3,Standard size footplate each,ProFee,0989,K0042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0043_3,Ftrst lower extension tube,ProFee,0989,K0043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0044_3,Ftrst upper hanger bracket,ProFee,0989,K0044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0045_3,Footrest complete assembly,ProFee,0989,K0045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0046_3,Elevat legrst low extension,ProFee,0989,K0046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0047_3,Elevat legrst up hangr brack,ProFee,0989,K0047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0050_3,Ratchet assembly,ProFee,0989,K0050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0051_3,Cam relese assem ftrst/lgrst,ProFee,0989,K0051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0052_3,Swingaway detach footrest,ProFee,0989,K0052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0053_3,Elevate footrest articulate,ProFee,0989,K0053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0056_3,Seat ht <17 or >=21 ltwt wc,ProFee,0989,K0056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0065_3,Spoke protectors,ProFee,0989,K0065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0069_3,Rear whl complete solid tire,ProFee,0989,K0069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0070_3,Rear whl compl pneum tire,ProFee,0989,K0070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0071_3,Front castr compl pneum tire,ProFee,0989,K0071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0072_3,Frnt cstr cmpl sem-pneum tir,ProFee,0989,K0072,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0073_3,Caster pin lock each,ProFee,0989,K0073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0077_3,Front caster assem complete,ProFee,0989,K0077,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0090_3,Rear tire power wheelchair,ProFee,0989,K0090,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0091_3,Rear tire tube power whlchr,ProFee,0989,K0091,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0092_3,Rear assem cmplt powr whlchr,ProFee,0989,K0092,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0093_3,Rear zero pressure tire tube,ProFee,0989,K0093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0094_3,Wheel tire for power base,ProFee,0989,K0094,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0095_3,Wheel tire tube each base,ProFee,0989,K0095,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0096_3,Wheel assem powr base complt,ProFee,0989,K0096,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0097_3,Wheel zero presure tire tube,ProFee,0989,K0097,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0098_3,Drive belt power wheelchair,ProFee,0989,K0098,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0099_3,Pwr wheelchair front  caster,ProFee,0989,K0099,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0105_3,Iv hanger,ProFee,0989,K0105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0108_3,W/c component-accessory NOS,ProFee,0989,K0108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0195_3,Elevating whlchair leg rests,ProFee,0989,K0195,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0455_3,Pump uninterrupted infusion,ProFee,0989,K0455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0462_3,Temporary replacement eqpmnt,ProFee,0989,K0462,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0552_3,Supply/ext inf pump syr type,ProFee,0989,K0552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0553_3,Ther cgm supply allowance,ProFee,0989,K0553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0554_3,Ther cgm receiver/monitor,ProFee,0989,K0554,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0601_3,Repl batt silver oxide 1.5 v,ProFee,0989,K0601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0602_3,Repl batt silver oxide 3 v,ProFee,0989,K0602,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0603_3,Repl batt alkaline 1.5 v,ProFee,0989,K0603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0604_3,Repl batt lithium 3.6 v,ProFee,0989,K0604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0605_3,Repl batt lithium 4.5 v,ProFee,0989,K0605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0606_3,AED garment w elec analysis,ProFee,0989,K0606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0607_3,Repl batt for AED,ProFee,0989,K0607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0608_3,Repl garment for AED,ProFee,0989,K0608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0609_3,Repl electrode for AED,ProFee,0989,K0609,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0669_3,Seat/back cus no sadmerc ver,ProFee,0989,K0669,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0672_3,Removable soft interface LE,ProFee,0989,K0672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0730_3,Ctrl dose inh drug deliv sys,ProFee,0989,K0730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0733_3,12-24hr sealed lead acid,ProFee,0989,K0733,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0734_3,Adj skin pro w/c cus wd<22in,ProFee,0989,K0734,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0735_3,Adj skin pro wc cus wd>=22in,ProFee,0989,K0735,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0736_3,Adj skin pro/pos wc cus<22in,ProFee,0989,K0736,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0737_3,Adj skin pro/pos wc cus>=22",ProFee,0989,K0737,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0738_3,Portable gas oxygen system,ProFee,0989,K0738,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0739_3,Repair/svc DME non-oxygen eq,ProFee,0989,K0739,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0740_3,Repair/svc oxygen equipment,ProFee,0989,K0740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0743_3,Portable home suction pump,ProFee,0989,K0743,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0744_3,Absorp drg <= 16 suc pump,ProFee,0989,K0744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0745_3,Absorp drg >16<=48 suc pump,ProFee,0989,K0745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0746_3,Absorp drg >48 suc pump,ProFee,0989,K0746,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0800_3,POV group 1 std up to 300lbs,ProFee,0989,K0800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0801_3,POV group 1 hd 301-450 lbs,ProFee,0989,K0801,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0802_3,POV group 1 vhd 451-600 lbs,ProFee,0989,K0802,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0806_3,POV group 2 std up to 300lbs,ProFee,0989,K0806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0807_3,POV group 2 hd 301-450 lbs,ProFee,0989,K0807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0808_3,POV group 2 vhd 451-600 lbs,ProFee,0989,K0808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0812_3,Power operated vehicle NOC,ProFee,0989,K0812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0813_3,PWC gp 1 std port seat/back,ProFee,0989,K0813,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0814_3,PWC gp 1 std port cap chair,ProFee,0989,K0814,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0815_3,PWC gp 1 std seat/back,ProFee,0989,K0815,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0816_3,PWC gp 1 std cap chair,ProFee,0989,K0816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0820_3,PWC gp 2 std port seat/back,ProFee,0989,K0820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0821_3,PWC gp 2 std port cap chair,ProFee,0989,K0821,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0822_3,PWC gp 2 std seat/back,ProFee,0989,K0822,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0823_3,PWC gp 2 std cap chair,ProFee,0989,K0823,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0824_3,PWC gp 2 hd seat/back,ProFee,0989,K0824,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0825_3,PWC gp 2 hd cap chair,ProFee,0989,K0825,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0826_3,PWC gp 2 vhd seat/back,ProFee,0989,K0826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0827_3,PWC gp vhd cap chair,ProFee,0989,K0827,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0828_3,PWC gp 2 xtra hd seat/back,ProFee,0989,K0828,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0829_3,PWC gp 2 xtra hd cap chair,ProFee,0989,K0829,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0830_3,PWC gp2 std seat elevate s/b,ProFee,0989,K0830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0831_3,PWC gp2 std seat elevate cap,ProFee,0989,K0831,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0835_3,PWC gp2 std sing pow opt s/b,ProFee,0989,K0835,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0836_3,PWC gp2 std sing pow opt cap,ProFee,0989,K0836,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0837_3,PWC gp 2 hd sing pow opt s/b,ProFee,0989,K0837,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0838_3,PWC gp 2 hd sing pow opt cap,ProFee,0989,K0838,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0839_3,PWC gp2 vhd sing pow opt s/b,ProFee,0989,K0839,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0840_3,PWC gp2 xhd sing pow opt s/b,ProFee,0989,K0840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0841_3,PWC gp2 std mult pow opt s/b,ProFee,0989,K0841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0842_3,PWC gp2 std mult pow opt cap,ProFee,0989,K0842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0843_3,PWC gp2 hd mult pow opt s/b,ProFee,0989,K0843,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0848_3,PWC gp 3 std seat/back,ProFee,0989,K0848,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0849_3,PWC gp 3 std cap chair,ProFee,0989,K0849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0850_3,PWC gp 3 hd seat/back,ProFee,0989,K0850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0851_3,PWC gp 3 hd cap chair,ProFee,0989,K0851,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0852_3,PWC gp 3 vhd seat/back,ProFee,0989,K0852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0853_3,PWC gp 3 vhd cap chair,ProFee,0989,K0853,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0854_3,PWC gp 3 xhd seat/back,ProFee,0989,K0854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0855_3,PWC gp 3 xhd cap chair,ProFee,0989,K0855,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0856_3,PWC gp3 std sing pow opt s/b,ProFee,0989,K0856,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0857_3,PWC gp3 std sing pow opt cap,ProFee,0989,K0857,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0858_3,PWC gp3 hd sing pow opt s/b,ProFee,0989,K0858,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0859_3,PWC gp3 hd sing pow opt cap,ProFee,0989,K0859,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0860_3,PWC gp3 vhd sing pow opt s/b,ProFee,0989,K0860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0861_3,PWC gp3 std mult pow opt s/b,ProFee,0989,K0861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0862_3,PWC gp3 hd mult pow opt s/b,ProFee,0989,K0862,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0863_3,PWC gp3 vhd mult pow opt s/b,ProFee,0989,K0863,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0864_3,PWC gp3 xhd mult pow opt s/b,ProFee,0989,K0864,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0868_3,PWC gp 4 std seat/back,ProFee,0989,K0868,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0869_3,PWC gp 4 std cap chair,ProFee,0989,K0869,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0870_3,PWC gp 4 hd seat/back,ProFee,0989,K0870,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0871_3,PWC gp 4 vhd seat/back,ProFee,0989,K0871,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0877_3,PWC gp4 std sing pow opt s/b,ProFee,0989,K0877,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0878_3,PWC gp4 std sing pow opt cap,ProFee,0989,K0878,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0879_3,PWC gp4 hd sing pow opt s/b,ProFee,0989,K0879,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0880_3,PWC gp4 vhd sing pow opt s/b,ProFee,0989,K0880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0884_3,PWC gp4 std mult pow opt s/b,ProFee,0989,K0884,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0885_3,PWC gp4 std mult pow opt cap,ProFee,0989,K0885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0886_3,PWC gp4 hd mult pow s/b,ProFee,0989,K0886,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0890_3,PWC gp5 ped sing pow opt s/b,ProFee,0989,K0890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0891_3,PWC gp5 ped mult pow opt s/b,ProFee,0989,K0891,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0898_3,Power wheelchair NOC,ProFee,0989,K0898,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0899_3,Pow mobil dev no SADMERC,ProFee,0989,K0899,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0900_3,Cstm dme other than wheelchr,ProFee,0989,K0900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K0901_3,Ko single upright pre ots,ProFee,0989,K0901,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0902_3,Ko double upright pre ots,ProFee,0989,K0902,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K0903_3,Mult den insert dir carv/cam,ProFee,0989,A5514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
K1001_3,Electronic posa treatment,ProFee,0989,K1001,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K1002_3,Ces system w/supplies access,ProFee,0989,K1002,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K1003_3,Whirlpool tub walkin portabl,ProFee,0989,K1003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K1004_3,Lo freq us diathermy device,ProFee,0989,K1004,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
K1005_3,Disp col sto bag breast milk,ProFee,0989,K1005,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L0100_3,Cranial orthosis/helmet mold,ProFee,0989,L0100,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L0110_3,Cranial orthosis/helmet nonm,ProFee,0989,L0110,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L0112_3,Cranial cervical orthosis,ProFee,0989,L0112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0113_3,Cranial cervical torticollis,ProFee,0989,L0113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0130_3,Flex thermoplastic collar mo,ProFee,0989,L0130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0140_3,Cervical semi-rigid adjustab,ProFee,0989,L0140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0150_3,Cerv semi-rig adj molded chn,ProFee,0989,L0150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0160_3,Cerv semi-rig wire occ/mand,ProFee,0989,L0160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0170_3,Cervical collar molded to pt,ProFee,0989,L0170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0172_3,Cerv col thermplas foam 2 pi,ProFee,0989,L0172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0174_3,Cerv col foam 2 piece w thor,ProFee,0989,L0174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0180_3,Cer post col occ/man sup adj,ProFee,0989,L0180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0190_3,Cerv collar supp adj cerv ba,ProFee,0989,L0190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0200_3,Cerv col supp adj bar & thor,ProFee,0989,L0200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0430_3,Dewall posture protector,ProFee,0989,L0430,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L0450_3,TLSO flex prefab thoracic,ProFee,0989,L0450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0452_3,tlso flex custom fab thoraci,ProFee,0989,L0452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0454_3,TLSO flex prefab sacrococ-T9,ProFee,0989,L0454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0455_3,Tlso flex trnk sj-t9 pre ots,ProFee,0989,L0455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0456_3,TLSO flex prefab,ProFee,0989,L0456,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0457_3,Tlso flex trnk sj-ss pre ots,ProFee,0989,L0457,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0458_3,TLSO 2Mod symphis-xipho pre,ProFee,0989,L0458,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0460_3,TLSO2Mod symphysis-stern pre,ProFee,0989,L0460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0462_3,TLSO 3Mod sacro-scap pre,ProFee,0989,L0462,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0464_3,TLSO 4Mod sacro-scap pre,ProFee,0989,L0464,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0466_3,TLSO rigid frame pre soft ap,ProFee,0989,L0466,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0467_3,Tlso r fram soft pre ots,ProFee,0989,L0467,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0468_3,TLSO rigid frame prefab pelv,ProFee,0989,L0468,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0469_3,Tlso rig fram pelvic pre ots,ProFee,0989,L0469,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0470_3,TLSO rigid frame pre subclav,ProFee,0989,L0470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0472_3,TLSO rigid frame hyperex pre,ProFee,0989,L0472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0480_3,TLSO rigid plastic custom fa,ProFee,0989,L0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0482_3,TLSO rigid lined custom fab,ProFee,0989,L0482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0484_3,TLSO rigid plastic cust fab,ProFee,0989,L0484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0486_3,TLSO rigidlined cust fab two,ProFee,0989,L0486,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0488_3,TLSO rigid lined pre one pie,ProFee,0989,L0488,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0490_3,TLSO rigid plastic pre one,ProFee,0989,L0490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0491_3,TLSO 2 piece rigid shell,ProFee,0989,L0491,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0492_3,TLSO 3 piece rigid shell,ProFee,0989,L0492,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0621_3,SIO flex pelvisacral prefab,ProFee,0989,L0621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0622_3,SIO flex pelvisacral custom,ProFee,0989,L0622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0623_3,SIO panel prefab,ProFee,0989,L0623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0624_3,SIO panel custom,ProFee,0989,L0624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0625_3,LO flexibl L1-below L5 pre,ProFee,0989,L0625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0626_3,LO sag stays/panels pre-fab,ProFee,0989,L0626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0627_3,LO sagitt rigid panel prefab,ProFee,0989,L0627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0628_3,LO flex w/o rigid stays pre,ProFee,0989,L0628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0629_3,LSO flex w/rigid stays cust,ProFee,0989,L0629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0630_3,LSO post rigid panel pre,ProFee,0989,L0630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0631_3,LSO sag-coro rigid frame pre,ProFee,0989,L0631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0632_3,LSO sag rigid frame cust,ProFee,0989,L0632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0633_3,LSO flexion control prefab,ProFee,0989,L0633,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0634_3,LSO flexion control custom,ProFee,0989,L0634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0635_3,LSO sagit rigid panel prefab,ProFee,0989,L0635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0636_3,LSO sagittal rigid panel cus,ProFee,0989,L0636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0637_3,LSO sag-coronal panel prefab,ProFee,0989,L0637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0638_3,LSO sag-coronal panel custom,ProFee,0989,L0638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0639_3,LSO s/c shell/panel prefab,ProFee,0989,L0639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0640_3,LSO s/c shell/panel custom,ProFee,0989,L0640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0641_3,Lo rig pos pnl l1-l5 pre ots,ProFee,0989,L0641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0642_3,Lo sag ri an/pos pnl pre ots,ProFee,0989,L0642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0643_3,Lso sag ctr rigi pos pre ots,ProFee,0989,L0643,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0648_3,Lso sag r an/pos pnl pre ots,ProFee,0989,L0648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0649_3,Lso sc r pos/lat pnl pre ots,ProFee,0989,L0649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0650_3,Lso sc r ant/pos pnl pre ots,ProFee,0989,L0650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0651_3,Lso sag-co shell pnl pre ots,ProFee,0989,L0651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0700_3,Ctlso a-p-l control molded,ProFee,0989,L0700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0710_3,Ctlso a-p-l control w/ inter,ProFee,0989,L0710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0810_3,Halo cervical into jckt vest,ProFee,0989,L0810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0820_3,Halo cervical into body jack,ProFee,0989,L0820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0830_3,Halo cerv into milwaukee typ,ProFee,0989,L0830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0859_3,MRI compatible system,ProFee,0989,L0859,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0861_3,Halo repl liner/interface,ProFee,0989,L0861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0960_3,Post surgical support pads,ProFee,0989,L0960,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L0970_3,Tlso corset front,ProFee,0989,L0970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0972_3,Lso corset front,ProFee,0989,L0972,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0974_3,Tlso full corset,ProFee,0989,L0974,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0976_3,Lso full corset,ProFee,0989,L0976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0978_3,Axillary crutch extension,ProFee,0989,L0978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0980_3,Peroneal straps pair,ProFee,0989,L0980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0982_3,Stocking supp grips set of f,ProFee,0989,L0982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0984_3,Protective body sock each,ProFee,0989,L0984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L0999_3,Add to spinal orthosis NOS,ProFee,0989,L0999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1000_3,Ctlso milwauke initial model,ProFee,0989,L1000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1001_3,CTLSO infant immobilizer,ProFee,0989,L1001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1005_3,Tension based scoliosis orth,ProFee,0989,L1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1010_3,Ctlso axilla sling,ProFee,0989,L1010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1020_3,Kyphosis pad,ProFee,0989,L1020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1025_3,Kyphosis pad floating,ProFee,0989,L1025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1030_3,Lumbar bolster pad,ProFee,0989,L1030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1040_3,Lumbar or lumbar rib pad,ProFee,0989,L1040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1050_3,Sternal pad,ProFee,0989,L1050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1060_3,Thoracic pad,ProFee,0989,L1060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1070_3,Trapezius sling,ProFee,0989,L1070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1080_3,Outrigger,ProFee,0989,L1080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1085_3,Outrigger bil w/ vert extens,ProFee,0989,L1085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1090_3,Lumbar sling,ProFee,0989,L1090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1100_3,Ring flange plastic/leather,ProFee,0989,L1100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1110_3,Ring flange plas/leather mol,ProFee,0989,L1110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1120_3,Covers for upright each,ProFee,0989,L1120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1200_3,Furnsh initial orthosis only,ProFee,0989,L1200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1210_3,Lateral thoracic extension,ProFee,0989,L1210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1220_3,Anterior thoracic extension,ProFee,0989,L1220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1230_3,Milwaukee type superstructur,ProFee,0989,L1230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1240_3,Lumbar derotation pad,ProFee,0989,L1240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1250_3,Anterior asis pad,ProFee,0989,L1250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1260_3,Anterior thoracic derotation,ProFee,0989,L1260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1270_3,Abdominal pad,ProFee,0989,L1270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1280_3,Rib gusset (elastic) each,ProFee,0989,L1280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1290_3,Lateral trochanteric pad,ProFee,0989,L1290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1300_3,Body jacket mold to patient,ProFee,0989,L1300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1310_3,Post-operative body jacket,ProFee,0989,L1310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1499_3,Spinal orthosis NOS,ProFee,0989,L1499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1500_3,Thkao mobility frame,ProFee,0989,L1500,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1510_3,Thkao standing frame,ProFee,0989,L1510,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1520_3,Thkao swivel walker,ProFee,0989,L1520,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1600_3,Abduct hip flex frejka w cvr,ProFee,0989,L1600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1610_3,Abduct hip flex frejka covr,ProFee,0989,L1610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1620_3,Abduct hip flex pavlik harne,ProFee,0989,L1620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1630_3,Abduct control hip semi-flex,ProFee,0989,L1630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1640_3,Pelv band/spread bar thigh c,ProFee,0989,L1640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1650_3,HO abduction hip adjustable,ProFee,0989,L1650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1652_3,HO bi thighcuffs w sprdr bar,ProFee,0989,L1652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1660_3,HO abduction static plastic,ProFee,0989,L1660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1680_3,Pelvic & hip control thigh c,ProFee,0989,L1680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1685_3,Post-op hip abduct custom fa,ProFee,0989,L1685,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1686_3,HO post-op hip abduction,ProFee,0989,L1686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1690_3,Combination bilateral HO,ProFee,0989,L1690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1700_3,Leg perthes orth toronto typ,ProFee,0989,L1700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1710_3,Legg perthes orth newington,ProFee,0989,L1710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1720_3,Legg perthes orthosis trilat,ProFee,0989,L1720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1730_3,Legg perthes orth scottish r,ProFee,0989,L1730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1755_3,Legg perthes patten bottom t,ProFee,0989,L1755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1800_3,Knee orthoses elas w stays,ProFee,0989,L1800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1810_3,Ko elastic with joints,ProFee,0989,L1810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1812_3,Ko elastic w/joints pre ots,ProFee,0989,L1812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1815_3,Elastic with condylar pads,ProFee,0989,L1815,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1820_3,Ko elas w/ condyle pads & jo,ProFee,0989,L1820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1831_3,Knee orth pos locking joint,ProFee,0989,L1831,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1832_3,KO adj jnt pos rigid support,ProFee,0989,L1832,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1833_3,Ko adj jnt pos r sup pre ots,ProFee,0989,L1833,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1834_3,Ko w/0 joint rigid molded to,ProFee,0989,L1834,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1836_3,Rigid KO wo joints,ProFee,0989,L1836,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1840_3,Ko derot ant cruciate custom,ProFee,0989,L1840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1843_3,KO single upright custom fit,ProFee,0989,L1843,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1844_3,Ko w/adj jt rot cntrl molded,ProFee,0989,L1844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1845_3,Ko w/ adj flex/ext rotat cus,ProFee,0989,L1845,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1846_3,Ko w adj flex/ext rotat mold,ProFee,0989,L1846,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1847_3,KO adjustable w air chambers,ProFee,0989,L1847,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1848_3,Ko dbl upright w/air pre ots,ProFee,0989,L1848,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1850_3,Ko swedish type,ProFee,0989,L1850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1851_3,Ko single upright prefab ots,ProFee,0989,L1851,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1852_3,Ko double upright prefab ots,ProFee,0989,L1852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1855_3,Ko plas doub upright jnt mol,ProFee,0989,L1855,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1858_3,Ko polycentric pneumatic pad,ProFee,0989,L1858,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1860_3,Ko supracondylar socket mold,ProFee,0989,L1860,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1870_3,Ko doub upright lacers molde,ProFee,0989,L1870,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1880_3,Ko doub upright cuffs/lacers,ProFee,0989,L1880,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1900_3,Afo sprng wir drsflx calf bd,ProFee,0989,L1900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1901_3,Prefab ankle orthosis,ProFee,0989,L1901,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L1902_3,Afo ankle gauntlet,ProFee,0989,L1902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1904_3,Afo molded ankle gauntlet,ProFee,0989,L1904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1907_3,AFO supramalleolar custom,ProFee,0989,L1907,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1910_3,Afo sing bar clasp attach sh,ProFee,0989,L1910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1920_3,Afo sing upright w/ adjust s,ProFee,0989,L1920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1930_3,Afo plastic,ProFee,0989,L1930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1932_3,Afo rig ant tib prefab TCF/=,ProFee,0989,L1932,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1940_3,Afo molded to patient plasti,ProFee,0989,L1940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1945_3,Afo molded plas rig ant tib,ProFee,0989,L1945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1950_3,Afo spiral molded to pt plas,ProFee,0989,L1950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1951_3,AFO spiral prefabricated,ProFee,0989,L1951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1960_3,Afo pos solid ank plastic mo,ProFee,0989,L1960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1970_3,Afo plastic molded w/ankle j,ProFee,0989,L1970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1971_3,"AFO w/ankle joint, prefab",ProFee,0989,L1971,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1980_3,Afo sing solid stirrup calf,ProFee,0989,L1980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L1990_3,Afo doub solid stirrup calf,ProFee,0989,L1990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2000_3,Kafo sing fre stirr thi/calf,ProFee,0989,L2000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2005_3,KAFO sng/dbl mechanical act,ProFee,0989,L2005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2006_3,Kaf sng/dbl swg/stn mcpr cus,ProFee,0989,L2006,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L2010_3,Kafo sng solid stirrup w/o j,ProFee,0989,L2010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2020_3,Kafo dbl solid stirrup band/,ProFee,0989,L2020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2030_3,Kafo dbl solid stirrup w/o j,ProFee,0989,L2030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2034_3,KAFO pla sin up w/wo k/a cus,ProFee,0989,L2034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2035_3,KAFO plastic pediatric size,ProFee,0989,L2035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2036_3,Kafo plas doub free knee mol,ProFee,0989,L2036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2037_3,Kafo plas sing free knee mol,ProFee,0989,L2037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2038_3,Kafo w/o joint multi-axis an,ProFee,0989,L2038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2040_3,Hkafo torsion bil rot straps,ProFee,0989,L2040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2050_3,Hkafo torsion cable hip pelv,ProFee,0989,L2050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2060_3,Hkafo torsion ball bearing j,ProFee,0989,L2060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2070_3,Hkafo torsion unilat rot str,ProFee,0989,L2070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2080_3,Hkafo unilat torsion cable,ProFee,0989,L2080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2090_3,Hkafo unilat torsion ball br,ProFee,0989,L2090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2106_3,Afo tib fx cast plaster mold,ProFee,0989,L2106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2108_3,Afo tib fx cast molded to pt,ProFee,0989,L2108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2112_3,Afo tibial fracture soft,ProFee,0989,L2112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2114_3,Afo tib fx semi-rigid,ProFee,0989,L2114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2116_3,Afo tibial fracture rigid,ProFee,0989,L2116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2126_3,Kafo fem fx cast thermoplas,ProFee,0989,L2126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2128_3,Kafo fem fx cast molded to p,ProFee,0989,L2128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2132_3,Kafo femoral fx cast soft,ProFee,0989,L2132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2134_3,Kafo fem fx cast semi-rigid,ProFee,0989,L2134,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2136_3,Kafo femoral fx cast rigid,ProFee,0989,L2136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2180_3,Plas shoe insert w ank joint,ProFee,0989,L2180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2182_3,Drop lock knee,ProFee,0989,L2182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2184_3,Limited motion knee joint,ProFee,0989,L2184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2186_3,Adj motion knee jnt lerman t,ProFee,0989,L2186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2188_3,Quadrilateral brim,ProFee,0989,L2188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2190_3,Waist belt,ProFee,0989,L2190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2192_3,Pelvic band & belt thigh fla,ProFee,0989,L2192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2200_3,Limited ankle motion ea jnt,ProFee,0989,L2200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2210_3,Dorsiflexion assist each joi,ProFee,0989,L2210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2220_3,Dorsi & plantar flex ass/res,ProFee,0989,L2220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2230_3,Split flat caliper stirr & p,ProFee,0989,L2230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2232_3,"Rocker bottom, contact AFO",ProFee,0989,L2232,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2240_3,Round caliper and plate atta,ProFee,0989,L2240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2250_3,Foot plate molded stirrup at,ProFee,0989,L2250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2260_3,Reinforced solid stirrup,ProFee,0989,L2260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2265_3,Long tongue stirrup,ProFee,0989,L2265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2270_3,Varus/valgus strap padded/li,ProFee,0989,L2270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2275_3,Plastic mod low ext pad/line,ProFee,0989,L2275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2280_3,Molded inner boot,ProFee,0989,L2280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2300_3,Abduction bar jointed adjust,ProFee,0989,L2300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2310_3,Abduction bar-straight,ProFee,0989,L2310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2320_3,Non-molded lacer,ProFee,0989,L2320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2330_3,Lacer molded to patient mode,ProFee,0989,L2330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2335_3,Anterior swing band,ProFee,0989,L2335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2340_3,Pre-tibial shell molded to p,ProFee,0989,L2340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2350_3,Prosthetic type socket molde,ProFee,0989,L2350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2360_3,Extended steel shank,ProFee,0989,L2360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2370_3,Patten bottom,ProFee,0989,L2370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2375_3,Torsion ank & half solid sti,ProFee,0989,L2375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2380_3,Torsion straight knee joint,ProFee,0989,L2380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2385_3,Straight knee joint heavy du,ProFee,0989,L2385,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2387_3,Add LE poly knee custom KAFO,ProFee,0989,L2387,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2390_3,Offset knee joint each,ProFee,0989,L2390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2395_3,Offset knee joint heavy duty,ProFee,0989,L2395,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2397_3,Suspension sleeve lower ext,ProFee,0989,L2397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2405_3,Knee joint drop lock ea jnt,ProFee,0989,L2405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2415_3,Knee joint cam lock each joi,ProFee,0989,L2415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2425_3,Knee disc/dial lock/adj flex,ProFee,0989,L2425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2430_3,Knee jnt ratchet lock ea jnt,ProFee,0989,L2430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2492_3,Knee lift loop drop lock rin,ProFee,0989,L2492,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2500_3,Thi/glut/ischia wgt bearing,ProFee,0989,L2500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2510_3,Th/wght bear quad-lat brim m,ProFee,0989,L2510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2520_3,Th/wght bear quad-lat brim c,ProFee,0989,L2520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2525_3,Th/wght bear nar m-l brim mo,ProFee,0989,L2525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2526_3,Th/wght bear nar m-l brim cu,ProFee,0989,L2526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2530_3,Thigh/wght bear lacer non-mo,ProFee,0989,L2530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2540_3,Thigh/wght bear lacer molded,ProFee,0989,L2540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2550_3,Thigh/wght bear high roll cu,ProFee,0989,L2550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2570_3,Hip clevis type 2 posit jnt,ProFee,0989,L2570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2580_3,Pelvic control pelvic sling,ProFee,0989,L2580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2600_3,Hip clevis/thrust bearing fr,ProFee,0989,L2600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2610_3,Hip clevis/thrust bearing lo,ProFee,0989,L2610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2620_3,Pelvic control hip heavy dut,ProFee,0989,L2620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2622_3,Hip joint adjustable flexion,ProFee,0989,L2622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2624_3,Hip adj flex ext abduct cont,ProFee,0989,L2624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2627_3,Plastic mold recipro hip & c,ProFee,0989,L2627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2628_3,Metal frame recipro hip & ca,ProFee,0989,L2628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2630_3,Pelvic control band & belt u,ProFee,0989,L2630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2640_3,Pelvic control band & belt b,ProFee,0989,L2640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2650_3,Pelv & thor control gluteal,ProFee,0989,L2650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2660_3,Thoracic control thoracic ba,ProFee,0989,L2660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2670_3,Thorac cont paraspinal uprig,ProFee,0989,L2670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2680_3,Thorac cont lat support upri,ProFee,0989,L2680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2750_3,Plating chrome/nickel pr bar,ProFee,0989,L2750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2755_3,Carbon graphite lamination,ProFee,0989,L2755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2760_3,Extension per extension per,ProFee,0989,L2760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2768_3,Ortho sidebar disconnect,ProFee,0989,L2768,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2770_3,Low ext orthosis per bar/jnt,ProFee,0989,L2770,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L2780_3,Non-corrosive finish,ProFee,0989,L2780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2785_3,Drop lock retainer each,ProFee,0989,L2785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2795_3,Knee control full kneecap,ProFee,0989,L2795,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2800_3,Knee cap medial or lateral p,ProFee,0989,L2800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2810_3,Knee control condylar pad,ProFee,0989,L2810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2820_3,Soft interface below knee se,ProFee,0989,L2820,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2830_3,Soft interface above knee se,ProFee,0989,L2830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2840_3,Tibial length sock fx or equ,ProFee,0989,L2840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2850_3,Femoral lgth sock fx or equa,ProFee,0989,L2850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2860_3,Torsion mechanism knee/ankle,ProFee,0989,L2860,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L2861_3,Torsion mechanism knee/ankle,ProFee,0989,L2861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L2999_3,Lower extremity orthosis NOS,ProFee,0989,L2999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3000_3,Ft insert ucb berkeley shell,ProFee,0989,L3000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3001_3,Foot insert remov molded spe,ProFee,0989,L3001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3002_3,Foot insert plastazote or eq,ProFee,0989,L3002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3003_3,Foot insert silicone gel eac,ProFee,0989,L3003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3010_3,Foot longitudinal arch suppo,ProFee,0989,L3010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3020_3,Foot longitud/metatarsal sup,ProFee,0989,L3020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3030_3,Foot arch support remov prem,ProFee,0989,L3030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3031_3,Foot lamin/prepreg composite,ProFee,0989,L3031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3040_3,Ft arch suprt premold longit,ProFee,0989,L3040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3050_3,Foot arch supp premold metat,ProFee,0989,L3050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3060_3,Foot arch supp longitud/meta,ProFee,0989,L3060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3070_3,Arch suprt att to sho longit,ProFee,0989,L3070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3080_3,Arch supp att to shoe metata,ProFee,0989,L3080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3090_3,Arch supp att to shoe long/m,ProFee,0989,L3090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3100_3,Hallus-valgus nght dynamic s,ProFee,0989,L3100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3140_3,Abduction rotation bar shoe,ProFee,0989,L3140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3150_3,Abduct rotation bar w/o shoe,ProFee,0989,L3150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3160_3,Shoe styled positioning dev,ProFee,0989,L3160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3170_3,Foot plastic heel stabilizer,ProFee,0989,L3170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3201_3,Oxford w supinat/pronat inf,ProFee,0989,L3201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3202_3,Oxford w/ supinat/pronator c,ProFee,0989,L3202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3203_3,Oxford w/ supinator/pronator,ProFee,0989,L3203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3204_3,Hightop w/ supp/pronator inf,ProFee,0989,L3204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3206_3,Hightop w/ supp/pronator chi,ProFee,0989,L3206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3207_3,Hightop w/ supp/pronator jun,ProFee,0989,L3207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3208_3,Surgical boot each infant,ProFee,0989,L3208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3209_3,Surgical boot each child,ProFee,0989,L3209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3211_3,Surgical boot each junior,ProFee,0989,L3211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3212_3,Benesch boot pair infant,ProFee,0989,L3212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3213_3,Benesch boot pair child,ProFee,0989,L3213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3214_3,Benesch boot pair junior,ProFee,0989,L3214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3215_3,Orthopedic ftwear ladies oxf,ProFee,0989,L3215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3216_3,Orthoped ladies shoes dpth i,ProFee,0989,L3216,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3217_3,Ladies shoes hightop depth i,ProFee,0989,L3217,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3219_3,Orthopedic mens shoes oxford,ProFee,0989,L3219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3221_3,Orthopedic mens shoes dpth i,ProFee,0989,L3221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3222_3,Mens shoes hightop depth inl,ProFee,0989,L3222,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3224_3,Woman's shoe oxford brace,ProFee,0989,L3224,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3225_3,Man's shoe oxford brace,ProFee,0989,L3225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3230_3,Custom shoes depth inlay,ProFee,0989,L3230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3250_3,Custom mold shoe remov prost,ProFee,0989,L3250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3251_3,Shoe molded to pt silicone s,ProFee,0989,L3251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3252_3,Shoe molded plastazote cust,ProFee,0989,L3252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3253_3,Shoe molded plastazote cust,ProFee,0989,L3253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3254_3,Orth foot non-stndard size/w,ProFee,0989,L3254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3255_3,Orth foot non-standard size/,ProFee,0989,L3255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3257_3,Orth foot add charge split s,ProFee,0989,L3257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3265_3,Plastazote sandal each,ProFee,0989,L3265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3300_3,Sho lift taper to metatarsal,ProFee,0989,L3300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3310_3,Shoe lift elev heel/sole neo,ProFee,0989,L3310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3320_3,Shoe lift elev heel/sole cor,ProFee,0989,L3320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3330_3,Lifts elevation metal extens,ProFee,0989,L3330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3332_3,Shoe lifts tapered to one-ha,ProFee,0989,L3332,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3334_3,Shoe lifts elevation heel /i,ProFee,0989,L3334,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3340_3,Shoe wedge sach,ProFee,0989,L3340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3350_3,Shoe heel wedge,ProFee,0989,L3350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3360_3,Shoe sole wedge outside sole,ProFee,0989,L3360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3370_3,Shoe sole wedge between sole,ProFee,0989,L3370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3380_3,Shoe clubfoot wedge,ProFee,0989,L3380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3390_3,Shoe outflare wedge,ProFee,0989,L3390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3400_3,Shoe metatarsal bar wedge ro,ProFee,0989,L3400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3410_3,Shoe metatarsal bar between,ProFee,0989,L3410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3420_3,Full sole/heel wedge btween,ProFee,0989,L3420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3430_3,Sho heel count plast reinfor,ProFee,0989,L3430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3440_3,Heel leather reinforced,ProFee,0989,L3440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3450_3,Shoe heel sach cushion type,ProFee,0989,L3450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3455_3,Shoe heel new leather standa,ProFee,0989,L3455,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3460_3,Shoe heel new rubber standar,ProFee,0989,L3460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3465_3,Shoe heel thomas with wedge,ProFee,0989,L3465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3470_3,Shoe heel thomas extend to b,ProFee,0989,L3470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3480_3,Shoe heel pad & depress for,ProFee,0989,L3480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3485_3,Shoe heel pad removable for,ProFee,0989,L3485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3500_3,Ortho shoe add leather insol,ProFee,0989,L3500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3510_3,Orthopedic shoe add rub insl,ProFee,0989,L3510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3520_3,O shoe add felt w leath insl,ProFee,0989,L3520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3530_3,Ortho shoe add half sole,ProFee,0989,L3530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3540_3,Ortho shoe add full sole,ProFee,0989,L3540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3550_3,O shoe add standard toe tap,ProFee,0989,L3550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3560_3,O shoe add horseshoe toe tap,ProFee,0989,L3560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3570_3,O shoe add instep extension,ProFee,0989,L3570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3580_3,O shoe add instep velcro clo,ProFee,0989,L3580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3590_3,O shoe convert to sof counte,ProFee,0989,L3590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3595_3,Ortho shoe add march bar,ProFee,0989,L3595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3600_3,Trans shoe calip plate exist,ProFee,0989,L3600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3610_3,Trans shoe caliper plate new,ProFee,0989,L3610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3620_3,Trans shoe solid stirrup exi,ProFee,0989,L3620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3630_3,Trans shoe solid stirrup new,ProFee,0989,L3630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3640_3,Shoe dennis browne splint bo,ProFee,0989,L3640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3649_3,Orthopedic shoe modifica NOS,ProFee,0989,L3649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3651_3,Prefab shoulder orthosis,ProFee,0989,L3651,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3652_3,Prefab dbl shoulder orthosis,ProFee,0989,L3652,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3660_3,Abduct restrainer canvas&web,ProFee,0989,L3660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3670_3,Acromio/clavicular canvas&we,ProFee,0989,L3670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3671_3,SO cap design w/o jnts CF,ProFee,0989,L3671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3672_3,SO airplane w/o jnts CF,ProFee,0989,L3672,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3673_3,SO airplane w/joint CF,ProFee,0989,L3673,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3674_3,SO airplane w/wo joint CF,ProFee,0989,L3674,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3675_3,Canvas vest SO,ProFee,0989,L3675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3677_3,SO hard plastic stabilizer,ProFee,0989,L3677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3678_3,So hard plas stabili pre ots,ProFee,0989,L3678,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3700_3,Elbow orthoses elas w stays,ProFee,0989,L3700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3701_3,Prefab elbow orthosis,ProFee,0989,L3701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3710_3,Elbow elastic with metal joi,ProFee,0989,L3710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3720_3,Forearm/arm cuffs free motio,ProFee,0989,L3720,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3730_3,Forearm/arm cuffs ext/flex a,ProFee,0989,L3730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3740_3,Cuffs adj lock w/ active con,ProFee,0989,L3740,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3760_3,"EO withjoint, Prefabricated",ProFee,0989,L3760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3761_3,"Eo, adj lock joint prefab ot",ProFee,0989,L3761,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3762_3,Rigid EO wo joints,ProFee,0989,L3762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3763_3,EWHO rigid w/o jnts CF,ProFee,0989,L3763,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3764_3,EWHO w/joint(s) CF,ProFee,0989,L3764,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3765_3,EWHFO rigid w/o jnts CF,ProFee,0989,L3765,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3766_3,EWHFO w/joint(s) CF,ProFee,0989,L3766,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3800_3,Whfo short opponen no attach,ProFee,0989,L3800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3805_3,Whfo long opponens no attach,ProFee,0989,L3805,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3806_3,WHFO w/joint(s) custom fab,ProFee,0989,L3806,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3807_3,"WHFO,no joint, prefabricated",ProFee,0989,L3807,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3808_3,"WHFO, rigid w/o joints",ProFee,0989,L3808,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3809_3,Whfo w/o joints pre ots,ProFee,0989,L3809,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3810_3,Whfo thumb abduction bar,ProFee,0989,L3810,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3815_3,Whfo second m.p. abduction a,ProFee,0989,L3815,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3820_3,Whfo ip ext asst w/ mp ext s,ProFee,0989,L3820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3825_3,Whfo m.p. extension stop,ProFee,0989,L3825,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3830_3,Whfo m.p. extension assist,ProFee,0989,L3830,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3835_3,Whfo m.p. spring extension a,ProFee,0989,L3835,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3840_3,Whfo spring swivel thumb,ProFee,0989,L3840,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3845_3,Whfo thumb ip ext ass w/ mp,ProFee,0989,L3845,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3850_3,Action wrist w/ dorsiflex as,ProFee,0989,L3850,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3855_3,Whfo adj m.p. flexion contro,ProFee,0989,L3855,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3860_3,Whfo adj m.p. flex ctrl & i.,ProFee,0989,L3860,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3890_3,Torsion mechanism wrist/elbo,ProFee,0989,L3890,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3891_3,Torsion mechanism wrist/elbo,ProFee,0989,L3891,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3900_3,Hinge extension/flex wrist/f,ProFee,0989,L3900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3901_3,Hinge ext/flex wrist finger,ProFee,0989,L3901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3902_3,Whfo ext power compress gas,ProFee,0989,L3902,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3904_3,Whfo electric custom fitted,ProFee,0989,L3904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3905_3,WHO w/nontorsion jnt(s) CF,ProFee,0989,L3905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3906_3,Wrist gauntlet molded to pt,ProFee,0989,L3906,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3907_3,Whfo wrst gauntlt thmb spica,ProFee,0989,L3907,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3908_2,Wrist cock-up non-molded,ProFee,0989,L3908,,,,0,80.00,60.00,60.00,60.00,0.00,N/A,N/A,N/A
L3908_3,Wrist cock-up non-molded,ProFee,0989,L3908,,,,0,81.00,60.75,60.75,60.75,0.00,N/A,N/A,N/A
L3909_3,Prefab wrist orthosis,ProFee,0989,L3909,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3910_3,Whfo swanson design,ProFee,0989,L3910,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3911_3,Prefab hand finger orthosis,ProFee,0989,L3911,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3912_3,Flex glove w/elastic finger,ProFee,0989,L3912,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3913_3,HFO w/o joints CF,ProFee,0989,L3913,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3915_3,WHO w nontor jnt(s) prefab,ProFee,0989,L3915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3916_3,Whfo wrist extens w/ outrigg,ProFee,0989,L3916,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3917_3,Prefab metacarpl fx orthosis,ProFee,0989,L3917,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3918_3,HFO knuckle bender,ProFee,0989,L3918,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3919_3,HO w/o joints CF,ProFee,0989,L3919,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3920_3,Knuckle bender with outrigge,ProFee,0989,L3920,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3921_3,HFO w/joint(s) CF,ProFee,0989,L3921,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3922_3,Knuckle bend 2 seg to flex j,ProFee,0989,L3922,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3923_3,"HFO, no joint, prefabricated",ProFee,0989,L3923,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3924_3,Oppenheimer,ProFee,0989,L3924,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3925_3,FO pip/dip with joint/spring,ProFee,0989,L3925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3926_3,Thomas suspension,ProFee,0989,L3926,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3927_3,FO pip/dip w/o joint/spring,ProFee,0989,L3927,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3928_3,Finger extension w/ clock sp,ProFee,0989,L3928,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3929_3,"HFO nontorsion joint, prefab",ProFee,0989,L3929,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3930_3,Finger extension with wrist,ProFee,0989,L3930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3931_3,WHFO nontorsion joint prefab,ProFee,0989,L3931,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3932_3,Safety pin spring wire,ProFee,0989,L3932,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3933_3,FO w/o joints CF,ProFee,0989,L3933,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3934_3,Safety pin modified,ProFee,0989,L3934,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3935_3,FO nontorsion joint CF,ProFee,0989,L3935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3936_3,Palmer,ProFee,0989,L3936,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3938_3,Dorsal wrist,ProFee,0989,L3938,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3940_3,Dorsal wrist w/ outrigger at,ProFee,0989,L3940,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3942_3,Reverse knuckle bender,ProFee,0989,L3942,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3944_3,Reverse knuckle bend w/ outr,ProFee,0989,L3944,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3946_3,HFO composite elastic,ProFee,0989,L3946,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3948_3,Finger knuckle bender,ProFee,0989,L3948,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3950_3,Oppenheimer w/ knuckle bend,ProFee,0989,L3950,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3952_3,Oppenheimer w/ rev knuckle 2,ProFee,0989,L3952,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3954_3,Spreading hand,ProFee,0989,L3954,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3956_3,Add joint upper ext orthosis,ProFee,0989,L3956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3960_3,Sewho airplan desig abdu pos,ProFee,0989,L3960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3961_3,SEWHO cap design w/o jnts CF,ProFee,0989,L3961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3962_3,Sewho erbs palsey design abd,ProFee,0989,L3962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3964_3,Seo mobile arm sup att to wc,ProFee,0989,L3964,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3965_3,Arm supp att to wc rancho ty,ProFee,0989,L3965,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3966_3,Mobile arm supports reclinin,ProFee,0989,L3966,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3967_3,SEWHO airplane w/o jnts CF,ProFee,0989,L3967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3968_3,Friction dampening arm supp,ProFee,0989,L3968,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3969_3,Monosuspension arm/hand supp,ProFee,0989,L3969,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3970_3,Elevat proximal arm support,ProFee,0989,L3970,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3971_3,SEWHO cap design w/jnt(s) CF,ProFee,0989,L3971,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3972_3,Offset/lat rocker arm w/ ela,ProFee,0989,L3972,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3973_3,SEWHO airplane w/jnt(s) CF,ProFee,0989,L3973,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3974_3,Mobile arm support supinator,ProFee,0989,L3974,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3975_3,SEWHFO cap design w/o jnt CF,ProFee,0989,L3975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3976_3,SEWHFO airplane w/o jnts CF,ProFee,0989,L3976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3977_3,SEWHFO cap desgn w/jnt(s) CF,ProFee,0989,L3977,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3978_3,SEWHFO airplane w/jnt(s) CF,ProFee,0989,L3978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3980_3,Upp ext fx orthosis humeral,ProFee,0989,L3980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3981_3,Ue fx orth shoul cap forearm,ProFee,0989,L3981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3982_3,Upper ext fx orthosis rad/ul,ProFee,0989,L3982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3984_3,Upper ext fx orthosis wrist,ProFee,0989,L3984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3985_3,Forearm hand fx orth w/ wr h,ProFee,0989,L3985,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3986_3,Humeral rad/ulna wrist fx or,ProFee,0989,L3986,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L3995_3,Sock fracture or equal each,ProFee,0989,L3995,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L3999_3,Upper limb orthosis NOS,ProFee,0989,L3999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4000_3,Repl girdle milwaukee orth,ProFee,0989,L4000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4002_3,"Replace strap, any orthosis",ProFee,0989,L4002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4010_3,Replace trilateral socket br,ProFee,0989,L4010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4020_3,Replace quadlat socket brim,ProFee,0989,L4020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4030_3,Replace socket brim cust fit,ProFee,0989,L4030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4040_3,Replace molded thigh lacer,ProFee,0989,L4040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4045_3,Replace non-molded thigh lac,ProFee,0989,L4045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4050_3,Replace molded calf lacer,ProFee,0989,L4050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4055_3,Replace non-molded calf lace,ProFee,0989,L4055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4060_3,Replace high roll cuff,ProFee,0989,L4060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4070_3,Replace prox & dist upright,ProFee,0989,L4070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4080_3,Repl met band kafo-afo prox,ProFee,0989,L4080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4090_3,Repl met band kafo-afo calf/,ProFee,0989,L4090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4100_3,Repl leath cuff kafo prox th,ProFee,0989,L4100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4110_3,Repl leath cuff kafo-afo cal,ProFee,0989,L4110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4130_3,Replace pretibial shell,ProFee,0989,L4130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4205_3,Ortho dvc repair per 15 min,ProFee,0989,L4205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4210_3,Orth dev repair/repl minor p,ProFee,0989,L4210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4350_3,Ankle control orthosi prefab,ProFee,0989,L4350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4360_3,Pneumati walking boot prefab,ProFee,0989,L4360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4361_3,Pneuma/vac walk boot pre ots,ProFee,0989,L4361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4370_3,Pneumatic full leg splint,ProFee,0989,L4370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4380_3,Pneumatic knee splint,ProFee,0989,L4380,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L4386_3,Non-pneum walk boot prefab,ProFee,0989,L4386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4387_3,Non-pneum walk boot pre ots,ProFee,0989,L4387,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4392_3,Replace AFO soft interface,ProFee,0989,L4392,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4394_3,Replace foot drop spint,ProFee,0989,L4394,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4396_3,Static AFO,ProFee,0989,L4396,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4397_3,Static or dynami afo pre ots,ProFee,0989,L4397,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4398_3,Foot drop splint recumbent,ProFee,0989,L4398,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L4631_3,"Afo, walk boot type, cus fab",ProFee,0989,L4631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5000_3,Sho insert w arch toe filler,ProFee,0989,L5000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5010_3,Mold socket ank hgt w/ toe f,ProFee,0989,L5010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5020_3,Tibial tubercle hgt w/ toe f,ProFee,0989,L5020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5050_3,Ank symes mold sckt sach ft,ProFee,0989,L5050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5060_3,Symes met fr leath socket ar,ProFee,0989,L5060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5100_3,Molded socket shin sach foot,ProFee,0989,L5100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5105_3,Plast socket jts/thgh lacer,ProFee,0989,L5105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5150_3,Mold sckt ext knee shin sach,ProFee,0989,L5150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5160_3,Mold socket bent knee shin s,ProFee,0989,L5160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5200_3,Kne sing axis fric shin sach,ProFee,0989,L5200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5210_3,No knee/ankle joints w/ ft b,ProFee,0989,L5210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5220_3,No knee joint with artic ali,ProFee,0989,L5220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5230_3,Fem focal defic constant fri,ProFee,0989,L5230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5250_3,Hip canad sing axi cons fric,ProFee,0989,L5250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5270_3,Tilt table locking hip sing,ProFee,0989,L5270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5280_3,Hemipelvect canad sing axis,ProFee,0989,L5280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5301_3,BK mold socket SACH ft endo,ProFee,0989,L5301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5311_3,"Knee disart, SACH ft, endo",ProFee,0989,L5311,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L5312_3,"Knee disart, sach ft, endo",ProFee,0989,L5312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5321_3,AK open end SACH,ProFee,0989,L5321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5331_3,Hip disart canadian SACH ft,ProFee,0989,L5331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5341_3,Hemipelvectomy canadian SACH,ProFee,0989,L5341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5400_3,Postop dress & 1 cast chg bk,ProFee,0989,L5400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5410_3,Postop dsg bk ea add cast ch,ProFee,0989,L5410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5420_3,Postop dsg & 1 cast chg ak/d,ProFee,0989,L5420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5430_3,Postop dsg ak ea add cast ch,ProFee,0989,L5430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5450_3,Postop app non-wgt bear dsg,ProFee,0989,L5450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5460_3,Postop app non-wgt bear dsg,ProFee,0989,L5460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5500_3,Init bk ptb plaster direct,ProFee,0989,L5500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5505_3,Init ak ischal plstr direct,ProFee,0989,L5505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5510_3,Prep BK ptb plaster molded,ProFee,0989,L5510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5520_3,Perp BK ptb thermopls direct,ProFee,0989,L5520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5530_3,Prep BK ptb thermopls molded,ProFee,0989,L5530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5535_3,Prep BK ptb open end socket,ProFee,0989,L5535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5540_3,Prep BK ptb laminated socket,ProFee,0989,L5540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5560_3,Prep AK ischial plast molded,ProFee,0989,L5560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5570_3,Prep AK ischial direct form,ProFee,0989,L5570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5580_3,Prep AK ischial thermo mold,ProFee,0989,L5580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5585_3,Prep AK ischial open end,ProFee,0989,L5585,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5590_3,Prep AK ischial laminated,ProFee,0989,L5590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5595_3,Hip disartic sach thermopls,ProFee,0989,L5595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5600_3,Hip disart sach laminat mold,ProFee,0989,L5600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5610_3,Above knee hydracadence,ProFee,0989,L5610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5611_3,Ak 4 bar link w/fric swing,ProFee,0989,L5611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5613_3,Ak 4 bar ling w/hydraul swig,ProFee,0989,L5613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5614_3,4-bar link above knee w/swng,ProFee,0989,L5614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5616_3,Ak univ multiplex sys frict,ProFee,0989,L5616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5617_3,AK/BK self-aligning unit ea,ProFee,0989,L5617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5618_3,Test socket symes,ProFee,0989,L5618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5620_3,Test socket below knee,ProFee,0989,L5620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5622_3,Test socket knee disarticula,ProFee,0989,L5622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5624_3,Test socket above knee,ProFee,0989,L5624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5626_3,Test socket hip disarticulat,ProFee,0989,L5626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5628_3,Test socket hemipelvectomy,ProFee,0989,L5628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5629_3,Below knee acrylic socket,ProFee,0989,L5629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5630_3,Syme typ expandabl wall sckt,ProFee,0989,L5630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5631_3,Ak/knee disartic acrylic soc,ProFee,0989,L5631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5632_3,Symes type ptb brim design s,ProFee,0989,L5632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5634_3,Symes type poster opening so,ProFee,0989,L5634,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5636_3,Symes type medial opening so,ProFee,0989,L5636,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5637_3,Below knee total contact,ProFee,0989,L5637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5638_3,Below knee leather socket,ProFee,0989,L5638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5639_3,Below knee wood socket,ProFee,0989,L5639,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5640_3,Knee disarticulat leather so,ProFee,0989,L5640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5642_3,Above knee leather socket,ProFee,0989,L5642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5643_3,Hip flex inner socket ext fr,ProFee,0989,L5643,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5644_3,Above knee wood socket,ProFee,0989,L5644,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5645_3,Bk flex inner socket ext fra,ProFee,0989,L5645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5646_3,Below knee cushion socket,ProFee,0989,L5646,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5647_3,Below knee suction socket,ProFee,0989,L5647,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5648_3,Above knee cushion socket,ProFee,0989,L5648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5649_3,Isch containmt/narrow m-l so,ProFee,0989,L5649,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5650_3,Tot contact ak/knee disart s,ProFee,0989,L5650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5651_3,Ak flex inner socket ext fra,ProFee,0989,L5651,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5652_3,Suction susp ak/knee disart,ProFee,0989,L5652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5653_3,Knee disart expand wall sock,ProFee,0989,L5653,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5654_3,Socket insert symes,ProFee,0989,L5654,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5655_3,Socket insert below knee,ProFee,0989,L5655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5656_3,Socket insert knee articulat,ProFee,0989,L5656,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5658_3,Socket insert above knee,ProFee,0989,L5658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5661_3,Multi-durometer symes,ProFee,0989,L5661,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5665_3,Multi-durometer below knee,ProFee,0989,L5665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5666_3,Below knee cuff suspension,ProFee,0989,L5666,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5668_3,Socket insert w/o lock lower,ProFee,0989,L5668,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5670_3,Bk molded supracondylar susp,ProFee,0989,L5670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5671_3,BK/AK locking mechanism,ProFee,0989,L5671,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5672_3,Bk removable medial brim sus,ProFee,0989,L5672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5673_3,Socket insert w lock mech,ProFee,0989,L5673,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5676_3,Bk knee joints single axis p,ProFee,0989,L5676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5677_3,Bk knee joints polycentric p,ProFee,0989,L5677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5678_3,Bk joint covers pair,ProFee,0989,L5678,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5679_3,Socket insert w/o lock mech,ProFee,0989,L5679,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5680_3,Bk thigh lacer non-molded,ProFee,0989,L5680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5681_3,Intl custm cong/latyp insert,ProFee,0989,L5681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5682_3,Bk thigh lacer glut/ischia m,ProFee,0989,L5682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5683_3,Initial custom socket insert,ProFee,0989,L5683,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5684_3,Bk fork strap,ProFee,0989,L5684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5685_3,Below knee sus/seal sleeve,ProFee,0989,L5685,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5686_3,Bk back check,ProFee,0989,L5686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5688_3,Bk waist belt webbing,ProFee,0989,L5688,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5690_3,Bk waist belt padded and lin,ProFee,0989,L5690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5692_3,Ak pelvic control belt light,ProFee,0989,L5692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5694_3,Ak pelvic control belt pad/l,ProFee,0989,L5694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5695_3,Ak sleeve susp neoprene/equa,ProFee,0989,L5695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5696_3,Ak/knee disartic pelvic join,ProFee,0989,L5696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5697_3,Ak/knee disartic pelvic band,ProFee,0989,L5697,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5698_3,Ak/knee disartic silesian ba,ProFee,0989,L5698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5699_3,Shoulder harness,ProFee,0989,L5699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5700_3,Replace socket below knee,ProFee,0989,L5700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5701_3,Replace socket above knee,ProFee,0989,L5701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5702_3,Replace socket hip,ProFee,0989,L5702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5703_3,Symes ankle w/o (SACH) foot,ProFee,0989,L5703,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5704_3,Custom shape cover BK,ProFee,0989,L5704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5705_3,Custom shape cover AK,ProFee,0989,L5705,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5706_3,Custom shape cvr knee disart,ProFee,0989,L5706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5707_3,Custom shape cvr hip disart,ProFee,0989,L5707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5710_3,Kne-shin exo sng axi mnl loc,ProFee,0989,L5710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5711_3,Knee-shin exo mnl lock ultra,ProFee,0989,L5711,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5712_3,Knee-shin exo frict swg & st,ProFee,0989,L5712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5714_3,Knee-shin exo variable frict,ProFee,0989,L5714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5716_3,Knee-shin exo mech stance ph,ProFee,0989,L5716,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5718_3,Knee-shin exo frct swg & sta,ProFee,0989,L5718,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5722_3,Knee-shin pneum swg frct exo,ProFee,0989,L5722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5724_3,Knee-shin exo fluid swing ph,ProFee,0989,L5724,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5726_3,Knee-shin ext jnts fld swg e,ProFee,0989,L5726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5728_3,Knee-shin fluid swg & stance,ProFee,0989,L5728,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5780_3,Knee-shin pneum/hydra pneum,ProFee,0989,L5780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5781_3,Lower limb pros vacuum pump,ProFee,0989,L5781,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5782_3,HD low limb pros vacuum pump,ProFee,0989,L5782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5785_3,Exoskeletal bk ultralt mater,ProFee,0989,L5785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5790_3,Exoskeletal ak ultra-light m,ProFee,0989,L5790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5795_3,Exoskel hip ultra-light mate,ProFee,0989,L5795,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5810_3,Endoskel knee-shin mnl lock,ProFee,0989,L5810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5811_3,Endo knee-shin mnl lck ultra,ProFee,0989,L5811,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5812_3,Endo knee-shin frct swg & st,ProFee,0989,L5812,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5814_3,Endo knee-shin hydral swg ph,ProFee,0989,L5814,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5816_3,Endo knee-shin polyc mch sta,ProFee,0989,L5816,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5818_3,Endo knee-shin frct swg & st,ProFee,0989,L5818,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5822_3,Endo knee-shin pneum swg frc,ProFee,0989,L5822,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5824_3,Endo knee-shin fluid swing p,ProFee,0989,L5824,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5826_3,Miniature knee joint,ProFee,0989,L5826,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5828_3,Endo knee-shin fluid swg/sta,ProFee,0989,L5828,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5830_3,Endo knee-shin pneum/swg pha,ProFee,0989,L5830,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5840_3,Multi-axial knee/shin system,ProFee,0989,L5840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5845_3,Knee-shin sys stance flexion,ProFee,0989,L5845,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5848_3,Knee-shin sys hydraul stance,ProFee,0989,L5848,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5850_3,Endo ak/hip knee extens assi,ProFee,0989,L5850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5855_3,Mech hip extension assist,ProFee,0989,L5855,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5856_3,Elec knee-shin swing/stance,ProFee,0989,L5856,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5857_3,Elec knee-shin swing only,ProFee,0989,L5857,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5858_3,Stance phase only,ProFee,0989,L5858,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5859_3,Knee-shin pro flex/ext cont,ProFee,0989,L5859,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5910_3,Endo below knee alignable sy,ProFee,0989,L5910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5920_3,Endo ak/hip alignable system,ProFee,0989,L5920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5925_3,Above knee manual lock,ProFee,0989,L5925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5930_3,High activity knee frame,ProFee,0989,L5930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5940_3,Endo bk ultra-light material,ProFee,0989,L5940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5950_3,Endo ak ultra-light material,ProFee,0989,L5950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5960_3,Endo hip ultra-light materia,ProFee,0989,L5960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5961_3,"Endo poly hip, pneu/hyd/rot",ProFee,0989,L5961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5962_3,Below knee flex cover system,ProFee,0989,L5962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5964_3,Above knee flex cover system,ProFee,0989,L5964,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5966_3,Hip flexible cover system,ProFee,0989,L5966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5968_3,Multiaxial ankle w dorsiflex,ProFee,0989,L5968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5969_3,Ak/ft power asst incl motors,ProFee,0989,L5969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5970_3,Foot external keel sach foot,ProFee,0989,L5970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5971_3,"SACH foot, replacement",ProFee,0989,L5971,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5972_3,Flexible keel foot,ProFee,0989,L5972,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5973_3,Ank-foot sys dors-plant flex,ProFee,0989,L5973,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5974_3,Foot single axis ankle/foot,ProFee,0989,L5974,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5975_3,Combo ankle/foot prosthesis,ProFee,0989,L5975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5976_3,Energy storing foot,ProFee,0989,L5976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5978_3,Ft prosth multiaxial ankl/ft,ProFee,0989,L5978,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5979_3,Multi-axial ankle/ft prosth,ProFee,0989,L5979,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5980_3,Flex foot system,ProFee,0989,L5980,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5981_3,Flex-walk sys low ext prosth,ProFee,0989,L5981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5982_3,Exoskeletal axial rotation u,ProFee,0989,L5982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5984_3,Endoskeletal axial rotation,ProFee,0989,L5984,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5985_3,Lwr ext dynamic prosth pylon,ProFee,0989,L5985,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5986_3,Multi-axial rotation unit,ProFee,0989,L5986,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5987_3,Shank ft w vert load pylon,ProFee,0989,L5987,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5988_3,Vertical shock reducing pylo,ProFee,0989,L5988,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5990_3,User adjustable heel height,ProFee,0989,L5990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L5993_3,"Heavy duty feature, foot",ProFee,0989,L5993,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L5994_3,"Heavy duty feature, knee",ProFee,0989,L5994,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L5995_3,Lower ext pros heavyduty fea,ProFee,0989,L5995,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L5999_3,Lowr extremity prosthes NOS,ProFee,0989,L5999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6000_3,Par hand robin-aids thum rem,ProFee,0989,L6000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6010_3,Hand robin-aids little/ring,ProFee,0989,L6010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6020_3,Part hand robin-aids no fing,ProFee,0989,L6020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6025_3,Part hand disart myoelectric,ProFee,0989,L6025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6026_3,Part hand myo exclu term dev,ProFee,0989,L6026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6050_3,Wrst MLd sck flx hng tri pad,ProFee,0989,L6050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6055_3,Wrst mold sock w/exp interfa,ProFee,0989,L6055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6100_3,Elb mold sock flex hinge pad,ProFee,0989,L6100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6110_3,Elbow mold sock suspension t,ProFee,0989,L6110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6120_3,Elbow mold doub splt soc ste,ProFee,0989,L6120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6130_3,Elbow stump activated lock h,ProFee,0989,L6130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6200_3,Elbow mold outsid lock hinge,ProFee,0989,L6200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6205_3,Elbow molded w/ expand inter,ProFee,0989,L6205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6250_3,Elbow inter loc elbow forarm,ProFee,0989,L6250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6300_3,Shlder disart int lock elbow,ProFee,0989,L6300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6310_3,Shoulder passive restor comp,ProFee,0989,L6310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6320_3,Shoulder passive restor cap,ProFee,0989,L6320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6350_3,Thoracic intern lock elbow,ProFee,0989,L6350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6360_3,Thoracic passive restor comp,ProFee,0989,L6360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6370_3,Thoracic passive restor cap,ProFee,0989,L6370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6380_3,Postop dsg cast chg wrst/elb,ProFee,0989,L6380,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6382_3,Postop dsg cast chg elb dis/,ProFee,0989,L6382,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6384_3,Postop dsg cast chg shlder/t,ProFee,0989,L6384,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6386_3,Postop ea cast chg & realign,ProFee,0989,L6386,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6388_3,Postop applicat rigid dsg on,ProFee,0989,L6388,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6400_3,Below elbow prosth tiss shap,ProFee,0989,L6400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6450_3,Elb disart prosth tiss shap,ProFee,0989,L6450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6500_3,Above elbow prosth tiss shap,ProFee,0989,L6500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6550_3,Shldr disar prosth tiss shap,ProFee,0989,L6550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6570_3,Scap thorac prosth tiss shap,ProFee,0989,L6570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6580_3,Wrist/elbow bowden cable mol,ProFee,0989,L6580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6582_3,Wrist/elbow bowden cbl dir f,ProFee,0989,L6582,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6584_3,Elbow fair lead cable molded,ProFee,0989,L6584,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6586_3,Elbow fair lead cable dir fo,ProFee,0989,L6586,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6588_3,Shdr fair lead cable molded,ProFee,0989,L6588,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6590_3,Shdr fair lead cable direct,ProFee,0989,L6590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6600_3,Polycentric hinge pair,ProFee,0989,L6600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6605_3,Single pivot hinge pair,ProFee,0989,L6605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6610_3,Flexible metal hinge pair,ProFee,0989,L6610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6611_3,"Additional switch, ext power",ProFee,0989,L6611,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6615_3,Disconnect locking wrist uni,ProFee,0989,L6615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6616_3,Disconnect insert locking wr,ProFee,0989,L6616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6620_3,Flexion/extension wrist unit,ProFee,0989,L6620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6621_3,Flex/ext wrist w/wo friction,ProFee,0989,L6621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6623_3,Spring-ass rot wrst w/ latch,ProFee,0989,L6623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6624_3,Flex/ext/rotation wrist unit,ProFee,0989,L6624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6625_3,Rotation wrst w/ cable lock,ProFee,0989,L6625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6628_3,Quick disconn hook adapter o,ProFee,0989,L6628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6629_3,Lamination collar w/ couplin,ProFee,0989,L6629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6630_3,Stainless steel any wrist,ProFee,0989,L6630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6632_3,Latex suspension sleeve each,ProFee,0989,L6632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6635_3,Lift assist for elbow,ProFee,0989,L6635,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6637_3,Nudge control elbow lock,ProFee,0989,L6637,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6638_3,Elec lock on manual pw elbow,ProFee,0989,L6638,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6639_3,Heavy duty elbow feature,ProFee,0989,L6639,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6640_3,Shoulder abduction joint pai,ProFee,0989,L6640,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6641_3,Excursion amplifier pulley t,ProFee,0989,L6641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6642_3,Excursion amplifier lever ty,ProFee,0989,L6642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6645_3,Shoulder flexion-abduction j,ProFee,0989,L6645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6646_3,Multipo locking shoulder jnt,ProFee,0989,L6646,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6647_3,Shoulder lock actuator,ProFee,0989,L6647,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6648_3,Ext pwrd shlder lock/unlock,ProFee,0989,L6648,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6650_3,Shoulder universal joint,ProFee,0989,L6650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6655_3,Standard control cable extra,ProFee,0989,L6655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6660_3,Heavy duty control cable,ProFee,0989,L6660,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6665_3,Teflon or equal cable lining,ProFee,0989,L6665,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6670_3,Hook to hand cable adapter,ProFee,0989,L6670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6672_3,Harness chest/shlder saddle,ProFee,0989,L6672,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6675_3,Harness figure of 8 sing con,ProFee,0989,L6675,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6676_3,Harness figure of 8 dual con,ProFee,0989,L6676,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6677_3,UE triple control harness,ProFee,0989,L6677,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6680_3,Test sock wrist disart/bel e,ProFee,0989,L6680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6682_3,Test sock elbw disart/above,ProFee,0989,L6682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6684_3,Test socket shldr disart/tho,ProFee,0989,L6684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6686_3,Suction socket,ProFee,0989,L6686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6687_3,Frame typ socket bel elbow/w,ProFee,0989,L6687,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6688_3,Frame typ sock above elb/dis,ProFee,0989,L6688,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6689_3,Frame typ socket shoulder di,ProFee,0989,L6689,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6690_3,Frame typ sock interscap-tho,ProFee,0989,L6690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6691_3,Removable insert each,ProFee,0989,L6691,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6692_3,Silicone gel insert or equal,ProFee,0989,L6692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6693_3,Lockingelbow forearm cntrbal,ProFee,0989,L6693,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6694_3,Elbow socket ins use w/lock,ProFee,0989,L6694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6695_3,Elbow socket ins use w/o lck,ProFee,0989,L6695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6696_3,Cus elbo skt in for con/atyp,ProFee,0989,L6696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6697_3,Cus elbo skt in not con/atyp,ProFee,0989,L6697,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6698_3,Below/above elbow lock mech,ProFee,0989,L6698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6700_3,Terminal device model #3,ProFee,0989,L6700,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6703_3,"Term dev, passive hand mitt",ProFee,0989,L6703,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6704_3,"Term dev, sport/rec/work att",ProFee,0989,L6704,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6705_3,Terminal device model #5,ProFee,0989,L6705,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6706_3,Term dev mech hook vol open,ProFee,0989,L6706,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6707_3,Term dev mech hook vol close,ProFee,0989,L6707,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6708_3,Term dev mech hand vol open,ProFee,0989,L6708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6709_3,Term dev mech hand vol close,ProFee,0989,L6709,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6710_3,Terminal device model #5x,ProFee,0989,L6710,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6711_3,"Ped term dev, hook, vol open",ProFee,0989,L6711,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6712_3,"Ped term dev, hook, vol clos",ProFee,0989,L6712,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6713_3,"Ped term dev, hand, vol open",ProFee,0989,L6713,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6714_3,"Ped term dev, hand, vol clos",ProFee,0989,L6714,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6715_3,Terminal device model #5xa,ProFee,0989,L6715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6720_3,Terminal device model #6,ProFee,0989,L6720,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6721_3,"Hook/hand, hvy dty, vol open",ProFee,0989,L6721,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6722_3,"Hook/hand, hvy dty, vol clos",ProFee,0989,L6722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6725_3,Terminal device model #7,ProFee,0989,L6725,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6730_3,Terminal device model #7lo,ProFee,0989,L6730,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6735_3,Terminal device model #8,ProFee,0989,L6735,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6740_3,Terminal device model #8x,ProFee,0989,L6740,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6745_3,Terminal device model #88x,ProFee,0989,L6745,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6750_3,Terminal device model #10p,ProFee,0989,L6750,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6755_3,Terminal device model #10x,ProFee,0989,L6755,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6765_3,Terminal device model #12p,ProFee,0989,L6765,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6770_3,Terminal device model #99x,ProFee,0989,L6770,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6775_3,Terminal device model#555,ProFee,0989,L6775,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6780_3,Terminal device model #ss555,ProFee,0989,L6780,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6790_3,Hooks-accu hook or equal,ProFee,0989,L6790,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6795_3,Hooks-2 load or equal,ProFee,0989,L6795,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6800_3,Hooks-aprl vc or equal,ProFee,0989,L6800,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6805_3,Modifier wrist flexion unit,ProFee,0989,L6805,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6806_3,Trs grip vc or equal,ProFee,0989,L6806,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6807_3,Term device grip1/2 or equal,ProFee,0989,L6807,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6808_3,Term device infant or child,ProFee,0989,L6808,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6809_3,Trs super sport passive,ProFee,0989,L6809,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6810_3,Pincher tool otto bock or eq,ProFee,0989,L6810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6825_3,Hands dorrance vo,ProFee,0989,L6825,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6830_3,Hand aprl vc,ProFee,0989,L6830,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6835_3,Hand sierra vo,ProFee,0989,L6835,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6840_3,Hand becker imperial,ProFee,0989,L6840,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6845_3,Hand becker lock grip,ProFee,0989,L6845,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6850_3,Term dvc-hand becker plylite,ProFee,0989,L6850,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6855_3,Hand robin-aids vo,ProFee,0989,L6855,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6860_3,Hand robin-aids vo soft,ProFee,0989,L6860,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6865_3,Hand passive hand,ProFee,0989,L6865,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6867_3,Hand detroit infant hand,ProFee,0989,L6867,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6868_3,Passive inf hand steeper/hos,ProFee,0989,L6868,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6870_3,Hand child mitt,ProFee,0989,L6870,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6872_3,Hand nyu child hand,ProFee,0989,L6872,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6873_3,Hand mech inf steeper or equ,ProFee,0989,L6873,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6875_3,Hand bock vc,ProFee,0989,L6875,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L6880_3,Hand bock vo,ProFee,0989,L6880,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6881_3,Autograsp feature ul term dv,ProFee,0989,L6881,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6882_3,Microprocessor control uplmb,ProFee,0989,L6882,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6883_3,Replc sockt below e/w disa,ProFee,0989,L6883,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6884_3,Replc sockt above elbow disa,ProFee,0989,L6884,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6885_3,Replc sockt shldr dis/interc,ProFee,0989,L6885,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6890_3,Prefab glove for term device,ProFee,0989,L6890,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6895_3,Custom glove for term device,ProFee,0989,L6895,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6900_3,Hand restorat thumb/1 finger,ProFee,0989,L6900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6905_3,Hand restoration multiple fi,ProFee,0989,L6905,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6910_3,Hand restoration no fingers,ProFee,0989,L6910,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6915_3,Hand restoration replacmnt g,ProFee,0989,L6915,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6920_3,Wrist disarticul switch ctrl,ProFee,0989,L6920,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6925_3,Wrist disart myoelectronic c,ProFee,0989,L6925,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6930_3,Below elbow switch control,ProFee,0989,L6930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6935_3,Below elbow myoelectronic ct,ProFee,0989,L6935,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6940_3,Elbow disarticulation switch,ProFee,0989,L6940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6945_3,Elbow disart myoelectronic c,ProFee,0989,L6945,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6950_3,Above elbow switch control,ProFee,0989,L6950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6955_3,Above elbow myoelectronic ct,ProFee,0989,L6955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6960_3,Shldr disartic switch contro,ProFee,0989,L6960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6965_3,Shldr disartic myoelectronic,ProFee,0989,L6965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6970_3,Interscapular-thor switch ct,ProFee,0989,L6970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L6975_3,Interscap-thor myoelectronic,ProFee,0989,L6975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7007_3,Adult electric hand,ProFee,0989,L7007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7008_3,Pediatric electric hand,ProFee,0989,L7008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7009_3,Adult electric hook,ProFee,0989,L7009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7010_3,Hand otto back steeper/eq sw,ProFee,0989,L7010,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7015_3,Hand sys teknik village swit,ProFee,0989,L7015,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7020_3,Electronic greifer switch ct,ProFee,0989,L7020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7025_3,Electron hand myoelectronic,ProFee,0989,L7025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7030_3,Hand sys teknik vill myoelec,ProFee,0989,L7030,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7035_3,Electron greifer myoelectro,ProFee,0989,L7035,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7040_3,Prehensile actuator hosmer s,ProFee,0989,L7040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7045_3,Electron hook child michigan,ProFee,0989,L7045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7170_3,Electronic elbow hosmer swit,ProFee,0989,L7170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7180_3,Electronic elbow sequential,ProFee,0989,L7180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7181_3,Electronic elbo simultaneous,ProFee,0989,L7181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7185_3,Electron elbow adolescent sw,ProFee,0989,L7185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7186_3,Electron elbow child switch,ProFee,0989,L7186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7190_3,Elbow adolescent myoelectron,ProFee,0989,L7190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7191_3,Elbow child myoelectronic ct,ProFee,0989,L7191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7259_3,Electronic wrist rotator any,ProFee,0989,L7259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7260_3,Electron wrist rotator otto,ProFee,0989,L7260,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7261_3,Electron wrist rotator utah,ProFee,0989,L7261,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7266_3,Servo control steeper or equ,ProFee,0989,L7266,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7272_3,Analogue control unb or equa,ProFee,0989,L7272,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7274_3,Proportional ctl 12 volt uta,ProFee,0989,L7274,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7360_3,Six volt bat otto bock/eq ea,ProFee,0989,L7360,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7362_3,Battery chrgr six volt otto,ProFee,0989,L7362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7364_3,Twelve volt battery utah/equ,ProFee,0989,L7364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7366_3,Battery chrgr 12 volt utah/e,ProFee,0989,L7366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7367_3,Replacemnt lithium ionbatter,ProFee,0989,L7367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7368_3,Lithium ion battery charger,ProFee,0989,L7368,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7400_3,"Add UE prost be/wd, ultlite",ProFee,0989,L7400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7401_3,Add UE prost a/e ultlite mat,ProFee,0989,L7401,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7402_3,Add UE prost s/d ultlite mat,ProFee,0989,L7402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7403_3,Add UE prost b/e acrylic,ProFee,0989,L7403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7404_3,Add UE prost a/e acrylic,ProFee,0989,L7404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7405_3,Add UE prost s/d acrylic,ProFee,0989,L7405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7499_3,Upper extremity prosthes NOS,ProFee,0989,L7499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7500_3,Prosthetic dvc repair hourly,ProFee,0989,L7500,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7510_3,Prosthetic device repair rep,ProFee,0989,L7510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7520_3,Repair prosthesis per 15 min,ProFee,0989,L7520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7600_3,Prosthetic donning sleeve,ProFee,0989,L7600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7611_3,"Ped term dev, hook, vol open",ProFee,0989,L7611,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7612_3,"Ped term dev, hook, vol clos",ProFee,0989,L7612,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7613_3,"Ped term dev, hand, vol open",ProFee,0989,L7613,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7614_3,"Ped term dev, hand, vol clos",ProFee,0989,L7614,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7621_3,"Hook/hand, hvy dty, vol open",ProFee,0989,L7621,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7622_3,"Hook/hand, hvy dty, vol clos",ProFee,0989,L7622,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L7700_3,Pros soc insert gasket/seal,ProFee,0989,L7700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7900_3,Male vacuum erection system,ProFee,0989,L7900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L7902_3,"Tension ring, vac erect dev",ProFee,0989,L7902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8000_3,Mastectomy bra,ProFee,0989,L8000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8001_3,Breast prosthesis bra & form,ProFee,0989,L8001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8002_3,Brst prsth bra & bilat form,ProFee,0989,L8002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8010_3,Mastectomy sleeve,ProFee,0989,L8010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8015_3,Ext breastprosthesis garment,ProFee,0989,L8015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8020_3,Mastectomy form,ProFee,0989,L8020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8030_3,Breast prosthesis silicone/e,ProFee,0989,L8030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8031_3,Breast prosthesis w adhesive,ProFee,0989,L8031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8032_3,Reusable nipple prosthesis,ProFee,0989,L8032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8033_3,"Nipple prosthesis custom, ea",ProFee,0989,L8033,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
L8035_3,Custom breast prosthesis,ProFee,0989,L8035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8039_3,Breast prosthesis NOS,ProFee,0989,L8039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8040_3,Nasal prosthesis,ProFee,0989,L8040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8041_3,Midfacial prosthesis,ProFee,0989,L8041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8042_3,Orbital prosthesis,ProFee,0989,L8042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8043_3,Upper facial prosthesis,ProFee,0989,L8043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8044_3,Hemi-facial prosthesis,ProFee,0989,L8044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8045_3,Auricular prosthesis,ProFee,0989,L8045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8046_3,Partial facial prosthesis,ProFee,0989,L8046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8047_3,Nasal septal prosthesis,ProFee,0989,L8047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8048_3,Unspec maxillofacial prosth,ProFee,0989,L8048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8049_3,Repair maxillofacial prosth,ProFee,0989,L8049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8300_3,Truss single w/ standard pad,ProFee,0989,L8300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8310_3,Truss double w/ standard pad,ProFee,0989,L8310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8320_3,Truss addition to std pad wa,ProFee,0989,L8320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8330_3,Truss add to std pad scrotal,ProFee,0989,L8330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8400_3,Sheath below knee,ProFee,0989,L8400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8410_3,Sheath above knee,ProFee,0989,L8410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8415_3,Sheath upper limb,ProFee,0989,L8415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8417_3,Pros sheath/sock w gel cushn,ProFee,0989,L8417,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8420_3,Prosthetic sock multi ply BK,ProFee,0989,L8420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8430_3,Prosthetic sock multi ply AK,ProFee,0989,L8430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8435_3,Pros sock multi ply upper lm,ProFee,0989,L8435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8440_3,Shrinker below knee,ProFee,0989,L8440,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8460_3,Shrinker above knee,ProFee,0989,L8460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8465_3,Shrinker upper limb,ProFee,0989,L8465,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8470_3,Pros sock single ply BK,ProFee,0989,L8470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8480_3,Pros sock single ply AK,ProFee,0989,L8480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8485_3,Pros sock single ply upper l,ProFee,0989,L8485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8499_3,Unlisted misc prosthetic ser,ProFee,0989,L8499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8500_3,Artificial larynx,ProFee,0989,L8500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8501_3,Tracheostomy speaking valve,ProFee,0989,L8501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8505_3,"Artificial larynx, accessory",ProFee,0989,L8505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8507_3,Trach-esoph voice pros pt in,ProFee,0989,L8507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8509_3,Trach-esoph voice pros md in,ProFee,0989,L8509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8510_3,Voice amplifier,ProFee,0989,L8510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8511_3,Indwelling trach insert,ProFee,0989,L8511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8512_3,Gel cap for trach voice pros,ProFee,0989,L8512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8513_3,Trach pros cleaning device,ProFee,0989,L8513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8514_3,Repl trach puncture dilator,ProFee,0989,L8514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8515_3,Gel cap app device for trach,ProFee,0989,L8515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8600_3,Implant breast silicone/eq,ProFee,0989,L8600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8603_3,Collagen imp urinary 2.5 ml,ProFee,0989,L8603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8604_3,Dextranomer/hyaluronic acid,ProFee,0989,L8604,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8605_3,Inj bulking agent anal canal,ProFee,0989,L8605,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8606_3,Synthetic implnt urinary 1ml,ProFee,0989,L8606,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8607_3,Inj vocal cord bulking agent,ProFee,0989,L8607,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8608_3,Arg ii ext com/sup/acc misc,ProFee,0989,L8608,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8609_3,Artificial cornea,ProFee,0989,L8609,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8610_3,Ocular implant,ProFee,0989,L8610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8612_3,Aqueous shunt prosthesis,ProFee,0989,L8612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8613_3,Ossicular implant,ProFee,0989,L8613,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8614_3,Cochlear device/system,ProFee,0989,L8614,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8615_3,Coch implant headset replace,ProFee,0989,L8615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8616_3,Coch implant microphone repl,ProFee,0989,L8616,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8617_3,Coch implant trans coil repl,ProFee,0989,L8617,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8618_3,Coch implant tran cable repl,ProFee,0989,L8618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8619_3,Replace cochlear processor,ProFee,0989,L8619,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8621_3,Repl zinc air battery,ProFee,0989,L8621,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8622_3,Repl alkaline battery,ProFee,0989,L8622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8623_3,"Lith ion batt CID,non-earlvl",ProFee,0989,L8623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8624_3,"Lith ion batt CID, ear level",ProFee,0989,L8624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8625_3,Charger coch impl/aoi battry,ProFee,0989,L8625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8627_3,CID ext speech process repl,ProFee,0989,L8627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8628_3,CID ext controller repl,ProFee,0989,L8628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8629_3,CID transmit coil and cable,ProFee,0989,L8629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8630_3,Metacarpophalangeal implant,ProFee,0989,L8630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8631_3,MCP joint repl 2 pc or more,ProFee,0989,L8631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8641_3,Metatarsal joint implant,ProFee,0989,L8641,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8642_3,Hallux implant,ProFee,0989,L8642,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8658_3,Interphalangeal joint spacer,ProFee,0989,L8658,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8659_3,Interphalangeal joint repl,ProFee,0989,L8659,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8670_3,"Vascular graft, synthetic",ProFee,0989,L8670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8679_3,Imp neurosti pls gn any type,ProFee,0989,L8679,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8680_3,Implt neurostim elctr each,ProFee,0989,L8680,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8681_3,Pt prgrm for implt neurostim,ProFee,0989,L8681,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8682_3,Implt neurostim radiofq rec,ProFee,0989,L8682,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8683_3,Radiofq trsmtr for implt neu,ProFee,0989,L8683,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8684_3,Radiof trsmtr implt scrl neu,ProFee,0989,L8684,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8685_3,Implt nrostm pls gen sng rec,ProFee,0989,L8685,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8686_3,Implt nrostm pls gen sng non,ProFee,0989,L8686,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8687_3,Implt nrostm pls gen dua rec,ProFee,0989,L8687,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8688_3,Implt nrostm pls gen dua non,ProFee,0989,L8688,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8689_3,External recharging system,ProFee,0989,L8689,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8690_3,"Aud osseo dev, int/ext comp",ProFee,0989,L8690,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8691_3,Aud osseo dev ext snd proces,ProFee,0989,L8691,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8692_3,Non-osseointegrated snd proc,ProFee,0989,L8692,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8693_3,"Aud osseo dev, abutment",ProFee,0989,L8693,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8694_3,Aoi transducer/actuator repl,ProFee,0989,L8694,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8695_3,External recharg sys extern,ProFee,0989,L8695,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8696_3,Ext antenna phren nerve stim,ProFee,0989,L8696,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8698_3,Misc used with tot art heart,ProFee,0989,L8698,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8699_3,Prosthetic implant NOS,ProFee,0989,L8699,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8701_3,Pow ue rom dev ewh uprt cust,ProFee,0989,L8701,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L8702_3,Pow ue rom dev ewhf uprt cus,ProFee,0989,L8702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
L9900_3,O&P supply/accessory/service,ProFee,0989,L9900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M0064_3,Visit for drug monitoring,ProFee,0989,M0064,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M0075_3,Cellular therapy,ProFee,0989,M0075,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M0076_3,Prolotherapy,ProFee,0989,M0076,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M0100_3,Intragastric hypothermia,ProFee,0989,M0100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M0300_3,IV chelationtherapy,ProFee,0989,M0300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M0301_3,Fabric wrapping of aneurysm,ProFee,0989,M0301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1000_3,Pain scr as mod to sevr,ProFee,0989,M1000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1001_3,Pln to adrs pain doc,ProFee,0989,M1001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1002_3,Pln to adrs pain not doc,ProFee,0989,M1002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1003_3,Tb scr 12 mo pri fst bio dz,ProFee,0989,M1003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1004_3,Doc med rsn no srn tb,ProFee,0989,M1004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1005_3,Tb scr no perf,ProFee,0989,M1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1006_3,"Dz not ases, no rsn",ProFee,0989,M1006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1007_3,>=50% total pt outpt ra enct,ProFee,0989,M1007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1008_3,<50% total pt outpt ra encts,ProFee,0989,M1008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1009_3,Dc eoc doc med rec,ProFee,0989,M1009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1010_3,Dc eoc doc med rec,ProFee,0989,M1010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1011_3,Dc eoc doc med rec,ProFee,0989,M1011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1012_3,Dc eoc doc med rec,ProFee,0989,M1012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1013_3,Dc eoc doc med rec,ProFee,0989,M1013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1014_3,Dc epi care doc medrec,ProFee,0989,M1014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1015_3,Dc eoc doc med rec,ProFee,0989,M1015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1016_3,Pt dx meop or sur steri,ProFee,0989,M1016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1017_3,Pt admt to palitve serv,ProFee,0989,M1017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1018_3,Pt dx hst cr pt sk lg cr scr,ProFee,0989,M1018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1019_3,Adl pt mj dep ds rs 12 phq<5,ProFee,0989,M1019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1020_3,Adl pt mj dep ds no rs 12 mo,ProFee,0989,M1020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1021_3,Pt uc in pp,ProFee,0989,M1021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1022_3,Pt hospice during perf pd,ProFee,0989,M1022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1023_3,Adl pt mj dep ds rs 6 phq<5,ProFee,0989,M1023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1024_3,Adl pt mj dep ds no rs 6 mo,ProFee,0989,M1024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1025_3,Pt hospice during perf pd,ProFee,0989,M1025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1026_3,Pt hospice during perf pd,ProFee,0989,M1026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1027_3,Img head (ct or mri) obtnd,ProFee,0989,M1027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1028_3,Doc of pt prm hda dx and otr,ProFee,0989,M1028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1029_3,Doc sysm rsn img hd,ProFee,0989,M1029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1030_3,Pt clin ind img hd,ProFee,0989,M1030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1031_3,Pt clin ind img hd,ProFee,0989,M1031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1032_3,Adt tkng pharmthry for oud,ProFee,0989,M1032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1033_3,Pharmthry for oud afr 6.30,ProFee,0989,M1033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1034_3,Adt 180 dys pharmthry oud,ProFee,0989,M1034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1035_3,Adt pd out mat pr 180 dys tx,ProFee,0989,M1035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1036_3,Adt no 180 dys pharmthry oud,ProFee,0989,M1036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1037_3,Pt dx lum sp reg cacr,ProFee,0989,M1037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1038_3,Pt dx lum sp reg fract,ProFee,0989,M1038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1039_3,Pt dx lum sp reg inf,ProFee,0989,M1039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1040_3,Pt dx lum idi or cong scol,ProFee,0989,M1040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1041_3,Pt cr ft inf lm or pt id sl,ProFee,0989,M1041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1042_3,Ftl st mea sco ot odi 3 mo,ProFee,0989,M1042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1043_3,Fs no odi 9-15mo,ProFee,0989,M1043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1044_3,Ftl st mea odi 3 mo,ProFee,0989,M1044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1045_3,Fs oks 9-15mo = 37,ProFee,0989,M1045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1046_3,Fs oks 9-15mo = 37,ProFee,0989,M1046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1047_3,Fs msrd oks pre and post,ProFee,0989,M1047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1048_3,Fsm wth scr odi pre and post,ProFee,0989,M1048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1049_3,Fs wth scr no odi pre and p,ProFee,0989,M1049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1050_3,Fs msrd odi pre and post,ProFee,0989,M1050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1051_3,Pt w/cancer scoliosis,ProFee,0989,M1051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1052_3,Lg pn not meas w/ vas 1yr po,ProFee,0989,M1052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1053_3,Pre and post vas wthn 3 mos,ProFee,0989,M1053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1054_3,Pt uc in pp,ProFee,0989,M1054,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1055_3,Aspirin used,ProFee,0989,M1055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1056_3,Presc antico med in pp,ProFee,0989,M1056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1057_3,"Aspirin not used, no rsn",ProFee,0989,M1057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1058_3,Pt prm nurs hm res in pp,ProFee,0989,M1058,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1059_3,Pt no prm nurs hm res in pp,ProFee,0989,M1059,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1060_3,Pt died in pp,ProFee,0989,M1060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1061_3,Pt preg,ProFee,0989,M1061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1062_3,Pt imcomprmd,ProFee,0989,M1062,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1063_3,Pt rec hg dos imsup thpy,ProFee,0989,M1063,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1064_3,Shing vac doc adm or pv rec,ProFee,0989,M1064,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1065_3,Shing vac no adm clinc rsn,ProFee,0989,M1065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1066_3,Shing vac no doc no rsn,ProFee,0989,M1066,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1067_3,Hspc pt prv time meam per,ProFee,0989,M1067,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1068_3,Pt not ambulatory,ProFee,0989,M1068,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1069_3,Pt scr ft fall rsk,ProFee,0989,M1069,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1070_3,Pt not scrn fut fall no rsn,ProFee,0989,M1070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1071_3,Pt had add'l sp pcr perf,ProFee,0989,M1071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
M1106_3,Start eoc doc med rec,ProFee,0989,M1106,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1107_3,Docu dx degen neuro,ProFee,0989,M1107,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1108_3,Oc ni pt 1-2 vis,ProFee,0989,M1108,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1109_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1109,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1110_3,Oc ni pt selfdc 1-2 vis,ProFee,0989,M1110,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1111_3,Start eoc doc med rec,ProFee,0989,M1111,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1112_3,Docu dx degen neuro,ProFee,0989,M1112,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1113_3,Oc ni pt 1-2 vis,ProFee,0989,M1113,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1114_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1114,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1115_3,Oc ni pt selfdc 1-2 vis,ProFee,0989,M1115,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1116_3,Start eoc doc med rec,ProFee,0989,M1116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1117_3,Docu dx degen neuro,ProFee,0989,M1117,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1118_3,Oc ni pt 1-2 vis,ProFee,0989,M1118,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1119_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1119,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1120_3,Oc ni pt selfdc 1-2 vis,ProFee,0989,M1120,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1121_3,Start eoc doc med rec,ProFee,0989,M1121,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1122_3,Docu dx degen neuro,ProFee,0989,M1122,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1123_3,Oc ni pt 1-2 vis,ProFee,0989,M1123,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1124_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1124,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1125_3,Oc ni pt selfdc 1-2 vis,ProFee,0989,M1125,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1126_3,Start eoc doc med rec,ProFee,0989,M1126,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1127_3,Docu dx degen neuro,ProFee,0989,M1127,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1128_3,Oc ni pt 1-2 vis,ProFee,0989,M1128,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1129_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1129,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1130_3,Oc ni pt self dc 1-2 vis,ProFee,0989,M1130,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1131_3,Docu dx degen neuro,ProFee,0989,M1131,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1132_3,Oc ni pt 1-2 vis,ProFee,0989,M1132,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1133_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1133,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1134_3,Oc ni pt self dc 1-2 vis,ProFee,0989,M1134,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1135_3,Start eoc doc med rec,ProFee,0989,M1135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1136_3,Start eoc doc med rec,ProFee,0989,M1136,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1137_3,Docu dx degen neuro,ProFee,0989,M1137,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1138_3,Oc ni pt 1-2 vis,ProFee,0989,M1138,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1139_3,Oc ni pt self dc 1-2 vis,ProFee,0989,M1139,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1140_3,Oc ni pt dc 1-2 vis,ProFee,0989,M1140,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1141_3,Fs no oks,ProFee,0989,M1141,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1142_3,Emerge cases,ProFee,0989,M1142,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1143_3,Ni rehab med chiro,ProFee,0989,M1143,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
M1144_3,Oc no ind pt 1-2 vis,ProFee,0989,M1144,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
MRSC_1,MRSA Cultture Screen Reflex,Inpatient,0300,87081,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
MRSC_1,MRSA Cultture Screen Reflex,Outpatient,0300,87081,,,,0,84.00,63.00,63.00,79.80,75.60,79.80,79.80,75.60
P2028_3,Cephalin floculation test,ProFee,0989,P2028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P2029_3,Congo red blood test,ProFee,0989,P2029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P2031_3,Hair analysis,ProFee,0989,P2031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P2033_3,Blood thymol turbidity,ProFee,0989,P2033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P2038_3,Blood mucoprotein,ProFee,0989,P2038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P3000_3,Screen pap by tech w md supv,ProFee,0989,P3000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P3001_3,Screening pap smear by phys,ProFee,0989,P3001,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
P7001_3,Culture bacterial urine,ProFee,0989,P7001,,,,0,3.00,2.25,2.25,27.00,0.00,27.00,27.00,N/A
P9010_3,Whole blood for transfusion,ProFee,0989,P9010,,,,0,3.00,2.25,2.25,64.00,0.00,64.00,64.00,N/A
P9011_3,Blood split unit,ProFee,0989,P9011,,,,0,3.00,2.25,2.25,91.50,0.00,91.50,91.50,N/A
P9012_3,Cryoprecipitate each unit,ProFee,0989,P9012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9016_3,RBC leukocytes reduced,ProFee,0989,P9016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9017_3,Plasma 1 donor frz w/in 8 hr,ProFee,0989,P9017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9019_3,"Platelets, each unit",ProFee,0989,P9019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9020_3,Plaelet rich plasma unit,ProFee,0989,P9020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9021_3,Red blood cells unit,ProFee,0989,P9021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9022_3,Washed red blood cells unit,ProFee,0989,P9022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9023_3,"Frozen plasma, pooled, sd",ProFee,0989,P9023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9031_3,Platelets leukocytes reduced,ProFee,0989,P9031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9032_3,"Platelets, irradiated",ProFee,0989,P9032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9033_3,Platelets leukoreduced irrad,ProFee,0989,P9033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9034_3,"Platelets, pheresis",ProFee,0989,P9034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9035_3,Platelet pheres leukoreduced,ProFee,0989,P9035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9036_3,Platelet pheresis irradiated,ProFee,0989,P9036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9037_3,Plate pheres leukoredu irrad,ProFee,0989,P9037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9038_3,RBC irradiated,ProFee,0989,P9038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9039_3,RBC deglycerolized,ProFee,0989,P9039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9040_3,RBC leukoreduced irradiated,ProFee,0989,P9040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9041_3,"Albumin (human),5%, 50ml",ProFee,0989,P9041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9043_3,"Plasma protein fract,5%,50ml",ProFee,0989,P9043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9044_3,Cryoprecipitatereducedplasma,ProFee,0989,P9044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9045_3,"Albumin (human), 5%, 250 ml",ProFee,0989,P9045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9046_3,"Albumin (human), 25%, 20 ml",ProFee,0989,P9046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9047_3,"Albumin (human), 25%, 50ml",ProFee,0989,P9047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9048_3,"Plasmaprotein fract,5%,250ml",ProFee,0989,P9048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9050_3,"Granulocytes, pheresis unit",ProFee,0989,P9050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9051_3,"Blood, l/r, cmv-neg",ProFee,0989,P9051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9052_3,"Platelets, hla-m, l/r, unit",ProFee,0989,P9052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9053_3,"Plt, pher, l/r cmv-neg, irr",ProFee,0989,P9053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9054_3,"Blood, l/r, froz/degly/wash",ProFee,0989,P9054,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9055_3,"Plt, aph/pher, l/r, cmv-neg",ProFee,0989,P9055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9056_3,"Blood, l/r, irradiated",ProFee,0989,P9056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9057_3,"RBC, frz/deg/wsh, l/r, irrad",ProFee,0989,P9057,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9058_3,"RBC, l/r, cmv-neg, irrad",ProFee,0989,P9058,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9059_3,"Plasma, frz between 8-24hour",ProFee,0989,P9059,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9060_3,Fr frz plasma donor retested,ProFee,0989,P9060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9070_3,Pathogen reduced plasma pool,ProFee,0989,P9070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9071_3,Pathogen reduced plasma sing,ProFee,0989,P9071,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9072_3,Plate path red/rapid bac tes,ProFee,0989,P9072,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
P9073_3,Platelets pheresis path redu,ProFee,0989,P9073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9099_3,Blood component/product noc,ProFee,0989,P9099,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
P9100_3,Pathogen test for platelets,ProFee,0989,P9100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9603_3,One-way allow prorated miles,ProFee,0989,P9603,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9604_3,One-way allow prorated trip,ProFee,0989,P9604,,,,0,3.00,2.25,2.25,5.00,0.00,5.00,5.00,N/A
P9612_3,Catheterize for urine spec,ProFee,0989,P9612,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
P9615_3,Urine specimen collect mult,ProFee,0989,P9615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
PM1_1,Urine Drug Screen PM1,Outpatient,0300,G0480,,,,0,183.00,137.25,137.25,173.85,164.70,173.85,173.85,164.70
PM1_1,Urine Drug Screen PM1,Inpatient,0300,G0480,,,,0,183.00,137.25,137.25,173.85,164.70,173.85,173.85,164.70
PM2_1,Urine Drug Screen PM2,Inpatient,0300,G0480,,,,0,186.00,139.50,139.50,176.70,167.40,176.70,176.70,167.40
PM2_1,Urine Drug Screen PM2,Outpatient,0300,G0480,,,,0,186.00,139.50,139.50,176.70,167.40,176.70,176.70,167.40
PM3_1,Urine Drug Screen PM3,Inpatient,0300,G0480,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
PM3_1,Urine Drug Screen PM3,Outpatient,0300,G0480,,,,0,198.00,148.50,148.50,188.10,178.20,188.10,188.10,178.20
PM4_1,Urine Drus Screen PM4,Outpatient,0300,G0480,,,,0,220.00,165.00,165.00,209.00,198.00,209.00,209.00,198.00
PM4_1,Urine Drus Screen PM4,Inpatient,0300,G0480,,,,0,220.00,165.00,165.00,209.00,198.00,209.00,209.00,198.00
PM5_1,Urine Drug Screen PM5,Inpatient,0300,G0480,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,228.00,216.00
PM5_1,Urine Drug Screen PM5,Outpatient,0300,G0480,,,,0,240.00,180.00,180.00,228.00,216.00,228.00,228.00,216.00
Q0035_3,Cardiokymography,ProFee,0989,Q0035,,,,0,3.00,2.25,2.25,12.50,0.00,12.50,12.50,N/A
Q0081_3,Infusion ther other than che,ProFee,0989,Q0081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0083_3,Chemo by other than infusion,ProFee,0989,Q0083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0084_3,Chemotherapy by infusion,ProFee,0989,Q0084,,,,0,3.00,2.25,2.25,142.00,0.00,142.00,142.00,N/A
Q0085_3,Chemo by both infusion and o,ProFee,0989,Q0085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0092_3,Set up port xray equipment,ProFee,0989,Q0092,,,,0,3.00,2.25,2.25,36.00,0.00,36.00,36.00,N/A
Q0111_3,Wet mounts/ w preparations,ProFee,0989,Q0111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0112_3,Potassium hydroxide preps,ProFee,0989,Q0112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0113_3,Pinworm examinations,ProFee,0989,Q0113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0114_3,Fern test,ProFee,0989,Q0114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0115_3,Post-coital mucous exam,ProFee,0989,Q0115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0138_3,"Ferumoxytol, non-esrd",ProFee,0989,Q0138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0139_3,"Ferumoxytol, esrd use",ProFee,0989,Q0139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0144_3,"Azithromycin dihydrate, oral",ProFee,0989,Q0144,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0161_3,Chlorpromazine hcl 5mg oral,ProFee,0989,Q0161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0162_3,Ondansetron oral,ProFee,0989,Q0162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0163_3,Diphenhydramine HCl 50mg,ProFee,0989,Q0163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0164_3,Prochlorperazine maleate 5mg,ProFee,0989,Q0164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0165_3,Prochlorperazine maleate10mg,ProFee,0989,Q0165,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0166_3,Granisetron HCl 1 mg oral,ProFee,0989,Q0166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0167_3,Dronabinol 2.5mg oral,ProFee,0989,Q0167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0168_3,Dronabinol 5mg oral,ProFee,0989,Q0168,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0169_2,Promethazine HCl 12.5mg oral,ProFee,0989,Q0169,,,,0,7.00,5.25,5.25,5.25,0.00,N/A,N/A,N/A
Q0169_3,Promethazine HCl 12.5mg oral,ProFee,0989,Q0169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0170_3,Promethazine HCl 25 mg oral,ProFee,0989,Q0170,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0171_3,Chlorpromazine HCl 10mg oral,ProFee,0989,Q0171,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0172_3,Chlorpromazine HCl 25mg oral,ProFee,0989,Q0172,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0173_3,Trimethobenzamide HCl 250mg,ProFee,0989,Q0173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0174_3,Thiethylperazine maleate10mg,ProFee,0989,Q0174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0175_3,Perphenazine 4mg oral,ProFee,0989,Q0175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0176_3,Perphenazine 8mg oral,ProFee,0989,Q0176,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0177_3,Hydroxyzine pamoate 25mg,ProFee,0989,Q0177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0178_3,Hydroxyzine pamoate 50mg,ProFee,0989,Q0178,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0179_2,Ondansetron HCl 8mg oral,ProFee,0989,Q0179,,,,0,10.00,7.50,7.50,7.50,N/A,N/A,N/A,N/A
Q0179_3,Ondansetron HCl 8mg oral,ProFee,0989,Q0179,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0180_3,Dolasetron mesylate oral,ProFee,0989,Q0180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0181_3,Unspecified oral anti-emetic,ProFee,0989,Q0181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0477_3,Pwr module pt cable lvad rpl,ProFee,0989,Q0477,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0478_3,"Power adapter, combo vad",ProFee,0989,Q0478,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0479_3,"Power module combo vad, rep",ProFee,0989,Q0479,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0480_3,"driver pneumatic vad, rep",ProFee,0989,Q0480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0481_3,"microprcsr cu elec vad, rep",ProFee,0989,Q0481,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0482_3,"microprcsr cu combo vad, rep",ProFee,0989,Q0482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0483_3,"monitor elec vad, rep",ProFee,0989,Q0483,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0484_3,monitor elec or comb vad rep,ProFee,0989,Q0484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0485_3,"monitor cable elec vad, rep",ProFee,0989,Q0485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0486_3,mon cable elec/pneum vad rep,ProFee,0989,Q0486,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0487_3,"leads any type vad, rep only",ProFee,0989,Q0487,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0488_3,"pwr pack base elec vad, rep",ProFee,0989,Q0488,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0489_3,"pwr pck base combo vad, rep",ProFee,0989,Q0489,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0490_3,"emr pwr source elec vad, rep",ProFee,0989,Q0490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0491_3,emr pwr source combo vad rep,ProFee,0989,Q0491,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0492_3,"emr pwr cbl elec vad, rep",ProFee,0989,Q0492,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0493_3,"emr pwr cbl combo vad, rep",ProFee,0989,Q0493,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0494_3,"emr hd pmp elec/combo, rep",ProFee,0989,Q0494,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0495_3,"charger elec/combo vad, rep",ProFee,0989,Q0495,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0496_3,"battery elec/combo vad, rep",ProFee,0989,Q0496,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0497_3,"bat clps elec/comb vad, rep",ProFee,0989,Q0497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0498_3,"holster elec/combo vad, rep",ProFee,0989,Q0498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0499_3,belt/vest elec/combo vad rep,ProFee,0989,Q0499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0500_3,"filters elec/combo vad, rep",ProFee,0989,Q0500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0501_3,"shwr cov elec/combo vad, rep",ProFee,0989,Q0501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0502_3,"mobility cart pneum vad, rep",ProFee,0989,Q0502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0503_3,battery pneum vad replacemnt,ProFee,0989,Q0503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0504_3,"pwr adpt pneum vad, rep veh",ProFee,0989,Q0504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0505_3,miscl supply/accessory vad,ProFee,0989,Q0505,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q0506_3,Lith-ion batt elec/pneum VAD,ProFee,0989,Q0506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0507_3,Misc sup/acc ext vad,ProFee,0989,Q0507,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0508_3,Mis sup/acc imp vad,ProFee,0989,Q0508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0509_3,Mis sup/ac imp vad nopay med,ProFee,0989,Q0509,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0510_3,Dispens fee immunosupressive,ProFee,0989,Q0510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0511_3,"Sup fee antiem,antica,immuno",ProFee,0989,Q0511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0512_3,Px sup fee anti-can sub pres,ProFee,0989,Q0512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0513_3,Disp fee inhal drugs/30 days,ProFee,0989,Q0513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0514_3,Disp fee inhal drugs/90 days,ProFee,0989,Q0514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q0515_3,Sermorelin acetate injection,ProFee,0989,Q0515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q1003_3,Ntiol category 3,ProFee,0989,Q1003,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q1004_3,Ntiol category 4,ProFee,0989,Q1004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q1005_3,Ntiol category 5,ProFee,0989,Q1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2004_3,Bladder calculi irrig sol,ProFee,0989,Q2004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2009_3,"Fosphenytoin, 50 mg",ProFee,0989,Q2009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2017_3,"Teniposide, 50 mg",ProFee,0989,Q2017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2026_3,Radiesse injection,ProFee,0989,Q2026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2027_3,Sculptra injection,ProFee,0989,Q2027,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q2028_3,"Inj, sculptra, 0.5mg",ProFee,0989,Q2028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2034_3,Agriflu vaccine,ProFee,0989,Q2034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2035_3,"Afluria vacc, 3 yrs & >, im",ProFee,0989,Q2035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2036_3,"Flulaval vacc, 3 yrs & >, im",ProFee,0989,Q2036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2037_3,"Fluvirin vacc, 3 yrs & >, im",ProFee,0989,Q2037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2038_3,"Fluzone vacc, 3 yrs & >, im",ProFee,0989,Q2038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2039_3,"NOS flu vacc, 3 yrs & >, im",ProFee,0989,Q2039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2040_3,Tisagenlecleucel car-pos t,ProFee,0989,Q2042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2041_3,Axicabtagene ciloleucel car+,ProFee,0989,Q2041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2042_3,Tisagenlecleucel car-pos t,ProFee,0989,Q2042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2043_3,Sipuleucel-t auto cd54+,ProFee,0989,Q2043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2049_3,Imported lipodox inj,ProFee,0989,Q2049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2050_3,Doxorubicin inj 10mg,ProFee,0989,Q2050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q2052_3,"Ivig demo, services/supplies",ProFee,0989,Q2052,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q3001_3,Brachytherapy Radioelements,ProFee,0989,Q3001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q3014_3,Telehealth facility fee,ProFee,0989,Q3014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q3019_3,ALS emer trans no ALS serv,ProFee,0989,Q3019,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q3020_3,ALS nonemer trans no ALS ser,ProFee,0989,Q3020,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q3025_3,IM inj interferon beta 1-a,ProFee,0989,Q3025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q3026_3,Subc inj interferon beta-1a,ProFee,0989,Q3026,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q3027_3,Inj beta interferon im 1 mcg,ProFee,0989,Q3027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q3028_3,Inj beta interferon sq 1 mcg,ProFee,0989,Q3028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q3031_3,Collagen skin test,ProFee,0989,Q3031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4001_3,Cast sup body cast plaster,ProFee,0989,Q4001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4002_3,Cast sup body cast fiberglas,ProFee,0989,Q4002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4003_3,Cast sup shoulder cast plstr,ProFee,0989,Q4003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4004_3,Cast sup shoulder cast fbrgl,ProFee,0989,Q4004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4005_3,Cast sup long arm adult plst,ProFee,0989,Q4005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4006_3,Cast sup long arm adult fbrg,ProFee,0989,Q4006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4007_3,Cast sup long arm ped plster,ProFee,0989,Q4007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4008_3,Cast sup long arm ped fbrgls,ProFee,0989,Q4008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4009_3,Cast sup sht arm adult plstr,ProFee,0989,Q4009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4010_3,Cast sup sht arm adult fbrgl,ProFee,0989,Q4010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4011_3,Cast sup sht arm ped plaster,ProFee,0989,Q4011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4012_3,Cast sup sht arm ped fbrglas,ProFee,0989,Q4012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4013_3,Cast sup gauntlet plaster,ProFee,0989,Q4013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4014_3,Cast sup gauntlet fiberglass,ProFee,0989,Q4014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4015_3,Cast sup gauntlet ped plster,ProFee,0989,Q4015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4016_3,Cast sup gauntlet ped fbrgls,ProFee,0989,Q4016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4017_3,Cast sup lng arm splint plst,ProFee,0989,Q4017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4018_3,Cast sup lng arm splint fbrg,ProFee,0989,Q4018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4019_3,Cast sup lng arm splnt ped p,ProFee,0989,Q4019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4020_3,Cast sup lng arm splnt ped f,ProFee,0989,Q4020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4021_3,Cast sup sht arm splint plst,ProFee,0989,Q4021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4022_3,Cast sup sht arm splint fbrg,ProFee,0989,Q4022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4023_3,Cast sup sht arm splnt ped p,ProFee,0989,Q4023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4024_3,Cast sup sht arm splnt ped f,ProFee,0989,Q4024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4025_3,Cast sup hip spica plaster,ProFee,0989,Q4025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4026_3,Cast sup hip spica fiberglas,ProFee,0989,Q4026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4027_3,Cast sup hip spica ped plstr,ProFee,0989,Q4027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4028_3,Cast sup hip spica ped fbrgl,ProFee,0989,Q4028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4029_3,Cast sup long leg plaster,ProFee,0989,Q4029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4030_3,Cast sup long leg fiberglass,ProFee,0989,Q4030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4031_3,Cast sup lng leg ped plaster,ProFee,0989,Q4031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4032_3,Cast sup lng leg ped fbrgls,ProFee,0989,Q4032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4033_3,Cast sup lng leg cylinder pl,ProFee,0989,Q4033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4034_3,Cast sup lng leg cylinder fb,ProFee,0989,Q4034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4035_3,Cast sup lngleg cylndr ped p,ProFee,0989,Q4035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4036_3,Cast sup lngleg cylndr ped f,ProFee,0989,Q4036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4037_3,Cast sup shrt leg plaster,ProFee,0989,Q4037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4038_3,Cast sup shrt leg fiberglass,ProFee,0989,Q4038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4039_3,Cast sup shrt leg ped plster,ProFee,0989,Q4039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4040_3,Cast sup shrt leg ped fbrgls,ProFee,0989,Q4040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4041_3,Cast sup lng leg splnt plstr,ProFee,0989,Q4041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4042_3,Cast sup lng leg splnt fbrgl,ProFee,0989,Q4042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4043_3,Cast sup lng leg splnt ped p,ProFee,0989,Q4043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4044_3,Cast sup lng leg splnt ped f,ProFee,0989,Q4044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4045_3,Cast sup sht leg splnt plstr,ProFee,0989,Q4045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4046_3,Cast sup sht leg splnt fbrgl,ProFee,0989,Q4046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4047_3,Cast sup sht leg splnt ped p,ProFee,0989,Q4047,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4048_3,Cast sup sht leg splnt ped f,ProFee,0989,Q4048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4049_3,"Finger splint, static",ProFee,0989,Q4049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4050_3,Cast supplies unlisted,ProFee,0989,Q4050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4051_3,Splint supplies misc,ProFee,0989,Q4051,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4074_3,Iloprost non-comp unit dose,ProFee,0989,Q4074,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4079_3,"Injection, Natalizumab, 1 mg",ProFee,0989,Q4079,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4080_3,Iloprost inhalation solution,ProFee,0989,Q4080,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4081_3,"Epoetin alfa, 100 units ESRD",ProFee,0989,Q4081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4082_3,Drug/bio NOC part B drug CAP,ProFee,0989,Q4082,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4100_3,"Skin substitute, NOS",ProFee,0989,Q4100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4101_3,Apligraf skin sub,ProFee,0989,Q4101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4102_3,Oasis wound matrix skin sub,ProFee,0989,Q4102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4103_3,Oasis burn matrix skin sub,ProFee,0989,Q4103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4104_3,Integra BMWD skin sub,ProFee,0989,Q4104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4105_3,Integra DRT skin sub,ProFee,0989,Q4105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4106_3,Dermagraft skin sub,ProFee,0989,Q4106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4107_3,Graftjacket skin sub,ProFee,0989,Q4107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4108_3,Integra matrix skin sub,ProFee,0989,Q4108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4109_3,Tissuemend skin sub,ProFee,0989,Q4109,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4110_3,Primatrix skin sub,ProFee,0989,Q4110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4111_3,Gammagraft skin sub,ProFee,0989,Q4111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4112_3,Cymetra allograft,ProFee,0989,Q4112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4113_3,Graftjacket express allograf,ProFee,0989,Q4113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4114_3,Integra flowable wound matri,ProFee,0989,Q4114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4115_3,Alloskin,ProFee,0989,Q4115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4116_3,Alloderm,ProFee,0989,Q4116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4117_3,Hyalomatrix,ProFee,0989,Q4117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4118_3,Matristem micromatrix,ProFee,0989,Q4118,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4119_3,Matristem wound matrix,ProFee,0989,Q4166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4120_3,Matristem burn matrix,ProFee,0989,Q4166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4121_3,Theraskin,ProFee,0989,Q4121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4122_3,"Dermacell, awm, porous sq cm",ProFee,0989,Q4122,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4123_3,Alloskin,ProFee,0989,Q4123,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4124_3,Oasis tri-layer wound matrix,ProFee,0989,Q4124,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4125_3,Arthroflex,ProFee,0989,Q4125,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4126_3,Memoderm/derma/tranz/integup,ProFee,0989,Q4126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4127_3,Talymed,ProFee,0989,Q4127,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4128_3,Flexhd/allopatchhd/matrixhd,ProFee,0989,Q4128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4129_3,Unite biomatrix,ProFee,0989,Q4129,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4130_3,Strattice tm,ProFee,0989,Q4130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4131_3,Epifix or epicord,ProFee,0989,Q4131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4132_3,"Grafix core, grafixpl core",ProFee,0989,Q4132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4133_3,Grafix stravix prime pl sqcm,ProFee,0989,Q4133,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4134_3,Hmatrix,ProFee,0989,Q4134,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4135_3,Mediskin,ProFee,0989,Q4135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4136_3,Ezderm,ProFee,0989,Q4136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4137_3,Amnioexcel biodexcel 1sq cm,ProFee,0989,Q4137,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4138_3,"Biodfence dryflex, 1cm",ProFee,0989,Q4138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4139_3,"Amnio or biodmatrix, inj 1cc",ProFee,0989,Q4139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4140_3,Biodfence 1cm,ProFee,0989,Q4140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4141_3,"Alloskin ac, 1 cm",ProFee,0989,Q4141,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4142_3,Xcm biologic tiss matrix 1cm,ProFee,0989,Q4142,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4143_3,"Repriza, 1cm",ProFee,0989,Q4143,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4145_3,"Epifix, inj, 1mg",ProFee,0989,Q4145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4146_3,"Tensix, 1cm",ProFee,0989,Q4146,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4147_3,Architect ecm px fx 1 sq cm,ProFee,0989,Q4147,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4148_3,Neox neox rt or clarix cord,ProFee,0989,Q4148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4149_3,"Excellagen, 0.1 cc",ProFee,0989,Q4149,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4150_3,Allowrap ds or dry 1 sq cm,ProFee,0989,Q4150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4151_3,"Amnioband, guardian 1 sq cm",ProFee,0989,Q4151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4152_3,Dermapure 1 square cm,ProFee,0989,Q4152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4153_3,"Dermavest, plurivest sq cm",ProFee,0989,Q4153,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4154_3,Biovance 1 square cm,ProFee,0989,Q4154,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4155_3,Neoxflo or clarixflo 1 mg,ProFee,0989,Q4155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4156_3,Neox 100 or clarix 100,ProFee,0989,Q4156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4157_3,Revitalon 1 square cm,ProFee,0989,Q4157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4158_3,"Kerecis omega3, per sq cm",ProFee,0989,Q4158,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4159_3,Affinity1 square cm,ProFee,0989,Q4159,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4160_3,Nushield 1 square cm,ProFee,0989,Q4160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4161_3,Bio-connekt per square cm,ProFee,0989,Q4161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4162_3,"Wndex flw, bioskn flw, 0.5cc",ProFee,0989,Q4162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4163_3,"Woundex, bioskin, per sq cm",ProFee,0989,Q4163,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4164_3,"Helicoll, per square cm",ProFee,0989,Q4164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4165_3,"Keramatrix, kerasorb sq cm",ProFee,0989,Q4165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4166_3,"Cytal, per square centimeter",ProFee,0989,Q4166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4167_3,"Truskin, per sq centimeter",ProFee,0989,Q4167,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4168_3,"Amnioband, 1 mg",ProFee,0989,Q4168,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4169_3,"Artacent wound, per sq cm",ProFee,0989,Q4169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4170_3,"Cygnus, per sq cm",ProFee,0989,Q4170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4171_3,"Interfyl, 1 mg",ProFee,0989,Q4171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4172_3,Puraply or puraply am,ProFee,0989,Q4172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4173_3,Palingen or palingen xplus,ProFee,0989,Q4173,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4174_3,Palingen or promatrx,ProFee,0989,Q4174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4175_3,Miroderm,ProFee,0989,Q4175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4176_3,"Neopatch, per sq centimeter",ProFee,0989,Q4176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4177_3,"Floweramnioflo, 0.1 cc",ProFee,0989,Q4177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4178_3,"Floweramniopatch, per sq cm",ProFee,0989,Q4178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4179_3,"Flowerderm, per sq cm",ProFee,0989,Q4179,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4180_3,"Revita, per sq cm",ProFee,0989,Q4180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4181_3,"Amnio wound, per square cm",ProFee,0989,Q4181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4182_3,"Transcyte, per sq centimeter",ProFee,0989,Q4182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4183_3,"Surgigraft, 1 sq cm",ProFee,0989,Q4183,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4184_3,Cellesta or duo per sq cm,ProFee,0989,Q4184,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4185_3,Cellesta flowab amnion 0.5cc,ProFee,0989,Q4185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4186_3,Epifix 1 sq cm,ProFee,0989,Q4186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4187_3,Epicord 1 sq cm,ProFee,0989,Q4187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4188_3,Amnioarmor 1 sq cm,ProFee,0989,Q4188,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4189_3,"Artacent ac, 1 mg",ProFee,0989,Q4189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4190_3,Artacent ac 1 sq cm,ProFee,0989,Q4190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4191_3,Restorigin 1 sq cm,ProFee,0989,Q4191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4192_3,"Restorigin, 1 cc",ProFee,0989,Q4192,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4193_3,Coll-e-derm 1 sq cm,ProFee,0989,Q4193,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4194_3,Novachor 1 sq cm,ProFee,0989,Q4194,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4195_3,Puraply 1 sq cm,ProFee,0989,Q4195,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4196_3,Puraply am 1 sq cm,ProFee,0989,Q4196,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4197_3,Puraply xt 1 sq cm,ProFee,0989,Q4197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4198_3,Genesis amnio membrane 1sqcm,ProFee,0989,Q4198,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4200_3,Skin te 1 sq cm,ProFee,0989,Q4200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4201_3,Matrion 1 sq cm,ProFee,0989,Q4201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4202_3,"Keroxx (2.5g/cc), 1cc",ProFee,0989,Q4202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4203_3,"Derma-gide, 1 sq cm",ProFee,0989,Q4203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4204_3,Xwrap 1 sq cm,ProFee,0989,Q4204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q4205_3,Membrane graft or wrap sq cm,ProFee,0989,Q4205,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4206_3,Fluid flow or fluid gf 1 cc,ProFee,0989,Q4206,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4208_3,Novafix per sq cm,ProFee,0989,Q4208,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4209_3,Surgraft per sq cm,ProFee,0989,Q4209,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4210_3,Axolotl graf dualgraf sq cm,ProFee,0989,Q4210,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4211_3,Amnion bio or axobio sq cm,ProFee,0989,Q4211,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4212_3,"Allogen, per cc",ProFee,0989,Q4212,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4213_3,"Ascent, 0.5 mg",ProFee,0989,Q4213,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4214_3,Cellesta cord per sq cm,ProFee,0989,Q4214,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4215_3,"Axolotl ambient, cryo 0.1 mg",ProFee,0989,Q4215,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4216_3,Artacent cord per sq cm,ProFee,0989,Q4216,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4217_3,Woundfix biowound plus xplus,ProFee,0989,Q4217,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4218_3,Surgicord per sq cm,ProFee,0989,Q4218,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4219_3,Surgigraft dual per sq cm,ProFee,0989,Q4219,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4220_3,"Bellacell hd, surederm sq cm",ProFee,0989,Q4220,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4221_3,Amniowrap2 per sq cm,ProFee,0989,Q4221,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4222_3,"Progenamatrix, per sq cm",ProFee,0989,Q4222,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q4226_3,Myown harv prep proc sq cm,ProFee,0989,Q4226,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q5001_3,Hospice in patient home,ProFee,0989,Q5001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5002_3,Hospice in assisted living,ProFee,0989,Q5002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5003_3,Hospice in LT/non-skilled NF,ProFee,0989,Q5003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5004_3,Hospice in SNF,ProFee,0989,Q5004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5005_3,"Hospice, inpatient hospital",ProFee,0989,Q5005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5006_3,Hospice in hospice facility,ProFee,0989,Q5006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5007_3,Hospice in LTCH,ProFee,0989,Q5007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5008_3,Hospice in inpatient psych,ProFee,0989,Q5008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5009_3,"Hospice care, NOS",ProFee,0989,Q5009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5010_3,Hospice home care in hospice,ProFee,0989,Q5010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5101_3,"Injection, zarxio",ProFee,0989,Q5101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5102_3,"Inj., infliximab biosimilar",ProFee,0989,Q5102,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q5103_3,"Injection, inflectra",ProFee,0989,Q5103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5104_3,"Injection, renflexis",ProFee,0989,Q5104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5105_3,Inj retacrit esrd on dialysi,ProFee,0989,Q5105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5106_3,Inj retacrit non-esrd use,ProFee,0989,Q5106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5107_3,Inj mvasi 10 mg,ProFee,0989,Q5107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5108_3,"Injection, fulphila",ProFee,0989,Q5108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5109_3,"Injection, ixifi, 10 mg",ProFee,0989,Q5109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5110_3,Nivestym,ProFee,0989,Q5110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5111_3,"Injection, udenyca 0.5 mg",ProFee,0989,Q5111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5112_3,Inj ontruzant 10 mg,ProFee,0989,Q5112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5113_3,Inj herzuma 10 mg,ProFee,0989,Q5113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5114_3,Inj ogivri 10 mg,ProFee,0989,Q5114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5115_3,Inj truxima 10 mg,ProFee,0989,Q5115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q5116_3,"Inj., trazimera, 10 mg",ProFee,0989,Q5116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q5117_3,"Inj., kanjinti, 10 mg",ProFee,0989,Q5117,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q5118_3,"Inj., zirabev, 10 mg",ProFee,0989,Q5118,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9945_3,"LOCM <=149 mg/ml iodine, 1ml",ProFee,0989,Q9945,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9946_3,"LOCM 150-199mg/ml iodine,1ml",ProFee,0989,Q9946,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9947_3,"LOCM 200-249mg/ml iodine,1ml",ProFee,0989,Q9947,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9948_3,"LOCM 250-299mg/ml iodine,1ml",ProFee,0989,Q9948,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9949_3,"LOCM 300-349mg/ml iodine,1ml",ProFee,0989,Q9949,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9950_3,"LOCM 350-399mg/ml iodine,1ml",ProFee,0989,Q9950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9951_3,"LOCM >= 400 mg/ml iodine,1ml",ProFee,0989,Q9951,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9952_3,"Inj Gad-base MR contrast, 1ml",ProFee,0989,Q9952,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9953_3,"Inj Fe-based MR contrast, 1ml",ProFee,0989,Q9953,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9954_3,"Oral MR contrast, 100 ml",ProFee,0989,Q9954,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9955_3,"Inj perflexane lip micros,ml",ProFee,0989,Q9955,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9956_3,"Inj octafluoropropane mic,ml",ProFee,0989,Q9956,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9957_3,"Inj perflutren lip micros,ml",ProFee,0989,Q9957,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9958_3,"HOCM <= 149mg/ml iodine, 1ml",ProFee,0989,Q9958,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9959_3,"HOCM 150-199mg/ml iodine, 1ml",ProFee,0989,Q9959,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9960_3,"HOCM 200-249mg/ml iodine, 1ml",ProFee,0989,Q9960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9961_3,"HOCM 250-299mg/ml iodine, 1ml",ProFee,0989,Q9961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9962_3,"HOCM 300-349mg/ml iodine, 1ml",ProFee,0989,Q9962,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9963_3,"HOCM 350-399mg/ml iodine, 1ml",ProFee,0989,Q9963,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9964_3,"HOCM >= 400mg/ml iodine, 1ml",ProFee,0989,Q9964,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9965_3,"LOCM 100-199mg/ml iodine,1ml",ProFee,0989,Q9965,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9966_3,"LOCM 200-299mg/ml iodine,1ml",ProFee,0989,Q9966,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9967_3,"LOCM 300-399mg/ml iodine,1ml",ProFee,0989,Q9967,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9968_3,Visualization adjunct,ProFee,0989,Q9968,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9969_3,Non-heu tc-99m add-on/dose,ProFee,0989,Q9969,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9970_3,Inj ferric carboxymaltos 1mg,ProFee,0989,Q9970,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9972_3,Epoetin beta esrd use,ProFee,0989,Q9972,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9973_3,Epoetin beta non esrd,ProFee,0989,Q9973,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9974_3,Morphine epidural/intratheca,ProFee,0989,Q9974,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
Q9975_3,Factor viii fc fusion recomb,ProFee,0989,J7205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9976_3,Inj ferric pyrophosphate cit,ProFee,0989,J1443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9977_3,Compounded drug noc,ProFee,0989,J7999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9978_3,Netupitant palonosetron oral,ProFee,0989,J8655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9979_3,"Injection, alemtuzumab",ProFee,0989,J0202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9980_3,"Genvisc, inj, 1mg",ProFee,0989,J7320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9981_3,"Rolapitant, oral, 1mg",ProFee,0989,J8670,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9982_3,Flutemetamol f18 diagnostic,ProFee,0989,Q9982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9983_3,Florbetaben f18 diagnostic,ProFee,0989,Q9983,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9984_3,"Kyleena, 19.5 mg",ProFee,0989,J7296,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9985_3,Inj hydroxyprogst capoat nos,ProFee,0989,J1729,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9986_3,"Makena, 10 mg",ProFee,0989,J1726,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9987_3,Pathogen test for platelets,ProFee,0989,P9100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9988_3,"Platelets, pathogen reduced",ProFee,0989,P9073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9989_3,"Ustekinumab, iv inject,1 mg",ProFee,0989,J3358,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9991_3,Buprenorph xr 100 mg or less,ProFee,0989,Q9991,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9992_3,Buprenorphine xr over 100 mg,ProFee,0989,Q9992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9993_3,"Inj., triamcinolone ext rel",ProFee,0989,J3304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9994_3,Enzyme cartridge enteral nut,ProFee,0989,B4105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
Q9995_3,"Inj., emicizumab-kxwh 0.5 mg",ProFee,0989,J7170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
R0070_3,Transport portable x-ray,ProFee,0989,R0070,,,,0,3.00,2.25,2.25,115.50,0.00,115.50,115.50,N/A
R0075_3,Transport port x-ray multipl,ProFee,0989,R0075,,,,0,3.00,2.25,2.25,239.50,0.00,239.50,239.50,N/A
R0076_3,Transport portable EKG,ProFee,0989,R0076,,,,0,3.00,2.25,2.25,46.00,0.00,46.00,46.00,N/A
RCOV_1,COVID-19 REF,Outpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
RCOV_1,COVID-19 REF,Inpatient,0300,87635,,,,0,103.00,77.25,77.25,97.85,92.70,97.85,97.85,92.70
RSVS_1,RSV Screen,Inpatient,0300,87420,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
RSVS_1,RSV Screen,Outpatient,0300,87420,,,,0,67.00,50.25,50.25,63.65,60.30,63.65,63.65,60.30
S0012_3,"Butorphanol tartrate, nasal",ProFee,0989,S0012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0014_3,"Tacrine hydrochloride, 10 mg",ProFee,0989,S0014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0017_3,"Injection, aminocaproic acid",ProFee,0989,S0017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0020_3,"Injection, bupivicaine hydro",ProFee,0989,S0020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0021_3,"Injection, cefoperazone sod",ProFee,0989,S0021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0023_3,"Injection, cimetidine hydroc",ProFee,0989,S0023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0028_3,"Injection, famotidine, 20 mg",ProFee,0989,S0028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0030_3,"Injection, metronidazole",ProFee,0989,S0030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0032_3,"Injection, nafcillin sodium",ProFee,0989,S0032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0034_3,"Injection, ofloxacin, 400 mg",ProFee,0989,S0034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0039_3,"Injection, sulfamethoxazole",ProFee,0989,S0039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0040_3,"Injection, ticarcillin disod",ProFee,0989,S0040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0073_3,"Injection, aztreonam, 500 mg",ProFee,0989,S0073,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0074_3,"Injection, cefotetan disodiu",ProFee,0989,S0074,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0077_3,"Injection, clindamycin phosp",ProFee,0989,S0077,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0078_3,"Injection, fosphenytoin sodi",ProFee,0989,S0078,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0080_3,"Injection, pentamidine iseth",ProFee,0989,S0080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0081_3,"Injection, piperacillin sodi",ProFee,0989,S0081,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0088_3,Imatinib 100 mg,ProFee,0989,S0088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0090_3,"Sildenafil citrate, 25 mg",ProFee,0989,S0090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0091_3,Granisetron 1mg,ProFee,0989,S0091,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0092_3,Hydromorphone 250 mg,ProFee,0989,S0092,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0093_3,Morphine 500 mg,ProFee,0989,S0093,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0104_3,"Zidovudine, oral, 100 mg",ProFee,0989,S0104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0106_3,Bupropion HCL SR 60 tablets,ProFee,0989,S0106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0108_3,Mercaptopurine 50 mg,ProFee,0989,S0108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0109_3,Methadone oral 5 mg,ProFee,0989,S0109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0116_3,Bevacizumab 100 mg,ProFee,0989,S0116,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0117_3,Tretinoin topical 5 g,ProFee,0989,S0117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0119_2,Ondansetron 4 mg,Inpatient,0521,S0119,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,15.20,14.40
S0119_2,Ondansetron 4 mg,Outpatient,0521,S0119,,,,0,16.00,12.00,12.00,15.20,14.40,15.20,0.00,14.40
S0119_3,Ondansetron 4 mg,Inpatient,0521,S0119,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,2.85,2.70
S0119_3,Ondansetron 4 mg,Outpatient,0521,S0119,,,,0,3.00,2.25,2.25,2.85,2.70,2.85,0.00,2.70
S0122_3,Inj menotropins 75 iu,ProFee,0989,S0122,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0126_3,Inj follitropin alfa 75 iu,ProFee,0989,S0126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0128_3,Inj follitropin beta 75 iu,ProFee,0989,S0128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0132_3,Inj ganirelix acetat 250 mcg,ProFee,0989,S0132,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0133_3,Histrelin implant,ProFee,0989,S0133,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0136_3,"Clozapine, 25 mg",ProFee,0989,S0136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0137_3,"Didanosine, 25 mg",ProFee,0989,S0137,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0138_3,"Finasteride, 5 mg",ProFee,0989,S0138,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0139_3,"Minoxidil, 10 mg",ProFee,0989,S0139,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0140_3,"Saquinavir, 200 mg",ProFee,0989,S0140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0141_3,"Zalcitabine, 0.375 mg",ProFee,0989,S0141,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0142_3,Colistimethate inh sol mg,ProFee,0989,S0142,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0143_3,Aztreonam inh sol gram,ProFee,0989,S0143,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0144_3,"Inj, propofol, 10 mg",ProFee,0989,S0144,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0145_3,Peg interferon alfa-2A/180,ProFee,0989,S0145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0146_3,Peg interferon alfa-2B/10,ProFee,0989,S0146,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0148_3,Peg interferon alfa-2b/10,ProFee,0989,S0148,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0155_3,Epoprostenol dilutant,ProFee,0989,S0155,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0156_3,"Exemestane, 25 mg",ProFee,0989,S0156,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0157_3,"Becaplermin gel 1%, 0.5 gm",ProFee,0989,S0157,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0160_3,Dextroamphetamine,ProFee,0989,S0160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0161_3,Calcitrol,ProFee,0989,S0161,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0162_3,Injection efalizumab,ProFee,0989,S0162,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0164_3,Injection pantroprazole,ProFee,0989,S0164,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0166_3,Inj olanzapine 2.5mg,ProFee,0989,S0166,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0167_3,Inj apomorphine HCL 1mg,ProFee,0989,S0167,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0169_3,Calcitrol,ProFee,0989,S0169,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0170_3,Anastrozole 1 mg,ProFee,0989,S0170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0171_3,Bumetanide 0.5 mg,ProFee,0989,S0171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0172_3,Chlorambucil 2 mg,ProFee,0989,S0172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0174_3,Dolasetron 50 mg,ProFee,0989,S0174,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0175_3,Flutamide 125 mg,ProFee,0989,S0175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0176_3,Hydroxyurea 500 mg,ProFee,0989,S0176,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0177_3,Levamisole 50 mg,ProFee,0989,S0177,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0178_3,Lomustine 10 mg,ProFee,0989,S0178,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0179_3,Megestrol 20 mg,ProFee,0989,S0179,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0181_3,Ondansetron 4 mg,ProFee,0989,S0181,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0182_3,Procarbazine 5 mg,ProFee,0989,S0182,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0183_3,Prochlorperazine 5 mg,ProFee,0989,S0183,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0187_3,Tamoxifen 10 mg,ProFee,0989,S0187,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0189_3,Testosterone pellet 75 mg,ProFee,0989,S0189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0190_3,"Mifepristone, oral, 200 mg",ProFee,0989,S0190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0191_3,"Misoprostol, oral, 200 mcg",ProFee,0989,S0191,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0194_3,Vitamin suppl 100 caps,ProFee,0989,S0194,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0196_3,Poly-l-lactic acid 1ml face,ProFee,0989,S0196,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0197_3,Prenatal viatamins 30 day,ProFee,0989,S0197,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0198_3,Inj pegaptanib 0.3 mg,ProFee,0989,S0198,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0199_3,Med abortion inc all ex drug,ProFee,0989,S0199,,,,0,3.00,2.25,2.25,596.50,0.00,596.50,596.50,N/A
S0201_3,Partial hospitalization serv,ProFee,0989,S0201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0207_3,Paramedicintercep nonhospals,ProFee,0989,S0207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0208_3,Paramed intrcept nonvol,ProFee,0989,S0208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0209_3,WC van mileage per mi,ProFee,0989,S0209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0215_3,Nonemerg transp mileage,ProFee,0989,S0215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0220_3,Medical conference by physic,ProFee,0989,S0220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0221_3,"Medical conference, 60 min",ProFee,0989,S0221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0250_3,Comp geriatr assmt team,ProFee,0989,S0250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0255_3,Hospice refer visit nonmd,ProFee,0989,S0255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0257_3,End of life counseling,ProFee,0989,S0257,,,,0,3.00,2.25,2.25,112.00,0.00,112.00,112.00,N/A
S0260_3,H&P for surgery,ProFee,0989,S0260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0265_3,Genetic counsel 15 mins,ProFee,0989,S0265,,,,0,3.00,2.25,2.25,33.50,0.00,33.50,33.50,N/A
S0270_3,Home std case rate 30 days,ProFee,0989,S0270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0271_3,Home hospice case 30 days,ProFee,0989,S0271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0272_3,Home episodic case 30 days,ProFee,0989,S0272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0273_3,MD home visit outside cap,ProFee,0989,S0273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0274_3,Nurse practr visit outs cap,ProFee,0989,S0274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0280_3,"Medical home, initial plan",ProFee,0989,S0280,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0281_3,"Medical home, maintenance",ProFee,0989,S0281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0285_3,Cnslt before screen colonosc,ProFee,0989,S0285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0302_3,Completed EPSDT,ProFee,0989,S0302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0310_3,Hospitalist visit,ProFee,0989,S0310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0311_3,Comp mgmt care coord adv ill,ProFee,0989,S0311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0315_3,Disease management program,ProFee,0989,S0315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0316_3,Follow-up/reassessment,ProFee,0989,S0316,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0317_3,Disease mgmt per diem,ProFee,0989,S0317,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0320_3,RN telephone calls to DMP,ProFee,0989,S0320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0340_3,Lifestyle mod 1st stage,ProFee,0989,S0340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0341_3,Lifestyle mod 2 or 3 stage,ProFee,0989,S0341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0342_3,Lifestyle mod 4th stage,ProFee,0989,S0342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0345_3,Home ecg monitrng global 24h,ProFee,0989,S0345,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0346_3,Home ecg monitrng tech 24hr,ProFee,0989,S0346,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0347_3,Home ecg monitrng prof 24hr,ProFee,0989,S0347,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0353_3,Cancer treatmentplan initial,ProFee,0989,S0353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0354_3,Cancer treatment plan change,ProFee,0989,S0354,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0390_3,Rout foot care per visit,ProFee,0989,S0390,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0395_3,Impression casting ft,ProFee,0989,S0395,,,,0,3.00,2.25,2.25,41.50,0.00,41.50,41.50,N/A
S0400_3,Global eswl kidney,ProFee,0989,S0400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0500_3,Dispos cont lens,ProFee,0989,S0500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0504_3,Singl prscrp lens,ProFee,0989,S0504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0506_3,Bifoc prscp lens,ProFee,0989,S0506,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0508_3,Trifoc prscrp lens,ProFee,0989,S0508,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0510_3,Non-prscrp lens,ProFee,0989,S0510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0512_3,Daily cont lens,ProFee,0989,S0512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0514_3,Color cont lens,ProFee,0989,S0514,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0515_3,Scleral lens liquid bandage,ProFee,0989,S0515,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0516_3,Safety frames,ProFee,0989,S0516,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0518_3,Sunglass frames,ProFee,0989,S0518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0580_3,Polycarb lens,ProFee,0989,S0580,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0581_3,Nonstnd lens,ProFee,0989,S0581,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0590_3,Misc integral lens serv,ProFee,0989,S0590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0592_3,Comp cont lens eval,ProFee,0989,S0592,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0595_3,New lenses in pts old frame,ProFee,0989,S0595,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0596_3,Phakic iol refractive error,ProFee,0989,S0596,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0601_3,Screening proctoscopy,ProFee,0989,S0601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0605_3,"Digital rectal examination,",ProFee,0989,S0605,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0610_3,Annual gynecological examina,ProFee,0989,S0610,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
S0612_3,Annual gynecological examina,ProFee,0989,S0612,,,,0,3.00,2.25,2.25,39.50,0.00,39.50,39.50,N/A
S0613_3,Ann breast exam,ProFee,0989,S0613,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
S0618_3,Audiometry for hearing aid,ProFee,0989,S0618,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0620_3,Routine ophthalmological exa,ProFee,0989,S0620,,,,0,3.00,2.25,2.25,49.30,0.00,49.30,49.30,N/A
S0621_3,Routine ophthalmological exa,ProFee,0989,S0621,,,,0,3.00,2.25,2.25,54.38,0.00,54.38,54.38,N/A
S0622_3,Phys exam for college,ProFee,0989,S0622,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S0625_3,Digital screening retinal,ProFee,0989,S0625,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S0630_3,Removal of sutures,ProFee,0989,S0630,,,,0,3.00,2.25,2.25,13.00,0.00,13.00,13.00,N/A
S0800_3,Laser in situ keratomileusis,ProFee,0989,S0800,,,,0,3.00,2.25,2.25,1662.50,0.00,1662.50,1662.50,N/A
S0810_3,Photorefractive keratectomy,ProFee,0989,S0810,,,,0,3.00,2.25,2.25,915.00,0.00,915.00,915.00,N/A
S0812_3,Phototherap keratect,ProFee,0989,S0812,,,,0,3.00,2.25,2.25,860.00,0.00,860.00,860.00,N/A
S0820_3,Computerized corneal topogra,ProFee,0989,S0820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S1001_3,Deluxe item,ProFee,0989,S1001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1002_3,Custom item,ProFee,0989,S1002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1015_3,IV tubing extension set,ProFee,0989,S1015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1016_3,Non-pvc intravenous administ,ProFee,0989,S1016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1025_3,Inhal nitric oxide neonate,ProFee,0989,S1025,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S1030_3,Gluc monitor purchase,ProFee,0989,S1030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1031_3,Gluc monitor rental,ProFee,0989,S1031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1034_3,Art pancreas system,ProFee,0989,S1034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1035_3,Art pancreas inv disp sensor,ProFee,0989,S1035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1036_3,Art pancreas ext transmitter,ProFee,0989,S1036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1037_3,Art pancreas ext receiver,ProFee,0989,S1037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1040_3,Cranial remolding orthosis,ProFee,0989,S1040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S1090_3,Mometasone sinus implant,ProFee,0989,S1090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2053_3,Transplantation of small int,ProFee,0989,S2053,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2054_3,Transplantation of multivisc,ProFee,0989,S2054,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2055_3,Harvesting of donor multivis,ProFee,0989,S2055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2060_3,Lobar lung transplantation,ProFee,0989,S2060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2061_3,Donor lobectomy (lung),ProFee,0989,S2061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2065_3,Simult panc kidn trans,ProFee,0989,S2065,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2066_3,Breast GAP flap reconst,ProFee,0989,S2066,,,,0,3.00,2.25,2.25,3969.50,0.00,3969.50,3969.50,N/A
S2067_3,Breast "stacked" DIEP/GAP,ProFee,0989,S2067,,,,0,3.00,2.25,2.25,5954.25,0.00,5954.25,5954.25,N/A
S2068_3,Breast DIEP flap reconstruct,ProFee,0989,S2068,,,,0,3.00,2.25,2.25,3969.50,0.00,3969.50,3969.50,N/A
S2070_3,Cysto laser tx ureteral calc,ProFee,0989,S2070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2075_3,Lap inc/vent hernia repair,ProFee,0989,S2075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2076_3,Lap umbilical hernia repair,ProFee,0989,S2076,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2077_3,Lap mesh implant hern rep,ProFee,0989,S2077,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2078_3,Lap supracerv hysterectomy,ProFee,0989,S2078,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2079_3,Lap esophagomyotomy,ProFee,0989,S2079,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2080_3,Laup,ProFee,0989,S2080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2083_3,Adjustment gastric band,ProFee,0989,S2083,,,,0,3.00,2.25,2.25,26.40,0.00,26.40,26.40,N/A
S2095_3,Transcath emboliz microspher,ProFee,0989,S2095,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2102_3,Islet cell tissue transplant,ProFee,0989,S2102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2103_3,Adrenal tissue transplant,ProFee,0989,S2103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2107_3,Adoptive immunotherapy,ProFee,0989,S2107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2112_3,Knee arthroscp harv,ProFee,0989,S2112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2114_3,Arthrosc sh tenodesis biceps,ProFee,0989,S2114,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2115_3,Periacetabular osteotomy,ProFee,0989,S2115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2117_3,"Arthroereisis, subtalar",ProFee,0989,S2117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2118_3,Total hip resurfacing,ProFee,0989,S2118,,,,0,3.00,2.25,2.25,1958.00,0.00,1958.00,1958.00,N/A
S2120_3,Low density lipoprotein(LDL),ProFee,0989,S2120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2135_3,Neurolysis interspace foot,ProFee,0989,S2135,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2140_3,Cord blood harvesting,ProFee,0989,S2140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2142_3,Cord blood-derived stem-cell,ProFee,0989,S2142,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2150_3,BMT harv/transpl 28d pkg,ProFee,0989,S2150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2152_3,Solid organ transpl pkg,ProFee,0989,S2152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2202_3,Echosclerotherapy,ProFee,0989,S2202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2205_3,Minimally invasive direct co,ProFee,0989,S2205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2206_3,Minimally invasive direct co,ProFee,0989,S2206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2207_3,Minimally invasive direct co,ProFee,0989,S2207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2208_3,Minimally invasive direct co,ProFee,0989,S2208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2209_3,Minimally invasive direct co,ProFee,0989,S2209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2213_3,Implant gastric stim,ProFee,0989,S2213,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2225_3,Myringotomy laser-assist,ProFee,0989,S2225,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2230_3,Implant semi-imp hear,ProFee,0989,S2230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2235_3,Implant auditory brain imp,ProFee,0989,S2235,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2250_3,Uterine artery emboliz,ProFee,0989,S2250,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2260_3,Induced abortion 17-24 weeks,ProFee,0989,S2260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2262_3,Abortion maternal indic>=25w,ProFee,0989,S2262,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2265_3,Abortion 25-28wks fetal indi,ProFee,0989,S2265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2266_3,Abortion 29-31wks fetal indi,ProFee,0989,S2266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2267_3,Abortion >=32wks fetal indic,ProFee,0989,S2267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2270_3,Insertion vaginal cylinder,ProFee,0989,S2270,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2300_3,"Arthroscopy, shoulder, surgi",ProFee,0989,S2300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2325_3,Hip core decompression,ProFee,0989,S2325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2340_3,Chemodenervation of abductor,ProFee,0989,S2340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2341_3,Chemodenerv adduct vocal,ProFee,0989,S2341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2342_3,Nasal endoscop po debrid,ProFee,0989,S2342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2344_3,Endosc balloon sinuplasty,ProFee,0989,S2344,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2348_3,Decompress disc RF lumbar,ProFee,0989,S2348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2350_3,"Diskectomy, anterior, with d",ProFee,0989,S2350,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2351_3,"Diskectomy, anterior, with d",ProFee,0989,S2351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2360_3,Vertebroplast cerv 1st,ProFee,0989,S2360,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2361_3,Vertebroplast cerv addl,ProFee,0989,S2361,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2362_3,"Kyphoplasty, first vertebra",ProFee,0989,S2362,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2363_3,"Kyphoplasty, each addl",ProFee,0989,S2363,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S2400_3,Fetal surg congen hernia,ProFee,0989,S2400,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2401_3,Fetal surg urin trac obstr,ProFee,0989,S2401,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2402_3,Fetal surg cong cyst malf,ProFee,0989,S2402,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2403_3,Fetal surg pulmon sequest,ProFee,0989,S2403,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2404_3,Fetal surg myelomeningo,ProFee,0989,S2404,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2405_3,Fetal surg sacrococ teratoma,ProFee,0989,S2405,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2409_3,Fetal surg noc,ProFee,0989,S2409,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2411_3,Fetoscop laser ther TTTS,ProFee,0989,S2411,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S2900_3,Robotic surgical system,ProFee,0989,S2900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3000_3,Bilat dil retinal exam,ProFee,0989,S3000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3005_3,Eval self-assess depression,ProFee,0989,S3005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3600_3,Stat lab,ProFee,0989,S3600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3601_3,Stat lab home/nf,ProFee,0989,S3601,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3620_3,Newborn metabolic screening,ProFee,0989,S3620,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3625_3,Maternal triple screen test,ProFee,0989,S3625,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3626_3,Maternal serum quad screen,ProFee,0989,S3626,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3628_3,PAMG-1 rapid assay for ROM,ProFee,0989,S3628,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3630_3,Eosinophil blood count,ProFee,0989,S3630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3645_3,HIV-1 antibody testing of or,ProFee,0989,S3645,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3650_3,"Saliva test, hormone level;",ProFee,0989,S3650,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3652_3,"Saliva test, hormone level;",ProFee,0989,S3652,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3655_3,Antisperm antibodies test,ProFee,0989,S3655,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3701_3,NMP-22 assay,ProFee,0989,S3701,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3708_3,Gastrointestinal fat absorpt,ProFee,0989,S3708,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3711_3,Circulating tumor cell test,ProFee,0989,S3711,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3713_3,KRAS mutation analysis,ProFee,0989,S3713,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3721_3,Pca3 testing,ProFee,0989,S3721,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3722_3,Dose optimization auc - 5fu,ProFee,0989,S3722,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3800_3,Genetic testing ALS,ProFee,0989,S3800,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3818_3,BRCA1 gene anal,ProFee,0989,S3818,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3819_3,BRCA2 gene anal,ProFee,0989,S3819,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3820_3,Comp BRCA1/BRCA2,ProFee,0989,S3820,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3822_3,Sing mutation brst/ovar,ProFee,0989,S3822,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3823_3,3 mutation brst/ovar,ProFee,0989,S3823,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3828_3,Comp MLH1 gene,ProFee,0989,S3828,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3829_3,Comp MLH2 gene,ProFee,0989,S3829,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3830_3,Gene test HNPCC comp,ProFee,0989,S3830,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3831_3,Gene test HNPCC single,ProFee,0989,S3831,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3833_3,Comp APC sequence,ProFee,0989,S3833,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3834_3,Sing mutation APC,ProFee,0989,S3834,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3835_3,Gene test cystic fibrosis,ProFee,0989,S3835,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3837_3,Gene test hemochromato,ProFee,0989,S3837,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3840_3,DNA analysis RET-oncogene,ProFee,0989,S3840,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3841_3,Gene test retinoblastoma,ProFee,0989,S3841,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3842_3,Gene test Hippel-Lindau,ProFee,0989,S3842,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3843_3,DNA analysis factor v,ProFee,0989,S3843,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3844_3,DNA analysis deafness,ProFee,0989,S3844,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3845_3,Gene test alpha-thalassemia,ProFee,0989,S3845,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3846_3,Gene test beta-thalassemia,ProFee,0989,S3846,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3847_3,Gene test Tay-Sachs,ProFee,0989,S3847,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3848_3,Gene test Gaucher,ProFee,0989,S3848,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3849_3,Gene test Niemann-Pick,ProFee,0989,S3849,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3850_3,Gene test sickle cell,ProFee,0989,S3850,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3851_3,Gene test canavan,ProFee,0989,S3851,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3852_3,DNA analysis APOE alzheimer,ProFee,0989,S3852,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3853_3,Gene test myo musclr dyst,ProFee,0989,S3853,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3854_3,Gene profile panel breast,ProFee,0989,S3854,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3855_3,Gene test presenilin-1 gene,ProFee,0989,S3855,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3860_3,Genet test cardiac ion-comp,ProFee,0989,S3860,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3861_3,Genetic test brugada,ProFee,0989,S3861,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3862_3,Genet test cardiac ion-spec,ProFee,0989,S3862,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3865_3,Comp genet test hyp cardiomy,ProFee,0989,S3865,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3866_3,Spec gene test hyp cardiomy,ProFee,0989,S3866,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3870_3,CGH test developmental delay,ProFee,0989,S3870,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3890_3,Fecal DNA analysis,ProFee,0989,S3890,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S3900_3,Surface EMG,ProFee,0989,S3900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3902_3,Ballistocardiogram,ProFee,0989,S3902,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3904_3,Masters two step,ProFee,0989,S3904,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S3905_3,Auto handheld diag nerv test,ProFee,0989,S3905,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S4005_3,Interim labor facility globa,ProFee,0989,S4005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4011_3,IVF package,ProFee,0989,S4011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4013_3,Compl GIFT case rate,ProFee,0989,S4013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4014_3,Compl ZIFT case rate,ProFee,0989,S4014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4015_3,Complete IVF nos case rate,ProFee,0989,S4015,,,,0,3.00,2.25,2.25,12500.00,0.00,12500.00,12500.00,N/A
S4016_3,Frozen IVF case rate,ProFee,0989,S4016,,,,0,3.00,2.25,2.25,3998.40,0.00,3998.40,3998.40,N/A
S4017_3,IVF canc a stim case rate,ProFee,0989,S4017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4018_3,F EMB trns canc case rate,ProFee,0989,S4018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4020_3,IVF canc a aspir case rate,ProFee,0989,S4020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4021_3,IVF canc p aspir case rate,ProFee,0989,S4021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4022_3,Asst oocyte fert case rate,ProFee,0989,S4022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4023_3,Incompl donor egg case rate,ProFee,0989,S4023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4025_3,Donor serv IVF case rate,ProFee,0989,S4025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4026_3,Procure donor sperm,ProFee,0989,S4026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4027_3,Store prev froz embryos,ProFee,0989,S4027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4028_3,Microsurg epi sperm asp,ProFee,0989,S4028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4030_3,Sperm procure init visit,ProFee,0989,S4030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4031_3,Sperm procure subs visit,ProFee,0989,S4031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4035_3,Stimulated IUI case rate,ProFee,0989,S4035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4036_3,Intravag cult case rate,ProFee,0989,S4036,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S4037_3,Cryo embryo transf case rate,ProFee,0989,S4037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4040_3,Monit store cryo embryo 30 d,ProFee,0989,S4040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4042_3,Ovulation mgmt per cycle,ProFee,0989,S4042,,,,0,3.00,2.25,2.25,360.00,0.00,360.00,360.00,N/A
S4981_3,Insert levonorgestrel ius,ProFee,0989,S4981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4989_3,Contracept IUD,ProFee,0989,S4989,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4990_3,Nicotine patch legend,ProFee,0989,S4990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4991_3,Nicotine patch nonlegend,ProFee,0989,S4991,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4993_3,Contraceptive pills for bc,ProFee,0989,S4993,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S4995_3,Smoking cessation gum,ProFee,0989,S4995,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5000_3,"Prescription drug, generic",ProFee,0989,S5000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5001_3,"Prescription drug,brand name",ProFee,0989,S5001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5010_3,5% dextrose and 0.45% saline,ProFee,0989,S5010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5011_3,5% dextrose in lactated ring,ProFee,0989,S5011,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S5012_3,5% dextrose with potassium,ProFee,0989,S5012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5013_3,5%dextrose/0.45%saline1000ml,ProFee,0989,S5013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5014_3,D5W/0.45NS w KCl and MGS04,ProFee,0989,S5014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5035_3,HIT routine device maint,ProFee,0989,S5035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5036_3,HIT device repair,ProFee,0989,S5036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5100_3,Adult daycare services 15min,ProFee,0989,S5100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5101_3,Adult day care per half day,ProFee,0989,S5101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5102_3,Adult day care per diem,ProFee,0989,S5102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5105_3,Centerbased day care perdiem,ProFee,0989,S5105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5108_3,Homecare train pt 15 min,ProFee,0989,S5108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5109_3,Homecare train pt session,ProFee,0989,S5109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5110_3,Family homecare training 15m,ProFee,0989,S5110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5111_3,Family homecare train/sessio,ProFee,0989,S5111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5115_3,Nonfamily homecare train/15m,ProFee,0989,S5115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5116_3,Nonfamily HC train/session,ProFee,0989,S5116,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5120_3,Chore services per 15 min,ProFee,0989,S5120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5121_3,Chore services per diem,ProFee,0989,S5121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5125_3,Attendant care service /15m,ProFee,0989,S5125,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5126_3,Attendant care service /diem,ProFee,0989,S5126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5130_3,Homaker service nos per 15m,ProFee,0989,S5130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5131_3,Homemaker service nos /diem,ProFee,0989,S5131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5135_3,Adult companioncare per 15m,ProFee,0989,S5135,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5136_3,Adult companioncare per diem,ProFee,0989,S5136,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5140_3,Adult foster care per diem,ProFee,0989,S5140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5141_3,Adult foster care per month,ProFee,0989,S5141,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5145_3,Child fostercare th per diem,ProFee,0989,S5145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5146_3,Ther fostercare child /month,ProFee,0989,S5146,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5150_3,Unskilled respite care /15m,ProFee,0989,S5150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5151_3,Unskilled respitecare /diem,ProFee,0989,S5151,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5160_3,Emer response sys instal&tst,ProFee,0989,S5160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5161_3,Emer rspns sys serv permonth,ProFee,0989,S5161,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5162_3,Emer rspns system purchase,ProFee,0989,S5162,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5165_3,Home modifications per serv,ProFee,0989,S5165,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5170_3,Homedelivered prepared meal,ProFee,0989,S5170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5175_3,"Laundry serv,ext,prof,/order",ProFee,0989,S5175,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5180_3,HH respiratory thrpy in eval,ProFee,0989,S5180,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5181_3,HH respiratory thrpy nos/day,ProFee,0989,S5181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5185_3,Med reminder serv per month,ProFee,0989,S5185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5190_3,Wellness assessment by nonph,ProFee,0989,S5190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5199_3,Personal care item nos each,ProFee,0989,S5199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5497_3,HIT cath care noc,ProFee,0989,S5497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5498_3,HIT simple cath care,ProFee,0989,S5498,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5501_3,HIT complex cath care,ProFee,0989,S5501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5502_3,HIT interim cath care,ProFee,0989,S5502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5517_3,HIT declotting kit,ProFee,0989,S5517,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5518_3,HIT cath repair kit,ProFee,0989,S5518,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5520_3,HIT picc insert kit,ProFee,0989,S5520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5521_3,HIT midline cath insert kit,ProFee,0989,S5521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5522_3,HIT picc insert no supp,ProFee,0989,S5522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5523_3,HIP midline cath insert kit,ProFee,0989,S5523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5550_3,Insulin rapid 5 u,ProFee,0989,S5550,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5551_3,Insulin most rapid 5 u,ProFee,0989,S5551,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5552_3,Insulin intermed 5 u,ProFee,0989,S5552,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5553_3,Insulin long acting 5 u,ProFee,0989,S5553,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5560_3,Insulin reuse pen 1.5 ml,ProFee,0989,S5560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5561_3,Insulin reuse pen 3 ml,ProFee,0989,S5561,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5565_3,Insulin cartridge 150 u,ProFee,0989,S5565,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5566_3,Insulin cartridge 300 u,ProFee,0989,S5566,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5570_3,Insulin dispos pen 1.5 ml,ProFee,0989,S5570,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S5571_3,Insulin dispos pen 3 ml,ProFee,0989,S5571,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8030_3,Tantalum ring application,ProFee,0989,S8030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8032_3,Low dose ct lung screening,ProFee,0989,S8032,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8035_3,Magnetic source imaging,ProFee,0989,S8035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8037_3,mrcp,ProFee,0989,S8037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8040_3,Topographic brain mapping,ProFee,0989,S8040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8042_3,MRI low field,ProFee,0989,S8042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8049_3,Intraoperative radiation the,ProFee,0989,S8049,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8055_3,Us guidance fetal reduct,ProFee,0989,S8055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8075_3,CAD of digital mammogr,ProFee,0989,S8075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8080_3,Scintimammography,ProFee,0989,S8080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8085_3,Fluorine-18 fluorodeoxygluco,ProFee,0989,S8085,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8092_3,Electron beam computed tomog,ProFee,0989,S8092,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8093_3,CT angiography coronary,ProFee,0989,S8093,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8096_3,Portable peak flow meter,ProFee,0989,S8096,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8097_3,Asthma kit,ProFee,0989,S8097,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8100_3,Spacer without mask,ProFee,0989,S8100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8101_3,Spacer with mask,ProFee,0989,S8101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8110_3,Peak expiratory flow rate (p,ProFee,0989,S8110,,,,0,3.00,2.25,2.25,12.00,0.00,12.00,12.00,N/A
S8120_3,O2 contents gas cubic ft,ProFee,0989,S8120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8121_3,O2 contents liquid lb,ProFee,0989,S8121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8130_3,Interferential stim 2 chan,ProFee,0989,S8130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8131_3,Interferential stim 4 chan,ProFee,0989,S8131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8185_3,Flutter device,ProFee,0989,S8185,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8186_3,Swivel adaptor,ProFee,0989,S8186,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8189_3,Trach supply noc,ProFee,0989,S8189,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8190_3,Electronic spirometer,ProFee,0989,S8190,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8210_3,Mucus trap,ProFee,0989,S8210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8260_3,Oral orthotic for treatment,ProFee,0989,S8260,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8262_3,Mandib ortho repos device,ProFee,0989,S8262,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S8265_3,Haberman feeder,ProFee,0989,S8265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8270_3,Enuresis alarm,ProFee,0989,S8270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8301_3,Infect control supplies NOS,ProFee,0989,S8301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8415_3,Supplies for home delivery,ProFee,0989,S8415,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8420_3,Custom gradient sleev/glov,ProFee,0989,S8420,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8421_3,Ready gradient sleev/glov,ProFee,0989,S8421,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8422_3,Custom grad sleeve med,ProFee,0989,S8422,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8423_3,Custom grad sleeve heavy,ProFee,0989,S8423,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8424_3,Ready gradient sleeve,ProFee,0989,S8424,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8425_3,Custom grad glove med,ProFee,0989,S8425,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8426_3,Custom grad glove heavy,ProFee,0989,S8426,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8427_3,Ready gradient glove,ProFee,0989,S8427,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8428_3,Ready gradient gauntlet,ProFee,0989,S8428,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8429_3,Gradient pressure wrap,ProFee,0989,S8429,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8430_3,Padding for comprssn bdg,ProFee,0989,S8430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8431_3,Compression bandage,ProFee,0989,S8431,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8450_3,Splint digit,ProFee,0989,S8450,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8451_3,Splint wrist or ankle,ProFee,0989,S8451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8452_3,Splint elbow,ProFee,0989,S8452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8460_3,Camisole post-mast,ProFee,0989,S8460,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8490_3,100 insulin syringes,ProFee,0989,S8490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8930_3,Auricular electrostimulation,ProFee,0989,S8930,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8940_3,Hippotherapy per session,ProFee,0989,S8940,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8948_3,Low-level laser trmt 15 min,ProFee,0989,S8948,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8950_3,"Complex lymphedema therapy,",ProFee,0989,S8950,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8990_3,Pt or manip for maint,ProFee,0989,S8990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S8999_3,Resuscitation bag,ProFee,0989,S8999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9001_3,Home uterine monitor with or,ProFee,0989,S9001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9007_3,Ultrafiltration monitor,ProFee,0989,S9007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9015_3,Automated EEG monitoring,ProFee,0989,S9015,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S9022_3,Digital subtraction angiogra,ProFee,0989,S9022,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S9024_3,Paranasal sinus ultrasound,ProFee,0989,S9024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9025_3,Omnicardiogram/cardiointegra,ProFee,0989,S9025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9034_3,ESWL for gallstones,ProFee,0989,S9034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9055_3,Procuren or other growth fac,ProFee,0989,S9055,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9056_3,Coma stimulation per diem,ProFee,0989,S9056,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9061_3,Medical supplies and equipme,ProFee,0989,S9061,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9075_3,Smoking cessation treatment,ProFee,0989,S9075,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S9083_3,Urgent care center global,ProFee,0989,S9083,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9088_3,Services provided in urgent,ProFee,0989,S9088,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9090_3,Vertebral axial decompressio,ProFee,0989,S9090,,,,0,3.00,2.25,2.25,129.00,0.00,129.00,129.00,N/A
S9092_3,Canolith repositioning,ProFee,0989,S9092,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S9097_3,Home visit wound care,ProFee,0989,S9097,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9098_3,Home phototherapy visit,ProFee,0989,S9098,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9109_3,CHF telemonitoring month,ProFee,0989,S9109,,,,0,3.00,2.25,2.25,2.25,N/A,N/A,N/A,N/A
S9110_3,Telemonitoring/home per mnth,ProFee,0989,S9110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9117_3,Back school visit,ProFee,0989,S9117,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9122_3,Home health aide or certifie,ProFee,0989,S9122,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9123_3,Nursing care in home RN,ProFee,0989,S9123,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9124_3,"Nursing care, in the home; b",ProFee,0989,S9124,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9125_3,"Respite care, in the home, p",ProFee,0989,S9125,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9126_3,"Hospice care, in the home, p",ProFee,0989,S9126,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9127_3,"Social work visit, in the ho",ProFee,0989,S9127,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9128_3,"Speech therapy, in the home,",ProFee,0989,S9128,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9129_3,"Occupational therapy, in the",ProFee,0989,S9129,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9131_3,PT in the home per diem,ProFee,0989,S9131,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9140_3,"Diabetic Management Program,",ProFee,0989,S9140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9141_3,"Diabetic Management Program,",ProFee,0989,S9141,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9145_3,Insulin pump initiation,ProFee,0989,S9145,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9150_3,Evaluation by ocularist,ProFee,0989,S9150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9152_3,"Speech therapy, re-eval",ProFee,0989,S9152,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9208_3,Home mgmt preterm labor,ProFee,0989,S9208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9209_3,Home mgmt PPROM,ProFee,0989,S9209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9211_3,Home mgmt gest hypertension,ProFee,0989,S9211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9212_3,Hm postpar hyper per diem,ProFee,0989,S9212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9213_3,Hm preeclamp per diem,ProFee,0989,S9213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9214_3,Hm gest dm per diem,ProFee,0989,S9214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9325_3,HIT pain mgmt per diem,ProFee,0989,S9325,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9326_3,HIT cont pain per diem,ProFee,0989,S9326,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9327_3,HIT int pain per diem,ProFee,0989,S9327,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9328_3,HIT pain imp pump diem,ProFee,0989,S9328,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9329_3,HIT chemo per diem,ProFee,0989,S9329,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9330_3,HIT cont chem diem,ProFee,0989,S9330,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9331_3,HIT intermit chemo diem,ProFee,0989,S9331,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9335_3,HT hemodialysis diem,ProFee,0989,S9335,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9336_3,HIT cont anticoag diem,ProFee,0989,S9336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9338_3,HIT immunotherapy diem,ProFee,0989,S9338,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9339_3,HIT periton dialysis diem,ProFee,0989,S9339,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9340_3,HIT enteral per diem,ProFee,0989,S9340,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9341_3,HIT enteral grav diem,ProFee,0989,S9341,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9342_3,HIT enteral pump diem,ProFee,0989,S9342,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9343_3,HIT enteral bolus nurs,ProFee,0989,S9343,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9345_3,HIT anti-hemophil diem,ProFee,0989,S9345,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9346_3,HIT alpha-1-proteinas diem,ProFee,0989,S9346,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9347_3,HIT longterm infusion diem,ProFee,0989,S9347,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9348_3,HIT sympathomim diem,ProFee,0989,S9348,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9349_3,HIT tocolysis diem,ProFee,0989,S9349,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9351_3,HIT cont antiemetic diem,ProFee,0989,S9351,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9353_3,HIT cont insulin diem,ProFee,0989,S9353,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9355_3,HIT chelation diem,ProFee,0989,S9355,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9357_3,HIT enzyme replace diem,ProFee,0989,S9357,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9359_3,HIT anti-tnf per diem,ProFee,0989,S9359,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9361_3,HIT diuretic infus diem,ProFee,0989,S9361,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9363_3,HIT anti-spasmotic diem,ProFee,0989,S9363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9364_3,HIT tpn total diem,ProFee,0989,S9364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9365_3,HIT tpn 1 liter diem,ProFee,0989,S9365,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9366_3,HIT tpn 2 liter diem,ProFee,0989,S9366,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9367_3,HIT tpn 3 liter diem,ProFee,0989,S9367,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9368_3,HIT tpn over 3l diem,ProFee,0989,S9368,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9370_3,HT inj antiemetic diem,ProFee,0989,S9370,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9372_3,HT inj anticoag diem,ProFee,0989,S9372,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9373_3,HIT hydra total diem,ProFee,0989,S9373,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9374_3,HIT hydra 1 liter diem,ProFee,0989,S9374,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9375_3,HIT hydra 2 liter diem,ProFee,0989,S9375,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9376_3,HIT hydra 3 liter diem,ProFee,0989,S9376,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9377_3,HIT hydra over 3l diem,ProFee,0989,S9377,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9379_3,HIT noc per diem,ProFee,0989,S9379,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9381_3,HIT high risk/escort,ProFee,0989,S9381,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9401_3,Anticoag clinic per session,ProFee,0989,S9401,,,,0,3.00,2.25,2.25,35.00,0.00,35.00,35.00,N/A
S9430_3,Pharmacy comp/disp serv,ProFee,0989,S9430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9433_3,Medical food oral 100% nutr,ProFee,0989,S9433,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9434_3,Mod solid food suppl,ProFee,0989,S9434,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9435_3,Medical foods for inborn err,ProFee,0989,S9435,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9436_3,Lamaze class,ProFee,0989,S9436,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9437_3,Childbirth refresher class,ProFee,0989,S9437,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9438_3,Cesarean birth class,ProFee,0989,S9438,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9439_3,VBAC class,ProFee,0989,S9439,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9441_3,Asthma education,ProFee,0989,S9441,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9442_3,Birthing class,ProFee,0989,S9442,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9443_3,Lactation class,ProFee,0989,S9443,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9444_3,Parenting class,ProFee,0989,S9444,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9445_3,PT education noc individ,ProFee,0989,S9445,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9446_3,PT education noc group,ProFee,0989,S9446,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9447_3,Infant safety class,ProFee,0989,S9447,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9449_3,Weight mgmt class,ProFee,0989,S9449,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9451_3,Exercise class,ProFee,0989,S9451,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9452_3,Nutrition class,ProFee,0989,S9452,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9453_3,Smoking cessation class,ProFee,0989,S9453,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9454_3,Stress mgmt class,ProFee,0989,S9454,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9455_3,"Diabetic Management Program,",ProFee,0989,S9455,,,,0,3.00,2.25,2.25,41.00,0.00,41.00,41.00,N/A
S9460_3,"Diabetic Management Program,",ProFee,0989,S9460,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
S9465_3,"Diabetic Management Program,",ProFee,0989,S9465,,,,0,3.00,2.25,2.25,75.50,0.00,75.50,75.50,N/A
S9470_3,"Nutritional counseling, diet",ProFee,0989,S9470,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9472_3,Cardiac rehabilitation progr,ProFee,0989,S9472,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9473_3,Pulmonary rehabilitation pro,ProFee,0989,S9473,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9474_3,Enterostomal therapy by a re,ProFee,0989,S9474,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9475_3,Ambulatory setting substance,ProFee,0989,S9475,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9476_3,Vestibular rehab per diem,ProFee,0989,S9476,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9480_3,Intensive outpatient psychia,ProFee,0989,S9480,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9482_3,Family stabilization 15 min,ProFee,0989,S9482,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9484_3,Crisis intervention per hour,ProFee,0989,S9484,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9485_3,Crisis intervention mental h,ProFee,0989,S9485,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9490_3,HIT corticosteroid/diem,ProFee,0989,S9490,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9494_3,HIT antibiotic total diem,ProFee,0989,S9494,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9497_3,HIT antibiotic q3h diem,ProFee,0989,S9497,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9500_3,HIT antibiotic q24h diem,ProFee,0989,S9500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9501_3,HIT antibiotic q12h diem,ProFee,0989,S9501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9502_3,HIT antibiotic q8h diem,ProFee,0989,S9502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9503_3,HIT antibiotic q6h diem,ProFee,0989,S9503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9504_3,HIT antibiotic q4h diem,ProFee,0989,S9504,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9529_3,Venipuncture home/snf,ProFee,0989,S9529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9537_3,HT hem horm inj diem,ProFee,0989,S9537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9538_3,HIT blood products diem,ProFee,0989,S9538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9542_3,HT inj noc per diem,ProFee,0989,S9542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9558_3,HT inj growth horm diem,ProFee,0989,S9558,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9559_3,HIT inj interferon diem,ProFee,0989,S9559,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9560_3,HT inj hormone diem,ProFee,0989,S9560,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9562_3,HT inj palivizumab diem,ProFee,0989,S9562,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9590_3,HT irrigation diem,ProFee,0989,S9590,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9810_3,HT pharm per hour,ProFee,0989,S9810,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9900_3,Christian Sci Pract visit,ProFee,0989,S9900,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9901_3,Christian sci nurse visit,ProFee,0989,S9901,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9960_3,Air ambulanc nonemerg fixed,ProFee,0989,S9960,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9961_3,Air ambulan nonemerg rotary,ProFee,0989,S9961,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9970_3,Health club membership yr,ProFee,0989,S9970,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9975_3,Transplant related per diem,ProFee,0989,S9975,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9976_3,Lodging per diem,ProFee,0989,S9976,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9977_3,Meals per diem,ProFee,0989,S9977,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9981_3,Med record copy admin,ProFee,0989,S9981,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9982_3,Med record copy per page,ProFee,0989,S9982,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9986_3,Not medically necessary svc,ProFee,0989,S9986,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9988_3,Serv part of phase I trial,ProFee,0989,S9988,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9989_3,Services outside US,ProFee,0989,S9989,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9990_3,Services provided as part of,ProFee,0989,S9990,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9991_3,Services provided as part of,ProFee,0989,S9991,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9992_3,Transportation costs to and,ProFee,0989,S9992,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9994_3,Lodging costs (e.g. hotel ch,ProFee,0989,S9994,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9996_3,Meals for clinical trial par,ProFee,0989,S9996,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
S9999_3,Sales tax,ProFee,0989,S9999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
SPORT_2,Sport Physical,ProFee,0989,SPORT,,,,0,25.00,18.75,18.75,18.75,N/A,N/A,N/A,N/A
SPORT_3,Sport Physical,ProFee,0989,,,,,0,28.00,21.00,21.00,21.00,N/A,N/A,N/A,N/A
T1000_3,Private duty/independent nsg,ProFee,0989,T1000,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1001_3,Nursing assessment/evaluatn,ProFee,0989,T1001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1002_3,RN services up to 15 minutes,ProFee,0989,T1002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1003_3,LPN/LVN services up to 15min,ProFee,0989,T1003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1004_3,Nsg aide service up to 15min,ProFee,0989,T1004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1005_3,Respite care service 15 min,ProFee,0989,T1005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1006_3,Family/Couple Counseling,ProFee,0989,T1006,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1007_3,Treatment Plan Development,ProFee,0989,T1007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1009_3,Child Sitting Services,ProFee,0989,T1009,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1010_3,Meals when Receive Services,ProFee,0989,T1010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1012_3,Alcohol/Substance Abuse Skil,ProFee,0989,T1012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1013_3,Sign Lang/Oral Interpreter,ProFee,0989,T1013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1014_3,"Telehealth transmit, per min",ProFee,0989,T1014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1016_3,Case management,ProFee,0989,T1016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1017_3,Targeted case management,ProFee,0989,T1017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1018_3,School-based IEP ser bundled,ProFee,0989,T1018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1019_3,Personal care ser per 15 min,ProFee,0989,T1019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1020_3,Personal care ser per diem,ProFee,0989,T1020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1021_3,HH Aide or cn aide per visit,ProFee,0989,T1021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1022_3,Contracted services per day,ProFee,0989,T1022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1023_3,Program intake assessment,ProFee,0989,T1023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1024_3,Team evaluation & management,ProFee,0989,T1024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1025_3,"Ped compr care pkg, per diem",ProFee,0989,T1025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1026_3,"Ped compr care pkg, per hour",ProFee,0989,T1026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1027_3,Family training & counseling,ProFee,0989,T1027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1028_3,Home environment assessment,ProFee,0989,T1028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1029_3,Dwelling lead investigation,ProFee,0989,T1029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1030_3,RN home care per diem,ProFee,0989,T1030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1031_3,LPN home care per diem,ProFee,0989,T1031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1040_3,Comm bh clinic svc per diem,ProFee,0989,T1040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1041_3,Comm bh clinic svc per month,ProFee,0989,T1041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1502_3,Medication admin visit,ProFee,0989,T1502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1503_3,"Med admin, not oral/inject",ProFee,0989,T1503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1505_3,"Elec med comp dev, noc",ProFee,0989,T1505,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T1999_3,NOC retail items andsupplies,ProFee,0989,T1999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2001_3,N-et; patient attend/escort,ProFee,0989,T2001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2002_3,N-et; per diem,ProFee,0989,T2002,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2003_3,N-et; encounter/trip,ProFee,0989,T2003,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2004_3,N-et; commerc carrier pass,ProFee,0989,T2004,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2005_3,N-et; stretcher van,ProFee,0989,T2005,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2007_3,Non-emer transport wait time,ProFee,0989,T2007,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2010_3,PASRR Level I,ProFee,0989,T2010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2011_3,PASRR Level II,ProFee,0989,T2011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2012_3,"Habil ed waiver, per diem",ProFee,0989,T2012,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2013_3,Habil ed waiver per hour,ProFee,0989,T2013,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2014_3,"Habil prevoc waiver, per d",ProFee,0989,T2014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2015_3,Habil prevoc waiver per hr,ProFee,0989,T2015,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2016_3,Habil res waiver per diem,ProFee,0989,T2016,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2017_3,Habil res waiver 15 min,ProFee,0989,T2017,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2018_3,Habil sup empl waiver/diem,ProFee,0989,T2018,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2019_3,Habil sup empl waiver 15min,ProFee,0989,T2019,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2020_3,Day habil waiver per diem,ProFee,0989,T2020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2021_3,Day habil waiver per 15 min,ProFee,0989,T2021,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2022_3,"Case management, per month",ProFee,0989,T2022,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2023_3,Targeted case mgmt per month,ProFee,0989,T2023,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2024_3,Serv asmnt/care plan waiver,ProFee,0989,T2024,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2025_3,"Waiver service, nos",ProFee,0989,T2025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2026_3,Special childcare waiver/d,ProFee,0989,T2026,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2027_3,Spec childcare waiver 15 min,ProFee,0989,T2027,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2028_3,"Special supply, nos waiver",ProFee,0989,T2028,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2029_3,"Special med equip, noswaiver",ProFee,0989,T2029,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2030_3,Assist living waiver/month,ProFee,0989,T2030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2031_3,Assist living waiver/diem,ProFee,0989,T2031,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2032_3,"Res care, nos waiver/month",ProFee,0989,T2032,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2033_3,"Res, nos waiver per diem",ProFee,0989,T2033,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2034_3,Crisis interven waiver/diem,ProFee,0989,T2034,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2035_3,Utility services waiver,ProFee,0989,T2035,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2036_3,Camp overnite waiver/session,ProFee,0989,T2036,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2037_3,Camp day waiver/session,ProFee,0989,T2037,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2038_3,Comm trans waiver/service,ProFee,0989,T2038,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2039_3,Vehicle mod waiver/service,ProFee,0989,T2039,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2040_3,Financial mgt waiver/15min,ProFee,0989,T2040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2041_3,Support broker waiver/15 min,ProFee,0989,T2041,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2042_3,Hospice routine home care,ProFee,0989,T2042,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2043_3,Hospice continuous home care,ProFee,0989,T2043,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2044_3,Hospice respite care,ProFee,0989,T2044,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2045_3,Hospice general care,ProFee,0989,T2045,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2046_3,"Hospice long term care, r&b",ProFee,0989,T2046,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2048_3,"Bh ltc res r&b, per diem",ProFee,0989,T2048,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2049_3,"N-ET; stretcher van, mileage",ProFee,0989,T2049,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T2101_3,Breast milk proc/store/dist,ProFee,0989,T2101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4521_3,Adult size brief/diaper sm,ProFee,0989,T4521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4522_3,Adult size brief/diaper med,ProFee,0989,T4522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4523_3,Adult size brief/diaper lg,ProFee,0989,T4523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4524_3,Adult size brief/diaper xl,ProFee,0989,T4524,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4525_3,Adult size pull-on sm,ProFee,0989,T4525,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4526_3,Adult size pull-on med,ProFee,0989,T4526,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4527_3,Adult size pull-on lg,ProFee,0989,T4527,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4528_3,Adult size pull-on xl,ProFee,0989,T4528,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4529_3,Ped size brief/diaper sm/med,ProFee,0989,T4529,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4530_3,Ped size brief/diaper lg,ProFee,0989,T4530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4531_3,Ped size pull-on sm/med,ProFee,0989,T4531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4532_3,Ped size pull-on lg,ProFee,0989,T4532,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4533_3,Youth size brief/diaper,ProFee,0989,T4533,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4534_3,Youth size pull-on,ProFee,0989,T4534,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4535_3,Disposable liner/shield/pad,ProFee,0989,T4535,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4536_3,Reusable pull-on any size,ProFee,0989,T4536,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4537_3,Reusable underpad bed size,ProFee,0989,T4537,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4538_3,Diaper serv reusable diaper,ProFee,0989,T4538,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4539_3,Reuse diaper/brief any size,ProFee,0989,T4539,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4540_3,Reusable underpad chair size,ProFee,0989,T4540,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4541_3,Large disposable underpad,ProFee,0989,T4541,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4542_3,Small disposable underpad,ProFee,0989,T4542,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4543_3,Disp bariatric brief/diaper,ProFee,0989,T4543,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4544_3,Adlt disp und/pull on abv xl,ProFee,0989,T4544,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T4545_3,Incon disposable penile wrap,ProFee,0989,T4545,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T5001_3,Special position seat/vehicl,ProFee,0989,T5001,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
T5999_3,"Supply, nos",ProFee,0989,T5999,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
TESF_1,"Testosterone, Free and Weakly Bound",Inpatient,0300,84410,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
TESF_1,"Testosterone, Free and Weakly Bound",Outpatient,0300,84410,,,,0,212.00,159.00,159.00,201.40,190.80,201.40,201.40,190.80
TSTO_1,"Testos, total by LCMSMS",Inpatient,0300,84403,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
TSTO_1,"Testos, total by LCMSMS",Outpatient,0300,84403,,,,0,96.00,72.00,72.00,91.20,86.40,91.20,91.20,86.40
UPRG_1,Urine Pregnancy Test,Outpatient,0300,81025,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
UPRG_1,Urine Pregnancy Test,Inpatient,0300,81025,,,,0,81.00,60.75,60.75,76.95,72.90,76.95,76.95,72.90
V2020_3,Vision svcs frames purchases,ProFee,0989,V2020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2025_3,Eyeglasses delux frames,ProFee,0989,V2025,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2100_3,Lens spher single plano 4.00,ProFee,0989,V2100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2101_3,Single visn sphere 4.12-7.00,ProFee,0989,V2101,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2102_3,Singl visn sphere 7.12-20.00,ProFee,0989,V2102,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2103_3,Spherocylindr 4.00d/12-2.00d,ProFee,0989,V2103,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2104_3,Spherocylindr 4.00d/2.12-4d,ProFee,0989,V2104,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2105_3,Spherocylinder 4.00d/4.25-6d,ProFee,0989,V2105,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2106_3,Spherocylinder 4.00d/>6.00d,ProFee,0989,V2106,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2107_3,Spherocylinder 4.25d/12-2d,ProFee,0989,V2107,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2108_3,Spherocylinder 4.25d/2.12-4d,ProFee,0989,V2108,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2109_3,Spherocylinder 4.25d/4.25-6d,ProFee,0989,V2109,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2110_3,Spherocylinder 4.25d/over 6d,ProFee,0989,V2110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2111_3,Spherocylindr 7.25d/.25-2.25,ProFee,0989,V2111,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2112_3,Spherocylindr 7.25d/2.25-4d,ProFee,0989,V2112,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2113_3,Spherocylindr 7.25d/4.25-6d,ProFee,0989,V2113,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2114_3,Spherocylinder over 12.00d,ProFee,0989,V2114,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2115_3,Lens lenticular bifocal,ProFee,0989,V2115,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2118_3,Lens aniseikonic single,ProFee,0989,V2118,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2121_3,"Lenticular lens, single",ProFee,0989,V2121,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2199_3,Lens single vision not oth c,ProFee,0989,V2199,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2200_3,Lens spher bifoc plano 4.00d,ProFee,0989,V2200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2201_3,Lens sphere bifocal 4.12-7.0,ProFee,0989,V2201,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2202_3,Lens sphere bifocal 7.12-20.,ProFee,0989,V2202,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2203_3,Lens sphcyl bifocal 4.00d/.1,ProFee,0989,V2203,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2204_3,Lens sphcy bifocal 4.00d/2.1,ProFee,0989,V2204,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2205_3,Lens sphcy bifocal 4.00d/4.2,ProFee,0989,V2205,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2206_3,Lens sphcy bifocal 4.00d/ove,ProFee,0989,V2206,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2207_3,Lens sphcy bifocal 4.25-7d/.,ProFee,0989,V2207,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2208_3,Lens sphcy bifocal 4.25-7/2.,ProFee,0989,V2208,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2209_3,Lens sphcy bifocal 4.25-7/4.,ProFee,0989,V2209,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2210_3,Lens sphcy bifocal 4.25-7/ov,ProFee,0989,V2210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2211_3,Lens sphcy bifo 7.25-12/.25-,ProFee,0989,V2211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2212_3,Lens sphcyl bifo 7.25-12/2.2,ProFee,0989,V2212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2213_3,Lens sphcyl bifo 7.25-12/4.2,ProFee,0989,V2213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2214_3,Lens sphcyl bifocal over 12.,ProFee,0989,V2214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2215_3,Lens lenticular bifocal,ProFee,0989,V2215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2218_3,Lens aniseikonic bifocal,ProFee,0989,V2218,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2219_3,Lens bifocal seg width over,ProFee,0989,V2219,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2220_3,Lens bifocal add over 3.25d,ProFee,0989,V2220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2221_3,"Lenticular lens, bifocal",ProFee,0989,V2221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2299_3,Lens bifocal speciality,ProFee,0989,V2299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2300_3,Lens sphere trifocal 4.00d,ProFee,0989,V2300,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2301_3,Lens sphere trifocal 4.12-7.,ProFee,0989,V2301,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2302_3,Lens sphere trifocal 7.12-20,ProFee,0989,V2302,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2303_3,Lens sphcy trifocal 4.0/.12-,ProFee,0989,V2303,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2304_3,Lens sphcy trifocal 4.0/2.25,ProFee,0989,V2304,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2305_3,Lens sphcy trifocal 4.0/4.25,ProFee,0989,V2305,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2306_3,Lens sphcyl trifocal 4.00/>6,ProFee,0989,V2306,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2307_3,Lens sphcy trifocal 4.25-7/.,ProFee,0989,V2307,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2308_3,Lens sphc trifocal 4.25-7/2.,ProFee,0989,V2308,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2309_3,Lens sphc trifocal 4.25-7/4.,ProFee,0989,V2309,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2310_3,Lens sphc trifocal 4.25-7/>6,ProFee,0989,V2310,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2311_3,Lens sphc trifo 7.25-12/.25-,ProFee,0989,V2311,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2312_3,Lens sphc trifo 7.25-12/2.25,ProFee,0989,V2312,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2313_3,Lens sphc trifo 7.25-12/4.25,ProFee,0989,V2313,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2314_3,Lens sphcyl trifocal over 12,ProFee,0989,V2314,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2315_3,Lens lenticular trifocal,ProFee,0989,V2315,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2318_3,Lens aniseikonic trifocal,ProFee,0989,V2318,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2319_3,Lens trifocal seg width > 28,ProFee,0989,V2319,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2320_3,Lens trifocal add over 3.25d,ProFee,0989,V2320,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2321_3,"Lenticular lens, trifocal",ProFee,0989,V2321,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2399_3,Lens trifocal speciality,ProFee,0989,V2399,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2410_3,Lens variab asphericity sing,ProFee,0989,V2410,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2430_3,Lens variable asphericity bi,ProFee,0989,V2430,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2499_3,Variable asphericity lens,ProFee,0989,V2499,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2500_3,Contact lens pmma spherical,ProFee,0989,V2500,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2501_3,Cntct lens pmma-toric/prism,ProFee,0989,V2501,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2502_3,Contact lens pmma bifocal,ProFee,0989,V2502,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2503_3,Cntct lens pmma color vision,ProFee,0989,V2503,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2510_3,Cntct gas permeable sphericl,ProFee,0989,V2510,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2511_3,Cntct toric prism ballast,ProFee,0989,V2511,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2512_3,Cntct lens gas permbl bifocl,ProFee,0989,V2512,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2513_3,Contact lens extended wear,ProFee,0989,V2513,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2520_3,Contact lens hydrophilic,ProFee,0989,V2520,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2521_3,Cntct lens hydrophilic toric,ProFee,0989,V2521,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2522_3,Cntct lens hydrophil bifocl,ProFee,0989,V2522,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2523_3,Cntct lens hydrophil extend,ProFee,0989,V2523,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2530_3,Contact lens gas impermeable,ProFee,0989,V2530,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2531_3,Contact lens gas permeable,ProFee,0989,V2531,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2599_3,Contact lens/es other type,ProFee,0989,V2599,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2600_3,Hand held low vision aids,ProFee,0989,V2600,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2610_3,Single lens spectacle mount,ProFee,0989,V2610,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2615_3,Telescop/othr compound lens,ProFee,0989,V2615,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2623_3,Plastic eye prosth custom,ProFee,0989,V2623,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2624_3,Polishing artifical eye,ProFee,0989,V2624,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2625_3,Enlargemnt of eye prosthesis,ProFee,0989,V2625,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2626_3,Reduction of eye prosthesis,ProFee,0989,V2626,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2627_3,Scleral cover shell,ProFee,0989,V2627,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2628_3,Fabrication & fitting,ProFee,0989,V2628,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2629_3,Prosthetic eye other type,ProFee,0989,V2629,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2630_3,Anter chamber intraocul lens,ProFee,0989,V2630,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2631_3,Iris support intraoclr lens,ProFee,0989,V2631,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2632_3,Post chmbr intraocular lens,ProFee,0989,V2632,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2700_3,Balance lens,ProFee,0989,V2700,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2702_3,Deluxe lens feature,ProFee,0989,V2702,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2710_3,Glass/plastic slab off prism,ProFee,0989,V2710,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2715_3,Prism lens/es,ProFee,0989,V2715,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2718_3,Fresnell prism press-on lens,ProFee,0989,V2718,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2730_3,Special base curve,ProFee,0989,V2730,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2744_3,Tint photochromatic lens/es,ProFee,0989,V2744,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2745_3,"Tint, any color/solid/grad",ProFee,0989,V2745,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2750_3,Anti-reflective coating,ProFee,0989,V2750,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2755_3,UV lens/es,ProFee,0989,V2755,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2756_3,Eye glass case,ProFee,0989,V2756,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2760_3,Scratch resistant coating,ProFee,0989,V2760,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2761_3,Mirror coating,ProFee,0989,V2761,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2762_3,"Polarization, any lens",ProFee,0989,V2762,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2770_3,Occluder lens/es,ProFee,0989,V2770,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2780_3,Oversize lens/es,ProFee,0989,V2780,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2781_3,Progressive lens per lens,ProFee,0989,V2781,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2782_3,"Lens, 1.54-1.65 p/1.60-1.79g",ProFee,0989,V2782,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2783_3,"Lens, >= 1.66 p/>=1.80 g",ProFee,0989,V2783,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2784_3,Lens polycarb or equal,ProFee,0989,V2784,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2785_3,Corneal tissue processing,ProFee,0989,V2785,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2786_3,Occupational multifocal lens,ProFee,0989,V2786,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2787_3,Astigmatism-correct function,ProFee,0989,V2787,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2788_3,Presbyopia-correct function,ProFee,0989,V2788,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2790_3,Amniotic membrane,ProFee,0989,V2790,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2797_3,Vis item/svc in other code,ProFee,0989,V2797,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V2799_3,Miscellaneous vision service,ProFee,0989,V2799,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5008_3,Hearing screening,ProFee,0989,V5008,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5010_3,Assessment for hearing aid,ProFee,0989,V5010,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5011_3,Hearing aid fitting/checking,ProFee,0989,V5011,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5014_3,Hearing aid repair/modifying,ProFee,0989,V5014,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5020_3,Conformity evaluation,ProFee,0989,V5020,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5030_3,Body-worn hearing aid air,ProFee,0989,V5030,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5040_3,Body-worn hearing aid bone,ProFee,0989,V5040,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5050_3,Hearing aid monaural in ear,ProFee,0989,V5050,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5060_3,Behind ear hearing aid,ProFee,0989,V5060,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5070_3,Glasses air conduction,ProFee,0989,V5070,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5080_3,Glasses bone conduction,ProFee,0989,V5080,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5090_3,Hearing aid dispensing fee,ProFee,0989,V5090,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5095_3,Implant mid ear hearing pros,ProFee,0989,V5095,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5100_3,Body-worn bilat hearing aid,ProFee,0989,V5100,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5110_3,Hearing aid dispensing fee,ProFee,0989,V5110,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5120_3,Body-worn binaur hearing aid,ProFee,0989,V5120,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5130_3,In ear binaural hearing aid,ProFee,0989,V5130,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5140_3,Behind ear binaur hearing ai,ProFee,0989,V5140,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5150_3,Glasses binaural hearing aid,ProFee,0989,V5150,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5160_3,Dispensing fee binaural,ProFee,0989,V5160,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5170_3,Within ear cros hearing aid,ProFee,0989,V5170,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5171_3,Hearing aid monaural ite,ProFee,0989,V5171,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5172_3,Hearing aid monaural itc,ProFee,0989,V5172,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5180_3,Behind ear cros hearing aid,ProFee,0989,V5181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5181_3,Hearing aid monaural bte,ProFee,0989,V5181,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5190_3,Glasses cros hearing aid,ProFee,0989,V5190,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5200_3,Cros hearing aid dispens fee,ProFee,0989,V5200,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5210_3,In ear bicros hearing aid,ProFee,0989,V5210,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5211_3,Hearing aid binaural ite/ite,ProFee,0989,V5211,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5212_3,Hearing aid binaural ite/itc,ProFee,0989,V5212,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5213_3,Hearing aid binaural ite/bte,ProFee,0989,V5213,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5214_3,Hearing aid binaural itc/itc,ProFee,0989,V5214,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5215_3,Hearing aid binaural itc/bte,ProFee,0989,V5215,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5220_3,Behind ear bicros hearing ai,ProFee,0989,V5220,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5221_3,Hearing aid binaural bte/bte,ProFee,0989,V5221,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5230_3,Glasses bicros hearing aid,ProFee,0989,V5230,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5240_3,Dispensing fee bicros,ProFee,0989,V5240,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5241_3,"Dispensing fee, monaural",ProFee,0989,V5241,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5242_3,"Hearing aid, monaural, cic",ProFee,0989,V5242,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5243_3,"Hearing aid, monaural, itc",ProFee,0989,V5243,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5244_3,"Hearing aid, prog, mon, cic",ProFee,0989,V5244,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5245_3,"Hearing aid, prog, mon, itc",ProFee,0989,V5245,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5246_3,"Hearing aid, prog, mon, ite",ProFee,0989,V5246,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5247_3,"Hearing aid, prog, mon, bte",ProFee,0989,V5247,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5248_3,"Hearing aid, binaural, cic",ProFee,0989,V5248,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5249_3,"Hearing aid, binaural, itc",ProFee,0989,V5249,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5250_3,"Hearing aid, prog, bin, cic",ProFee,0989,V5250,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5251_3,"Hearing aid, prog, bin, itc",ProFee,0989,V5251,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5252_3,"Hearing aid, prog, bin, ite",ProFee,0989,V5252,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5253_3,"Hearing aid, prog, bin, bte",ProFee,0989,V5253,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5254_3,"Hearing id, digit, mon, cic",ProFee,0989,V5254,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5255_3,"Hearing aid, digit, mon, itc",ProFee,0989,V5255,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5256_3,"Hearing aid, digit, mon, ite",ProFee,0989,V5256,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5257_3,"Hearing aid, digit, mon, bte",ProFee,0989,V5257,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5258_3,"Hearing aid, digit, bin, cic",ProFee,0989,V5258,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5259_3,"Hearing aid, digit, bin, itc",ProFee,0989,V5259,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5260_3,"Hearing aid, digit, bin, ite",ProFee,0989,V5260,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5261_3,"Hearing aid, digit, bin, bte",ProFee,0989,V5261,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5262_3,"Hearing aid, disp, monaural",ProFee,0989,V5262,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5263_3,"Hearing aid, disp, binaural",ProFee,0989,V5263,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5264_3,Ear mold/insert,ProFee,0989,V5264,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5265_3,"Ear mold/insert, disp",ProFee,0989,V5265,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5266_3,Battery for hearing device,ProFee,0989,V5266,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5267_3,Hearing aid supply/accessory,ProFee,0989,V5267,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5268_3,ALD Telephone Amplifier,ProFee,0989,V5268,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5269_3,"Alerting device, any type",ProFee,0989,V5269,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5270_3,"ALD, TV amplifier, any type",ProFee,0989,V5270,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5271_3,"ALD, TV caption decoder",ProFee,0989,V5271,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5272_3,Tdd,ProFee,0989,V5272,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5273_3,ALD for cochlear implant,ProFee,0989,V5273,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5274_3,ALD unspecified,ProFee,0989,V5274,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5275_3,Ear impression,ProFee,0989,V5275,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5281_3,"Ald fm/dm system, monaural",ProFee,0989,V5281,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5282_3,Ald fm/dm system binaural,ProFee,0989,V5282,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5283_3,"Ald neck, loop ind receiver",ProFee,0989,V5283,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5284_3,Ald fm/dm ear level receiver,ProFee,0989,V5284,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5285_3,Ald fm/dm aud input receiver,ProFee,0989,V5285,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5286_3,Ald blu tooth fm/dm receiver,ProFee,0989,V5286,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5287_3,"Ald fm/dm receiver, nos",ProFee,0989,V5287,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5288_3,Ald fm/dm transmitter ald,ProFee,0989,V5288,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5289_3,Ald fm/dm adapt/boot couplin,ProFee,0989,V5289,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5290_3,Ald transmitter microphone,ProFee,0989,V5290,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5298_3,Hearing aid noc,ProFee,0989,V5298,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5299_3,Hearing service,ProFee,0989,V5299,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5336_3,Repair communication device,ProFee,0989,V5336,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5362_3,Speech screening,ProFee,0989,V5362,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5363_3,Language screening,ProFee,0989,V5363,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
V5364_3,Dysphagia screening,ProFee,0989,V5364,,,,0,3.00,2.25,2.25,2.25,0.00,N/A,N/A,N/A
VGCCAB_1,Voltage Gatec CA Channel AB,Outpatient,0300,83519,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50
VGCCAB_1,Voltage Gatec CA Channel AB,Inpatient,0300,83519,,,,0,215.00,161.25,161.25,204.25,193.50,204.25,204.25,193.50

Diagnosis Related Group Code,Description,Price Tier,Revenue Code,CPT HCPCS DRG Code,NDC Code,Rx Unit Multiplier,Gross Charge,Discounted Cash Price,De-identified minimum negotiated charge,De-identified maximum negotiated charge,AETNA-ALL_PLANS,ASURIS_INDIV_AND_FAMILY_NETW_PPO,ASURIS_NW_HEALTH-ALL_OTHER_PLANS,UHC-ALL_PLANS
194,SIMPLE PNEUMONIA AND PLEURISY WITH CC,Inpatient,NA,194,NA,NA,8030.0000,6022.50,7227.00,7628.50,7227.00,7628.50,7628.50,7227.00
603,CELLULITIS WITHOUT MCC,Inpatient,NA,603,NA,NA,3866.0000,2899.50,3479.40,3672.70,3479.40,3672.70,3672.70,3479.40
641,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",Inpatient,NA,641,NA,NA,1949.0000,1461.75,1754.10,1851.55,1754.10,1851.55,1851.55,1754.10
689,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,Inpatient,NA,689,NA,NA,8805.5000,6604.13,7924.95,8365.23,7924.95,8365.23,8365.23,7924.95
690,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,Inpatient,NA,690,NA,NA,14213.0000,10659.75,12791.70,13502.35,12791.70,13502.35,13502.35,12791.70

Shoppable Services Code,Description,Price Tier,Revenue Code,CPT HCPCS DRG Code,NDC Code,Rx Unit Multiplier,Gross Charge,Discounted Cash Price,De-identified minimum negotiated charge,De-identified maximum negotiated charge,AETNA-ALL_PLANS,ASURIS_INDIV_AND_FAMILY_NETW_PPO,ASURIS_NW_HEALTH-ALL_OTHER_PLANS,UHC-ALL_PLANS
194,SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATIONS,NA,NA,194,NA,NA,8030.00,6022.50,7227.00,7628.50,7227.00,7628.50,7628.50,7227.00
20552,"Injection of trigger points, 1-2 muscles",NA,NA,20552,NA,NA,7429.57,5572.18,4428.10,4899.61,4428.10,4899.61,4899.61,4428.10
20605,Aspiration and/or injection of fluid from medium joint,NA,NA,20605,NA,NA,4403.99,3303.00,2513.99,2774.16,2513.99,2774.16,2774.16,2513.99
20610,Aspiration and/or injection of fluid from large joint,NA,NA,20610,NA,NA,7346.87,5510.15,4210.08,4723.47,4210.08,4723.47,4723.47,4210.08
59400,Vaginal delivery with care before and after delivery,NA,NA,59400,NA,NA,3.00,2.25,2996.00,2996.00,N/A,2996.00,2996.00,N/A
59510,Cesarean delivery with care before and after delivery,NA,NA,59510,NA,NA,3.00,2.25,3323.00,3323.00,N/A,3323.00,3323.00,N/A
59610,Vaginal delivery and care before and after delivery after previous cesarean delivery,NA,NA,59610,NA,NA,3.00,2.25,3154.00,3154.00,N/A,3154.00,3154.00,N/A
62321,Injection of substance into middle or upper spine canal using imaging guidance,NA,NA,62321,NA,NA,3790.71,2843.03,2318.14,2600.93,2318.14,2600.93,2600.93,2318.14
641,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MAJOR COMPLICATIONS",NA,NA,641,NA,NA,1949.00,1461.75,1467.00,1548.50,1467.00,1548.50,1548.50,1467.00
64417,Injection of anesthetic agent and/or steroid into upper arm and shoulder nerve,NA,NA,64417,NA,NA,5058.67,3794.00,3109.20,3536.93,3109.20,3536.93,3536.93,3109.20
64445,Injection of anesthetic agent and/or steroid into lower back and leg nerve,NA,NA,64445,NA,NA,7183.62,5387.71,4272.57,4735.44,4272.57,4735.44,4735.44,4272.57
64450,Injection of anesthetic agent and/or steroid into other nerve or branch,NA,NA,64450,NA,NA,4913.70,3685.28,2978.73,3399.22,2978.73,3399.22,3399.22,2978.73
64454,Injection of anesthetic agent and/or steroid into knee nerve branch using imaging guidance,NA,NA,64454,NA,NA,4160.48,3120.36,2286.43,2413.45,2286.43,2413.45,2413.45,2286.43
64483,"Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level",NA,NA,64483,NA,NA,6668.15,5001.11,3276.22,3693.73,3276.22,3693.73,3693.73,3276.22
64490,"Injection of upper or middle spine facet joint using imaging guidance, single level",NA,NA,64490,NA,NA,7411.19,5558.39,4429.31,5001.38,4429.31,5001.38,5001.38,4429.31
64493,"Injection of lower or sacral spine facet joint using imaging guidance, single level",NA,NA,64493,NA,NA,9262.58,6946.94,5195.80,5764.46,5195.80,5764.46,5764.46,5195.80
64624,Destruction of nerve branches of knee using imaging guidance,NA,NA,64624,NA,NA,7096.28,5322.21,3871.15,4086.21,3871.15,4086.21,4086.21,3871.15
64635,"Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint",NA,NA,64635,NA,NA,11279.81,8459.86,6325.48,7080.90,6325.48,7080.90,7080.90,6325.48
64640,Destruction of peripheral nerve or branch,NA,NA,64640,NA,NA,5055.21,3791.41,2981.89,3281.05,2981.89,3281.05,3281.05,2981.89
689,KIDNEY AND URINARY TRACT INFECTIONS WITH MAJOR COMPLICATIONS,NA,NA,689,NA,NA,8805.50,6604.13,7716.60,8145.30,7716.60,8145.30,8145.30,7716.60
70220,"X-ray of paranasal sinus, minimum of 3 views",NA,NA,70220,NA,NA,426.00,319.50,380.70,419.85,380.70,419.85,419.85,380.70
70450,CT scan head or brain without contrast,NA,NA,70450,NA,NA,1502.00,1126.50,1349.10,1484.55,1349.10,1484.55,1484.55,1349.10
70487,CT scan of face with contrast,NA,NA,70487,NA,NA,1919.00,1439.25,1724.40,1900.20,1724.40,1900.20,1900.20,1724.40
70496,CT scan of blood vessels of head with contrast,NA,NA,70496,NA,NA,2349.00,1761.75,2111.40,2353.20,2111.40,2353.20,2353.20,2111.40
70546,MRI scan of blood vessels of head before and after contrast,NA,NA,70546,NA,NA,3806.00,2854.50,3422.70,3717.85,3422.70,3717.85,3717.85,3422.70
70551,MRI scan of brain without contrast,NA,NA,70551,NA,NA,2338.00,1753.50,2101.50,2324.25,2101.50,2324.25,2324.25,2101.50
70553,MRI scan of brain before and after contrast,NA,NA,70553,NA,NA,3731.00,2798.25,3355.20,3704.10,3355.20,3704.10,3704.10,3355.20
71045,"X-ray of chest, 1 view",NA,NA,71045,NA,NA,237.00,177.75,210.60,235.30,210.60,235.30,235.30,210.60
71046,"X-ray of chest, 2 views",NA,NA,71046,NA,NA,314.00,235.50,279.90,310.95,279.90,310.95,310.95,279.90
71250,CT scan of chest without contrast,NA,NA,71250,NA,NA,1586.00,1189.50,1424.70,1586.85,1424.70,1586.85,1586.85,1424.70
71260,CT scan of chest with contrast,NA,NA,71260,NA,NA,2280.00,1710.00,2049.30,2251.65,2049.30,2251.65,2251.65,2049.30
71270,CT scan of chest before and after contrast,NA,NA,71270,NA,NA,2650.00,1987.50,2382.30,2613.15,2382.30,2613.15,2613.15,2382.30
71271,Low dose CT scan of chest for lung cancer screening,NA,NA,71271,NA,NA,1074.00,805.50,963.90,1017.45,963.90,1017.45,1017.45,963.90
71275,CT scan of blood vessels of chest with contrast,NA,NA,71275,NA,NA,3203.00,2402.25,2880.00,3169.50,2880.00,3169.50,3169.50,2880.00
72040,"X-ray of upper spine, 2-3 views",NA,NA,72040,NA,NA,370.00,277.50,330.30,364.65,330.30,364.65,364.65,330.30
72100,"X-ray of lower and sacral spine, 2-3 views",NA,NA,72100,NA,NA,401.00,300.75,358.20,394.10,358.20,394.10,394.10,358.20
72110,"X-ray of lower and sacral spine, minimum of 4 views",NA,NA,72110,NA,NA,479.00,359.25,428.40,474.70,428.40,474.70,474.70,428.40
72125,CT scan of upper spine without contrast,NA,NA,72125,NA,NA,1634.00,1225.50,1467.90,1625.45,1467.90,1625.45,1625.45,1467.90
72128,CT scan of middle spine without contrast,NA,NA,72128,NA,NA,1585.00,1188.75,1423.80,1574.40,1423.80,1574.40,1574.40,1423.80
72131,CT scan of lower spine without contrast,NA,NA,72131,NA,NA,1813.00,1359.75,1629.00,1791.00,1629.00,1791.00,1791.00,1629.00
72141,MRI scan of upper spinal canal without contrast,NA,NA,72141,NA,NA,2318.00,1738.50,2083.50,2305.25,2083.50,2305.25,2305.25,2083.50
72146,MRI scan of middle spinal canal without contrast,NA,NA,72146,NA,NA,2586.00,1939.50,2324.70,2559.85,2324.70,2559.85,2559.85,2324.70
72148,MRI scan of lower spinal canal without contrast,NA,NA,72148,NA,NA,2444.00,1833.00,2196.90,2424.95,2196.90,2424.95,2424.95,2196.90
72158,MRI scan of lower spinal canal before and after contrast,NA,NA,72158,NA,NA,3687.00,2765.25,3315.60,3662.80,3315.60,3662.80,3662.80,3315.60
72192,CT scan of pelvis without contrast,NA,NA,72192,NA,NA,1605.00,1203.75,1441.80,1599.40,1441.80,1599.40,1599.40,1441.80
72193,CT scan of pelvis with contrast,NA,NA,72193,NA,NA,2276.00,1707.00,2045.70,2242.35,2045.70,2242.35,2242.35,2045.70
72202,"X-ray of joint between lower spine and hip bone, 3 or more views",NA,NA,72202,NA,NA,352.00,264.00,314.10,345.05,314.10,345.05,345.05,314.10
73030,"X-ray of shoulder, minimum of 2 views",NA,NA,73030,NA,NA,332.00,249.00,296.10,326.05,296.10,326.05,326.05,296.10
73080,"X-ray of elbow, minimum of 3 views",NA,NA,73080,NA,NA,321.00,240.75,286.20,314.60,286.20,314.60,314.60,286.20
73100,"X-ray of wrist, 2 views",NA,NA,73100,NA,NA,286.00,214.50,254.70,281.35,254.70,281.35,281.35,254.70
73110,"X-ray of wrist, minimum of 3 views",NA,NA,73110,NA,NA,336.00,252.00,299.70,328.85,299.70,328.85,328.85,299.70
73130,"X-ray of hand, minimum of 3 views",NA,NA,73130,NA,NA,360.00,270.00,321.30,351.65,321.30,351.65,351.65,321.30
73200,CT scan of arm without contrast,NA,NA,73200,NA,NA,1602.00,1201.50,1439.10,1590.55,1439.10,1590.55,1590.55,1439.10
73201,CT scan of arm with contrast,NA,NA,73201,NA,NA,1927.00,1445.25,1731.60,1910.80,1731.60,1910.80,1910.80,1731.60
73218,MRI scan of arm without contrast,NA,NA,73218,NA,NA,2098.00,1573.50,1885.50,2086.75,1885.50,2086.75,2086.75,1885.50
73220,MRI scan of arm before and after contrast,NA,NA,73220,NA,NA,2803.00,2102.25,2520.00,2813.00,2520.00,2813.00,2813.00,2520.00
73221,MRI scan of arm joint without contrast,NA,NA,73221,NA,NA,2254.00,1690.50,2025.90,2235.45,2025.90,2235.45,2235.45,2025.90
73502,"X-ray of hip, 2-3 views",NA,NA,73502,NA,NA,282.00,211.50,251.10,281.05,251.10,281.05,281.05,251.10
73503,"X-ray of hip, minimum of 4 views",NA,NA,73503,NA,NA,405.00,303.75,361.80,402.40,361.80,402.40,402.40,361.80
73551,"X-ray of thigh bone, 1 view",NA,NA,73551,NA,NA,146.00,109.50,128.70,147.85,128.70,147.85,147.85,128.70
73562,"X-ray of knee, 3 views",NA,NA,73562,NA,NA,441.00,330.75,394.20,429.60,394.20,429.60,429.60,394.20
73590,"X-ray of lower leg, 2 views",NA,NA,73590,NA,NA,266.00,199.50,236.70,261.85,236.70,261.85,261.85,236.70
73610,"X-ray of ankle, minimum of 3 views",NA,NA,73610,NA,NA,329.00,246.75,293.40,322.20,293.40,322.20,322.20,293.40
73630,"X-ray of foot, minimum of 3 views",NA,NA,73630,NA,NA,321.00,240.75,286.20,314.10,286.20,314.10,314.10,286.20
73718,MRI scan of leg without contrast,NA,NA,73718,NA,NA,2487.00,1865.25,2235.60,2456.30,2235.60,2456.30,2456.30,2235.60
73721,MRI scan of leg joint without contrast,NA,NA,73721,NA,NA,2269.00,1701.75,2039.40,2249.70,2039.40,2249.70,2249.70,2039.40
74018,"X-ray of abdomen, 1 view",NA,NA,74018,NA,NA,284.00,213.00,252.90,279.95,252.90,279.95,279.95,252.90
74022,X-ray series of abdomen with single X-ray of chest,NA,NA,74022,NA,NA,479.00,359.25,428.40,475.20,428.40,475.20,475.20,428.40
74150,CT scan of abdomen without contrast,NA,NA,74150,NA,NA,1608.00,1206.00,1444.50,1609.75,1444.50,1609.75,1609.75,1444.50
74176,CT scan of abdomen and pelvis without contrast,NA,NA,74176,NA,NA,2055.00,1541.25,1846.80,2073.40,1846.80,2073.40,2073.40,1846.80
74177,CT scan of abdomen and pelvis with contrast,NA,NA,74177,NA,NA,2737.00,2052.75,2460.60,2727.30,2460.60,2727.30,2727.30,2460.60
74183,MRI scan of abdomen before and after contrast,NA,NA,74183,NA,NA,3822.00,2866.50,3437.10,3784.55,3437.10,3784.55,3784.55,3437.10
76536,Ultrasound scan of head and neck soft tissue,NA,NA,76536,NA,NA,753.00,564.75,675.00,752.50,675.00,752.50,752.50,675.00
76700,Complete ultrasound scan of abdomen,NA,NA,76700,NA,NA,919.00,689.25,824.40,927.70,824.40,927.70,927.70,824.40
76705,Limited ultrasound scan of abdomen,NA,NA,76705,NA,NA,791.00,593.25,709.20,790.60,709.20,790.60,790.60,709.20
76770,Complete ultrasound scan behind abdominal cavity,NA,NA,76770,NA,NA,898.00,673.50,805.50,902.75,805.50,902.75,902.75,805.50
76775,Limited ultrasound scan behind abdominal cavity,NA,NA,76775,NA,NA,706.00,529.50,632.70,708.85,632.70,708.85,708.85,632.70
76801,"Ultrasound scan of pregnant uterus (less than 14 weeks), single or first fetus",NA,NA,76801,NA,NA,1320.00,990.00,1185.30,1322.15,1185.30,1322.15,1322.15,1185.30
76805,"Ultrasound scan of pregnant uterus (14 weeks or more), single or first fetus",NA,NA,76805,NA,NA,1716.00,1287.00,1541.70,1699.35,1541.70,1699.35,1699.35,1541.70
76815,Limited ultrasound of pregnant uterus,NA,NA,76815,NA,NA,823.00,617.25,738.00,825.50,738.00,825.50,825.50,738.00
76830,"Ultrasound scan of uterus, ovaries, tubes, cervix and pelvic area through vagina",NA,NA,76830,NA,NA,688.00,516.00,616.50,700.25,616.50,700.25,700.25,616.50
76856,Complete ultrasound scan of pelvis,NA,NA,76856,NA,NA,929.00,696.75,833.40,928.70,833.40,928.70,928.70,833.40
76881,Complete ultrasound scan of joint,NA,NA,76881,NA,NA,739.00,554.25,662.40,744.20,662.40,744.20,744.20,662.40
76882,Limited ultrasound scan of joint or other extremity structure lacking blood vessels,NA,NA,76882,NA,NA,430.00,322.50,384.30,440.65,384.30,440.65,440.65,384.30
77065,Diagnostic mammography of 1 breast,NA,NA,77065,NA,NA,3.00,2.25,58.00,58.00,N/A,58.00,58.00,N/A
77066,Diagnostic mammography of both breasts,NA,NA,77066,NA,NA,3.00,2.25,71.50,71.50,N/A,71.50,71.50,N/A
77067,Screening mammography,NA,NA,77067,NA,NA,3.00,2.25,54.00,54.00,N/A,108.00,108.00,N/A
80048,"Blood test, basic group of blood chemicals (Calcium, total)",NA,NA,80048,NA,NA,138.00,103.50,124.20,131.10,124.20,131.10,131.10,124.20
80053,"Blood test, comprehensive group of blood chemicals",NA,NA,80053,NA,NA,161.00,120.75,144.90,152.95,144.90,152.95,152.95,144.90
80061,"Blood test, lipids (cholesterol and triglycerides)",NA,NA,80061,NA,NA,145.00,108.75,130.50,137.75,261.00,275.50,275.50,261.00
80069,Kidney function blood test panel,NA,NA,80069,NA,NA,129.00,96.75,116.10,122.55,116.10,122.55,122.55,116.10
80076,Liver function blood test panel,NA,NA,80076,NA,NA,114.00,85.50,102.60,108.30,102.60,108.30,108.30,102.60
80305,"Testing for presence of drug, read by direct observation",NA,NA,80305,NA,NA,44.00,33.00,39.60,41.80,39.60,41.80,41.80,39.60
80307,"Testing for presence of drug, by chemistry analyzers",NA,NA,80307,NA,NA,,,,,N/A,N/A,N/A,N/A
81001,"Manual urinalysis test with examination using microscope, automated",NA,NA,81001,NA,NA,64.00,48.00,57.60,60.80,57.60,60.80,60.80,57.60
81005,"Analysis of urine, except immunoassays",NA,NA,81005,NA,NA,57.00,42.75,51.30,54.15,51.30,54.15,54.15,51.30
81015,Urinalysis using microscope,NA,NA,81015,NA,NA,43.00,32.25,38.70,40.85,38.70,40.85,40.85,38.70
82024,Adrenocorticotropic hormone (ACTH) level,NA,NA,82024,NA,NA,263.00,197.25,236.70,249.85,236.70,249.85,249.85,236.70
82075,Measurement of alcohol level in breath specimen,NA,NA,82075,NA,NA,127.00,95.25,114.30,120.65,114.30,120.65,120.65,114.30
82140,Ammonia level,NA,NA,82140,NA,NA,157.00,117.75,141.30,149.15,141.30,149.15,149.15,141.30
82247,"Bilirubin level, total",NA,NA,82247,NA,NA,80.00,60.00,72.00,76.00,72.00,76.00,76.00,72.00
82270,Stool analysis for blood to screen for colon tumors,NA,NA,82270,NA,NA,44.00,33.00,39.60,41.80,39.60,41.80,41.80,39.60
82306,Vitamin D-3 level,NA,NA,82306,NA,NA,130.00,97.50,117.00,123.50,117.00,123.50,123.50,117.00
82380,Carotene level,NA,NA,82380,NA,NA,260.00,195.00,234.00,247.00,234.00,247.00,247.00,234.00
82465,Cholesterol level,NA,NA,82465,NA,NA,26.00,19.50,23.40,24.70,23.40,24.70,24.70,23.40
82550,"Creatine kinase (cardiac enzyme) level, total",NA,NA,82550,NA,NA,100.00,75.00,90.00,95.00,90.00,95.00,95.00,90.00
82565,Blood creatinine level,NA,NA,82565,NA,NA,59.00,44.25,53.10,56.05,53.10,56.05,56.05,53.10
82607,Cyanocobalamin (vitamin B-12) level,NA,NA,82607,NA,NA,112.00,84.00,100.80,106.40,100.80,106.40,106.40,100.80
82656,Detection of pancreatic elastase (enzyme) in stool,NA,NA,82656,NA,NA,307.00,230.25,276.30,291.65,276.30,291.65,291.65,276.30
82670,Measurement of total estradiol (hormone),NA,NA,82670,NA,NA,145.00,108.75,130.50,137.75,130.50,137.75,137.75,130.50
82728,Ferritin (blood protein) level,NA,NA,82728,NA,NA,127.00,95.25,114.30,120.65,114.30,120.65,120.65,114.30
82947,Blood glucose (sugar) level,NA,NA,82947,NA,NA,62.00,46.50,55.80,58.90,111.60,117.80,117.80,111.60
82952,"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens",NA,NA,82952,NA,NA,42.00,31.50,37.80,39.90,37.80,39.90,39.90,37.80
83013,Breath test analysis for helicobacter pylori,NA,NA,83013,NA,NA,283.00,212.25,254.70,268.85,254.70,268.85,268.85,254.70
83036,Hemoglobin A1C level,NA,NA,83036,NA,NA,91.00,68.25,81.90,86.45,81.90,86.45,86.45,81.90
83516,"Analysis of substance using immunoassay technique, multiple step method",NA,NA,83516,NA,NA,120.00,90.00,108.00,114.00,108.00,114.00,114.00,108.00
83550,Iron binding capacity,NA,NA,83550,NA,NA,67.00,50.25,60.30,63.65,60.30,63.65,63.65,60.30
83655,Lead level,NA,NA,83655,NA,NA,89.00,66.75,80.10,84.55,80.10,84.55,84.55,80.10
83690,Lipase (fat enzyme) level,NA,NA,83690,NA,NA,120.00,90.00,108.00,114.00,108.00,114.00,114.00,108.00
83718,HDL cholesterol level,NA,NA,83718,NA,NA,102.00,76.50,91.80,96.90,91.80,96.90,96.90,91.80
83735,Magnesium level,NA,NA,83735,NA,NA,78.00,58.50,70.20,74.10,70.20,74.10,74.10,70.20
83874,Myoglobin (muscle protein) level,NA,NA,83874,NA,NA,135.00,101.25,121.50,128.25,121.50,128.25,128.25,121.50
83935,Urine osmolality (concentration) measurement,NA,NA,83935,NA,NA,86.00,64.50,77.40,81.70,77.40,81.70,81.70,77.40
84153,"PSA (prostate specific antigen) measurement, total",NA,NA,84153,NA,NA,118.00,88.50,106.20,112.10,106.20,112.10,112.10,106.20
84154,"PSA (prostate specific antigen) measurement, free",NA,NA,84154,NA,NA,126.00,94.50,113.40,119.70,113.40,119.70,119.70,113.40
84270,Sex hormone binding globulin (protein) level,NA,NA,84270,NA,NA,93.00,69.75,83.70,88.35,83.70,88.35,88.35,83.70
84295,Blood sodium level,NA,NA,84295,NA,NA,51.00,38.25,45.90,48.45,45.90,48.45,48.45,45.90
84425,Vitamin B-1 (thiamine) level,NA,NA,84425,NA,NA,146.00,109.50,131.40,138.70,131.40,138.70,138.70,131.40
84436,"Thyroxine (thyroid chemical), total",NA,NA,84436,NA,NA,68.00,51.00,61.20,64.60,61.20,64.60,64.60,61.20
84439,"Thyroxine (thyroid chemical), free",NA,NA,84439,NA,NA,109.00,81.75,98.10,103.55,98.10,103.55,103.55,98.10
84443,"Blood test, thyroid stimulating hormone (TSH)",NA,NA,84443,NA,NA,125.00,93.75,112.50,118.75,112.50,118.75,118.75,112.50
84450,"Liver enzyme (SGOT), level",NA,NA,84450,NA,NA,61.00,45.75,54.90,57.95,54.90,57.95,57.95,54.90
84460,"Liver enzyme (SGPT), level",NA,NA,84460,NA,NA,63.00,47.25,56.70,59.85,56.70,59.85,59.85,56.70
84478,Triglycerides level,NA,NA,84478,NA,NA,46.00,34.50,41.40,43.70,82.80,87.40,87.40,82.80
84480,"Thyroid hormone, T3 measurement, total",NA,NA,84480,NA,NA,86.00,64.50,77.40,81.70,77.40,81.70,81.70,77.40
84484,"Troponin (protein) analysis, quantitative",NA,NA,84484,NA,NA,172.00,129.00,154.80,163.40,154.80,163.40,163.40,154.80
84520,"Urea nitrogen level to assess kidney function, quantitative",NA,NA,84520,NA,NA,56.00,42.00,50.40,53.20,50.40,53.20,53.20,50.40
85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count",NA,NA,85025,NA,NA,96.00,72.00,86.40,91.20,86.40,91.20,91.20,86.40
85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",NA,NA,85027,NA,NA,78.00,58.50,70.20,74.10,70.20,74.10,74.10,70.20
85230,"Clotting factor VII (proconvertin, stable factor)",NA,NA,85230,NA,NA,190.00,142.50,171.00,180.50,171.00,180.50,180.50,171.00
85305,Protein S (clotting inhibitor) level,NA,NA,85305,NA,NA,123.00,92.25,110.70,116.85,110.70,116.85,116.85,110.70
85379,"Coagulation function measurement, D-dimer; quantitative",NA,NA,85379,NA,NA,148.00,111.00,133.20,140.60,133.20,140.60,140.60,133.20
85610,"Blood test, clotting time",NA,NA,85610,NA,NA,56.00,42.00,50.40,53.20,50.40,53.20,53.20,50.40
85730,"Coagulation assessment blood test, plasma or whole blood",NA,NA,85730,NA,NA,105.00,78.75,94.50,99.75,94.50,99.75,99.75,94.50
86038,Screening test for autoimmune disorder,NA,NA,86038,NA,NA,100.00,75.00,90.00,95.00,90.00,95.00,95.00,90.00
86060,Measurement for Strep antibody (strep throat),NA,NA,86060,NA,NA,62.00,46.50,55.80,58.90,55.80,58.90,58.90,55.80
86140,Measurement C-reactive protein for detection of infection or inflammation,NA,NA,86140,NA,NA,98.00,73.50,88.20,93.10,88.20,93.10,93.10,88.20
86431,Rheumatoid factor level,NA,NA,86431,NA,NA,84.00,63.00,75.60,79.80,75.60,79.80,79.80,75.60
86580,Skin test for tuberculosis,NA,NA,86580,NA,NA,36.00,27.00,32.40,34.20,32.40,34.20,34.20,32.40
86592,Syphilis detection test,NA,NA,86592,NA,NA,80.00,60.00,72.00,76.00,72.00,76.00,76.00,72.00
86665,"Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid",NA,NA,86665,NA,NA,148.00,111.00,133.20,140.60,133.20,140.60,140.60,133.20
86677,Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria),NA,NA,86677,NA,NA,149.00,111.75,134.10,141.55,134.10,141.55,141.55,134.10
86694,Analysis for antibody to Herpes simplex virus,NA,NA,86694,NA,NA,240.00,180.00,216.00,228.00,216.00,228.00,228.00,216.00
86703,Analysis for antibody to HIV-1 and HIV-2 virus,NA,NA,86703,NA,NA,125.00,93.75,112.50,118.75,112.50,118.75,118.75,112.50
86706,Hepatitis B surface antibody measurement,NA,NA,86706,NA,NA,106.00,79.50,95.40,100.70,95.40,100.70,100.70,95.40
86769,Measure of severe acute respiratory syndrome coronavirus 2 (Covid-19) antibody,NA,NA,86769,NA,NA,77.00,57.75,69.30,73.15,69.30,73.15,73.15,69.30
86780,"Analysis for antibody, Treponema pallidum",NA,NA,86780,NA,NA,85.00,63.75,76.50,80.75,76.50,80.75,80.75,76.50
86787,Analysis for antibody to varicella-zoster virus (chicken pox),NA,NA,86787,NA,NA,151.00,113.25,135.90,143.45,135.90,143.45,143.45,135.90
86812,"Immunologic analysis for autoimmune disease, A, B, or C, single antigen",NA,NA,86812,NA,NA,219.00,164.25,197.10,208.05,197.10,208.05,208.05,197.10
86900,Blood group typing (ABO),NA,NA,86900,NA,NA,58.00,43.50,52.20,55.10,52.20,55.10,55.10,52.20
86901,Blood typing for Rh (D) antigen,NA,NA,86901,NA,NA,47.00,35.25,42.30,44.65,42.30,44.65,44.65,42.30
86920,"Blood unit compatibility test, immediate spin technique",NA,NA,86920,NA,NA,155.00,116.25,139.50,147.25,139.50,147.25,147.25,139.50
87045,Stool culture,NA,NA,87045,NA,NA,100.00,75.00,90.00,95.00,90.00,95.00,95.00,90.00
87070,"Bacterial culture, any other source except urine, blood or stool, aerobic",NA,NA,87070,NA,NA,89.00,66.75,80.10,84.55,80.10,84.55,84.55,80.10
87086,"Bacterial colony count, urine",NA,NA,87086,NA,NA,98.00,73.50,88.20,93.10,88.20,93.10,93.10,88.20
87101,"Fungal culture (mold or yeast) of skin, hair, or nail",NA,NA,87101,NA,NA,114.00,85.50,102.60,108.30,102.60,108.30,108.30,102.60
87110,Culture for chlamydia,NA,NA,87110,NA,NA,204.00,153.00,183.60,193.80,367.20,387.60,387.60,367.20
87220,Tissue fungi or parasites,NA,NA,87220,NA,NA,57.00,42.75,51.30,54.15,51.30,54.15,54.15,51.30
87340,Detection test by immunoassay technique for hepatitis B surface antigen,NA,NA,87340,NA,NA,90.00,67.50,81.00,85.50,162.00,171.00,171.00,162.00
87400,Detection test by immunoassay technique for influenza virus,NA,NA,87400,NA,NA,125.00,93.75,112.50,118.75,112.50,118.75,118.75,112.50
87430,"Detection test by immunoassay technique for Streptococcus, group A (strep)",NA,NA,87430,NA,NA,,,,,N/A,N/A,N/A,N/A
87491,"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique",NA,NA,87491,NA,NA,173.00,129.75,155.70,164.35,311.40,328.70,328.70,311.40
87591,"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique",NA,NA,87591,NA,NA,152.00,114.00,136.80,144.40,273.60,288.80,288.80,273.60
87635,Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen,NA,NA,87635,NA,NA,103.00,77.25,92.70,97.85,92.70,97.85,97.85,92.70
87880,"Detection test by immunoassay with direct visual observation for Streptococcus, group A (strep)",NA,NA,87880,NA,NA,58.00,43.50,52.20,55.10,52.20,55.10,55.10,52.20
89051,Body fluid cell count with cell identification,NA,NA,89051,NA,NA,115.00,86.25,103.50,109.25,103.50,109.25,109.25,103.50
90670,"Pneumococcal vaccine, 13-valent",NA,NA,90670,NA,NA,30.00,22.50,27.00,28.50,27.00,28.50,28.50,27.00
90732,"Pneumococcal vaccine, 23-valent",NA,NA,90732,NA,NA,362.00,271.50,325.80,343.90,325.80,343.90,343.90,325.80
90832,"Psychotherapy, 30 minutes",NA,NA,90832,NA,NA,3.00,2.25,88.50,88.50,N/A,88.50,88.50,N/A
90834,"Psychotherapy, 45 minutes",NA,NA,90834,NA,NA,3.00,2.25,118.00,118.00,N/A,118.00,118.00,N/A
90837,"Psychotherapy, 1 hour",NA,NA,90837,NA,NA,3.00,2.25,135.92,135.92,N/A,135.92,135.92,N/A
90846,"Family psychotherapy without patient, 50 minutes",NA,NA,90846,NA,NA,3.00,2.25,143.00,143.00,N/A,143.00,143.00,N/A
90847,"Family psychotherapy with patient, 50 minutes",NA,NA,90847,NA,NA,3.00,2.25,149.00,149.00,N/A,149.00,149.00,N/A
90853,Group psychotherapy,NA,NA,90853,NA,NA,3.00,2.25,35.00,35.00,N/A,35.00,35.00,N/A
92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",NA,NA,92507,NA,NA,261.00,195.75,232.20,356.10,232.20,356.10,356.10,232.20
92521,"Evaluation of speech continuity, smoothness, rate, and effort",NA,NA,92521,NA,NA,404.00,303.00,360.90,492.39,360.90,492.39,492.39,360.90
92522,Evaluation of speech sound production,NA,NA,92522,NA,NA,351.00,263.25,313.20,420.30,313.20,420.30,420.30,313.20
92526,Treatment of swallowing and feeding disorder,NA,NA,92526,NA,NA,266.00,199.50,236.70,371.35,236.70,371.35,371.35,236.70
92607,"Evaluation with prescription of speech-generating and alternative communication device, first hour",NA,NA,92607,NA,NA,505.00,378.75,451.80,662.40,451.80,662.40,662.40,451.80
92609,Therapy service for use of speech-generating device with programming,NA,NA,92609,NA,NA,343.00,257.25,306.00,478.50,306.00,478.50,478.50,306.00
92610,Evaluation of swallowing function,NA,NA,92610,NA,NA,359.00,269.25,320.40,441.20,320.40,441.20,441.20,320.40
93000,Routine electrocardiogram (ECG) using at least 12 leads with interpretation and report,NA,NA,93000,NA,NA,340.00,255.00,214.20,323.00,306.00,323.00,323.00,306.00
93797,"Outpatient heart rehabilitation, qualified health care professional services",NA,NA,93797,NA,NA,3.00,2.25,12.50,12.50,N/A,12.50,12.50,N/A
93798,"Outpatient heart rehabilitation with electrocardiogram (ECG) monitoring, quality health care professional services",NA,NA,93798,NA,NA,3.00,2.25,20.00,20.00,N/A,20.00,20.00,N/A
93880,Ultrasound of both sides of head and neck blood flow,NA,NA,93880,NA,NA,1429.00,1071.75,1283.40,1411.70,1283.40,1411.70,1411.70,1283.40
93931,Ultrasound of one arm arteries or artery grafts,NA,NA,93931,NA,NA,1304.00,978.00,1170.90,1270.95,1170.90,1270.95,1270.95,1170.90
93970,Ultrasound study of arm or leg veins with compression and maneuvers,NA,NA,93970,NA,NA,2000.00,1500.00,1797.30,1946.15,1797.30,1946.15,1946.15,1797.30
93971,Ultrasound study of one arm or leg veins with compression and maneuvers,NA,NA,93971,NA,NA,1418.00,1063.50,1273.50,1376.25,1273.50,1376.25,1376.25,1273.50
94640,Inhalation treatment for airway obstruction or sputum production,NA,NA,94640,NA,NA,375.00,281.25,337.50,356.25,337.50,356.25,356.25,337.50
95810,Sleep study in sleep lab (6 years or older),NA,NA,95810,NA,NA,3.00,2.25,173.00,173.00,N/A,173.00,173.00,N/A
96105,"Test to assess the loss of the ability to speak, write, and understand language",NA,NA,96105,NA,NA,328.00,246.00,292.50,462.25,292.50,462.25,462.25,292.50
96125,Test to assess the ability to complete specific functional tasks applicable to environment,NA,NA,96125,NA,NA,357.00,267.75,318.60,504.30,318.60,504.30,504.30,318.60
97032,"Application of electrical stimulation with therapist present, each 15 minutes",NA,NA,97032,NA,NA,79.00,59.25,68.40,87.38,68.40,87.38,87.38,68.40
97035,"Application of ultrasound, each 15 minutes",NA,NA,97035,NA,NA,3.00,2.25,13.11,13.11,N/A,13.11,13.11,N/A
97110,"Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",NA,NA,97110,NA,NA,3.00,2.25,30.02,30.02,N/A,30.02,30.02,N/A
97110,"Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",NA,NA,97110,NA,NA,109.00,81.75,95.40,130.72,95.40,130.72,130.72,95.40
97112,"Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",NA,NA,97112,NA,NA,3.00,2.25,34.16,34.16,N/A,34.16,34.16,N/A
97112,"Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",NA,NA,97112,NA,NA,112.00,84.00,98.10,137.71,98.10,137.71,137.71,98.10
97116,"Therapy procedure for walking training, each 15 minutes",NA,NA,97116,NA,NA,96.00,72.00,83.70,118.02,83.70,118.02,118.02,83.70
97129,"Therapy procedure for a range of mental processes, initial 15 minutes",NA,NA,97129,NA,NA,88.00,66.00,76.50,80.75,76.50,80.75,80.75,76.50
97130,"Therapy procedure for a range of mental processes, each additional 15 minutes",NA,NA,97130,NA,NA,68.00,51.00,58.50,61.75,58.50,61.75,61.75,58.50
97140,"Therapy procedure using manual technique, each 15 minutes",NA,NA,97140,NA,NA,121.00,90.75,106.20,139.36,212.40,278.72,278.72,212.40
97161,"Evaluation for physical therapy, typically 20 minutes",NA,NA,97161,NA,NA,221.00,165.75,196.20,289.21,196.20,289.21,289.21,196.20
97162,"Evaluation for physical therapy, typically 30 minutes",NA,NA,97162,NA,NA,221.00,165.75,196.20,289.21,196.20,289.21,289.21,196.20
97165,"Evaluation for occupational therapy, typically 30 minutes",NA,NA,97165,NA,NA,187.00,140.25,165.60,263.47,165.60,263.47,263.47,165.60
97166,"Evaluation for occupational therapy, typically 45 minutes",NA,NA,97166,NA,NA,216.00,162.00,191.70,291.02,191.70,291.02,291.02,191.70
97530,Therapy procedure using functional activities,NA,NA,97530,NA,NA,3.00,2.25,39.68,39.68,N/A,39.68,39.68,N/A
97530,Therapy procedure using functional activities,NA,NA,97530,NA,NA,114.00,85.50,99.90,145.13,99.90,145.13,145.13,99.90
97542,"Evaluation for wheelchair, each 15 minutes",NA,NA,97542,NA,NA,96.00,72.00,83.70,121.13,83.70,121.13,121.13,83.70
97605,"Therapy procedure using a special bandage and vacuum pump, surface area 50.0 sq cm or less",NA,NA,97605,NA,NA,285.00,213.75,253.80,304.90,253.80,304.90,304.90,253.80
97605,"Therapy procedure using a special bandage and vacuum pump, surface area 50.0 sq cm or less",NA,NA,97605,NA,NA,25695.51,19271.63,23123.26,24444.88,23123.26,24444.88,24444.88,23123.26
99203,"New patient office or other outpatient visit, 30-44 minutes",NA,NA,99203,NA,NA,218.00,163.50,196.20,207.10,196.20,207.10,N/A,196.20
99204,"New patient office or other outpatient visit, 45-59 minutes",NA,NA,99204,NA,NA,331.00,248.25,297.90,314.45,297.90,314.45,N/A,297.90
99205,"New patient office or other outpatient visit, 60-74 minutes",NA,NA,99205,NA,NA,331.00,248.25,297.90,314.45,297.90,314.45,N/A,297.90
99243,"Office consultation, typically 40 minutes",NA,NA,99243,NA,NA,253.00,189.75,,0.00,N/A,N/A,N/A,N/A
99244,"Office consultation, typically 1 hour",NA,NA,99244,NA,NA,373.00,279.75,,0.00,N/A,N/A,N/A,N/A
99385,Initial new patient preventive medicine evaluation (18-39 years),NA,NA,99385,NA,NA,535.00,401.25,138.50,409.25,256.50,409.25,138.50,256.50
99386,Initial new patient preventive medicine evaluation (40-64 years),NA,NA,99386,NA,NA,596.00,447.00,168.50,470.60,286.20,470.60,168.50,286.20
C9803,"HOSPITAL OUTPATIENT CLINIC VISIT SPECIMEN COLLECTION FOR SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS  2 (SARS-COV-2) (CORONAVIRUS DISEASE [COVID-19]), ANY SPECIMEN SOURCE",NA,NA,C9803,NA,NA,37.00,27.75,33.30,35.15,66.60,70.30,70.30,66.60
E039,"Hypothyroidism, unspecified",NA,NA,E039,NA,NA,505.00,378.75,454.50,479.75,454.50,479.75,479.75,454.50
E119,Type 2 diabetes mellitus without complications,NA,NA,E119,NA,NA,484.14,363.11,435.73,459.93,435.73,459.93,459.93,435.73
E785,"Hyperlipidemia, unspecified",NA,NA,E785,NA,NA,400.76,300.57,360.68,380.72,360.68,380.72,380.72,360.68
G0422,"INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING WITH EXERCISE, PER SESSION",NA,NA,G0422,NA,NA,3.00,2.25,162.00,162.00,N/A,162.00,162.00,N/A
G0423,"INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING; WITHOUT EXERCISE, PER SESSION",NA,NA,G0423,NA,NA,3.00,2.25,162.00,162.00,N/A,162.00,162.00,N/A
G0480,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT LIMITED TO GC/MS (ANY TYPE, SINGLE OR TANDEM) AND LC/MS (ANY TYPE, SINGLE OR TANDEM AND EXCLUDING IMMUNOASSAYS (E.G., IA, EIA, ELISA, EMIT, FPIA) AND ENZYMATIC METHODS (E.G., ALCOHOL DEHYDROGENASE)), (2) STABLE ISOTOPE OR OTHER UNIVERSALLY RECOGNIZED INTERNAL STANDARDS IN ALL SAMPLES (E.G., TO CONTROL FOR MATRIX EFFECTS, INTERFERENCES AND VARIATIONS IN SIGNAL STRENGTH), AND (3) METHOD OR DRUG-SPECIFIC CALIBRATION AND MATRIX-MATCHED QUALITY CONTROL MATERIAL (E.G., TO CONTROL FOR INSTRUMENT VARIATIONS AND MASS SPECTRAL DRIFT); QUALITATIVE OR QUANTITATIVE, ALL SOURCES, INCLUDES SPECIMEN VALIDITY TESTING, PER DAY; 1-7 DRUG CLASS(ES), INCLUDING METABOLITE(S) IF PERFORMED",NA,NA,G0480,NA,NA,198.00,148.50,178.20,188.10,178.20,188.10,188.10,178.20
I10,Essential (primary) hypertension,NA,NA,I10,NA,NA,406.41,304.81,365.77,386.09,365.77,386.09,386.09,365.77
J181,SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATIONS,NA,NA,J181,NA,NA,8030.00,6022.50,7227.00,7628.50,7227.00,7628.50,7628.50,7227.00
J90,"Pleural effusion, not elsewhere classified",NA,NA,J90,NA,NA,310.00,232.50,279.00,294.50,279.00,294.50,294.50,279.00
M542,Cervicalgia,NA,NA,M542,NA,NA,1476.43,1107.32,1328.79,1402.61,1328.79,1402.61,1402.61,1328.79
M545,Low back pain,NA,NA,M545,NA,NA,958.80,719.10,862.92,910.86,862.92,910.86,910.86,862.92
N390,KIDNEY AND URINARY TRACT INFECTIONS WITH MAJOR COMPLICATIONS,NA,NA,N390,NA,NA,10608.00,7956.00,9408.30,9930.98,9408.30,9930.98,9930.98,9408.30
N390,"Urinary tract infection, site not specified",NA,NA,N390,NA,NA,85.91,64.43,77.32,81.61,77.32,81.61,81.61,77.32
R0602,Shortness of breath,NA,NA,R0602,NA,NA,1530.90,1148.18,1377.81,1454.36,1377.81,1454.36,1454.36,1377.81
R2689,Other abnormalities of gait and mobility,NA,NA,R2689,NA,NA,1508.19,1131.14,1357.37,1432.78,1357.37,1432.78,1432.78,1357.37
R531,Weakness,NA,NA,R531,NA,NA,851.86,638.89,766.67,809.26,766.67,809.26,809.26,766.67
U071,COVID-19,NA,NA,U071,NA,NA,150.57,112.93,135.51,143.04,135.51,143.04,143.04,135.51