IBRC1610B.TXT

Version 3.19 Update - Outpatient Facility,,,,,,,,,,,,,
,,,,,,,,,,,,,
Item Code,Code Type,Description,Modifier,Service Category Code,Multiple Surgery Indicator,Primary/Pass-Through Indicator,Unit Charge,Base Charge,Unit Type,Inpatient Indicator,Skilled Nursing Facility Indicator,Start Date,End Date
10021,CPT,FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
10022,CPT,FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
10030,CPT,IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
10035,CPT,PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE,,30,,,"$3,025.36",$0.00,1,0,1,20161001,
10040,CPT,ACNE SURGERY,,30,,,$398.75,$0.00,1,0,1,20161001,
10060,CPT,INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE,,30,,,$465.39,$0.00,1,0,1,20161001,
10061,CPT,INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
10080,CPT,INCISION & DRAINAGE PILONIDAL CYST SIMPLE,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
10081,CPT,INCISION & DRAINAGE PILONIDAL CYST COMPLICATED,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
10120,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
10121,CPT,INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
10140,CPT,I&D HEMATOMA SEROMA/FLUID COLLECTION,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
10160,CPT,PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
10180,CPT,INCISION & DRAINAGE COMPLEX PO WOUND INFECTION,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11000,CPT,DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11001,CPT,DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF,,30,,,$436.25,$0.00,1,0,1,20161001,
11010,CPT,DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11011,CPT,DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
11012,CPT,DBRDMT FX&/DISLC SUBQ T/M/F BONE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11042,CPT,DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11043,CPT,DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11044,CPT,DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11045,CPT,DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM,,30,,,"$1,090.62",$0.00,1,0,1,20161001,
11046,CPT,DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM,,30,,,"$1,744.99",$0.00,1,0,1,20161001,
11047,CPT,DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM,,30,,,"$2,617.49",$0.00,1,0,1,20161001,
11055,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1,,30,,,$398.75,$0.00,1,0,1,20161001,
11056,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4,,30,,,$398.75,$0.00,1,0,1,20161001,
11057,CPT,PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11100,CPT,BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11101,CPT,BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN,,30,,,$305.37,$0.00,1,0,1,20161001,
11200,CPT,REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15,,30,,,$398.75,$0.00,1,0,1,20161001,
11201,CPT,REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10,,30,,,"$1,013.79",$0.00,1,0,1,20161001,
11300,CPT,SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
11301,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
11302,CPT,SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
11303,CPT,SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
11305,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
11306,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
11307,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11308,CPT,SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
11310,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11311,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11312,CPT,SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11313,CPT,SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11400,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11401,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11402,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11403,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11404,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11406,CPT,EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11420,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11421,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11422,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11423,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11424,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11426,CPT,EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11440,CPT,EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11441,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11442,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11443,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11444,CPT,EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11446,CPT,EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11450,CPT,EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11451,CPT,EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11462,CPT,EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11463,CPT,EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11470,CPT,EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11471,CPT,EXCISION H/P/P/U COMPLEX REPAIR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11600,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11601,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11602,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11603,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/<,,30,,,"$5,733.20",$0.00,1,0,1,20161001,
11604,CPT,EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11606,CPT,EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11620,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11621,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11622,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11623,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11624,CPT,EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11626,CPT,EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11640,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11641,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11642,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11643,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11644,CPT,EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
11646,CPT,EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11719,CPT,TRIMMING NONDYSTROPHIC NAILS ANY NUMBER,,30,,,$306.21,$0.00,1,0,1,20161001,
11720,CPT,DEBRIDEMENT NAIL ANY METHOD 1-5,,30,,,$425.53,$0.00,1,0,1,20161001,
11721,CPT,DEBRIDEMENT NAIL ANY METHOD 6/>,,30,,,$306.21,$0.00,1,0,1,20161001,
11730,CPT,AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1,,30,,,$398.75,$0.00,1,0,1,20161001,
11732,CPT,AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL,,30,,,$398.75,$0.00,1,0,1,20161001,
11740,CPT,EVACUATION SUBUNGUAL HEMATOMA,,30,,,$306.21,$0.00,1,0,1,20161001,
11750,CPT,EXCISION NAIL MATRIX PERMANENT REMOVAL,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
11752,CPT,EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11755,CPT,BIOPSY NAIL UNIT SEPARATE PROCEDURE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
11760,CPT,REPAIR NAIL BED,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11762,CPT,RECONSTRUCTION NAIL BED W/GRAFT,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
11765,CPT,WEDGE EXCISION SKIN NAIL FOLD,,30,,,$398.75,$0.00,1,0,1,20161001,
11770,CPT,EXCISION PILONIDAL CYST/SINUS SIMPLE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11771,CPT,EXCISION PILONIDAL CYST/SINUS EXTENSIVE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11772,CPT,EXCISION PILONIDAL CYST/SINUS COMPLICATED,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11900,CPT,INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS,,30,,,$398.75,$0.00,1,0,1,20161001,
11901,CPT,INJECTION INTRALESIONAL >7 LESIONS,,30,,,$398.75,$0.00,1,0,1,20161001,
11920,CPT,TATTOOING INCL MICROPIGMENTATION 6.0 CM/<,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11921,CPT,TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11922,CPT,TATTOOING INCL MICROPIGMENTATION EA 20.0 CM,,30,,,"$2,066.99",$0.00,1,0,1,20161001,
11950,CPT,SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11951,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11952,CPT,SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
11954,CPT,SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
11960,CPT,INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
11970,CPT,REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
11971,CPT,REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
11976,CPT,REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
11980,CPT,SUBCUTANEOUS HORMONE PELLET IMPLANTATION,,30,,,$425.53,$0.00,1,0,1,20161001,
11981,CPT,INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,30,,,$425.53,$0.00,1,0,1,20161001,
11982,CPT,REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,,30,,,$425.53,$0.00,1,0,1,20161001,
11983,CPT,RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,,30,,,$425.53,$0.00,1,0,1,20161001,
12001,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
12002,CPT,SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12004,CPT,SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12005,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12006,CPT,SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12007,CPT,SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12011,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
12013,CPT,SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12014,CPT,SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12015,CPT,SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12016,CPT,SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12017,CPT,SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12018,CPT,SIMPLE REPAIR F/E/E/N/L/M >30.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12020,CPT,TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
12021,CPT,TX SUPERFICIAL WOUND DEHISCENCE W/PACKING,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
12031,CPT,REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12032,CPT,REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12034,CPT,REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12035,CPT,REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12036,CPT,REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
12037,CPT,REPAIR INTERMEDIATE S/A/T/E >30.0 CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
12041,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
12042,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12044,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12045,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12046,CPT,RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12047,CPT,REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
12051,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12052,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12053,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12054,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12055,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
12056,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
12057,CPT,REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
13100,CPT,REPAIR COMPLEX TRUNK 1.1-2.5 CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
13101,CPT,REPAIR COMPLEX TRUNK 2.6-7.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13102,CPT,REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<,,30,,,"$1,702.90",$0.00,1,0,1,20161001,
13120,CPT,REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13121,CPT,REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13122,CPT,REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<,,30,,,"$1,702.90",$0.00,1,0,1,20161001,
13131,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13132,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13133,CPT,REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<,,30,,,"$2,231.39",$0.00,1,0,1,20161001,
13151,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13152,CPT,REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
13153,CPT,REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/<,,30,,,"$2,231.39",$0.00,1,0,1,20161001,
13160,CPT,SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
14000,CPT,ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14001,CPT,ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14020,CPT,ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14021,CPT,ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14040,CPT,ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14041,CPT,ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14060,CPT,ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14061,CPT,ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
14301,CPT,ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
14302,CPT,ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/<,,30,,,"$7,046.49",$0.00,1,0,1,20161001,
14350,CPT,FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15002,CPT,PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15003,CPT,PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT,,30,,,"$4,227.89",$0.00,1,0,1,20161001,
15004,CPT,PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
15005,CPT,PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT,,30,,,"$4,227.89",$0.00,1,0,1,20161001,
15040,CPT,HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
15050,CPT,PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
15100,CPT,SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15101,CPT,SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,30,,,"$4,932.54",$0.00,1,0,1,20161001,
15110,CPT,EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15111,CPT,EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD,,30,,,"$5,872.07",$0.00,1,0,1,20161001,
15115,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15116,CPT,EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM,,30,,,"$6,106.95",$0.00,1,0,1,20161001,
15120,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15121,CPT,SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 %,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15130,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15131,CPT,DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA,,30,,,"$4,815.10",$0.00,1,0,1,20161001,
15135,CPT,DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15136,CPT,DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA,,30,,,"$6,576.72",$0.00,1,0,1,20161001,
15150,CPT,CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15151,CPT,CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM,,30,,,"$5,284.86",$0.00,1,0,1,20161001,
15152,CPT,CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15155,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15156,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15157,CPT,CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA,,30,,,"$5,872.07",$0.00,1,0,1,20161001,
15200,CPT,FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15201,CPT,FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM/<,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15220,CPT,FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15221,CPT,FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15240,CPT,FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15241,CPT,FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15260,CPT,FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15261,CPT,FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/<,,30,,,"$5,637.19",$0.00,1,0,1,20161001,
15271,CPT,APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15272,CPT,APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC,,30,,,$197.30,$0.00,1,0,1,20161001,
15273,CPT,APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15274,CPT,APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM,,30,,,$503.82,$0.00,1,0,1,20161001,
15275,CPT,SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15276,CPT,SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM,,30,,,$258.37,$0.00,1,0,1,20161001,
15277,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15278,CPT,SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM,,30,,,$604.82,$0.00,1,0,1,20161001,
15570,CPT,FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15572,CPT,FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15574,CPT,FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15576,CPT,FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15600,CPT,DELAY FLAP/SECTIONING FLAP TRUNK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15610,CPT,DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15620,CPT,DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15630,CPT,DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15650,CPT,TRANSFER ANY PEDICLE FLAP ANY LOCATION,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15731,CPT,FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15732,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15734,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15736,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15738,CPT,MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15740,CPT,FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15750,CPT,FLAP NEUROVASCULAR PEDICLE,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15760,CPT,GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15770,CPT,GRAFT DERMA-FAT-FASCIA,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15775,CPT,PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
15776,CPT,PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
15777,CPT,IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT,,30,,,"$3,125.12",$0.00,1,0,1,20161001,
15780,CPT,DERMABRASION TOTAL FACE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15781,CPT,DERMABRASION SEGMENTAL FACE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
15782,CPT,DERMABRASION REGIONAL OTHER THAN FACE,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
15783,CPT,DERMABRASION SUPERFICIAL ANY SITE,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
15786,CPT,ABRASION 1 LESION,,30,,,$398.75,$0.00,1,0,1,20161001,
15787,CPT,ABRASION EACH ADDITIONAL 4 LESIONS OR LESS,,30,,,$294.31,$0.00,1,0,1,20161001,
15788,CPT,CHEMICAL PEEL FACIAL EPIDERMAL,,30,,,$398.75,$0.00,1,0,1,20161001,
15789,CPT,CHEMICAL PEEL FACIAL DERMAL,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
15792,CPT,CHEMICAL PEEL NONFACIAL EPIDERMAL,,30,,,$398.75,$0.00,1,0,1,20161001,
15793,CPT,CHEMICAL PEEL NONFACIAL DERMAL,,30,,,$398.75,$0.00,1,0,1,20161001,
15819,CPT,CERVICOPLASTY,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15820,CPT,BLEPHAROPLASTY LOWER EYELID,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15821,CPT,BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15822,CPT,BLEPHAROPLASTY UPPER EYELID,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15823,CPT,BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15824,CPT,RHYTIDECTOMY FOREHEAD,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15825,CPT,RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15826,CPT,RHYTIDECTOMY GLABELLAR FROWN LINES,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15828,CPT,RHYTIDECTOMY CHEEK CHIN & NECK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15829,CPT,RHYTIDECTOMY SMAS FLAP,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15830,CPT,EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
15832,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15833,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15834,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15835,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15836,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15837,CPT,EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15838,CPT,EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15839,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15840,CPT,GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15841,CPT,GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15842,CPT,GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15845,CPT,GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15847,CPT,EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN,,30,,,"$5,486.10",$0.00,1,0,1,20161001,
15850,CPT,REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15851,CPT,REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
15852,CPT,DRESSING CHANGE UNDER ANESTHESIA,,30,,,$425.53,$0.00,1,0,1,20161001,
15860,CPT,IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT,,30,,,$425.53,$0.00,1,0,1,20161001,
15876,CPT,SUCTION ASSISTED LIPECTOMY HEAD & NECK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15877,CPT,SUCTION ASSISTED LIPECTOMY TRUNK,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15878,CPT,SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15879,CPT,SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY,,30,,,"$11,856.65",$0.00,1,0,1,20161001,
15920,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15922,CPT,EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15931,CPT,EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15933,CPT,EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15934,CPT,EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15935,CPT,EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15936,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15937,CPT,EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15940,CPT,EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15941,CPT,EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15944,CPT,EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15945,CPT,EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15946,CPT,EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN,,30,,,"$11,856.65",$0.00,1,0,1,20161001,
15950,CPT,EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15951,CPT,EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
15952,CPT,EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15953,CPT,EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
15956,CPT,EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15958,CPT,EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
15999,CPT,UNLISTED PROCEDURE EXCISION PRESSURE ULCER,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
16000,CPT,INITIAL TX 1ST DEGREE BURN LOCAL TX,,30,,,$398.75,$0.00,1,0,1,20161001,
16020,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL,,30,,,$398.75,$0.00,1,0,1,20161001,
16025,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
16030,CPT,DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
16035,CPT,ESCHAROTOMY FIRST INCISION,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17000,CPT,DESTRUCTION PREMALIGNANT LESION 1ST,,30,,,$398.75,$0.00,1,0,1,20161001,
17003,CPT,DESTRUCTION PREMALIGNANT LESION 2-14 EA,,30,,,$132.20,$0.00,1,0,1,20161001,
17004,CPT,DESTRUCTION PREMALIGNANT LESION 15/>,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17106,CPT,DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17107,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17108,CPT,DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM,,30,,,"$6,908.09",$0.00,1,0,1,20161001,
17110,CPT,DESTRUCTION BENIGN LESIONS UP TO 14,,30,,,$398.75,$0.00,1,0,1,20161001,
17111,CPT,DESTRUCTION BENIGN LESIONS 15/>,,30,,,$398.75,$0.00,1,0,1,20161001,
17250,CPT,CHEMICAL CAUTERIZATION GRANULATION TISSUE,,30,,,$398.75,$0.00,1,0,1,20161001,
17260,CPT,DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
17261,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM,,30,,,$398.75,$0.00,1,0,1,20161001,
17262,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
17263,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
17264,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17266,CPT,DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17270,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/>,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17271,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17272,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM,,30,,,$398.75,$0.00,1,0,1,20161001,
17273,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17274,CPT,DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17276,CPT,DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17280,CPT,DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<,,30,,,$398.75,$0.00,1,0,1,20161001,
17281,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17282,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17283,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17284,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17286,CPT,DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
17311,CPT,MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17312,CPT,MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE,,30,,,"$1,335.51",$0.00,1,0,1,20161001,
17313,CPT,MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17314,CPT,MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE,,30,,,"$2,391.97",$0.00,1,0,1,20161001,
17315,CPT,MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE,,30,,,"$1,129.96",$0.00,1,0,1,20161001,
17340,CPT,CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE,,30,,,$156.54,$0.00,1,0,1,20161001,
17360,CPT,CHEMICAL EXFOLIATION ACNE,,30,,,$398.75,$0.00,1,0,1,20161001,
17380,CPT,ELECTROLYSIS EPILATION EACH 30 MINUTES,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
17999,CPT,UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE,,30,,,$398.75,$0.00,1,0,1,20161001,
19000,CPT,PUNCTURE ASPIRATION CYST BREAST,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
19001,CPT,PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST,,30,,,$739.90,$0.00,1,0,1,20161001,
19020,CPT,MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
19030,CPT,INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM,,30,,,$807.71,$0.00,1,0,1,20161001,
19081,CPT,BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
19083,CPT,BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
19085,CPT,BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
19100,CPT,BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
19101,CPT,BIOPSY BREAST OPEN INCISIONAL,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19105,CPT,ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19110,CPT,NIPPLE EXPLORATION,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19112,CPT,EXCISION LACTIFEROUS DUCT FISTULA,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19120,CPT,EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19125,CPT,EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19126,CPT,EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL,,30,,,"$4,307.81",$0.00,1,0,1,20161001,
19260,CPT,EXCISION CHEST WALL TUMOR INCLUDING RIBS,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
19281,CPT,PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
19283,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
19285,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
19287,CPT,PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
19296,CPT,PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
19297,CPT,PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST,,30,,,"$5,384.76",$0.00,1,0,1,20161001,
19298,CPT,PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
19300,CPT,MASTECTOMY GYNECOMASTIA,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19301,CPT,MASTECTOMY PARTIAL,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19302,CPT,MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19303,CPT,MASTECTOMY SIMPLE COMPLETE,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19304,CPT,MASTECTOMY SUBCUTANEOUS,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19307,CPT,MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19316,CPT,MASTOPEXY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19318,CPT,REDUCTION MAMMAPLASTY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19324,CPT,MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19325,CPT,MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
19328,CPT,REMOVAL INTACT MAMMARY IMPLANT,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19330,CPT,REMOVAL MAMMARY IMPLANT MATERIAL,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19340,CPT,IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19342,CPT,DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
19350,CPT,NIPPLE/AREOLA RECONSTRUCTION,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19355,CPT,CORRECTION INVERTED NIPPLES,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19357,CPT,BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
19366,CPT,BREAST RECONSTRUCTION OTHER TECHNIQUE,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19370,CPT,OPEN PERIPROSTHETIC CAPSULOTOMY BREAST,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19371,CPT,PERIPROSTHETIC CAPSULECTOMY BREAST,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19380,CPT,REVISION RECONSTRUCTED BREAST,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
19396,CPT,PREPARATION MOULAGE CUSTOM BREAST IMPLANT,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
19499,CPT,UNLISTED PROCEDURE BREAST,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
20005,CPT,I&D SOFT TISSUE ABSCESS SUBFASC,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20100,CPT,EXPLORATION PENETRATING WOUND SPX NECK,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
20101,CPT,EXPLORATION PENETRATING WOUND SPX CHEST,,30,,,"$11,856.65",$0.00,1,0,1,20161001,
20102,CPT,EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
20103,CPT,EXPLORATION PENETRATING WOUND SPX EXTREMITY,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
20150,CPT,EXCISION EPIPHYSEAL BAR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20200,CPT,BIOPSY MUSCLE SUPERFICIAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20205,CPT,BIOPSY MUSCLE DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20206,CPT,BIOPSY MUSCLE PERCUTANEOUS NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
20220,CPT,BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
20225,CPT,BIOPSY BONE TROCAR/NEEDLE DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20240,CPT,BIOPSY BONE OPEN SUPERFICIAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20245,CPT,BIOPSY BONE OPEN DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20250,CPT,BIOPSY VERTEBRAL BODY OPEN THORACIC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20251,CPT,BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20500,CPT,INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
20501,CPT,INJECTION SINUS TRACT DIAGNOSTIC,,30,,,"$1,256.87",$0.00,1,0,1,20161001,
20520,CPT,REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
20525,CPT,RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20526,CPT,INJECTION THERAPEUTIC CARPAL TUNNEL,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20527,CPT,INJECTION ENZYME PALMAR FASCIAL CORD,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20550,CPT,INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20551,CPT,INJECTION SINGLE TENDON ORIGIN/INSERTION,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20552,CPT,INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20553,CPT,INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20555,CPT,PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
20600,CPT,ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20604,CPT,ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20605,CPT,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20606,CPT,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20610,CPT,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20611,CPT,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20612,CPT,ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
20615,CPT,ASPIRATION & INJECTION TREATMENT BONE CYST,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
20650,CPT,INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20660,CPT,APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
20662,CPT,APPLICATION HALO PELVIC INCLUDING REMOVAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
20663,CPT,APPLICATION HALO FEMORAL INCLUDING REMOVAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20665,CPT,REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL,,30,,,$425.53,$0.00,1,0,1,20161001,
20670,CPT,REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20680,CPT,REMOVAL IMPLANT DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
20690,CPT,APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
20692,CPT,APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
20693,CPT,ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20694,CPT,REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
20696,CPT,XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
20697,CPT,XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
20822,CPT,RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20900,CPT,BONE GRAFT ANY DONOR AREA MINOR/SMALL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20902,CPT,BONE GRAFT ANY DONOR AREA MAJOR/LARGE,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
20910,CPT,CARTILAGE GRAFT COSTOCHONDRAL,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
20912,CPT,CARTILAGE GRAFT NASAL SEPTUM,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
20920,CPT,FASCIA LATA GRAFT BY STRIPPER,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
20922,CPT,FASCIA LATA GRAFT INCISION & AREA EXPOSURE,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
20924,CPT,TENDON GRAFT FROM A DISTANCE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20926,CPT,TISSUE GRAFTS OTHER,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
20930,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED,,30,,,"$5,693.70",$0.00,1,0,1,20161001,
20931,CPT,ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL,,30,,,"$5,618.20",$0.00,1,0,1,20161001,
20936,CPT,AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION,,30,,,"$5,128.43",$0.00,1,0,1,20161001,
20937,CPT,AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION,,30,,,"$4,579.53",$0.00,1,0,1,20161001,
20938,CPT,AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC,,30,,,"$6,792.45",$0.00,1,0,1,20161001,
20950,CPT,MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME,,30,,,"$3,025.36",$0.00,1,0,1,20161001,
20972,CPT,FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
20973,CPT,FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
20975,CPT,ELECTRICAL STIMULATION BONE HEALING INVASIVE,,30,,,"$8,007.63",$0.00,1,0,1,20161001,
20979,CPT,LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE,,30,,,$156.54,$0.00,1,0,1,20161001,
20982,CPT,ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
20983,CPT,ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
20985,CPT,CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS,,30,,,"$4,104.48",$0.00,1,0,1,20161001,
20999,CPT,UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21010,CPT,ARTHROTOMY TEMPOROMANDIBULAR JOINT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21011,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
21012,CPT,EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21013,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
21014,CPT,EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21015,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21016,CPT,RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21025,CPT,EXCISION BONE MANDIBLE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21026,CPT,EXCISION FACIAL BONE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21029,CPT,REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21030,CPT,EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21031,CPT,EXCISION TORUS MANDIBULARIS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21032,CPT,EXCISION MAXILLARY TORUS PALATINUS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21034,CPT,EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21040,CPT,EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21044,CPT,EXCISION MALIGNANT TUMOR MANDIBLE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21046,CPT,EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21047,CPT,EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21048,CPT,EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21049,CPT,EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21050,CPT,CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21060,CPT,MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21070,CPT,CORONOIDECTOMY SEPARATE PROCEDURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21073,CPT,MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21076,CPT,IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21077,CPT,IMPRESSION & PREPARATION ORBITAL PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21079,CPT,IMPRESSION & PREPARATION INTERIM OBTURATOR PROST,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21080,CPT,IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21081,CPT,IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21082,CPT,IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21083,CPT,IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21084,CPT,IMPRESSION & PREPARATION SPEECH AID PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21085,CPT,IMPRESSION & PREPARATION ORAL SURGICAL SPLINT,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21086,CPT,IMPRESSION & PREPARATION AURICULAR PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21087,CPT,IMPRESSION & PREPARATION NASAL PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21088,CPT,IMPRESSION & PREPARATION FACIAL PROSTHESIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21089,CPT,UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE,,30,,,$853.29,$0.00,1,0,1,20161001,
21100,CPT,APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21110,CPT,APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21116,CPT,INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY,,30,,,"$1,098.85",$0.00,1,0,1,20161001,
21120,CPT,GENIOPLASTY AUGMENTATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21121,CPT,GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21122,CPT,GENIOPLASTY 2/> SLIDING OSTEOTOMIES,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21123,CPT,GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21125,CPT,AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21127,CPT,AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21137,CPT,REDUCTION FOREHEAD CONTOURING ONLY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21138,CPT,RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21139,CPT,RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21150,CPT,RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21172,CPT,RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21175,CPT,RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21181,CPT,RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21193,CPT,RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21195,CPT,RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21198,CPT,OSTEOTOMY MANDIBLE SEGMENTAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21199,CPT,OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21206,CPT,OSTEOTOMY MAXILLA SEGMENTAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21208,CPT,OSTEOPLASTY FACIAL BONES AUGMENTATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21209,CPT,OSTEOPLASTY FACIAL BONES REDUCTION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21210,CPT,GRAFT BONE NASAL/MAXILLARY/MALAR AREAS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21215,CPT,GRAFT BONE MANDIBLE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21230,CPT,GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21235,CPT,GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21240,CPT,ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21242,CPT,ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21243,CPT,ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
21244,CPT,RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21245,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21246,CPT,RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21248,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21249,CPT,RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21256,CPT,RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21260,CPT,PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21261,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21263,CPT,PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21267,CPT,ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21270,CPT,MALAR AUGMENTATION PROSTHETIC MATERIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21275,CPT,SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21280,CPT,MEDIAL CANTHOPEXY SEPARATE PROCEDURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21282,CPT,LATERAL CANTHOPEXY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21295,CPT,REDUCTION MASSETER MUSCLE & BONE EXTRAORAL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21296,CPT,REDUCTION MASSETER MUSCLE & BONE INTRAORAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21299,CPT,UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE,,30,,,$853.29,$0.00,1,0,1,20161001,
21310,CPT,CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION,,30,,,$853.29,$0.00,1,0,1,20161001,
21315,CPT,CLOSED TX NASAL FRACTURE W/O STABILIZATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21320,CPT,CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21325,CPT,OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21330,CPT,OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21335,CPT,OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21336,CPT,OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
21337,CPT,CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21338,CPT,OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21339,CPT,OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21340,CPT,PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21345,CPT,CLOSED TX NASOMAXILLARY COMPLEX FRACTURE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21346,CPT,OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21355,CPT,PERCUTANEOUS TX MALAR AREA FRACTURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21356,CPT,OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21360,CPT,OPEN TX DEPRESSED MALAR FRACTURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21365,CPT,OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21385,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21386,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21387,CPT,OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21390,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21395,CPT,OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21400,CPT,CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21401,CPT,CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21406,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21407,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21408,CPT,OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21421,CPT,CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21440,CPT,CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21445,CPT,OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21450,CPT,CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
21451,CPT,CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21452,CPT,PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21453,CPT,CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21454,CPT,OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21461,CPT,OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21462,CPT,OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21465,CPT,OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21470,CPT,OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21480,CPT,CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ,,30,,,$853.29,$0.00,1,0,1,20161001,
21485,CPT,CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21490,CPT,OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
21495,CPT,OPEN TREATMENT HYOID FRACTURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21497,CPT,INTERDENTAL WIRING OTHER THAN FRACTURE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
21499,CPT,UNLISTED MUSCULOSKELETAL PROCEDURE HEAD,,30,,,$853.29,$0.00,1,0,1,20161001,
21501,CPT,I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21502,CPT,I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21550,CPT,BIOPSY SOFT TISSUE NECK/THORAX,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
21552,CPT,EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21554,CPT,EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21555,CPT,EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21556,CPT,EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21557,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21558,CPT,RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21600,CPT,EXCISION RIB PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
21610,CPT,COSTOTRANSVERSECTOMY SEPARATE PROCEDURE,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
21685,CPT,HYOID MYOTOMY & SUSPENSION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
21700,CPT,DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21720,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21725,CPT,DIVISION STERNOCLEIDOMASTOID OPEN W/CAST,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
21742,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
21743,CPT,REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
21811,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21812,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21813,CPT,OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
21820,CPT,CLOSED TREATMENT STERNUM FRACTURE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
21899,CPT,UNLISTED PROCEDURE NECK/THORAX,,30,,,$853.29,$0.00,1,0,1,20161001,
21920,CPT,BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
21925,CPT,BIOPSY SOFT TISSUE BACK/FLANK DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21930,CPT,EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
21931,CPT,EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21932,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21933,CPT,EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21935,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
21936,CPT,RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22100,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
22101,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
22102,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
22103,CPT,PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA,,30,,,"$30,351.11",$0.00,1,0,1,20161001,
22305,CPT,CLOSED TX VERTEBRAL PROCESS FRACTURE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
22310,CPT,CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
22315,CPT,CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
22505,CPT,MANIPULATION SPINE REQUIRING ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
22510,CPT,PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
22511,CPT,PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
22513,CPT,PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
22514,CPT,PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
22526,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL,,30,,,"$2,583.02",$0.00,1,0,1,20161001,
22527,CPT,PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL,,30,,,"$2,583.02",$0.00,1,0,1,20161001,
22551,CPT,ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
22552,CPT,ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC,,30,,,"$6,408.82",$0.00,1,0,1,20161001,
22554,CPT,ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
22612,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
22614,CPT,ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL,,30,,,"$30,351.11",$0.00,1,0,1,20161001,
22851,CPT,APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE,,30,,,"$19,314.34",$0.00,1,0,1,20161001,
22856,CPT,TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
22899,CPT,UNLISTED PROCEDURE SPINE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
22900,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22901,CPT,EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22902,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22903,CPT,EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22904,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22905,CPT,RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
22999,CPT,UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
23000,CPT,REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23020,CPT,CAPSULAR CONTRACTURE RELEASE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23030,CPT,I&D SHOULDER DEEP ABSCESS/HEMATOMA,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23031,CPT,I&D SHOULDER INFECTED BURSA,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23035,CPT,INCISION BONE CORTEX SHOULDER AREA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
23040,CPT,ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23044,CPT,ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23065,CPT,BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
23066,CPT,BIOPSY SOFT TISSUE SHOULDER DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23071,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23073,CPT,EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23075,CPT,EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23076,CPT,EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23077,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23078,CPT,RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23100,CPT,ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
23101,CPT,ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23105,CPT,ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23106,CPT,ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23107,CPT,ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23120,CPT,CLAVICULECTOMY PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23125,CPT,CLAVICULECTOMY TOTAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23130,CPT,PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23140,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
23145,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23146,CPT,EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23150,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23155,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23156,CPT,EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23170,CPT,SEQUESTRECTOMY CLAVICLE,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
23172,CPT,SEQUESTRECTOMY SCAPULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23174,CPT,SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23180,CPT,PARTIAL EXCISION BONE CLAVICLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23182,CPT,PARTIAL EXCISION BONE SCAPULA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
23184,CPT,PARTIAL EXCISION BONE PROXIMAL HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23190,CPT,OSTECTOMY SCAPULA PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23195,CPT,RESECTION HUMERAL HEAD,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23330,CPT,REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
23333,CPT,REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23334,CPT,PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23350,CPT,INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG,,30,,,$838.09,$0.00,1,0,1,20161001,
23395,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
23397,CPT,MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23400,CPT,SCAPULOPEXY,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23405,CPT,TENOTOMY SHOULDER AREA 1 TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23406,CPT,TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23410,CPT,OPEN REPAIR OF ROTATOR CUFF ACUTE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23412,CPT,OPEN REPAIR OF ROTATOR CUFF CHRONIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23415,CPT,CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23420,CPT,RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23430,CPT,TENODESIS LONG TENDON BICEPS,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23440,CPT,RESECTION/TRANSPLANTATION LONG TENDON BICEPS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23450,CPT,CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
23455,CPT,CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23460,CPT,CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
23462,CPT,CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23465,CPT,CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23466,CPT,CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23470,CPT,ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
23473,CPT,REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23480,CPT,OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23485,CPT,OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23490,CPT,PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
23491,CPT,PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23500,CPT,CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23505,CPT,CLSD TX CLAVICULAR FRACTURE W/MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
23515,CPT,OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23520,CPT,CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
23525,CPT,CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23530,CPT,OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23532,CPT,OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
23540,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23545,CPT,CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23550,CPT,OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23552,CPT,OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23570,CPT,CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23575,CPT,CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
23585,CPT,OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
23600,CPT,CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23605,CPT,CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
23615,CPT,OPEN TREATMENT PROXIMAL HUMERAL FRACTURE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23616,CPT,OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
23620,CPT,CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
23625,CPT,CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
23630,CPT,OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23650,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23655,CPT,CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
23660,CPT,OPEN TX ACUTE SHOULDER DISLOCATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
23665,CPT,CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
23670,CPT,OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
23675,CPT,CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
23680,CPT,OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23700,CPT,MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
23800,CPT,ARTHRODESIS GLENOHUMERAL JOINT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23802,CPT,ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
23921,CPT,DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
23929,CPT,UNLISTED PROCEDURE SHOULDER,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
23930,CPT,I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
23931,CPT,INCISION&DRAINAGE UPPER ARM/ELBOW BURSA,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
23935,CPT,INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
24000,CPT,ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24006,CPT,ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24065,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24066,CPT,BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24071,CPT,EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24073,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24075,CPT,EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24076,CPT,EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24077,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24079,CPT,RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24100,CPT,ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
24101,CPT,ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24102,CPT,ARTHROTOMY ELBOW W/SYNOVECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24105,CPT,EXCISION OLECRANON BURSA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
24110,CPT,EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24115,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24116,CPT,EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24120,CPT,EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
24125,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24126,CPT,EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24130,CPT,EXCISION RADIAL HEAD,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24134,CPT,SEQUESTRECTOMY SHAFT/DISTAL HUMERUS,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
24136,CPT,SEQUESTRECTOMY RADIAL HEAD OR NECK,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24138,CPT,SEQUESTRECTOMY OLECRANON PROCESS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24140,CPT,PARTIAL EXCISION BONE HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24145,CPT,PARTIAL EXCISION BONE RADIAL HEAD/NECK,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24147,CPT,PARTIAL EXCISION BONE OLECRANON PROCESS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24149,CPT,RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24150,CPT,RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24152,CPT,RADICAL RESECTION TUMOR RADIAL HEAD/NECK,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24155,CPT,RESECTION ELBOW JOINT ARTHRECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24160,CPT,PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24164,CPT,PROSTHESIS REMOVAL RADIAL HEAD,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24200,CPT,RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
24201,CPT,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
24220,CPT,INJECTION ELBOW ARTHROGRAPHY,,30,,,$879.99,$0.00,1,0,1,20161001,
24300,CPT,MANIPULATION ELBOW UNDER ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
24301,CPT,MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24305,CPT,TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24310,CPT,TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24320,CPT,TENOPLASTY ELBOW TO SHOULDER SINGLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24330,CPT,FLEXOR-PLASTY ELBOW,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24331,CPT,FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24332,CPT,TENOLYSIS TRICEPS,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
24340,CPT,TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
24341,CPT,REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24342,CPT,RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24343,CPT,REPAIR LATERAL COLLATERAL LIGAMENT ELBOW,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24344,CPT,RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24345,CPT,REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24346,CPT,RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24357,CPT,TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
24358,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24359,CPT,TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24360,CPT,ARTHROPLASTY ELBOW W/MEMBRANE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24361,CPT,ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24362,CPT,ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24363,CPT,ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24365,CPT,ARTHROPLASTY RADIAL HEAD,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24366,CPT,ARTHROPLASTY RADIAL HEAD W/IMPLANT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24370,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24371,CPT,REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24400,CPT,OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
24410,CPT,MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24420,CPT,OSTEOPLASTY HUMERUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24430,CPT,REPAIR NON/MALUNION HUMERUS W/O GRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24435,CPT,REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24470,CPT,HEMIEPIPHYSEAL ARREST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24495,CPT,DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24498,CPT,PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24500,CPT,CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
24505,CPT,CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24515,CPT,OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24516,CPT,TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24530,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
24535,CPT,CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24538,CPT,PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24545,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24546,CPT,OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24560,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
24565,CPT,CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24566,CPT,PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24575,CPT,OPEN TX HUMERAL EPICONDYLAR FRACTURE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24576,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
24577,CPT,CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24579,CPT,OPEN TREATMENT HUMERAL CONDYLAR FRACTURE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24582,CPT,PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
24586,CPT,OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24587,CPT,OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
24600,CPT,TREATMENT CLOSED ELBOW DISLOCATION W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
24605,CPT,TREATMENT CLOSED ELBOW DISLOCATION REQ ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
24615,CPT,OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24620,CPT,CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
24635,CPT,OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
24640,CPT,CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
24650,CPT,CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
24655,CPT,CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24665,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24666,CPT,OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24670,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
24675,CPT,CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
24685,CPT,OPEN TREATMENT ULNAR FRACTURE PROXIMAL END,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24800,CPT,ARTHRODESIS ELBOW JOINT LOCAL,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
24802,CPT,ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
24925,CPT,AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
24935,CPT,STUMP ELONGATION UPPER EXTREMITY,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
24999,CPT,UNLISTED PROCEDURE HUMERUS/ELBOW,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25000,CPT,INCISION EXTENSOR TENDON SHEATH WRIST,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25001,CPT,INCISION FLEXOR TENDON SHEATH WRIST,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25020,CPT,DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25023,CPT,DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25024,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25025,CPT,DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25028,CPT,I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25031,CPT,INCISION & DRAINAGE FOREARM&/WRIST BURSA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25035,CPT,INCISION DEEP BONE CORTEX FOREARM&/WRIST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25040,CPT,ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25065,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
25066,CPT,BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25071,CPT,EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25073,CPT,EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25075,CPT,EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25076,CPT,EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25077,CPT,RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
25078,CPT,RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
25085,CPT,CAPSULOTOMY WRIST,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
25100,CPT,ARTHROTOMY WRIST JOINT WITH BIOPSY,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
25101,CPT,ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25105,CPT,ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25107,CPT,ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25109,CPT,EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25110,CPT,EXCISION LESION TENDON SHEATH FOREARM&/WRIST,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25111,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25112,CPT,EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25115,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25116,CPT,RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25118,CPT,SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25119,CPT,SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25120,CPT,EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25125,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25126,CPT,EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25130,CPT,EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25135,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25136,CPT,EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25145,CPT,SEQUESTRECTOMY FOREARM &/WRIST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25150,CPT,PARTIAL EXCISION BONE ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25151,CPT,PARTIAL EXCISION BONE RADIUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25170,CPT,RADICAL RESECTION TUMOR RADIUS OR ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25210,CPT,CARPECTOMY 1 BONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25215,CPT,CARPECTOMY ALL BONES PROXIMAL ROW,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25230,CPT,RADICAL STYLOIDECTOMY SEPARATE PROCEDURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25240,CPT,EXCISION DISTAL ULNA PARTIAL/COMPLETE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25246,CPT,INJECTION WRIST ARTHROGRAPHY,,30,,,$998.31,$0.00,1,0,1,20161001,
25248,CPT,EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25250,CPT,REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25251,CPT,REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25259,CPT,MANIPULATION WRIST UNDER ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
25260,CPT,RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25263,CPT,RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25265,CPT,RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25270,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25272,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25274,CPT,RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25275,CPT,RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25280,CPT,LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25290,CPT,TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
25295,CPT,TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25300,CPT,TENODESIS WRIST FLEXORS FINGERS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25301,CPT,TENODESIS WRIST EXTENSORS FINGERS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25310,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25312,CPT,TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25315,CPT,FLEXOR ORIGIN SLIDE FOREARM &/WRIST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25316,CPT,FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
25320,CPT,CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25332,CPT,ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25335,CPT,CENTRALIZATION WRST ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25337,CPT,RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25350,CPT,OSTEOTOMY RADIUS DISTAL THIRD,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25355,CPT,OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25360,CPT,OSTEOTOMY ULNA,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
25365,CPT,OSTEOTOMY RADIUS & ULNA,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25370,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25375,CPT,MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25390,CPT,OSTEOPLASTY RADIUS/ULNA SHORTENING,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25391,CPT,OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
25392,CPT,OSTEOPLASTY RADIUS & ULNA SHORTENING,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25393,CPT,OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25394,CPT,OSTEOPLASTY CARPAL BONE SHORTENING,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25400,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25405,CPT,RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25415,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25420,CPT,RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
25425,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25426,CPT,REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25430,CPT,INSERTION VASCULAR PEDICLE CARPAL BONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25431,CPT,REPAIR NONUNION CARPAL BONE EACH BONE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25440,CPT,RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
25441,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
25442,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
25443,CPT,ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25444,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
25445,CPT,ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25446,CPT,ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
25447,CPT,ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25449,CPT,REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25450,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25455,CPT,EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25490,CPT,PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25491,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25492,CPT,PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25500,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25505,CPT,CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
25515,CPT,OPEN TREATMENT RADIAL SHAFT FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25520,CPT,CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
25525,CPT,OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25526,CPT,OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25530,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25535,CPT,CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25545,CPT,OPEN TREATMENT OF ULNAR SHAFT FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25560,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25565,CPT,CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
25574,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25575,CPT,OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
25600,CPT,CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25605,CPT,CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
25606,CPT,PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
25607,CPT,OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25608,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25609,CPT,OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25622,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25624,CPT,CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
25628,CPT,OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25630,CPT,CLTX CARPAL BONE FX W/O MANJ EACH BONE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
25635,CPT,CLTX CARPAL BONE FX W/MANJ EACH BONE,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
25645,CPT,OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25650,CPT,CLOSED TREATMENT ULNAR STYLOID FRACTURE,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25651,CPT,PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25652,CPT,OPEN TREATMENT ULNAR STYLOID FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25660,CPT,CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25670,CPT,OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25671,CPT,PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25675,CPT,CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25676,CPT,OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
25680,CPT,CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
25685,CPT,OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25690,CPT,CLOSED TX LUNATE DISLOCATION W/MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
25695,CPT,OPEN TREATMENT LUNATE DISLOCATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25800,CPT,ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
25805,CPT,ARTHRODESIS WRIST W/SLIDING GRAFT,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
25810,CPT,ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
25820,CPT,ARTHRODESIS WRIST LIMITED W/O BONE GRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25825,CPT,ARTHRODESIS WRIST LIMITED W/AUTOGRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25830,CPT,ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
25907,CPT,AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25909,CPT,AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
25922,CPT,DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25929,CPT,TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
25931,CPT,TRANSMETACARPAL AMPUTATION RE-AMPUTATION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
25999,CPT,UNLISTED PROCEDURE FOREARM/WRIST,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26010,CPT,DRAINAGE FINGER ABSCESS SIMPLE,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
26011,CPT,DRAINAGE FINGER ABSCESS COMPLICATED,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
26020,CPT,DRAINAGE TENDON SHEATH DIGIT&/PALM EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26025,CPT,DRAINAGE OF PALMAR BURSA SINGLE BURSA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26030,CPT,DRAINAGE OF PALMAR BURSA MULTIPLE BURSA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26034,CPT,INCISION BONE CORTEX HAND/FINGER,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26035,CPT,DECOMPRESSION FINGERS&/HAND INJECTION INJURY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26037,CPT,DECOMPRESSIVE FASCIOTOMY HAND,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26040,CPT,FASCIOTOMY PALMAR PERCUTANEOUS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26045,CPT,FASCIOTOMY PALMAR OPEN PARTIAL,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26055,CPT,TENDON SHEATH INCISION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26060,CPT,TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26070,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26075,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26080,CPT,ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26100,CPT,ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26105,CPT,ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26110,CPT,ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26111,CPT,EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26113,CPT,EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26115,CPT,EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26116,CPT,EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26117,CPT,RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26118,CPT,RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26121,CPT,FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26123,CPT,FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26125,CPT,FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR,,30,,,"$9,583.73",$0.00,1,0,1,20161001,
26130,CPT,SYNOVECTOMY CARPOMETACARPAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26135,CPT,SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26140,CPT,SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26145,CPT,SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26160,CPT,EXC LESION TDN SHTH/JT CAPSL HAND/FNGR,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26170,CPT,EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26180,CPT,EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26185,CPT,SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26200,CPT,EXCISION/CURETTAGE CYST/TUMOR METACARPAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26205,CPT,EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26210,CPT,EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26215,CPT,EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26230,CPT,PARTIAL EXCISION BONE METACARPAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26235,CPT,PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26236,CPT,PARTIAL EXCISION DISTAL PHALANX FINGER,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26250,CPT,RADICAL RESECTION TUMOR METACARPAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26260,CPT,RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26262,CPT,RADICAL RESECTION TUMOR DISTAL PHALANX FINGER,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26320,CPT,REMOVAL IMPLANT FROM FINGER/HAND,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
26340,CPT,MANIPULATION FINGER JOINT UNDER ANES EACH JOINT,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
26341,CPT,MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26350,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26352,CPT,RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26356,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26357,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26358,CPT,RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26370,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26372,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26373,CPT,RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26390,CPT,EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
26392,CPT,RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
26410,CPT,REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26412,CPT,REPAIR EXTENSOR TENDON HAND W/GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26415,CPT,EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26416,CPT,RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26418,CPT,REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26420,CPT,REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26426,CPT,RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26428,CPT,RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26432,CPT,CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26433,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26434,CPT,REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26437,CPT,REALIGNMENT EXTENSOR TENDON HAND EACH TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26440,CPT,TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26442,CPT,TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26445,CPT,TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26449,CPT,TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26450,CPT,TENOTOMY FLEXOR PALM OPEN EACH TENDON,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26455,CPT,TENOTOMY FLEXOR FINGER OPEN EACH TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26460,CPT,TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26471,CPT,TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26474,CPT,TENODESIS DISTAL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26476,CPT,LENGTHENING TENDON EXTENSOR HAND/FINGER EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26477,CPT,SHORTENING TENDON EXTENSOR HAND/FINGER EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26478,CPT,LENGTHENING TENDON FLEXOR HAND/FINGER EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26479,CPT,SHORTENING TENDON FLEXOR HAND/FINGER EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26480,CPT,TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26483,CPT,TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26485,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26489,CPT,TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26490,CPT,OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26492,CPT,OPPONENSPLASTY TDN TR W/GRF EA TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26494,CPT,OPPONENSPLASTY HYPOTHENAR MUSC TR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26496,CPT,OPPONENSPLASTY OTHER METHODS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26497,CPT,TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26498,CPT,TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26499,CPT,CORRECTION CLAW FINGER OTHER METHODS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26500,CPT,RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26502,CPT,RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26508,CPT,RELEASE THENAR MUSCLE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26510,CPT,CROSS INTRINSIC TRANSFER EACH TENDON,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26516,CPT,CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
26517,CPT,CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26518,CPT,CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26520,CPT,CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26525,CPT,CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26530,CPT,ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26531,CPT,ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
26535,CPT,ARTHROPLASTY INTERPHALANGEAL JOINT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26536,CPT,ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
26540,CPT,RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26541,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26542,CPT,RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26545,CPT,RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26546,CPT,RPR NON-UNION MTCRPL/PHALANX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26548,CPT,RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26550,CPT,POLLICIZATION DIGIT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26555,CPT,TR FNGR AXH POS W/O MVASC ANAST,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26560,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26561,CPT,REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26562,CPT,REPAIR SYNDACTYLY EACH SPACE COMPLEX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26565,CPT,OSTEOTOMY METACARPAL EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26567,CPT,OSTEOTOMY PHALANX FINGER EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26568,CPT,OSTEOPLASTY LENGTHENING METACARPAL/PHALANX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26580,CPT,REPAIR CLEFT HAND,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26587,CPT,RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26590,CPT,REPAIR MACRODACTYLIA EACH DIGIT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26591,CPT,REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26593,CPT,RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26596,CPT,EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26600,CPT,CLTX METACARPAL FX W/O MANIPULATION EACH BONE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26605,CPT,CLTX METACARPAL FX W/MANIPULATION EACH BONE,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26607,CPT,CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
26608,CPT,PRQ SKELETAL FIXJ METACARPAL FX EACH BONE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26615,CPT,OPEN TX METACARPAL FRACTURE SINGLE EA BONE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26641,CPT,CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26645,CPT,CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
26650,CPT,PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26665,CPT,OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26670,CPT,CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26675,CPT,CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
26676,CPT,PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26685,CPT,OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26686,CPT,OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26700,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26705,CPT,CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
26706,CPT,PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
26715,CPT,OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26720,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26725,CPT,CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26727,CPT,PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26735,CPT,OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26740,CPT,CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26742,CPT,CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
26746,CPT,OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26750,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26755,CPT,CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
26756,CPT,PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26765,CPT,OPEN TX DISTAL PHALANGEAL FRACTURE EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26770,CPT,CLTX IPHAL JT DISLC W/MANJ W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26775,CPT,CLTX IPHAL JT DISLC W/MANJ REQ ANES,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
26776,CPT,PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26785,CPT,OPEN TX INTERPHALANGEAL JOINT DISLOCATION,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26820,CPT,FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26841,CPT,ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26842,CPT,ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
26843,CPT,ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
26844,CPT,ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
26850,CPT,ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26852,CPT,ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26860,CPT,ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26861,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT,,30,,,"$8,625.36",$0.00,1,0,1,20161001,
26862,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26863,CPT,ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT,,30,,,"$9,583.73",$0.00,1,0,1,20161001,
26910,CPT,AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
26951,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26952,CPT,AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
26989,CPT,UNLISTED PROCEDURE HANDS/FINGERS,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
26990,CPT,I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
26991,CPT,I&D PELVIS/HIP JOINT AREA INFECTED BURSA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27000,CPT,TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27001,CPT,TENOTOMY ADDUCTOR HIP OPEN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27003,CPT,TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27006,CPT,TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27027,CPT,DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27033,CPT,ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27035,CPT,DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27040,CPT,BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
27041,CPT,BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
27043,CPT,EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27045,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27047,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27048,CPT,EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27049,CPT,RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27050,CPT,ARTHROTOMY W/BIOPSY SACROILIAC JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27052,CPT,ARTHROTOMY W/BIOPSY HIP JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27057,CPT,DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27059,CPT,RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27060,CPT,EXCISION ISCHIAL BURSA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27062,CPT,EXCISION TROCHANTERIC BURSA/CALCIFICATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27065,CPT,EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27066,CPT,EXCISION BONE CYST/BENIGN TUMOR DEEP,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27067,CPT,EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27080,CPT,COCCYGECTOMY PRIMARY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27086,CPT,RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27087,CPT,REMOVAL FOREIGN BODY PELVIS/HIP DEEP,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27093,CPT,INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA,,30,,,"$1,256.84",$0.00,1,0,1,20161001,
27095,CPT,INJECTION HIP ARTHROGRAPHY W/ANESTHESIA,,30,,,"$2,356.57",$0.00,1,0,1,20161001,
27096,CPT,INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA,,30,,,"$1,571.05",$0.00,1,0,1,20161001,
27097,CPT,RELEASE/RECESSION HAMSTRING PROXIMAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27098,CPT,TRANSFER ADDUCTOR ISCHIUM,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27100,CPT,TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27105,CPT,TR PARASPI MUSC HIP FASC/TDN XTN GRF,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27110,CPT,TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27111,CPT,TRANSFER ILIOPSOAS FEMORAL NECK,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27179,CPT,OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
27193,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27194,CPT,CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/MANJ ANES,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27200,CPT,CLOSED TREATMENT COCCYGEAL FRACTURE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27202,CPT,OPEN TREATMENT COCCYGEAL FRACTURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27216,CPT,PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS,,30,,,"$18,852.57",$0.00,1,0,1,20161001,
27220,CPT,CLTX ACETABULUM HIP/SOCKT FX W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27230,CPT,CLTX FEM FX PROX END NCK W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27235,CPT,PRQ SKEL FIXJ FEMORAL FX PROX END NECK,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27238,CPT,CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27246,CPT,CLTX GREATER TROCHANTERIC FX W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27250,CPT,CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27252,CPT,CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27256,CPT,TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27257,CPT,TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27265,CPT,CLTX POST HIP ARTHRP DISLC W/O ANES,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27266,CPT,CLTX POST HIP ARTHRP DISLC REQ ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27267,CPT,CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27275,CPT,MANIPULATION HIP JOINT GENERAL ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27279,CPT,ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27299,CPT,UNLISTED PROCEDURE PELVIS/HIP JOINT,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27301,CPT,I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27305,CPT,FASCIOTOMY ILIOTIBIAL OPEN,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27306,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27307,CPT,TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27310,CPT,ARTHRT KNE W/EXPL DRG/RMVL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27323,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27324,CPT,BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27325,CPT,NEURECTOMY HAMSTRING MUSCLE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
27326,CPT,NEURECTOMY POPLITEAL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
27327,CPT,EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27328,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27329,CPT,RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27330,CPT,ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27331,CPT,ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27332,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27333,CPT,ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27334,CPT,ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27335,CPT,ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27337,CPT,EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27339,CPT,EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27340,CPT,EXCISION PREPATELLAR BURSA,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27345,CPT,EXCISION SYNOVIAL CYST POPLITEAL SPACE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27347,CPT,EXCISION LESION MENISCUS/CAPSULE KNEE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27350,CPT,PATELLECTOMY/HEMIPATELLECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27355,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27356,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27357,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27358,CPT,EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION,,30,,,"$9,426.29",$0.00,1,0,1,20161001,
27360,CPT,PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27364,CPT,RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27370,CPT,INJECTION KNEE ARTHROGRAPHY,,30,,,$864.08,$0.00,1,0,1,20161001,
27372,CPT,REMOVAL FOREIGN BODY DEEP THIGH/KNEE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27380,CPT,SUTURE INFRAPATELLAR TENDON PRIMARY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27381,CPT,SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27385,CPT,SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27386,CPT,SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27390,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27391,CPT,TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27392,CPT,TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27393,CPT,LENGTHENING HAMSTRING TENDON SINGLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27394,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27395,CPT,LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27396,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27397,CPT,TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27400,CPT,TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27403,CPT,ARTHROTOMY W/MENISCUS REPAIR KNEE,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27405,CPT,RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27407,CPT,REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27409,CPT,RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27412,CPT,AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27415,CPT,OSTEOCHONDRAL ALLOGRAFT KNEE OPEN,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27416,CPT,OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27418,CPT,ANTERIOR TIBIAL TUBERCLEPLASTY,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27420,CPT,RCNSTJ DISLOCATING PATELLA,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27422,CPT,RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27424,CPT,RCNSTJ DISLC PATELLA W/PATELLECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27425,CPT,LATERAL RETINACULAR RELEASE OPEN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27427,CPT,LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27428,CPT,LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27429,CPT,LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27430,CPT,QUADRICEPSPLASTY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27435,CPT,CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27437,CPT,ARTHROPLASTY PATELLA W/O PROSTHESIS,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
27438,CPT,ARTHROPLASTY PATELLA W/PROSTHESIS,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27440,CPT,ARTHROPLASTY KNEE TIBIAL PLATEAU,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27441,CPT,ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27442,CPT,ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27443,CPT,ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27446,CPT,ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27475,CPT,ARREST EPIPHYSEAL DISTAL FEMUR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27477,CPT,ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27479,CPT,ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27485,CPT,ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27496,CPT,DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27497,CPT,DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27498,CPT,DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27499,CPT,DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27500,CPT,CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27501,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27502,CPT,CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27503,CPT,CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27508,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27509,CPT,PRQ SKELETAL FIXJ FEMORAL FX DISTAL END,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27510,CPT,CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27516,CPT,CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27517,CPT,CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27520,CPT,CLOSED TX PATELLAR FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27524,CPT,OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27530,CPT,CLTX TIBIAL FX PROXIMAL W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27532,CPT,CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27538,CPT,CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27550,CPT,CLOSED TX KNEE DISLOCATION W/O ANESTHESIA,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27552,CPT,CLOSED TX KNEE DISLOCATION W/ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27560,CPT,CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27562,CPT,CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27566,CPT,OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27570,CPT,MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27594,CPT,AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27599,CPT,UNLISTED PROCEDURE FEMUR/KNEE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27600,CPT,DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27601,CPT,DCMPRN FASCT LEG POST COMPARTMENT ONLY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27602,CPT,DCMPRN FASCT LEG ANT&/LAT&PST CMPRT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27603,CPT,INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27604,CPT,INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27605,CPT,TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27606,CPT,TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27607,CPT,INCISION LEG/ANKLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27610,CPT,ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27612,CPT,ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27613,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
27614,CPT,BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27615,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27616,CPT,RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27618,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27619,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27620,CPT,ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27625,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27626,CPT,ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27630,CPT,EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
27632,CPT,EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27634,CPT,EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
27635,CPT,EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27637,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27638,CPT,EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27640,CPT,PARTIAL EXCISION BONE TIBIA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27641,CPT,PARTIAL EXCISION BONE FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27647,CPT,RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27648,CPT,INJECTION ANKLE ARTHROGRAPHY,,30,,,"$1,082.47",$0.00,1,0,1,20161001,
27650,CPT,REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27652,CPT,RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27654,CPT,REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27656,CPT,REPAIR FASCIAL DEFECT LEG,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27658,CPT,REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27659,CPT,RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27664,CPT,RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27665,CPT,RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27675,CPT,RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27676,CPT,REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27680,CPT,TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27681,CPT,TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27685,CPT,LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27686,CPT,LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27687,CPT,GASTROCNEMIUS RECESSION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27690,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27691,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27692,CPT,TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN,,30,,,"$1,804.12",$0.00,1,0,1,20161001,
27695,CPT,RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27696,CPT,RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27698,CPT,REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27700,CPT,ARTHROPLASTY ANKLE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27704,CPT,REMOVAL ANKLE IMPLANT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27705,CPT,OSTEOTOMY TIBIA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27707,CPT,OSTEOTOMY FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27709,CPT,OSTEOTOMY TIBIA & FIBULA,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
27720,CPT,REPAIR NONUNION/MALUNION TIBIA W/O GRAFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27722,CPT,REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
27726,CPT,REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27730,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27732,CPT,ARREST EPIPHYSEAL OPEN DISTAL FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27734,CPT,ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27740,CPT,ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27742,CPT,ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27745,CPT,PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27750,CPT,CLTX TIBIAL SHAFT FX W/O MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27752,CPT,CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27756,CPT,PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27758,CPT,OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27759,CPT,TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27760,CPT,CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27762,CPT,CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27766,CPT,OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27767,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27768,CPT,CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
27769,CPT,OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27780,CPT,CLTX PROX FIBULA/SHFT FX W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27781,CPT,CLTX PROX FIBULA/SHFT FX W/MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27784,CPT,OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27786,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27788,CPT,CLTX DSTL FIBULAR FX LAT MALLS W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27792,CPT,OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27808,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27810,CPT,CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27814,CPT,OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27816,CPT,CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27818,CPT,CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27822,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27823,CPT,OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27824,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
27825,CPT,CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27826,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
27827,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27828,CPT,OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27829,CPT,OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27830,CPT,CLTX PROX TIBFIB JT DISLC W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27831,CPT,CLTX PROX TIBFIB JT DISLC REQ ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27832,CPT,OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
27840,CPT,CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
27842,CPT,CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27846,CPT,OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27848,CPT,OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27860,CPT,MANIPULATION ANKLE UNDER GENERAL ANESTHESIA,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
27870,CPT,ARTHRODESIS ANKLE OPEN,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
27871,CPT,ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
27884,CPT,AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
27889,CPT,ANKLE DISARTICULATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27892,CPT,DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27893,CPT,DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
27894,CPT,DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
27899,CPT,UNLISTED PROCEDURE LEG/ANKLE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28001,CPT,INCISION&DRAINAGE BURSA FOOT,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
28002,CPT,I&D BELOW FASCIA FOOT 1 BURSAL SPACE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28003,CPT,I&D BELOW FASCIA FOOT MULTIPLE AREAS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28005,CPT,INCISION BONE CORTEX FOOT,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28008,CPT,FASCIOTOMY FOOT&/TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28010,CPT,TENOTOMY PERCUTANEOUS TOE SINGLE TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28011,CPT,TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28020,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28022,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28024,CPT,ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28035,CPT,RELEASE TARSAL TUNNEL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
28039,CPT,EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28041,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28043,CPT,EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28045,CPT,EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28046,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28047,CPT,RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/>,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28050,CPT,ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28052,CPT,ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28054,CPT,ARTHRTOMY W/BX INTERPHALANGEAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28055,CPT,NEURECTOMY INTRINSIC MUSCULATURE OF FOOT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
28060,CPT,FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28062,CPT,FASCIOTOMY PLANTAR FASCIA RADICAL SPX,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28070,CPT,SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28072,CPT,SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28080,CPT,EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28086,CPT,SYNOVECTOMY TENDON SHEATH FOOT FLEXOR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28088,CPT,SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28090,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28092,CPT,EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28100,CPT,EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28102,CPT,EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28103,CPT,EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28104,CPT,EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28106,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28107,CPT,EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
28108,CPT,EXC/CURTG CST/B9 TUM PHALANGES FOOT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28110,CPT,OSTECTOMY PRTL 5TH METAR HEAD SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28111,CPT,OSTECTOMY COMPLETE 1ST METATARSAL HEAD,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28112,CPT,OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28113,CPT,OSTECTOMY COMPLETE 5TH METATARSAL HEAD,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28114,CPT,OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28116,CPT,OSTECTOMY TARSAL COALITION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28118,CPT,OSTECTOMY CALCANEUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28119,CPT,OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28120,CPT,PARTIAL EXCISION BONE TALUS/CALCANEUS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28122,CPT,PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28124,CPT,PARTICAL EXCISION BONE PHALANX TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28126,CPT,RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28130,CPT,TALECTOMY ASTRAGALECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28140,CPT,METATARSECTOMY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28150,CPT,PHALANGECTOMY TOE EACH TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28153,CPT,RESECTION CONDYLE DISTAL END PHALANX EACH TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28160,CPT,HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28171,CPT,RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28173,CPT,RADICAL RESECTION TUMOR METATARSAL,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28175,CPT,RADICAL RESECTION TUMOR PHALANX OR TOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28190,CPT,REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
28192,CPT,REMOVAL FOREIGN BODY FOOT DEEP,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28193,CPT,REMOVAL FOREIGN BODY FOOT COMPLICATED,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
28200,CPT,RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28202,CPT,RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
28208,CPT,REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28210,CPT,RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28220,CPT,TENOLYSIS FLEXOR FOOT SINGLE TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28222,CPT,TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28225,CPT,TENOLYSIS EXTENSOR FOOT SINGLE TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28226,CPT,TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
28230,CPT,TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28232,CPT,TX OPEN TENDON FLEXOR TOE 1 TENDON SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28234,CPT,TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28238,CPT,RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28240,CPT,TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28250,CPT,DIVISION PLANTAR FASCIA & MUSCLE SPX,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28260,CPT,CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28261,CPT,CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28262,CPT,CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
28264,CPT,CAPSULOTOMY MIDTARSAL,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
28270,CPT,CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28272,CPT,CAPSULOTOMY IPHAL JOINT EACH JOINT SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28280,CPT,SYNDACTYLIZATION TOES,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28285,CPT,CORRECTION HAMMERTOE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28286,CPT,CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28288,CPT,OSTC PRTL EXOSTC/CONDYLC METAR HEAD,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28289,CPT,HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28290,CPT,CORRJ HALLUX VALGUS W/WO SESMDC SMPL EXOSTECTOMY,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28292,CPT,KELLER/MCBRIDE/MAYO PROCEDURE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28293,CPT,CORRJ HALLUX VALGUS W/WO SESMDC RESCJ JT W/IMPLT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
28294,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/TDN TRNSPLS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28296,CPT,CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28297,CPT,CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
28298,CPT,CORRJ HALLUX VALGUS W/WO SESMDC PHALANX OSTEOT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28299,CPT,CORRJ HALLUX VALGUS W/WO SESMDC 2 OSTEOT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28300,CPT,OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28302,CPT,OSTEOTOMY TALUS,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28304,CPT,OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28305,CPT,OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28306,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28307,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28308,CPT,OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28309,CPT,OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28310,CPT,OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28312,CPT,OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28313,CPT,RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28315,CPT,SESAMOIDECTOMY FIRST TOE SPX,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28320,CPT,REPAIR NONUNION/MALUNION TARSAL BONES,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
28322,CPT,RPR NON/MALUNION METARSAL W/WO BONE GRAFT,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
28340,CPT,RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28341,CPT,RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28344,CPT,RECONSTRUCTION TOE POLYDACTYLY,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28345,CPT,RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28360,CPT,RECONSTRUCTION CLEFT FOOT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28400,CPT,CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
28405,CPT,CLOSED TX CALCANEAL FRACTURE W/MANIPULATION,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
28406,CPT,PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28415,CPT,OPEN TREATMENT CALCANEAL FRACTURE,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
28420,CPT,OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
28430,CPT,CLOSED TX TALUS FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28435,CPT,CLOSED TX TALUS FRACTURE W/MANIPULATION,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
28436,CPT,PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28445,CPT,OPEN TREATMENT TALUS FRACTURE,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28446,CPT,OPEN OSTEOCHONDRAL AUTOGRAFT TALUS,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28450,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
28455,CPT,TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ,,30,,,"$6,596.94",$0.00,1,0,1,20161001,
28456,CPT,PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
28465,CPT,OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28470,CPT,CLOSED TX METATARSAL FRACTURE W/O MANIPULATION,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28475,CPT,CLTX METAR FX W/MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28476,CPT,PRQ SKEL FIXJ METAR FX W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28485,CPT,OPEN TREATMENT METATARSAL FRACTURE EACH,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28490,CPT,CLTX FX GRT TOE PHLX/PHLG W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28495,CPT,CLTX FX GRT TOE PHLX/PHLG W/MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28496,CPT,PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28505,CPT,OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28510,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28515,CPT,CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
28525,CPT,OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28530,CPT,CLOSED TREATMENT SESAMOID FRACTURE,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28531,CPT,OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28540,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28545,CPT,CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28546,CPT,PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
28555,CPT,OPEN TREATMENT TARSAL BONE DISLOCATION,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
28570,CPT,CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28575,CPT,CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
28576,CPT,PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28585,CPT,OPEN TREATMENT TALOTARSAL JOINT DISLOCATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28600,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES,,30,,,"$1,520.98",$0.00,1,0,1,20161001,
28605,CPT,CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28606,CPT,PRQ SKEL FIXJ TARS JT DISLC W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28615,CPT,OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28630,CPT,CLTX METATARSOPHLNGL JT DISLC W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28635,CPT,CLTX METATARSOPHLNGL JT DISLC REQ ANES,,30,,,"$6,781.86",$0.00,1,0,1,20161001,
28636,CPT,PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28645,CPT,OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28660,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
28665,CPT,CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
28666,CPT,PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
28675,CPT,OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28705,CPT,ARTHRODESIS PANTALAR,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
28715,CPT,ARTHRODESIS TRIPLE,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
28725,CPT,ARTHRODESIS SUBTALAR,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
28730,CPT,ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
28735,CPT,ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
28737,CPT,ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
28740,CPT,ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
28750,CPT,ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28755,CPT,ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28760,CPT,ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
28805,CPT,AMPUTATION FOOT TRANSMETARSAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
28810,CPT,AMPUTATION METATARSAL W/TOE SINGLE,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28820,CPT,AMPUTATION TOE METATARSOPHALANGEAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28825,CPT,AMPUTATION TOE INTERPHALANGEAL JOINT,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
28890,CPT,ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
28899,CPT,UNLISTED PROCEDURE FOOT/TOES,,30,,,"$1,190.16",$0.00,1,0,1,20161001,
29000,CPT,APPLICATION HALO TYPE BODY CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29010,CPT,APPLICATION RISSER JACKET LOCALIZER BODY ONLY,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29015,CPT,APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29035,CPT,APPLICATION BODY CAST SHOULDER HIPS,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29040,CPT,APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29044,CPT,APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH,,30,,,$571.56,$0.00,1,0,1,20161001,
29046,CPT,APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29049,CPT,APPLICATION CAST FIGURE-OF-8,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29055,CPT,APPLICATION CAST SHOULDER SPICA,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29058,CPT,APPLICATION CAST PLASTER VELPEAU,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29065,CPT,APPLICATION CAST SHOULDER HAND LONG ARM,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29075,CPT,APPLICATION CAST ELBOW FINGER SHORT ARM,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29085,CPT,APPLICATION CAST HAND & LOWER FOREARM GAUNTLET,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29086,CPT,APPLICATION CAST FINGER,,30,,,$571.56,$0.00,1,0,1,20161001,
29105,CPT,APPLICATION LONG ARM SPLINT SHOULDER HAND,,30,,,$571.56,$0.00,1,0,1,20161001,
29125,CPT,APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC,,30,,,$425.53,$0.00,1,0,1,20161001,
29126,CPT,APPLICATION SHORT ARM SPLINT DYNAMIC,,30,,,$425.53,$0.00,1,0,1,20161001,
29130,CPT,APPLICATION FINGER SPLINT STATIC,,30,,,$306.21,$0.00,1,0,1,20161001,
29131,CPT,APPLICATION FINGER SPLINT DYNAMIC,,30,,,$306.21,$0.00,1,0,1,20161001,
29200,CPT,STRAPPING THORAX,,30,,,$571.56,$0.00,1,0,1,20161001,
29240,CPT,STRAPPING SHOULDER,,30,,,$306.21,$0.00,1,0,1,20161001,
29260,CPT,STRAPPING ELBOW/WRIST,,30,,,$156.54,$0.00,1,0,1,20161001,
29280,CPT,STRAPPING HAND/FINGER,,30,,,$156.54,$0.00,1,0,1,20161001,
29305,CPT,APPLICATION HIP SPICA CAST 1 LEG,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29325,CPT,APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29345,CPT,APPLICATION LONG LEG CAST THIGH-TOE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29355,CPT,APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29358,CPT,APPLICATION LONG LEG CAST BRACE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29365,CPT,APPLICATION CYLINDER CAST THIGH ANKLE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29405,CPT,APPLICATION SHORT LEG CAST BELOW KNEE-TOE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29425,CPT,APPLICATION SHORT LEG CAST WALKING/AMBULATORY,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29435,CPT,APPLICATION PATELLAR TENDON BEARING CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29440,CPT,ADDING WALKER PREVIOUSLY APPLIED CAST,,30,,,$571.56,$0.00,1,0,1,20161001,
29445,CPT,APPLICATION RIGID TOTAL CONTACT LEG CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29450,CPT,APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG,,30,,,$651.23,$0.00,1,0,1,20161001,
29505,CPT,APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES,,30,,,$571.56,$0.00,1,0,1,20161001,
29515,CPT,APPLICATION SHORT LEG SPLINT CALF FOOT,,30,,,$571.56,$0.00,1,0,1,20161001,
29520,CPT,STRAPPING HIP,,30,,,$306.21,$0.00,1,0,1,20161001,
29530,CPT,STRAPPING KNEE,,30,,,$306.21,$0.00,1,0,1,20161001,
29540,CPT,STRAPPING ANKLE &/FOOT,,30,,,$571.56,$0.00,1,0,1,20161001,
29550,CPT,STRAPPING TOES,,30,,,$306.21,$0.00,1,0,1,20161001,
29580,CPT,STRAPPING UNNA BOOT,,30,,,$651.23,$0.00,1,0,1,20161001,
29581,CPT,APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT,,30,,,$651.23,$0.00,1,0,1,20161001,
29582,CPT,APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29583,CPT,APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM,,30,,,$571.56,$0.00,1,0,1,20161001,
29584,CPT,APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING,,30,,,$571.56,$0.00,1,0,1,20161001,
29700,CPT,REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29705,CPT,REMOVAL/BIVALVING FULL ARM/FULL LEG CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29710,CPT,RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29720,CPT,REPAIR SPICA BODY CAST/JACKET,,30,,,$571.56,$0.00,1,0,1,20161001,
29730,CPT,WINDOWING CAST,,30,,,$571.56,$0.00,1,0,1,20161001,
29740,CPT,WEDGING CAST EXCEPT CLUBFOOT CASTS,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29750,CPT,WEDGING CLUBFOOT CAST,,30,,,"$1,334.07",$0.00,1,0,1,20161001,
29799,CPT,UNLISTED PROCEDURE CASTING/STRAPPING,,30,,,$571.56,$0.00,1,0,1,20161001,
29800,CPT,ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29804,CPT,ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29805,CPT,ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29806,CPT,ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29807,CPT,ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29819,CPT,ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29820,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
29821,CPT,ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29822,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29823,CPT,ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29824,CPT,ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29825,CPT,ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29826,CPT,ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE,,30,,,"$17,750.22",$0.00,1,0,1,20161001,
29827,CPT,ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29828,CPT,ARTHROSCOPY SHOULDER BICEPS TENODESIS,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
29830,CPT,ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
29834,CPT,ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29835,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29836,CPT,ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29837,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29838,CPT,ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29840,CPT,ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29843,CPT,ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29844,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29845,CPT,ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29846,CPT,ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29847,CPT,ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29848,CPT,NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
29850,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
29851,CPT,ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
29855,CPT,ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
29856,CPT,ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
29860,CPT,ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29861,CPT,ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29862,CPT,ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29863,CPT,ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29866,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29867,CPT,ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
29868,CPT,ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29870,CPT,ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29871,CPT,ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE,,30,,,"$13,009.40",$0.00,1,0,1,20161001,
29873,CPT,ARTHROSCOPY KNEE LATERAL RELEASE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29874,CPT,ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29875,CPT,ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29876,CPT,ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29877,CPT,ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29879,CPT,ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29880,CPT,ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29881,CPT,ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29882,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29883,CPT,ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29884,CPT,ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29885,CPT,ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG,,30,,,"$21,216.29",$0.00,1,0,1,20161001,
29886,CPT,ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29887,CPT,ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29888,CPT,ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
29889,CPT,ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
29891,CPT,ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29892,CPT,ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29893,CPT,ENDOSCOPIC PLANTAR FASCIOTOMY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
29894,CPT,ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29895,CPT,ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29897,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29898,CPT,ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29899,CPT,ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
29900,CPT,ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29901,CPT,ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29902,CPT,ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
29904,CPT,ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29905,CPT,ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
29906,CPT,ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
29907,CPT,ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
29914,CPT,ARTHROSCOPY HIP W/FEMOROPLASTY,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
29915,CPT,ARTHROSCOPY HIP W/ACETABULOPLASTY,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
29916,CPT,ARTHROSCOPY HIP W/LABRAL REPAIR,,30,,,"$23,484.36",$0.00,1,0,1,20161001,
29999,CPT,UNLISTED PROCEDURE ARTHROSCOPY,,30,,,"$8,040.80",$0.00,1,0,1,20161001,
30000,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH,,30,,,$853.29,$0.00,1,0,1,20161001,
30020,CPT,DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
30100,CPT,BIOPSY INTRANASAL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30110,CPT,EXCISION NASAL POLYP SIMPLE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30115,CPT,EXCISION NASAL POLYP EXTENSIVE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30117,CPT,EXCISION/DESTRUCTION INTRANASAL LESION INT APPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30118,CPT,EXCISION/DESTRUCTION INTRANASAL LESION XTRNL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30120,CPT,EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30124,CPT,EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30125,CPT,EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30130,CPT,EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30140,CPT,SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30150,CPT,RHINECTOMY PARTIAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30160,CPT,RHINECTOMY TOTAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30200,CPT,INJECTION TURBINATE THERAPEUTIC,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30210,CPT,DISPLACEMENT THERAPY PROETZ TYPE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30220,CPT,INSERTION NASAL SEPTAL PROSTHESIS BUTTON,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30300,CPT,REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE,,30,,,$425.53,$0.00,1,0,1,20161001,
30310,CPT,REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30320,CPT,RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30400,CPT,RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30410,CPT,RHINP PRIM COMPLETE XTRNL PARTS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30420,CPT,RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30430,CPT,RHINOPLASTY SECONDARY MINOR REVISION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30435,CPT,RHINOPLASTY SECONDARY INTERMEDIATE REVISION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30450,CPT,RHINOPLASTY SECONDARY MAJOR REVISION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30460,CPT,RHINP DFRM W/COLUM LNGTH TIP ONLY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30462,CPT,RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30465,CPT,REPAIR NASAL VESTIBULAR STENOSIS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30520,CPT,SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30540,CPT,REPAIR CHOANAL ATRESIA INTRANASAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30545,CPT,REPAIR CHOANAL ATRESIA TRANSPALATINE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30560,CPT,LYSIS INTRANASAL SYNECHIA,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
30580,CPT,REPAIR FISTULA OROMAXILLARY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30600,CPT,REPAIR FISTULA ORONASAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30620,CPT,SEPTAL/OTHER INTRANASAL DERMATOPLASTY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
30630,CPT,REPAIR NASAL SEPTAL PERFORATIONS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30801,CPT,ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
30802,CPT,ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30901,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE,,30,,,$425.53,$0.00,1,0,1,20161001,
30903,CPT,CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX,,30,,,$853.29,$0.00,1,0,1,20161001,
30905,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST,,30,,,$853.29,$0.00,1,0,1,20161001,
30906,CPT,CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ,,30,,,$853.29,$0.00,1,0,1,20161001,
30915,CPT,LIGATION ARTERIES ETHMOIDAL,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
30920,CPT,LIGATION ARTERIES INT MAXILLARY TRANSANTRAL,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
30930,CPT,FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
30999,CPT,UNLISTED PROCEDURE NOSE,,30,,,$853.29,$0.00,1,0,1,20161001,
31000,CPT,LAVAGE CANNULATION MAXILLARY SINUS,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
31002,CPT,LAVAGE CANNULATION SPHENOID SINUS,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
31020,CPT,SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31030,CPT,SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31032,CPT,SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31040,CPT,PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31050,CPT,SINUSOTOMY SPHENOID W/WO BIOPSY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31051,CPT,SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31070,CPT,SINUSOTOMY FRONTAL EXTERNAL SIMPLE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31075,CPT,SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31080,CPT,SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31081,CPT,SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31084,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31085,CPT,SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31086,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31087,CPT,SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31090,CPT,SINUSOT UNI 3/> PARANSL SINUSES,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31200,CPT,ETHMOIDECTOMY INTRANASAL ANTERIOR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31201,CPT,ETHMOIDECTOMY INTRANASAL TOTAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31205,CPT,ETHMOIDECTOMY EXTRANASAL TOTAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31231,CPT,NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX,,30,,,$578.94,$0.00,1,0,1,20161001,
31233,CPT,NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31235,CPT,NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31237,CPT,NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31238,CPT,NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31239,CPT,NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31240,CPT,NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION,,30,,,"$6,163.92",$0.00,1,0,1,20161001,
31254,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31255,CPT,NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31256,CPT,NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31267,CPT,NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31276,CPT,NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31287,CPT,NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31288,CPT,NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31292,CPT,NSL/SINUS NDSC SURG W/MEDIAL/INF ORB WALL DCMPRN,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31293,CPT,NASAL/SINUS NDSC MEDIAL ORB&NF ORB WALL DCMPR,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31294,CPT,NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31295,CPT,NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31296,CPT,NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31297,CPT,NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31299,CPT,UNLISTED PROCEDURE ACCESSORY SINUSES,,30,,,$853.29,$0.00,1,0,1,20161001,
31300,CPT,LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31320,CPT,LARYNGOTOMY THYROTOMY LARYNGOFISSURE DX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31400,CPT,ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31420,CPT,EPIGLOTTIDECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31500,CPT,INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE,,30,,,$853.29,$0.00,1,0,1,20161001,
31502,CPT,TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT,,30,,,$853.29,$0.00,1,0,1,20161001,
31505,CPT,LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX,,30,,,$578.94,$0.00,1,0,1,20161001,
31510,CPT,LARYNGOSCOPY INDIRECT W/BIOPSY,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31511,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY,,30,,,$578.94,$0.00,1,0,1,20161001,
31512,CPT,LARYNGOSCOPY INDIRECT W/REMOVAL LESION,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31513,CPT,LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION,,30,,,"$6,163.92",$0.00,1,0,1,20161001,
31515,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31520,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31525,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31526,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31527,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31528,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31529,CPT,LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31530,CPT,LARYNGOSCOPY W/FOREIGN BODY REMOVAL,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31531,CPT,LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31535,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31536,CPT,LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31540,CPT,LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31541,CPT,LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31545,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31546,CPT,LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31560,CPT,LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31561,CPT,LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31570,CPT,LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31571,CPT,LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31575,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC,,30,,,$578.94,$0.00,1,0,1,20161001,
31576,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC W/BIOPSY,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31577,CPT,LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31578,CPT,LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31579,CPT,LARYNGOSCOPY FLX/RGD FIBOPT W/STROBOSCOPY,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31580,CPT,LARYNGOPLASTY LARYN WEB 2 STG W/KEEL INSJ&RMVL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31582,CPT,LARYNGP LARYN STENOSIS GRF/CORE MOLD W/TRACHT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31588,CPT,LARYNGOPLASTY NOT OTHERWISE SPECIFIED,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31590,CPT,LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31595,CPT,SECTION RECURRENT LARYNGEAL NERVE THER UNI SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31599,CPT,UNLISTED PROCEDURE LARYNX,,30,,,$853.29,$0.00,1,0,1,20161001,
31600,CPT,TRACHEOSTOMY PLANNED SEPARATE PROCEDURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31601,CPT,TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31603,CPT,TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
31605,CPT,TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
31610,CPT,TRACHEOSTOMY FENESTRATION W/SKIN FLAPS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31611,CPT,CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31612,CPT,TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31613,CPT,TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31614,CPT,TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31615,CPT,TRACHEOBRNCHSC THRU EST TRACHS INC,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
31622,CPT,BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31623,CPT,BRNCHSC BRUSHING/PROTECTED BRUSHINGS,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31624,CPT,BRNCHSC W/BRNCL ALVEOLAR LAVAGE,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31625,CPT,BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31626,CPT,BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31627,CPT,BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION,,30,,,"$5,758.21",$0.00,1,0,1,20161001,
31628,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31629,CPT,BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31630,CPT,BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31631,CPT,BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31632,CPT,BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE,,30,,,"$2,879.10",$0.00,1,0,1,20161001,
31633,CPT,BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE,,30,,,"$2,879.10",$0.00,1,0,1,20161001,
31634,CPT,BRONCHOSCOPY BALLOON OCCLUSION,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31635,CPT,BRONCHOSCOPY W/REMOVAL FOREIGN BODY,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31636,CPT,BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31637,CPT,BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED,,30,,,"$5,758.21",$0.00,1,0,1,20161001,
31638,CPT,BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS,,30,,,"$15,724.61",$0.00,1,0,1,20161001,
31640,CPT,BRONCHOSCOPY W/EXCISION TUMOR,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31641,CPT,BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31643,CPT,BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31645,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31646,CPT,BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ,,30,,,"$2,379.09",$0.00,1,0,1,20161001,
31647,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31648,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL,,30,,,"$11,460.85",$0.00,1,0,1,20161001,
31649,CPT,BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
31651,CPT,BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE,,30,,,"$4,203.49",$0.00,1,0,1,20161001,
31652,CPT,BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31653,CPT,BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX,,30,,,"$10,075.87",$0.00,1,0,1,20161001,
31660,CPT,BRONCHOSCOPIC THERMOPLASTY ONE LOBE,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31661,CPT,BRONCHOSCOPIC THERMOPLASTY 2/> LOBES,,30,,,"$17,504.76",$0.00,1,0,1,20161001,
31717,CPT,CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY,,30,,,"$2,376.99",$0.00,1,0,1,20161001,
31720,CPT,CATHETER ASPIRATION NASOTRACHEAL SPX,,30,,,$238.49,$0.00,1,0,1,20161001,
31730,CPT,TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER,,30,,,"$6,163.92",$0.00,1,0,1,20161001,
31750,CPT,TRACHEOPLASTY CERVICAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31755,CPT,TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
31785,CPT,EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31820,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31825,CPT,SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31830,CPT,REVISION TRACHEOSTOMY SCAR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
31899,CPT,UNLISTED PROCEDURE TRACHEA BRONCHI,,30,,,"$3,256.97",$0.00,1,0,1,20161001,
32400,CPT,BIOPSY PLEURA PERCUTANEOUS NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
32405,CPT,BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
32550,CPT,INSERTION INDWELLING TUNNELED PLEURAL CATHETER,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
32551,CPT,TUBE THORACOSTOMY INCLUDES WATER SEAL,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32552,CPT,RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32553,CPT,PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT,,30,,,"$6,357.83",$0.00,1,0,1,20161001,
32554,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32555,CPT,THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32556,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING,,30,,,"$7,205.95",$0.00,1,0,1,20161001,
32557,CPT,PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32560,CPT,INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32561,CPT,INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32562,CPT,INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32601,CPT,THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32604,CPT,THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32606,CPT,THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32607,CPT,THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32608,CPT,THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32609,CPT,THORACOSCOPY WITH BIOPSYIES OF PLEURA,,30,,,"$16,088.82",$0.00,1,0,1,20161001,
32960,CPT,PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
32998,CPT,ABLATION PULMONARY TUMOR PERQ RADIOFREQUENCY UNI,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
32999,CPT,UNLISTED PROCEDURE LUNGS & PLEURA,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
33010,CPT,PERICARDIOCENTESIS INITIAL,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
33011,CPT,PERICARDIOCENTESIS SUBSEQUENT,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
33206,CPT,INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33207,CPT,INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33208,CPT,INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33210,CPT,INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33211,CPT,INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33212,CPT,INS PM PLS GEN W/EXIST SINGLE LEAD,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33213,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33214,CPT,UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33215,CPT,RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
33216,CPT,INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33217,CPT,INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33218,CPT,RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33220,CPT,RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33221,CPT,INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS,,30,,,"$33,969.60",$0.00,1,0,1,20161001,
33222,CPT,RELOCATION OF SKIN POCKET FOR PACEMAKER,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
33223,CPT,RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
33224,CPT,INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33225,CPT,INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN,,30,,,"$19,869.53",$0.00,1,0,1,20161001,
33226,CPT,RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
33227,CPT,REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33228,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
33229,CPT,REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD,,30,,,"$33,969.60",$0.00,1,0,1,20161001,
33230,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS,,30,,,"$44,371.92",$0.00,1,0,1,20161001,
33231,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS,,30,,,"$61,541.58",$0.00,1,0,1,20161001,
33233,CPT,REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY,,30,,,"$23,372.96",$0.00,1,0,1,20161001,
33234,CPT,RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33235,CPT,RMVL TRANSVNS PM ELTRD DUAL LEAD SYS,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33240,CPT,INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD,,30,,,"$44,371.92",$0.00,1,0,1,20161001,
33241,CPT,REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33244,CPT,RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33249,CPT,INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR,,30,,,"$61,541.58",$0.00,1,0,1,20161001,
33262,CPT,RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD,,30,,,"$44,371.92",$0.00,1,0,1,20161001,
33263,CPT,RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD,,30,,,"$44,371.92",$0.00,1,0,1,20161001,
33264,CPT,RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD,,30,,,"$61,541.58",$0.00,1,0,1,20161001,
33270,CPT,INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD,,30,,,"$61,541.58",$0.00,1,0,1,20161001,
33271,CPT,INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33272,CPT,RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33273,CPT,REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
33282,CPT,IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
33284,CPT,RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
33419,CPT,TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS,,30,,,"$22,030.41",$0.00,1,0,1,20161001,
33999,CPT,UNLISTED CARDIAC SURGERY,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
34101,CPT,EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34111,CPT,EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34201,CPT,EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34203,CPT,EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34421,CPT,THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
34471,CPT,THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
34490,CPT,THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
34501,CPT,VALVULOPLASTY FEMORAL VEIN,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34510,CPT,VENOUS VALVE TRANSPOSITION ANY VEIN DONOR,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34520,CPT,CROSS-OVER VEIN GRAFT VENOUS SYSTEM,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
34530,CPT,SAPHENOPOPLITEAL VEIN ANASTOMOSIS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35011,CPT,DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35045,CPT,DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35180,CPT,REPAIR CONGENITAL AV FISTULA HEAD & NECK,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35184,CPT,RPR CONGENITAL AV FISTULA EXTREMITIES,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35188,CPT,RPR/TRAUMATIC AV FISTULA HEAD & NECK,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35190,CPT,RPR/TRAUMATIC AV FISTULA EXTREMITIES,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35201,CPT,REPAIR BLOOD VESSEL DIRECT NECK,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35206,CPT,REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35207,CPT,REPAIR BLOOD VESSEL DIRECT HAND FINGER,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35226,CPT,RPR BLOOD VESSEL DIRECT LOWER EXTREMITY,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
35231,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT NECK,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35236,CPT,REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35256,CPT,REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35261,CPT,REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35266,CPT,RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35286,CPT,RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35321,CPT,TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35458,CPT,TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35460,CPT,TRLUML BALLOON ANGIOPLASTY OPEN VENOUS,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35471,CPT,TRLUML BALLOON ANGIOP PRQ RENAL/VISCERAL ART,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35472,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS AORTIC,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35475,CPT,TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35476,CPT,TRLUML BALLOON ANGIOPLASTY PERCUTANEOUS VENOUS,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
35500,CPT,HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX,,30,,,"$9,683.56",$0.00,1,0,1,20161001,
35685,CPT,PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT,,30,,,"$58,110.18",$0.00,1,0,1,20161001,
35686,CPT,CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO,,30,,,"$58,110.18",$0.00,1,0,1,20161001,
35761,CPT,EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35860,CPT,EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
35875,CPT,THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35876,CPT,THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35879,CPT,REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35881,CPT,REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35883,CPT,REVISION FEMORAL ANAST OPEN NONAUTOG GRAFT,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35884,CPT,REVISION FEMORAL ANAST OPEN W/AUTOG GRAFT,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
35903,CPT,EXCISION INFECTED GRAFT EXTREMITY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36000,CPT,INTRODUCTION NEEDLE/INTRACATHETER VEIN,,30,,,$471.76,$0.00,1,0,1,20161001,
36002,CPT,INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
36005,CPT,NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH,,30,,,$687.99,$0.00,1,0,1,20161001,
36010,CPT,INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36011,CPT,SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36012,CPT,SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36013,CPT,INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY,,30,,,"$8,255.83",$0.00,1,0,1,20161001,
36014,CPT,SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36015,CPT,SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36100,CPT,INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36120,CPT,INTRO NEEDLE/INTRACATH RETROGRADE BRACHIAL ART,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36140,CPT,INTRO NEEDLE/INTRACATH EXTREMITY ARTERY,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36147,CPT,INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36148,CPT,INTRO NDL/CATH AV SHUNT ADDL ACCESS THER IVNTJ,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36160,CPT,INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36200,CPT,INTRODUCTION CATHETER AORTA,,30,,,"$4,717.62",$0.00,1,0,1,20161001,
36215,CPT,SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36216,CPT,SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36217,CPT,SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36218,CPT,SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH,,30,,,$786.27,$0.00,1,0,1,20161001,
36221,CPT,NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36222,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36223,CPT,SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART,,30,,,"$18,214.01",$0.00,1,0,1,20161001,
36224,CPT,SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36225,CPT,SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36226,CPT,SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36227,CPT,SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC,,30,,,"$10,327.30",$0.00,1,0,1,20161001,
36228,CPT,SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT,,30,,,"$10,541.65",$0.00,1,0,1,20161001,
36245,CPT,SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36246,CPT,SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36247,CPT,SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH,,30,,,"$7,076.43",$0.00,1,0,1,20161001,
36248,CPT,SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH,,30,,,$638.84,$0.00,1,0,1,20161001,
36251,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36252,CPT,SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36253,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36254,CPT,SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
36260,CPT,INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36261,CPT,REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
36262,CPT,REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
36299,CPT,UNLISTED PROCEDURE VASCULAR INJECTION,,30,,,"$4,927.32",$0.00,1,0,1,20161001,
36400,CPT,VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN,,30,,,$179.59,$0.00,1,0,1,20161001,
36405,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN,,30,,,$134.70,$0.00,1,0,1,20161001,
36406,CPT,VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN,,30,,,$134.70,$0.00,1,0,1,20161001,
36410,CPT,VNPNXR 3 YEARS/> PHYS/QHP SKILL,,30,,,$134.70,$0.00,1,0,1,20161001,
36415,CPT,COLLECTION VENOUS BLOOD VENIPUNCTURE,,30,,,$35.92,$0.00,1,0,1,20161001,
36416,CPT,COLLECTION CAPILLARY BLOOD SPECIMEN,,30,,,$34.42,$0.00,1,0,1,20161001,
36420,CPT,VENIPUNCTURE CUTDOWN UNDER AGE 1 YR,,30,,,$306.21,$0.00,1,0,1,20161001,
36425,CPT,VENIPUNCTURE CUTDOWN AGE 1 YR/>,,30,,,$425.53,$0.00,1,0,1,20161001,
36430,CPT,TRANSFUSION BLOOD/BLOOD COMPONENTS,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
36440,CPT,PUSH TRANSFUSION BLOOD 2 YR/UNDER,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
36450,CPT,EXCHNG TRANSFUSION BLOOD NEWBORN,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
36455,CPT,EXCHNG TRANSFUSION BLOOD OTHER/THAN NEW BORN,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
36460,CPT,TRANSFUSION INTRAUTERINE FETAL,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
36468,CPT,1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK,,30,,,$398.75,$0.00,1,0,1,20161001,
36470,CPT,NJX SCLEROSING SOLUTION SINGLE VEIN,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
36471,CPT,NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
36475,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36476,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS,,30,,,"$10,921.84",$0.00,1,0,1,20161001,
36478,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36479,CPT,ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS,,30,,,"$10,921.84",$0.00,1,0,1,20161001,
36481,CPT,PRQ PORTAL VEIN CATHETERIZATION ANY METHOD,,30,,,"$12,135.38",$0.00,1,0,1,20161001,
36500,CPT,VEN CATHJ SLCTV ORGAN BLD SAMPLING,,30,,,"$9,708.30",$0.00,1,0,1,20161001,
36511,CPT,THERAPEUTIC APHERESIS WHITE BLOOD CELLS,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
36512,CPT,THERAPEUTIC APHERESIS RED BLOOD CELLS,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
36513,CPT,THERAPEUTIC APHERESIS PLATELETS,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
36514,CPT,THERAPEUTIC APHERESIS PLASMA PHERESIS,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
36515,CPT,THER APHERESIS W/XTRCORP IMMUNODSPTJ& PLSM RENFJ,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
36516,CPT,THER APHRS XTRCORP SLCTV ADSRPJ/FILTRJ & REINFSJ,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
36522,CPT,PHOTOPHERESIS EXTRACORPOREAL,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
36555,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36556,CPT,INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36557,CPT,INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36558,CPT,INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36560,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36561,CPT,INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36563,CPT,INSJ TUNNELED CTR VAD W/SUBQ PUMP,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36565,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36566,CPT,INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT,,30,,,"$18,214.01",$0.00,1,0,1,20161001,
36568,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36569,CPT,INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/>,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36570,CPT,INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36571,CPT,INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36575,CPT,RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
36576,CPT,RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36578,CPT,RPLCMT CATH CTR VAD SUBQ PORT/PMP,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36580,CPT,RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36581,CPT,RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36582,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PORT,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36583,CPT,RPLCMT COMPL TUN CTR VAD W/SUBQ PMP,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36584,CPT,RPLCMT COMPL PRPH CVC W/O SUBQ PORT/PMP,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36585,CPT,RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36589,CPT,RMVL TUN CVC W/O SUBQ PORT/PMP,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
36590,CPT,RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36591,CPT,COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE,,30,,,$425.53,$0.00,1,0,1,20161001,
36592,CPT,COLLECT BLOOD FROM CATHETER VENOUS NOS,,30,,,$425.53,$0.00,1,0,1,20161001,
36593,CPT,DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH,,30,,,"$1,302.06",$0.00,1,0,1,20161001,
36595,CPT,MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36596,CPT,MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36597,CPT,RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
36598,CPT,CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT,,30,,,"$1,302.06",$0.00,1,0,1,20161001,
36600,CPT,ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX,,30,,,$425.53,$0.00,1,0,1,20161001,
36620,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ,,30,,,"$1,719.18",$0.00,1,0,1,20161001,
36625,CPT,ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN,,30,,,"$1,719.18",$0.00,1,0,1,20161001,
36640,CPT,ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36680,CPT,PLACEMENT NEEDLE INTRAOSSEOUS INFUSION,,30,,,$425.53,$0.00,1,0,1,20161001,
36800,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36810,CPT,INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36815,CPT,INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36818,CPT,ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36819,CPT,ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36820,CPT,ARVEN ANAST OPN F/ARM VEIN TRPOS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36821,CPT,ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36825,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36830,CPT,CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36831,CPT,THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36832,CPT,REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36833,CPT,REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36835,CPT,INSERTION THOMAS SHUNT SEPARATE PROCEDURE,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
36838,CPT,DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
36860,CPT,XTRNL CANNULA DECLTNG SPX W/O BALO CATH,,30,,,"$5,280.44",$0.00,1,0,1,20161001,
36861,CPT,XTRNL CANNULA DECLTNG SPX W/BALO CATH,,30,,,"$18,214.01",$0.00,1,0,1,20161001,
36870,CPT,THRMBC PRQ ARVEN FSTL AUTOG/NONAUTOG GRF,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
37183,CPT,REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
37184,CPT,PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37185,CPT,PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ,,30,,,"$7,078.97",$0.00,1,0,1,20161001,
37186,CPT,SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL,,30,,,"$7,078.97",$0.00,1,0,1,20161001,
37187,CPT,PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37188,CPT,PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37191,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37192,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37193,CPT,RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37195,CPT,THROMBOLYSIS CEREBRAL IV INFUSION,,30,,,"$1,302.06",$0.00,1,0,1,20161001,
37197,CPT,PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37200,CPT,TRANSCATHETER BIOPSY,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37211,CPT,THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37212,CPT,THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
37213,CPT,THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37214,CPT,CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37220,CPT,REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
37221,CPT,REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37222,CPT,REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL,,30,,,"$7,887.99",$0.00,1,0,1,20161001,
37223,CPT,REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL,,30,,,"$9,101.53",$0.00,1,0,1,20161001,
37224,CPT,REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
37225,CPT,REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37226,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37227,CPT,REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
37228,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37229,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
37230,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
37231,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
37232,CPT,REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL,,30,,,"$9,204.81",$0.00,1,0,1,20161001,
37233,CPT,REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL,,30,,,"$8,090.25",$0.00,1,0,1,20161001,
37234,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL,,30,,,"$7,078.97",$0.00,1,0,1,20161001,
37235,CPT,REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL,,30,,,"$10,112.81",$0.00,1,0,1,20161001,
37236,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37237,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL,,30,,,"$21,756.05",$0.00,1,0,1,20161001,
37238,CPT,OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37239,CPT,OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL,,30,,,"$14,615.64",$0.00,1,0,1,20161001,
37241,CPT,VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37242,CPT,VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37243,CPT,VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37244,CPT,VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
37500,CPT,VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37501,CPT,UNLISTED VASCULAR ENDOSCOPY PROCEDURE,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
37565,CPT,LIGATION INTERNAL JUGULAR VEIN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37600,CPT,LIGATION EXTERNAL CAROTID ARTERY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37605,CPT,LIGATION INTERNAL/COMMON CAROTID ARTERY,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37606,CPT,LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37607,CPT,LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37609,CPT,LIGATION/BIOPSY TEMPORAL ARTERY,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
37615,CPT,LIGATION MAJOR ARTERY NECK,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37619,CPT,INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I,,30,,,"$18,610.01",$0.00,1,0,1,20161001,
37650,CPT,REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37700,CPT,LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37718,CPT,LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37722,CPT,LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37735,CPT,LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37760,CPT,LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37761,CPT,LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37765,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37766,CPT,STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37780,CPT,LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37785,CPT,LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
37790,CPT,PENILE VENOUS OCCLUSIVE PROCEDURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
37799,CPT,UNLISTED PROCEDURE VASCULAR SURGERY,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
38120,CPT,LAPAROSCOPIC SURGICAL SPLENECTOMY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
38129,CPT,UNLISTED LAPAROSCOPY PROCEDURE SPLEEN,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38200,CPT,INJECTION PROCEDURE SPLENOPORTOGRAPY,,30,,,"$3,872.40",$0.00,1,0,1,20161001,
38204,CPT,MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ,,30,,,"$2,452.83",$0.00,1,0,1,20161001,
38205,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC,,30,,,"$10,933.84",$0.00,1,0,1,20161001,
38206,CPT,BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38207,CPT,TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
38208,CPT,TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
38209,CPT,TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
38210,CPT,TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38211,CPT,TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38212,CPT,TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38213,CPT,TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38214,CPT,TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38215,CPT,TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38220,CPT,MARROW ASPIRATION ONLY,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
38221,CPT,BONE MARROW BIOPSY NEEDLE/TROCAR,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
38230,CPT,BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
38232,CPT,BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
38240,CPT,TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
38241,CPT,TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
38242,CPT,ALLOGENEIC LYMPHOCYTE INFUSIONS,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38243,CPT,TRNSPLJ HEMATOPOIETIC CELL BOOST,,30,,,"$6,423.33",$0.00,1,0,1,20161001,
38300,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
38305,CPT,DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
38308,CPT,LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38500,CPT,BX/EXC LYMPH NODE OPEN SUPERFICIAL,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38505,CPT,BX/EXC LYMPH NODE NEEDLE SUPERFICIAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
38510,CPT,BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38520,CPT,BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38525,CPT,BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38530,CPT,BX/EXC LYMPH NODE OPEN INT MAMMARY NODE,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38542,CPT,DISSECTION DEEP JUGULAR NODE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38550,CPT,EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38555,CPT,EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
38570,CPT,LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38571,CPT,LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
38572,CPT,LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
38589,CPT,UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38700,CPT,SUPRAHYOID LYMPHADENECTOMY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
38720,CPT,CERVICAL LYMPHADENECTOMY,,30,,,"$17,848.07",$0.00,1,0,1,20161001,
38740,CPT,AXILLARY LYMPHADENECTOMY SUPERFICIAL,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38745,CPT,AXILLARY LYMPHADENECTOMY COMPLETE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
38760,CPT,INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX,,30,,,"$12,201.56",$0.00,1,0,1,20161001,
38790,CPT,INJECTION PROCEDURE LYMPHANGIOGRAPHY,,30,,,"$3,872.40",$0.00,1,0,1,20161001,
38792,CPT,INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
38900,CPT,INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION,,30,,,"$1,822.31",$0.00,1,0,1,20161001,
38999,CPT,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM,,30,,,"$2,268.27",$0.00,1,0,1,20161001,
39401,CPT,MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY,,30,,,"$16,044.92",$0.00,1,0,1,20161001,
39402,CPT,MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES,,30,,,"$16,044.92",$0.00,1,0,1,20161001,
40490,CPT,BIOPSY OF LIP,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
40500,CPT,VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40510,CPT,EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40520,CPT,EXC LIP V-EXC W/PRIM DIR LINR CLSR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40525,CPT,EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40527,CPT,EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40530,CPT,RESCJ LIP > ONE-FOURTH W/O RCNSTJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40650,CPT,RPR LIP FULL THICKNESS VERMILION ONLY,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40652,CPT,RPR LIP FULL THICKNESS HALF/< VERTICAL HEIGHT,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40654,CPT,RPR LIP FULL THKNS >ONE-HALF VERT HEIGHT/COMPLE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40700,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40701,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40702,CPT,PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40720,CPT,PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40761,CPT,PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40799,CPT,UNLISTED PROCEDURE LIPS,,30,,,$853.29,$0.00,1,0,1,20161001,
40800,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
40801,CPT,DRG ABSC CST HMTMA VESTIBULE MOUTH COMP,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40804,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH SMPL,,30,,,$425.53,$0.00,1,0,1,20161001,
40805,CPT,RMVL EMBEDDED FB VESTIBULE MOUTH COMP,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40806,CPT,INCISION LABIAL FRENUM FRENOTOMY,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
40808,CPT,BIOPSY VESTIBULE MOUTH,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
40810,CPT,EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40812,CPT,EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40814,CPT,EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40816,CPT,EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40818,CPT,EXC MUCOSA VESTIBULE MOUTH AS DON GRF,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
40819,CPT,EXC FRENUM LABIAL/BUCCAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40820,CPT,DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40830,CPT,CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/<,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
40831,CPT,CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
40840,CPT,VESTIBULOPLASTY ANTERIOR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40842,CPT,VESTIBULOPLASTY POSTERIOR UNILATERAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40843,CPT,VESTIBULOPLASTY POSTERIOR BILATERAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
40844,CPT,VESTIBULOPLASTY ENTIRE ARCH,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40845,CPT,VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
40899,CPT,UNLISTED PROCEDURE VESTIBULE MOUTH,,30,,,$853.29,$0.00,1,0,1,20161001,
41000,CPT,INTRAORAL I&D TONGUE/FLOOR LINGUAL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41005,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
41006,CPT,INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41007,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41008,CPT,INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41009,CPT,INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
41010,CPT,INCISION LINGUAL FRENUM FRENOTOMY,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41015,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
41016,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41017,CPT,XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41018,CPT,XTRORAL I&D FLOOR MASTICATOR SPACE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41019,CPT,PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41100,CPT,BIOPSY TONGUE ANTERIOR TWO-THIRDS,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41105,CPT,BIOPSY TONGUE POSTERIOR ONE-THIRD,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41108,CPT,BIOPSY FLOOR MOUTH,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
41110,CPT,EXCISION LESION TONGUE W/O CLOSURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41112,CPT,EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41113,CPT,EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41114,CPT,EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41115,CPT,EXCISION LINGUAL FRENUM FRENECTOMY,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41116,CPT,EXCISION LESION FLOOR MOUTH,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41120,CPT,GLOSSECTOMY <ONE-HALF TONGUE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41250,CPT,RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG,,30,,,$425.53,$0.00,1,0,1,20161001,
41251,CPT,RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
41252,CPT,RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41500,CPT,FIXJ TONGUE MECHANICAL OTHER/THAN SUTURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41510,CPT,SUTURE TONGUE LIP MICROGNATHIA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41512,CPT,TONGUE BASE SUSPENSION PERMANENT SUTURE TQ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41520,CPT,FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41530,CPT,SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41599,CPT,UNLISTED PROCEDURE TONGUE FLOOR MOUTH,,30,,,$853.29,$0.00,1,0,1,20161001,
41800,CPT,DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS,,30,,,$425.53,$0.00,1,0,1,20161001,
41805,CPT,RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41806,CPT,RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41820,CPT,GINGIVECTOMY EXC GINGIVA EACH QUADRANT,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41821,CPT,OPRCULECTOMY EXC PRICORONAL TISSUE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41822,CPT,EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
41823,CPT,EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41825,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41826,CPT,EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41827,CPT,EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41828,CPT,EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41830,CPT,ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41850,CPT,DESTRUCTION LESION DENTOALVEOLAR STRUCTURES,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41870,CPT,PERIODONTAL MUCOSAL GRAFTING,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41872,CPT,GINGIVOPLASTY EACH QUADRANT SPECIFY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
41874,CPT,ALVEOLOPLASTY EACH QUADRANT SPECIFY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
41899,CPT,UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES,,30,,,$853.29,$0.00,1,0,1,20161001,
42000,CPT,DRAINAGE ABSCESS PALATE UVULA,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42100,CPT,BIOPSY PALATE UVULA,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42104,CPT,EXC LESION PALATE UVULA W/O CLOSURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42106,CPT,EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42107,CPT,EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42120,CPT,RESCJ PALATE/EXTENSIVE RESCJ LESION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42140,CPT,UVULECTOMY EXCISION UVULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42145,CPT,PALATOPHARYNGOPLASTY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42160,CPT,DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42180,CPT,REPAIR LACERATION PALATE </2 CM,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42182,CPT,REPAIR LACERATION PALATE >2 CM/COMPLEX,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42200,CPT,PALATOP CL PALATE SOFT&/HARD PALATE ONLY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42205,CPT,PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42210,CPT,PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42215,CPT,PALATOPLASTY CLEFT PALATE MAJOR REVJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42220,CPT,PALATOPLASTY CLEFT PALATE SEC LNGTH PX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42225,CPT,PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42226,CPT,LENGTHENING PALATE & PHARYNGEAL FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42227,CPT,LENGTHENING PALATE W/ISLAND FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42235,CPT,REPAIR ANTERIOR PALATE W/VOMER FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42260,CPT,REPAIR NASOLABIAL FISTULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42280,CPT,MAXILLARY IMPRESJ PALATAL PROSTHESIS,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42281,CPT,INSJ PIN-RETAINED PALATAL PROSTHESIS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42299,CPT,UNLISTED PROCEDURE PALATE UVULA,,30,,,$853.29,$0.00,1,0,1,20161001,
42300,CPT,DRAINAGE ABSCESS PAROTID SIMPLE,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42305,CPT,DRAINAGE ABSCESS PAROTID COMPLICATED,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42310,CPT,DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42320,CPT,DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42330,CPT,SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42335,CPT,SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42340,CPT,SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42400,CPT,BIOPSY SALIVARY GLAND NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
42405,CPT,BIOPSY SALIVARY GLAND INCISIONAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42408,CPT,EXC SUBLINGUAL SALIVARY CYST RANULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42409,CPT,MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42410,CPT,EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42415,CPT,EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42420,CPT,EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42425,CPT,EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42440,CPT,EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42450,CPT,EXISION OF SUBLINGUAL GLAND,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42500,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42505,CPT,PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42507,CPT,PAROTID DUCT DIVERSION BILATERAL WILKE PX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42509,CPT,PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42510,CPT,PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42550,CPT,INJECTION PROCEDURE SIALOGRAPHY,,30,,,$477.44,$0.00,1,0,1,20161001,
42600,CPT,CLOSURE SALIVARY FISTULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42650,CPT,DILATION SALIVARY DUCT,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42660,CPT,DILAT&CATHJ SALIVARY DUCT W/WO INJECTION,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42665,CPT,LIGATION SALIVARY DUCT INTRAORAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42699,CPT,UNLISTED PX SALIVARY GLANDS/DUCTS,,30,,,$853.29,$0.00,1,0,1,20161001,
42700,CPT,I&D ABSCESS PERITONSILLAR,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
42720,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42725,CPT,I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42800,CPT,BIOPSY OROPHARYNX,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42804,CPT,BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42806,CPT,BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42808,CPT,EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42809,CPT,REMOVAL FOREIGN BODY PHARYNX,,30,,,$425.53,$0.00,1,0,1,20161001,
42810,CPT,EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42815,CPT,EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42820,CPT,TONSILLECTOMY & ADENOIDECTOMY <AGE 12,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42821,CPT,TONSILLECTOMY & ADENOIDECTOMY AGE 12/>,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42825,CPT,TONSILLECTOMY ONE-HALF <AGE 12,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42826,CPT,TONSILLECTOMY ONE-HALF AGE 12/>,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42830,CPT,ADENOIDECTOMY PRIMARY <AGE 12,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42831,CPT,ADENOIDECTOMY PRIMARY AGE 12/>,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42835,CPT,ADENOIDECTOMY SECONDARY<AGE 12,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42836,CPT,ADENOIDECTOMY SECONDARY AGE 12/>,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42842,CPT,RADICAL RESECTION TONSIL W/O CLOSURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42844,CPT,RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42860,CPT,EXCISION TONSIL TAGS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42870,CPT,EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42890,CPT,LIMITED PHARYNGECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42892,CPT,RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42900,CPT,SUTURE PHARYNX WOUND/INJURY,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42950,CPT,PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
42955,CPT,PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
42960,CPT,CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE,,30,,,$853.29,$0.00,1,0,1,20161001,
42962,CPT,CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42970,CPT,CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS,,30,,,$853.29,$0.00,1,0,1,20161001,
42972,CPT,CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
42999,CPT,UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS,,30,,,$853.29,$0.00,1,0,1,20161001,
43020,CPT,ESOPHAGOTOMY CERVICAL APPR W/RMVL FB,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
43030,CPT,CRICOPHARYNGEAL MYOTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
43130,CPT,DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
43180,CPT,ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
43191,CPT,ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43192,CPT,ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43193,CPT,ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43194,CPT,ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43195,CPT,ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43196,CPT,ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43197,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43198,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43200,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43201,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43202,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43204,CPT,ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43205,CPT,ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43206,CPT,ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43210,CPT,EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY,,30,,,"$17,638.18",$0.00,1,0,1,20161001,
43211,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43212,CPT,ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
43213,CPT,ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43214,CPT,ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43215,CPT,ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43216,CPT,ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43217,CPT,ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43220,CPT,ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43226,CPT,ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43227,CPT,ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43229,CPT,ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43231,CPT,ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43232,CPT,ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43233,CPT,EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43235,CPT,ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43236,CPT,ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43237,CPT,ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43238,CPT,EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43239,CPT,EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43240,CPT,EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43241,CPT,EGD INTRALUMINAL TUBE/CATHETER INSERTION,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43242,CPT,EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43243,CPT,EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43244,CPT,EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43245,CPT,EGD DILATION GASTRIC/DUODENAL STRICTURE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43246,CPT,EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43247,CPT,EGD FLEXIBLE FOREIGN BODY REMOVAL,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43248,CPT,EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43249,CPT,EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43250,CPT,EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43251,CPT,EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43252,CPT,EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43253,CPT,EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43254,CPT,EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43255,CPT,EGD TRANSORAL CONTROL BLEEDING ANY METHOD,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43257,CPT,EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43259,CPT,EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43260,CPT,ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43261,CPT,ERCP W/BIOPSY SINGLE/MULTIPLE,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43262,CPT,ERCP W/SPHINCTEROTOMY/PAPILLOTOMY,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43263,CPT,ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43264,CPT,ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43265,CPT,ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43266,CPT,EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
43270,CPT,EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43273,CPT,ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC,,30,,,"$8,088.39",$0.00,1,0,1,20161001,
43274,CPT,ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
43275,CPT,ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43276,CPT,ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
43277,CPT,ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43278,CPT,ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43280,CPT,LAPS SURG ESOPG/GSTR FUNDOPLASTY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
43281,CPT,LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
43289,CPT,UNLISTED LAPAROSCOPIC PROCEDURE ESOPHAGUS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43420,CPT,CLSR ESOPHAGOSTOMY/FSTL CRV APPR,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
43450,CPT,DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43453,CPT,DILATION ESOPHAGUS GUIDE WIRE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
43499,CPT,UNLISTED PROCEDURE ESOPHAGUS,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43510,CPT,GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43647,CPT,LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
43648,CPT,LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43651,CPT,LAPS SURG TRNSXJ VAGUS NRV TRUNCAL,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43652,CPT,LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43653,CPT,LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43659,CPT,UNLISTED LAPAROSCOPIC PROCEDURE STOMACH,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
43752,CPT,NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
43753,CPT,GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE,,30,,,"$1,361.23",$0.00,1,0,1,20161001,
43754,CPT,GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN,,30,,,"$1,361.23",$0.00,1,0,1,20161001,
43755,CPT,GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC,,30,,,$666.94,$0.00,1,0,1,20161001,
43756,CPT,DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN,,30,,,$655.16,$0.00,1,0,1,20161001,
43757,CPT,DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43760,CPT,CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GDNCE,,30,,,"$1,302.06",$0.00,1,0,1,20161001,
43761,CPT,REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43770,CPT,LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
43830,CPT,GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43831,CPT,GASTROSTOMY OPN NEONATAL FEEDING,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
43842,CPT,GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY,,30,,,$910.72,$0.00,1,0,1,20161001,
43870,CPT,CLOSURE GASTROSTOMY SURG,,30,,,"$11,261.45",$0.00,1,0,1,20161001,
43886,CPT,GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
43887,CPT,GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY,,30,,,"$11,856.65",$0.00,1,0,1,20161001,
43888,CPT,GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
43999,CPT,UNLISTED PROCEDURE STOMACH,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
44100,CPT,BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44180,CPT,LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
44186,CPT,LAPAROSCOPY SURGICAL JEJUNOSTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
44238,CPT,UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
44312,CPT,REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
44340,CPT,REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
44360,CPT,ENDOSCOPY UPPER SMALL INTESTINE,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
44361,CPT,ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44363,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44364,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44365,CPT,ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44366,CPT,ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44369,CPT,ENTEROSCOPY > 2ND PRTN ABLTJ LESION,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44370,CPT,ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
44372,CPT,ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44373,CPT,ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44376,CPT,ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44377,CPT,ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44378,CPT,ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
44379,CPT,ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
44380,CPT,ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
44381,CPT,ILEOSCOPY STOMA W/BALLOON DILATION,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
44382,CPT,ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
44384,CPT,ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
44385,CPT,NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44386,CPT,NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44388,CPT,COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44389,CPT,COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44390,CPT,COLONOSCOPY STOMA W/RMVL FOREIGN BODY,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44391,CPT,COLONOSCOPY STOMA CONTROL BLEEDING,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44392,CPT,COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44394,CPT,COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44401,CPT,COLONOSCOPY STOMA ABLATION LESION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44402,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
44403,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44404,CPT,COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44405,CPT,COLONOSCOPY STOMA W/BALLOON DILATION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44406,CPT,COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44407,CPT,COLONOSCOPY STOMA W/US GID NDL ASPIR/BX,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44408,CPT,COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
44500,CPT,INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
44705,CPT,PREPARE FECAL MICROBIOTA FOR INSTILLATION,,30,,,"$2,534.52",$0.00,1,0,1,20161001,
44799,CPT,UNLISTED PROCEDURE SMALL INTESTINE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
44950,CPT,APPENDECTOMY,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
44955,CPT,APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX,,30,,,"$5,735.64",$0.00,1,0,1,20161001,
44970,CPT,LAPAROSCOPIC APPENDECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
44979,CPT,UNLISTED LAPAROSCOPY PROCEDURE APPENDIX,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
45000,CPT,TRANSRECTAL DRAINAGE OF PELVIC ABSCESS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45005,CPT,I&D SUBMUCOSAL ABSCESS RECTUM,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45020,CPT,I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45100,CPT,BX ANORECTAL WALL ANAL APPROACH,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45108,CPT,ANORECTAL MYOMECTOMY,,30,,,"$12,707.33",$0.00,1,0,1,20161001,
45150,CPT,DIVISION STRICTURE RECTUM,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45160,CPT,EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45171,CPT,EXC RCT TUM NOT INCL MUSCULARIS PROPRIA,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
45172,CPT,EXC RCT TUM INCL MUSCULARIS PROPRIA,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
45190,CPT,DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45300,CPT,PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45303,CPT,PROCTOSGMDSC RIGID W/DILATION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45305,CPT,PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45307,CPT,PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45308,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45309,CPT,PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45315,CPT,PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45317,CPT,PROCTOSGMDSC RIGID CONTROL BLEEDING,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45320,CPT,PROCTOSGMDSC RIGID ABLATION LESION,,30,,,"$12,707.33",$0.00,1,0,1,20161001,
45321,CPT,PROCTOSGMDSC RIGID DCMPRN VOLVULUS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45327,CPT,PROCTOSGMDSC RIGID TNDSC STENT PLMT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
45330,CPT,SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45331,CPT,SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45332,CPT,SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45333,CPT,SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45334,CPT,SIGMOIDOSCOPY FLX CONTROL BLEEDING,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45335,CPT,SGMDSC FLX DIRED SBMCSL NJX ANY SBST,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45337,CPT,SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45338,CPT,SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45340,CPT,SIGMOIDOSCOPY FLX TNDSC BALO DILAT,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45341,CPT,SIGMOIDOSCOPY FLX NDSC US XM,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45342,CPT,SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45346,CPT,SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45347,CPT,SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
45349,CPT,SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45350,CPT,SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S),,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45378,CPT,COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45379,CPT,COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S),,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45380,CPT,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45381,CPT,COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45382,CPT,COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45384,CPT,COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45385,CPT,COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45386,CPT,COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45388,CPT,COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45389,CPT,COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT,,30,,,"$17,681.70",$0.00,1,0,1,20161001,
45390,CPT,COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45391,CPT,COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45392,CPT,COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
45393,CPT,COLONOSCOPY FLEXIBLE WITH DECOMPRESSION,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45398,CPT,COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S),,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45399,CPT,UNLISTED PROCEDURE COLON,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
45499,CPT,UNLISTED LAPAROSCOPY PROCEDURE RECTUM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
45500,CPT,PROCTOPLASTY STENOSIS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45505,CPT,PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
45520,CPT,PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE,,30,,,$398.75,$0.00,1,0,1,20161001,
45541,CPT,PROCTOPEXY PERINEAL APPROACH,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
45560,CPT,REPAIR RECTOCELE SEPARATE PROCEDURE,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
45900,CPT,RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
45905,CPT,DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45910,CPT,DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45915,CPT,RMVL FECAL IMPACTION/FB SPX UNDER ANES,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45990,CPT,ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
45999,CPT,UNLISTED PROCEDURE RECTUM,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46020,CPT,PLACEMENT SETON,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46030,CPT,REMOVAL ANAL SETON OTHER MARKER,,30,,,"$4,645.80",$0.00,1,0,1,20161001,
46040,CPT,I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46045,CPT,I&D INTRAMURAL IM/ABSC TRANSANAL ANES,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46050,CPT,I&D PERIANAL ABSCESS SUPERFICIAL,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46060,CPT,I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46070,CPT,INCISION ANAL SEPTUM INFANT,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46080,CPT,SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46083,CPT,INCISION THROMBOSED HEMORRHOID EXTERNAL,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
46200,CPT,FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46220,CPT,EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46221,CPT,HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46230,CPT,EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46250,CPT,HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46255,CPT,HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46257,CPT,HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46258,CPT,HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY,,30,,,"$12,707.33",$0.00,1,0,1,20161001,
46260,CPT,HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46261,CPT,HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46262,CPT,HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY,,30,,,"$12,707.33",$0.00,1,0,1,20161001,
46270,CPT,SURG TX ANAL FISTULA SUBQ,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46275,CPT,SURG TX ANAL FISTULA INTERSPHINCTERIC,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46280,CPT,TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46285,CPT,SURG TX ANAL FISTULA 2ND STAGE,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46288,CPT,CLSR ANAL FSTL W/RCT ADVMNT FLAP,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46320,CPT,EXC THROMBOSED HEMORRHOID XTRNL,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46500,CPT,INJECTION SCLEROSING SOLUTION HEMORRHOIDS,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46505,CPT,CHEMODENERVATION INTERNAL ANAL SPHINCTER,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46600,CPT,ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD,,30,,,$425.53,$0.00,1,0,1,20161001,
46601,CPT,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT,,30,,,$306.21,$0.00,1,0,1,20161001,
46604,CPT,ANOSCOPY W/DILATION,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
46606,CPT,ANOSCOPY W/BX SINGLE/MULTIPLE,,30,,,"$9,573.11",$0.00,1,0,1,20161001,
46607,CPT,ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
46608,CPT,ANOSCOPY W/RMVL FOREIGN BODY,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
46610,CPT,ANOSCOPY W/RMVL LESION CAUTERY,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46611,CPT,ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
46612,CPT,ANOSC RMVL MULT TUMORS CAUTERY/SNARE,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46614,CPT,ANOSCOPY CONTROL BLEEDING,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
46615,CPT,ANOSCOPY ABLATION LESION,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46700,CPT,ANOPLASTY PLASTIC OPERATION STRICTURE ADULT,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46706,CPT,REPAIR ANAL FISTULA W/FIBRIN GLUE,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46707,CPT,REPAIR ANORECTAL FISTULA PLUG,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46750,CPT,SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46753,CPT,GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46754,CPT,RMVL THIERSCH WIRE/SUTURE ANAL CANAL,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46760,CPT,SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46761,CPT,SPHNCTROP ANAL LEVATOR MUSC IMBRCJ,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46762,CPT,SPHNCTROP ANAL IMPLTJ ARTIF SPHNCTR,,30,,,"$17,638.18",$0.00,1,0,1,20161001,
46900,CPT,DSTRJ LESION ANUS SIMPLE CHEMICAL,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
46910,CPT,DSTRJ LESION ANUS SMPL ELTRDSICCATION,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
46916,CPT,DSTRJ LESION ANUS SIMPLE CRYOSURGERY,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
46917,CPT,DSTRJ LESION ANUS SIMPLE LASER SURG,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46922,CPT,DSTRJ LESION ANUS SIMPLE SURG EXCISION,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46924,CPT,DSTRJ LESION ANUS EXTENSIVE,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46930,CPT,DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46940,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46942,CPT,CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
46945,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46946,CPT,HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
46947,CPT,HEMORRHOIDOPEXY STAPLING,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
46999,CPT,UNLISTED PROCEDURE ANUS,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
47000,CPT,BIOPSY LIVER NEEDLE PERCUTANEOUS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
47001,CPT,BX LVR NDL DONE PURPOSE TM OTH MAJOR PX,,30,,,"$6,072.36",$0.00,1,0,1,20161001,
47370,CPT,LAPS SURG ABLTJ 1/> LVR TUM RF,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
47371,CPT,LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
47379,CPT,UNLIS LAPAROSCOPIC PROCEDURE LIVER,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
47382,CPT,ABLTJ 1/> LVR TUM PRQ RF,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
47383,CPT,ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
47399,CPT,UNLISTED PROCEDURE LIVER,,30,,,"$1,917.62",$0.00,1,0,1,20161001,
47490,CPT,CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
47531,CPT,NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS,,30,,,"$2,033.10",$0.00,1,0,1,20161001,
47532,CPT,NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47533,CPT,PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47534,CPT,PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47535,CPT,CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47536,CPT,EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47537,CPT,REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I,,30,,,"$3,038.67",$0.00,1,0,1,20161001,
47538,CPT,PLMT BILE DUCT STENT PRQ EXISTING ACCESS,,30,,,"$19,163.90",$0.00,1,0,1,20161001,
47539,CPT,PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH,,30,,,"$19,163.90",$0.00,1,0,1,20161001,
47540,CPT,PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH,,30,,,"$19,163.90",$0.00,1,0,1,20161001,
47541,CPT,PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW,,30,,,"$12,037.51",$0.00,1,0,1,20161001,
47552,CPT,BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
47553,CPT,BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
47554,CPT,BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS,,30,,,"$19,163.90",$0.00,1,0,1,20161001,
47555,CPT,BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
47556,CPT,BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
47562,CPT,LAPAROSCOPY SURG CHOLECYSTECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
47563,CPT,LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
47564,CPT,LAPS SURG CHOLECSTC W/EXPL COMMON DUCT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
47579,CPT,UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
47999,CPT,UNLISTED PROCEDURE BILIARY TRACT,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
48102,CPT,BIOPSY PANCREA PERCUTANEOUS NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
48999,CPT,UNLISTED PROCEDURE PANCREAS,,30,,,"$1,917.62",$0.00,1,0,1,20161001,
49082,CPT,ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49083,CPT,ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49084,CPT,PERITONEAL LAVAGE W/WO IMAGING GUIDANCE,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49180,CPT,BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
49185,CPT,SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID,,30,,,"$5,733.20",$0.00,1,0,1,20161001,
49250,CPT,UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49320,CPT,LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49321,CPT,LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49322,CPT,LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49323,CPT,LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49324,CPT,LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49325,CPT,LAPS W/REVISION INTRAPERITONEAL CATHETER,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49326,CPT,LAPAROSCOPY W/OMENTOPEXY,,30,,,"$6,964.71",$0.00,1,0,1,20161001,
49327,CPT,LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT,,30,,,"$16,368.58",$0.00,1,0,1,20161001,
49329,CPT,UNLISTED LAPAROSCOPIC PX ABD PERTONEUM & OMENTUM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49400,CPT,INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX,,30,,,"$2,298.35",$0.00,1,0,1,20161001,
49402,CPT,REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49405,CPT,IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
49406,CPT,IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
49407,CPT,IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
49411,CPT,INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT,,30,,,"$6,357.83",$0.00,1,0,1,20161001,
49418,CPT,INSJ INTRAPERITONEAL CATHETER W/IMG GUID,,30,,,"$12,131.57",$0.00,1,0,1,20161001,
49419,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
49421,CPT,INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49422,CPT,REMOVAL TUNNELED INTRAPERITONEAL CATHETER,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
49423,CPT,EXCHNG ABSC/CST DRG CATH RAD GID SPX,,30,,,"$7,207.04",$0.00,1,0,1,20161001,
49424,CPT,CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX,,30,,,"$1,950.12",$0.00,1,0,1,20161001,
49426,CPT,REVIS PERITONEAL-VENOUS SHUNT,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49427,CPT,INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT,,30,,,"$1,810.82",$0.00,1,0,1,20161001,
49429,CPT,RMVL PERITONEAL-VENOUS SHUNT,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
49435,CPT,INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER,,30,,,"$6,686.12",$0.00,1,0,1,20161001,
49436,CPT,DELAYED CREATION EXIT SITE EMBEDDED CATHETER,,30,,,"$7,207.04",$0.00,1,0,1,20161001,
49440,CPT,INSERT GASTROSTOMY TUBE PERCUTANEOUS,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
49441,CPT,INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
49442,CPT,INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS,,30,,,"$9,960.92",$0.00,1,0,1,20161001,
49446,CPT,CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ,,30,,,"$6,638.77",$0.00,1,0,1,20161001,
49450,CPT,REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49451,CPT,REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49452,CPT,REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49460,CPT,OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
49465,CPT,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE,,30,,,$655.16,$0.00,1,0,1,20161001,
49491,CPT,RPR 1ST INGUN HRNA PRETERM INFT RDC,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49492,CPT,RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49495,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49496,CPT,RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49500,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49501,CPT,RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49505,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49507,CPT,RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49520,CPT,RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49521,CPT,RPR RECRT INGUN HERNIA ANY AGE INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49525,CPT,RPR INGUN HERNIA SLIDING ANY AGE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49540,CPT,REPAIR LUMBAR HERNIA,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49550,CPT,RPR 1ST FEM HRNA ANY AGE REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49553,CPT,RPR 1ST FEM HERNIA ANY AGE INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49555,CPT,RPR RECRT FEM HERNIA REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49557,CPT,RPR RECRT FEM HRNA INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49560,CPT,REPAIR FIRST ABDOMINAL WALL HERNIA,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49561,CPT,RPR 1ST INCAL/VNT HERNIA INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49565,CPT,RPR RECRT INCAL/VNT HERNIA REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49566,CPT,RPR RECRT INCAL/VNT HERNIA INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49568,CPT,IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE,,30,,,"$6,686.12",$0.00,1,0,1,20161001,
49570,CPT,RPR EPIGASTRIC HERNIA REDUCIBLE SPX,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49572,CPT,RPR EPIGASTRIC HERNIA INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49580,CPT,RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49582,CPT,RPR UMBILICAL HERNIA < 5 YRS INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49585,CPT,RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49587,CPT,RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49590,CPT,RPR SPIGELIAN HERNIA,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49600,CPT,RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
49650,CPT,LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49651,CPT,LAPS SURG RPR RECURRENT INGUINAL HERNIA,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49652,CPT,LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49653,CPT,LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49654,CPT,LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
49655,CPT,LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
49656,CPT,LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
49657,CPT,LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
49659,CPT,UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
49999,CPT,UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
50020,CPT,DRAINAGE PERIRENAL/RENAL ABSCESS OPEN,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
50080,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY </2 CM,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
50081,CPT,PRQ NEPHROSTOLITHOTOMY/PYELOSTOLITHOTOMY > 2 CM,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
50200,CPT,RENAL BIOPSY PRQ TROCAR/NEEDLE,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
50382,CPT,RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
50384,CPT,REMOVAL INDWELLING URETERAL STENT PRQ,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
50385,CPT,REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50386,CPT,REMOVE INT DWELL URETERAL STENT TRANSURETHRAL,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50387,CPT,RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH,,30,,,"$7,207.04",$0.00,1,0,1,20161001,
50389,CPT,RMVL NFROS TUBE REQ FLUORO GUIDANCE,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50390,CPT,ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
50391,CPT,INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
50395,CPT,INTRO GUIDE PELVIS&/URETER W/DILAT NFROS TRACT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
50396,CPT,MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50430,CPT,NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS,,30,,,"$3,069.05",$0.00,1,0,1,20161001,
50431,CPT,NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS,,30,,,"$3,069.05",$0.00,1,0,1,20161001,
50432,CPT,PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50433,CPT,PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50434,CPT,CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ,,30,,,"$3,069.05",$0.00,1,0,1,20161001,
50435,CPT,EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I,,30,,,"$3,069.05",$0.00,1,0,1,20161001,
50541,CPT,LAPAROSCOPY SURG ABLATION RENAL CYSTS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
50542,CPT,LAPS ABLTJ RENAL MASS LESION W/INTRAOP US,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
50543,CPT,LAPAROSCOPY SURG PARTIAL NEPHRECTOMY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
50544,CPT,LAPAROSCOPY SURG PYELOPLASTY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
50549,CPT,UNLISTED LAPAROSCOPY PROCEDURE RENAL,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
50551,CPT,RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50553,CPT,RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50555,CPT,RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50557,CPT,RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI,,30,,,"$23,474.66",$0.00,1,0,1,20161001,
50561,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50562,CPT,RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50570,CPT,RENAL NDSC NEPHROTOMY W/WO IRRIGATION,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50572,CPT,RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50574,CPT,RENAL NDSC NEPHROTOMY W/BIOPSY,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50575,CPT,RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
50576,CPT,RNL NDSC NFROT FULGURATION &/INCISION W/WO BX,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
50580,CPT,RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
50590,CPT,LITHOTRIPSY XTRCORP SHOCK WAVE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50592,CPT,ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
50593,CPT,ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
50684,CPT,INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH,,30,,,$924.38,$0.00,1,0,1,20161001,
50686,CPT,MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH,,30,,,$746.33,$0.00,1,0,1,20161001,
50688,CPT,CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL,,30,,,"$7,207.04",$0.00,1,0,1,20161001,
50690,CPT,NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG,,30,,,"$1,232.51",$0.00,1,0,1,20161001,
50693,CPT,PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50694,CPT,PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50695,CPT,PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50727,CPT,REVJ URINARY-CUTANEOUS ANASTAMOSIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
50945,CPT,LAPAROSCOPY URTROLITHOTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
50947,CPT,LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
50948,CPT,LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
50949,CPT,UNLISTED LAPAROSCOPY PROCEDURE URETER,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
50951,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50953,CPT,URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER,,30,,,"$12,104.95",$0.00,1,0,1,20161001,
50955,CPT,URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
50957,CPT,URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50961,CPT,URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
50970,CPT,URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50972,CPT,NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
50974,CPT,URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50976,CPT,URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
50980,CPT,NDSC URETEROTOMY RMVL FB/CALCULUS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51020,CPT,CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51030,CPT,CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51040,CPT,CYSTOSTOMY CYSTOTOMY W/DRAINAGE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
51045,CPT,CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
51050,CPT,CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
51060,CPT,TRANSVESICAL URETROLITHOTOMY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51065,CPT,CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
51080,CPT,DRG PRIVESICAL/PREVESICAL SPACE ABSC,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
51100,CPT,ASPIRATION BLADDER NEEDLE,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
51101,CPT,ASPIRATION BLADDER TROCAR/INTRACATHETER,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
51102,CPT,ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
51500,CPT,EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
51520,CPT,CYSTOTOMY SIMPLE EXCISION VESICAL NECK,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51535,CPT,CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51600,CPT,NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY,,30,,,"$1,155.48",$0.00,1,0,1,20161001,
51605,CPT,NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY,,30,,,"$1,232.51",$0.00,1,0,1,20161001,
51610,CPT,NJX RETROGRADE URETHROCSTOGRAPY,,30,,,"$1,386.57",$0.00,1,0,1,20161001,
51700,CPT,BLDR IRRIGATION SMPL LAVAGE &/INSTLJ,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
51701,CPT,INSJ NON-NDWELLG BLADDER CATHETER,,30,,,$425.53,$0.00,1,0,1,20161001,
51702,CPT,INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE,,30,,,$425.53,$0.00,1,0,1,20161001,
51703,CPT,INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED,,30,,,$746.33,$0.00,1,0,1,20161001,
51705,CPT,CHANGE CYSTOSTOMY TUBE SIMPLE,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
51710,CPT,CHANGE CYSTOSTOMY TUBE COMPLICATED,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
51715,CPT,NDSC NJX IMPLT MATRL URT&/BLDR NCK,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
51720,CPT,BLADDER INSTILLATION ANTICARCINOGENIC AGENT,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
51725,CPT,SIMPLE CYSTOMETROGRAM,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
51726,CPT,BLADDER PRESSURE MEASUREMENT DURING FILLING,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
51727,CPT,COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
51728,CPT,COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
51729,CPT,COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
51736,CPT,SIMPLE UROFLOMETRY,,30,,,$425.53,$0.00,1,0,1,20161001,
51741,CPT,COMPLEX UROFLOMETRY,,30,,,$666.94,$0.00,1,0,1,20161001,
51784,CPT,EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL,,30,,,$746.33,$0.00,1,0,1,20161001,
51785,CPT,NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
51792,CPT,STIMULUS EVOKED RESPONSE,,30,,,$306.21,$0.00,1,0,1,20161001,
51797,CPT,VOID PRESSURE STUDIES INTRAABDOMINAL,,30,,,"$1,617.67",$0.00,1,0,1,20161001,
51798,CPT,MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP,,30,,,$425.53,$0.00,1,0,1,20161001,
51845,CPT,ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
51860,CPT,CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
51880,CPT,CLOSURE CYSTOSTOMY SEPARATE PROCEDURE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
51990,CPT,LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
51992,CPT,LAPAROSCOPY SLING OPERATION STRESS INCONT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
51999,CPT,UNLISTED LAPAROSCOPY PROCEDURE BLADDER,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
52000,CPT,CYSTOURETHROSCOPY,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
52001,CPT,CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52005,CPT,CYSTO BLADDER W/URETERAL CATHETERIZATION,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52007,CPT,CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52010,CPT,CYSTO W/EJACULATORY DUCT CATHETERIZATION,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
52204,CPT,CYSTOURETHROSCOPY WITH BIOPSY,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52214,CPT,CYSTO W/DESTRUCTION OF LESIONS,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52224,CPT,CYSTO W/REMOVAL OF LESIONS SMALL,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52234,CPT,CYSTO W/REMOVAL OF TUMORS SMALL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52235,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52240,CPT,CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52250,CPT,CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52260,CPT,CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52265,CPT,CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52270,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52275,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52276,CPT,CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52277,CPT,CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52281,CPT,CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52282,CPT,CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52283,CPT,CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52285,CPT,CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52287,CPT,CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52290,CPT,CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52300,CPT,CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52301,CPT,CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52305,CPT,CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52310,CPT,CYSTO W/SIMPLE REMOVAL STONE & STENT,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52315,CPT,CYSTO W/COMPLEX REMOVAL STONE & STENT,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
52317,CPT,LITHOLAPAXY SMPL/SM <2.5 CM,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52318,CPT,LITHOLAPAXY COMP/LG > 2.5 CM,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52320,CPT,CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52325,CPT,CYSTO FRAGMENTATION URETERAL STONE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52327,CPT,CYSTO W/SUBURTRIC NJX IMPLT MATRL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52330,CPT,CYSTO MANJ W/O RMVL URETERAL STONE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52332,CPT,CYSTO W/INSERT URETERAL STENT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52334,CPT,CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52341,CPT,CYSTO W/TX URETERAL STRICTURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52342,CPT,CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52343,CPT,CYSTO W/TX INTRA-RENAL STRICTURE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
52344,CPT,CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52345,CPT,CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52346,CPT,CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52351,CPT,CYSTO W/URTROSCOPY&/PYELOSCOPY DX,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52352,CPT,CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52353,CPT,CYSTO W/URETEROSCOPY W/LITHOTRIPSY,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52354,CPT,CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52355,CPT,CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52356,CPT,CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
52400,CPT,CYSTO INC FULG/RESCJ URTL VALVES/FOLDS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52402,CPT,CSTO W/TRURL RESCJ/INC EJACULATORY DUXS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52441,CPT,CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE,,30,,,"$25,882.65",$0.00,1,0,1,20161001,
52442,CPT,CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL,,30,,,"$25,882.65",$0.00,1,0,1,20161001,
52450,CPT,TRANSURETHRAL INCISION PROSTATE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52500,CPT,TRANSURETHRAL RESECTION PROSTATE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52601,CPT,TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52630,CPT,TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52640,CPT,TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
52647,CPT,LASER COAGULATION OF PROSTATE FOR URINE FLOW,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52648,CPT,LASER VAPORIZATION OF PROSTATE FOR URINE FLOW,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
52649,CPT,LASER ENUCLEATION PROSTATE W/MORCELLATION,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
52700,CPT,TRURL DRAINAGE PROSTATIC ABSCESS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53000,CPT,URTT/URTS XTRNL SPX PENDULOUS URETHRA,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53010,CPT,URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53020,CPT,MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53025,CPT,MEATOTOMY CUTTING MEATUS SPX INFANT,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53040,CPT,DRAINAGE DEEP PERIURETHRAL ABSCESS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53060,CPT,DRG OF SKENE'S GLAND ABSCESS OR CYST,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53080,CPT,DRG PERINEAL URINARY XTRVASATION UNCOMP SPX,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53085,CPT,DRG PERINEAL URINARY XTRVASATION COMPLIC,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53200,CPT,BIOPSY URETHRA,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53210,CPT,URETHRECTOMY TOT W/CYSTOST FEMALE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53215,CPT,URETHRECTOMY TOT W/CYSTOST MALE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53220,CPT,EXC/FULGURATION CARCINOMA URETHRA,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53230,CPT,EXC URETHRAL DIVERTICULUM SPX FEMALE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53235,CPT,EXC URETHRAL DIVERTICULUM SPX MALE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53240,CPT,MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53250,CPT,EXCISION OF BULBOURETHRAL GLAND,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53260,CPT,EXC/FULGURATION URETHRAL POLYP DSTL URETHRA,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53265,CPT,EXC/FULGURATION URETHRAL CARUNCLE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
53270,CPT,EXCISION OR FULGURATION SKENES GLANDS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53275,CPT,EXCISION/FULGURATION URETHRAL PROLAPSE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53400,CPT,URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53405,CPT,URETHROPLASTY 2ND STAGE W/URINARY DIVERSION,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53410,CPT,URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53420,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53425,CPT,URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53430,CPT,URETHROPLASTY RCNSTJ FEMALE URETHRA,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53431,CPT,URTP W/TUBULARIZATION POST URT&/LWR BLDR,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53440,CPT,SLING OPRATION CORRJ MALE URINARY INCONTINENCE,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
53442,CPT,RMVL/REVJ SLING MALE URINARY INCONTINENCE,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53444,CPT,INSERTION TANDEM CUFF,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
53445,CPT,INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
53446,CPT,REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53447,CPT,RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
53449,CPT,RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53450,CPT,URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53460,CPT,URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53500,CPT,URETHROLSS TRVG SEC OPN W/CSTO,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53502,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
53505,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53510,CPT,URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53515,CPT,URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
53520,CPT,CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53600,CPT,DILAT URETHRAL STRIX DILATOR MALE 1ST,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
53601,CPT,DILAT URETHRAL STRIX DILATOR MALE SBSQ,,30,,,$425.53,$0.00,1,0,1,20161001,
53605,CPT,DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53620,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
53621,CPT,DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
53660,CPT,DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI,,30,,,$746.33,$0.00,1,0,1,20161001,
53661,CPT,DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ,,30,,,$425.53,$0.00,1,0,1,20161001,
53665,CPT,DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53850,CPT,TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
53852,CPT,TRURL DSTRJ PRSTATE TISS RF THERMOTH,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
53855,CPT,INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
53860,CPT,TRURL RF FEMALE BLADDER NECK STRS URIN INCONT,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
53899,CPT,UNLISTED PROCEDURE URINARY SYSTEM,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54000,CPT,SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54001,CPT,SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54015,CPT,I&D PENIS DEEP,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
54050,CPT,DSTRJ LESION PENIS SIMPLE CHEMICAL,,30,,,$398.75,$0.00,1,0,1,20161001,
54055,CPT,DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
54056,CPT,DSTRJ LESION PENIS SIMPLE CRYOSURGERY,,30,,,$398.75,$0.00,1,0,1,20161001,
54057,CPT,DSTRJ LESION PENIS SIMPLE LASER,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
54060,CPT,DSTRJ LESION PENIS SIMPLE SURG EXCISION,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
54065,CPT,DSTRJ LESION PENIS EXTENSIVE,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
54100,CPT,BIOPSY PENIS SEPARATE PROCEDURE,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
54105,CPT,BIOPSY PENIS DEEP STRUCTURES,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
54110,CPT,EXCISION OF PENILE PLAQUE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54111,CPT,EXC PENILE PLAQUE GRAFT &/5 CM LENGTH,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
54112,CPT,EXC PENILE PLAQUE GRAFT > 5 CM LENGTH,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
54115,CPT,REMOVAL FOREIGN BODY DEEP PENILE TISSUE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
54120,CPT,AMPUTATION PENIS PARTIAL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54150,CPT,CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54160,CPT,CIRCUMCISION NEONATE,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54161,CPT,CIRCUMCISION AGE >28 DAYS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54162,CPT,LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54163,CPT,REPAIR INCOMPLETE CIRCUMCISION,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54164,CPT,FRENULOTOMY PENIS,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
54200,CPT,INJECTION PEYRONIE DISEASE,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54205,CPT,NJX PEYRONIE W/SURG EXPOS PLAQUE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54220,CPT,IRRIGATION CORPORA CAVERNOSA PRIAPISM,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54230,CPT,INJECTION CORPORA CAVERNOSOGRAPY,,30,,,"$2,481.75",$0.00,1,0,1,20161001,
54231,CPT,DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54235,CPT,NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54240,CPT,PENILE PLETHYSMOGRAPHY,,30,,,$666.94,$0.00,1,0,1,20161001,
54250,CPT,NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54300,CPT,PENIS STRAIGHTENING CHORDEE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54304,CPT,PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54308,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54312,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54316,CPT,URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54318,CPT,URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54322,CPT,1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54324,CPT,1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54326,CPT,1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54328,CPT,1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54332,CPT,1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54336,CPT,1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54340,CPT,RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54344,CPT,RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54348,CPT,RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54352,CPT,RPR HYPOSPADIAS CRIPPLE W/DSJ & EXC & GRFS/FLAP,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54360,CPT,PLASTIC RPR PENIS CORRECT ANGULATION,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54380,CPT,PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54385,CPT,PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54400,CPT,INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
54401,CPT,INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54405,CPT,INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54406,CPT,RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54408,CPT,RPR COMPONENT INFLATABLE PENILE PROSTHESIS,,30,,,"$18,503.20",$0.00,1,0,1,20161001,
54410,CPT,RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54411,CPT,RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54415,CPT,RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54416,CPT,RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54417,CPT,RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD,,30,,,"$28,954.76",$0.00,1,0,1,20161001,
54420,CPT,CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
54435,CPT,CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
54437,CPT,REPAIR OF TRAUMATIC CORPOREAL TEAR(S),,30,,,"$8,784.97",$0.00,1,0,1,20161001,
54440,CPT,PLASTIC OPERATION PENIS INJURY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54450,CPT,FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
54500,CPT,BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
54505,CPT,BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54512,CPT,EXC XTRPARENCHYMAL LESION TESTIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54520,CPT,ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54522,CPT,ORCHIECTOMY PARTIAL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54530,CPT,ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
54535,CPT,ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54550,CPT,EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
54560,CPT,EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54600,CPT,RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54620,CPT,FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
54640,CPT,ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
54650,CPT,ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
54660,CPT,INSJ TESTICULAR PROSTH SEPARATE PROCEDURE,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
54670,CPT,SUTURE/REPAIR TESTICULAR INJURY,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54680,CPT,TRANSPLANTATION TESTIS TO THIGH,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54690,CPT,LAPAROSCOPY SURGICAL ORCHIECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
54692,CPT,LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
54699,CPT,UNLISTED LAPAROSCOPY PROCEDURE TESTIS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
54700,CPT,I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54800,CPT,BIOPSY EPIDIDYMIS NEEDLE,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
54830,CPT,EXCISION LOCAL LESION EPIDIDYMIS,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54840,CPT,EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54860,CPT,EPIDIDYMECTOMY UNILATERAL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54861,CPT,EPIDIDYMECTOMY BILATERAL,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54865,CPT,EXPLORATION EPIDIDYMIS W/WO BIOPSY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
54900,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
54901,CPT,EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55000,CPT,PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
55040,CPT,EXCISION HYDROCELE UNILATERAL,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
55041,CPT,EXCISION HYDROCELE BILATERAL,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
55060,CPT,RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55100,CPT,DRAINAGE SCROTAL WALL ABSCESS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
55110,CPT,SCROTAL EXPLORATION,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55120,CPT,REMOVAL FOREIGN BODY SCROTUM,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
55150,CPT,RESECTION SCROTUM,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55175,CPT,SCROTOPLASTY SIMPLE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55180,CPT,SCROTOPLASTY COMPLICATED,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
55200,CPT,VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55250,CPT,VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55300,CPT,VASOTOMY VASOGRAMS UNI/BI,,30,,,"$11,345.14",$0.00,1,0,1,20161001,
55400,CPT,VASOVASOSTOMY VASOVASORRHAPHY,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55450,CPT,LIGATION PRQ VAS DEFERENS UNI/BI SPX,,30,,,"$8,784.97",$0.00,1,0,1,20161001,
55500,CPT,EXC HYDROCELE SPRMATIC CORD UNI SPX,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55520,CPT,EXC LESION SPERMATIC CORD SEPARATE PROCEDURE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55530,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55535,CPT,EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
55540,CPT,EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
55550,CPT,LAPS LIGATION SPERMATIC VEINS VARICOCELE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
55559,CPT,UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
55600,CPT,VESICULOTOMY,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55680,CPT,EXCISION MULLERIAN DUCT CYST,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55700,CPT,PROSTATE NEEDLE BIOPSY ANY APPROACH,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55705,CPT,BIOPSY PROSTATE INCISIONAL ANY APPROACH,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55706,CPT,BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55720,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
55725,CPT,PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55860,CPT,EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55870,CPT,ELECTROEJACULATION,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
55873,CPT,CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI,,30,,,"$23,464.65",$0.00,1,0,1,20161001,
55875,CPT,TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
55876,CPT,PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT,,30,,,"$6,357.83",$0.00,1,0,1,20161001,
55899,CPT,UNLISTED PROCEDURE MALE GENITAL SYSTEM,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
55920,CPT,PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL,,30,,,"$14,066.64",$0.00,1,0,1,20161001,
55970,CPT,INTERSEX SURG MALE FEMALE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
55980,CPT,INTERSEX SURG FEMALE MALE,,30,,,"$13,584.43",$0.00,1,0,1,20161001,
56405,CPT,I&D VULVA/PERINEAL ABSCESS,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
56420,CPT,I&D OF BARTHOLINS GLAND ABSCESS,,30,,,$916.02,$0.00,1,0,1,20161001,
56440,CPT,MARSUPIALIZATION BARTHOLINS GLAND CYST,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56441,CPT,LYSIS LABIAL ADHESIONS,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56442,CPT,HYMENOTOMY SIMPLE INCISION,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56501,CPT,DESTRUCTION LESIONS VULVA SIMPLE,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
56515,CPT,DESTRUCTION LESIONS VULVA EXTENSIVE,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
56605,CPT,BIOPSY VULVA/PERINEUM 1 LESION SPX,,30,,,"$1,605.28",$0.00,1,0,1,20161001,
56606,CPT,BIOPSY VULVA/PERINEUM EACH ADDL LESION,,30,,,"$1,222.39",$0.00,1,0,1,20161001,
56620,CPT,VULVECTOMY SIMPLE PARTIAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56625,CPT,VULVECTOMY SIMPLE COMPLETE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56700,CPT,PRTL HYMENECTOMY/REVJ HYMENAL RING,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56740,CPT,EXC BARTHOLINS GLAND/CYST,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56800,CPT,PLASTIC REPAIR INTROITUS,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56805,CPT,CLITOROPLASTY INTERSEX STATE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56810,CPT,PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
56820,CPT,COLPOSCOPY VULVA,,30,,,$916.02,$0.00,1,0,1,20161001,
56821,CPT,COLPOSCOPY VULVA W/BIOPSY,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57000,CPT,COLPOTOMY W/EXPLORATION,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57010,CPT,COLPOTOMY W/DRAINAGE PELVIC ABSCESS,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57020,CPT,COLPOCENTESIS SEPARATE PROCEDURE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57022,CPT,I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
57023,CPT,I&D VAGINAL HEMATOMA NON-OBSTETRICAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
57061,CPT,DESTRUCTION VAGINAL LESIONS SIMPLE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57065,CPT,DESTRUCTION VAGINAL LESIONS EXTENSIVE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57100,CPT,BIOPSY VAGINAL MUCOSA SIMPLE,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
57105,CPT,BIOPSY VAGINAL MUCOSA EXTENSIVE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57106,CPT,VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57107,CPT,VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57109,CPT,VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57120,CPT,COLPOCLEISIS LE FORT TYPE,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57130,CPT,EXCISION VAGINAL SEPTUM,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57135,CPT,EXCISION VAGINAL CYST/TUMOR,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57150,CPT,IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE,,30,,,$425.53,$0.00,1,0,1,20161001,
57155,CPT,INSERTION UTERINE TANDEM&/VAGINAL OVOIDS,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57156,CPT,INSERTION VAGINAL RADIATION DEVICE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57160,CPT,FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI,,30,,,$916.02,$0.00,1,0,1,20161001,
57170,CPT,DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS,,30,,,$916.02,$0.00,1,0,1,20161001,
57180,CPT,INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX,,30,,,$916.02,$0.00,1,0,1,20161001,
57200,CPT,COLPORRHAPHY SUTURE INJURY VAGINA,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57210,CPT,COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57220,CPT,PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57230,CPT,PLASTIC REPAIR URETHROCELE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57240,CPT,ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57250,CPT,POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57260,CPT,COMBINED ANTEROPOSTERIOR COLPORRHAPHY,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57265,CPT,CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57267,CPT,INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE,,30,,,"$6,519.39",$0.00,1,0,1,20161001,
57268,CPT,REPAIR ENTEROCELE VAGINAL APPROACH SPX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57282,CPT,COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57283,CPT,COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57284,CPT,PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57285,CPT,PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57287,CPT,RMVL/REVJ SLING STRESS INCONTINENCE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57288,CPT,SLING OPERATION STRESS INCONTINENCE,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57289,CPT,PEREYRA PX W/ANTERIOR COLPORRHAPHY,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57291,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57292,CPT,CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57295,CPT,REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57300,CPT,CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57310,CPT,CLOSURE URETHROVAGINAL FISTULA,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57320,CPT,CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57330,CPT,CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57335,CPT,VAGINOPLASTY INTERSEX STATE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57400,CPT,DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57410,CPT,PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57415,CPT,REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57420,CPT,COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57421,CPT,COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
57423,CPT,PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
57425,CPT,LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
57426,CPT,REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
57452,CPT,COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA,,30,,,$916.02,$0.00,1,0,1,20161001,
57454,CPT,COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57455,CPT,COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57456,CPT,COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57460,CPT,COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57461,CPT,COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57500,CPT,BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
57505,CPT,ENDOCERVICAL CURETTAGE W/DILATION & CURETTAGE,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
57510,CPT,CAUTERY CERVIX ELECTRO/THERMAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57511,CPT,CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
57513,CPT,CAUTERY CERVIX LASER ABLATION,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57520,CPT,CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57522,CPT,CONIZATION CERVIX W/WO D&C RPR ELTRD EXC,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57530,CPT,TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57550,CPT,EXCISION CERVICAL STUMP VAGINAL APPROACH,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57555,CPT,EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57556,CPT,EXC CRV STUMP VAG APPR W/RPR NTRCL,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
57558,CPT,DILATION & CURETTAGE CERVICAL STUMP,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57700,CPT,CERCLAGE UTERINE CERVIX NONOBSTETRICAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57720,CPT,TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
57800,CPT,DILATION CERVICAL CANAL INSTRUMENTAL SPX,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58100,CPT,ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX,,30,,,$916.02,$0.00,1,0,1,20161001,
58110,CPT,ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY,,30,,,"$1,086.56",$0.00,1,0,1,20161001,
58120,CPT,DILATION & CURETTAGE DX&/THER NONOBSTETRIC,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58145,CPT,MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58260,CPT,VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58262,CPT,VAG HYST 250 GM/< W/RMVL TUBE&/OVARY,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58263,CPT,VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58270,CPT,VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58290,CPT,VAGINAL HYSTERECTOMY UTERUS > 250 GM,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
58291,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58292,CPT,VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
58294,CPT,VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58300,CPT,INSERTION INTRAUTERINE DEVICE IUD,,30,,,"$2,308.95",$0.00,1,0,1,20161001,
58301,CPT,REMOVAL INTRAUTERINE DEVICE IUD,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
58321,CPT,ARTIFICIAL INSEMINATION INTRA-CERVICAL,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
58322,CPT,ARTIFICIAL INSEMINATION INTRA-UTERINE,,30,,,$916.02,$0.00,1,0,1,20161001,
58323,CPT,SPERM WASHING ARTIFICIAL INSEMINATION,,30,,,$916.02,$0.00,1,0,1,20161001,
58340,CPT,CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI,,30,,,"$2,444.77",$0.00,1,0,1,20161001,
58345,CPT,TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58346,CPT,INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58350,CPT,CHROMOTUBATION OVIDUCT W/MATERIALS,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58353,CPT,ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58356,CPT,ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58541,CPT,LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/<,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58542,CPT,LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58543,CPT,LAPS SUPRACERVICAL HYSTERECTOMY >250,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58544,CPT,LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58545,CPT,LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/<,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58546,CPT,LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58550,CPT,LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58552,CPT,LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58553,CPT,LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58554,CPT,LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58555,CPT,HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58558,CPT,HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58559,CPT,HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58560,CPT,HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58561,CPT,HYSTEROSCOPY REMOVAL LEIOMYOMATA,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58562,CPT,HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58563,CPT,HYSTEROSCOPY ENDOMETRIAL ABLATION,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58565,CPT,HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58570,CPT,LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/<,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58571,CPT,LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58572,CPT,LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58573,CPT,LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
58578,CPT,UNLISTED LAPAROSCOPY PROCEDURE UTERUS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58579,CPT,UNLISTED HYSTEROSCOPY PROCEDURE UTERUS,,30,,,"$3,401.12",$0.00,1,0,1,20161001,
58600,CPT,LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58615,CPT,OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58660,CPT,LAPAROSCOPY W/LYSIS OF ADHESIONS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58661,CPT,LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58662,CPT,LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58670,CPT,LAPAROSCOPY FULGURATION OVIDUCTS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58671,CPT,LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58672,CPT,LAPAROSCOPY FIMBRIOPLASTY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58673,CPT,LAPAROSCOPY SALPINGOSTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58679,CPT,UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT/OVARY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
58770,CPT,SALPINGOSTOMY,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58800,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58805,CPT,DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58820,CPT,DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58900,CPT,BIOPSY OVARY UNI/BI SEPARATE PROCEDURE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
58920,CPT,WEDGE RESCJ/BISCTJ OVARY UNI/BI,,30,,,"$22,540.88",$0.00,1,0,1,20161001,
58925,CPT,OVARIAN CYSTECTOMY UNI/BI,,30,,,"$17,955.82",$0.00,1,0,1,20161001,
58970,CPT,FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
58974,CPT,EMBRYO TRANSFER INTRAUTERINE,,30,,,"$1,605.28",$0.00,1,0,1,20161001,
58976,CPT,GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
58999,CPT,UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL,,30,,,$916.02,$0.00,1,0,1,20161001,
59000,CPT,AMNIOCENTESIS DIAGNOSIC,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
59001,CPT,AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59012,CPT,CORDOCENTESIS INTRAUTERINE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59015,CPT,CHORIONIC VILLUS SAMPLING,,30,,,"$3,963.68",$0.00,1,0,1,20161001,
59020,CPT,FETAL CONTRACTION STRESS TEST,,30,,,$916.02,$0.00,1,0,1,20161001,
59025,CPT,FETAL NONSTRESS TEST,,30,,,$916.02,$0.00,1,0,1,20161001,
59030,CPT,FETAL SCALP BLOOD SAMPLING,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59050,CPT,FETAL MONITORING LABOR PHYS WRITTEN REPORT,,30,,,$826.80,$0.00,1,0,1,20161001,
59051,CPT,FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY,,30,,,$641.23,$0.00,1,0,1,20161001,
59070,CPT,TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE,,30,,,"$1,605.28",$0.00,1,0,1,20161001,
59072,CPT,FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59074,CPT,FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59076,CPT,FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59100,CPT,HYSTEROTOMY ABDOMINAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59150,CPT,LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
59151,CPT,LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
59160,CPT,CURETTAGE POSTPARTUM,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59200,CPT,INSERTION CERVICAL DILATOR SEPARATE PROCEDURE,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59300,CPT,EPISIOTOMY/VAG RPR OTH/THN ATTENDING,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59320,CPT,CERCLAGE CERVIX PREGNANCY VAGINAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59400,CPT,OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM,,30,,,"$6,315.81",$0.00,1,0,1,20161001,
59409,CPT,VAGINAL DELIVERY ONLY,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59410,CPT,VAGINAL DELIVERY ONLY W/POSTPARTUM CARE,,30,,,"$4,019.15",$0.00,1,0,1,20161001,
59412,CPT,EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59414,CPT,DELIVERY PLACENTA SEPARATE PROCEDURE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59425,CPT,ANTEPARTUM CARE ONLY 4-6 VISITS,,30,,,$289.38,$0.00,1,0,1,20161001,
59426,CPT,ANTEPARTUM CARE ONLY 7/> VISITS,,30,,,$413.26,$0.00,1,0,1,20161001,
59430,CPT,POSTPARTUM CARE ONLY SEPARATE PROCEDURE,,30,,,$296.96,$0.00,1,0,1,20161001,
59612,CPT,VAGINAL DELIVERY AFTER CESAREAN DELIVERY,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59812,CPT,TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59820,CPT,TX MISSED ABORTION FIRST TRIMESTER SURGICAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59821,CPT,TX MISSED ABORTION SECOND TRIMESTER SURGICAL,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59840,CPT,INDUCED ABORTION DILATION AND CURETTAGE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59841,CPT,INDUCED ABORTION DILATION & EVACUATION,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59866,CPT,MULTIFETAL PREGNANCY REDUCTION,,30,,,"$1,513.74",$0.00,1,0,1,20161001,
59870,CPT,UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59871,CPT,REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA,,30,,,"$10,673.06",$0.00,1,0,1,20161001,
59897,CPT,UNLISTED FETAL INVASIVE PX W/ULTRASOUND,,30,,,$916.02,$0.00,1,0,1,20161001,
59898,CPT,UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
59899,CPT,UNLISTED PROCEDURE MATERNITY CARE & DELIVERY,,30,,,$916.02,$0.00,1,0,1,20161001,
60000,CPT,I&D THYROGLOSSAL DUCT CYST INFECTED,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
60100,CPT,BIOPSY THYROID PERCUTANEOUS CORE NEEDLE,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
60200,CPT,EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60210,CPT,PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60212,CPT,PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60220,CPT,TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60225,CPT,TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60240,CPT,THYROIDECTOMY TOTAL/COMPLETE,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60252,CPT,THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60260,CPT,THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60271,CPT,THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60280,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60281,CPT,EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60300,CPT,ASPIRATION AND/OR INJECTION THYROID CYST,,30,,,"$3,058.90",$0.00,1,0,1,20161001,
60500,CPT,PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60502,CPT,PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60512,CPT,PARATHYROID AUTOTRANSPLANTATION ADD-ON,,30,,,"$7,724.99",$0.00,1,0,1,20161001,
60520,CPT,THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
60659,CPT,UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
60699,CPT,UNLISTED PROCEDURE ENDOCRINE SYSTEM,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
61000,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
61001,CPT,SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
61020,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
61026,CPT,VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ,,30,,,"$2,614.09",$0.00,1,0,1,20161001,
61050,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
61055,CPT,CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
61070,CPT,PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX,,30,,,"$3,084.03",$0.00,1,0,1,20161001,
61215,CPT,INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
61330,CPT,DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
61623,CPT,EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
61626,CPT,TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
61720,CPT,CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
61770,CPT,STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
61781,CPT,STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL,,30,,,"$3,198.91",$0.00,1,0,1,20161001,
61782,CPT,STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL,,30,,,"$3,503.84",$0.00,1,0,1,20161001,
61790,CPT,CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
61791,CPT,CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
61796,CPT,STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES,,30,,,"$23,200.57",$0.00,1,0,1,20161001,
61797,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE,,30,,,"$7,733.52",$0.00,1,0,1,20161001,
61798,CPT,STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES,,30,,,"$25,133.95",$0.00,1,0,1,20161001,
61799,CPT,STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX,,30,,,"$9,666.90",$0.00,1,0,1,20161001,
61800,CPT,APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY,,30,,,"$4,833.45",$0.00,1,0,1,20161001,
61880,CPT,REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
61885,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR,,30,,,"$34,569.16",$0.00,1,0,1,20161001,
61886,CPT,INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS,,30,,,"$53,493.40",$0.00,1,0,1,20161001,
61888,CPT,REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
62000,CPT,ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
62194,CPT,RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
62225,CPT,RPLCMT/IRRIGATION VENTRICULAR CATHETER,,30,,,"$7,207.04",$0.00,1,0,1,20161001,
62230,CPT,RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
62252,CPT,REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT,,30,,,$973.44,$0.00,1,0,1,20161001,
62263,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62264,CPT,PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62267,CPT,PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
62268,CPT,PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62269,CPT,BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE,,30,,,"$5,733.20",$0.00,1,0,1,20161001,
62270,CPT,SPINAL PUNCTURE LUMBAR DIAGNOSTIC,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62272,CPT,SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62273,CPT,INJECTION EPIDURAL BLOOD/CLOT PATCH,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62280,CPT,INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62281,CPT,INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62282,CPT,INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62284,CPT,INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR,,30,,,"$3,286.75",$0.00,1,0,1,20161001,
62287,CPT,DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
62290,CPT,INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR,,30,,,"$3,528.42",$0.00,1,0,1,20161001,
62291,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,30,,,"$3,286.75",$0.00,1,0,1,20161001,
62292,CPT,INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
62294,CPT,NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62302,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
62303,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
62304,CPT,MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
62305,CPT,MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
62310,CPT,NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62311,CPT,NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
62318,CPT,NJXS INFUS/BOLUS DX/SBST EDRL/SUBARACH CRV/THRC,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
62319,CPT,NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL,,30,,,"$5,048.03",$0.00,1,0,1,20161001,
62350,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
62351,CPT,IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
62355,CPT,RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
62360,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR,,30,,,"$30,781.06",$0.00,1,0,1,20161001,
62361,CPT,IMPLTJ/RPLCMT FS NON-PRGRBL PUMP,,30,,,"$30,781.06",$0.00,1,0,1,20161001,
62362,CPT,IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP,,30,,,"$30,781.06",$0.00,1,0,1,20161001,
62365,CPT,RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
62367,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL,,30,,,$973.44,$0.00,1,0,1,20161001,
62368,CPT,ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG,,30,,,$973.44,$0.00,1,0,1,20161001,
62369,CPT,ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL,,30,,,$973.44,$0.00,1,0,1,20161001,
62370,CPT,ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP,,30,,,$973.44,$0.00,1,0,1,20161001,
63001,CPT,LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63003,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63005,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63011,CPT,LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63012,CPT,LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63015,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63016,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63017,CPT,LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63020,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63030,CPT,LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63035,CPT,LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR,,30,,,"$25,520.62",$0.00,1,0,1,20161001,
63040,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63042,CPT,LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63044,CPT,LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR,,30,,,"$9,898.77",$0.00,1,0,1,20161001,
63045,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63046,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63047,CPT,LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63048,CPT,LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR,,30,,,"$25,520.62",$0.00,1,0,1,20161001,
63055,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63056,CPT,TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63057,CPT,TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR,,30,,,"$25,520.62",$0.00,1,0,1,20161001,
63064,CPT,COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63066,CPT,COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG,,30,,,"$25,520.62",$0.00,1,0,1,20161001,
63075,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
63076,CPT,DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC,,30,,,"$25,520.62",$0.00,1,0,1,20161001,
63600,CPT,CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
63610,CPT,STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
63615,CPT,STRTCTC BX ASPIRAT/EXC LESION SPINAL CORD,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
63620,CPT,STEREOTACTIC RADIOSURGERY 1 SPINAL LESION,,30,,,"$20,880.51",$0.00,1,0,1,20161001,
63621,CPT,STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION,,30,,,"$5,800.14",$0.00,1,0,1,20161001,
63650,CPT,PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
63655,CPT,LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL,,30,,,"$34,569.16",$0.00,1,0,1,20161001,
63661,CPT,RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
63662,CPT,RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
63663,CPT,REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
63664,CPT,REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
63685,CPT,INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING,,30,,,"$53,493.40",$0.00,1,0,1,20161001,
63688,CPT,REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
63741,CPT,CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
63744,CPT,RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
63746,CPT,RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64400,CPT,NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64402,CPT,INJECTION ANESTHETIC AGENT FACIAL NERVE,,30,,,$425.53,$0.00,1,0,1,20161001,
64405,CPT,INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV,,30,,,"$1,757.91",$0.00,1,0,1,20161001,
64408,CPT,INJECTION ANESTHETIC AGENT VAGUS NERVE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64410,CPT,INJECTION ANESTHETIC AGENT PHRENIC NERVE,,30,,,"$3,655.73",$0.00,1,0,1,20161001,
64413,CPT,INJECTION ANESTHETIC AGENT CERVICAL PLEXUS,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64415,CPT,SINGLE NERVE BLOCK INJECTION ARM NERVE,,30,,,"$5,048.03",$0.00,1,0,1,20161001,
64416,CPT,INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64417,CPT,INJECTION ANESTHETIC AGENT AXILLARY NERVE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64418,CPT,INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64420,CPT,INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64421,CPT,MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64425,CPT,INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64430,CPT,INJECTION ANESTHETIC AGENT PUDENDAL NERVE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64435,CPT,INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64445,CPT,INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64446,CPT,INJECTION ANES SCIATIC NERVE CONT INFUSION CATH,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64447,CPT,INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64448,CPT,INJECTION ANES FEMORAL NERVE CONT INFUSION CATH,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64449,CPT,INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64450,CPT,INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH,,30,,,"$1,757.91",$0.00,1,0,1,20161001,
64455,CPT,NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64461,CPT,PVB THORACIC SINGLE INJECTION SITE W/IMG GID,,30,,,"$3,655.73",$0.00,1,0,1,20161001,
64463,CPT,PVB THORACIC CONT CATHETER INFUSION W/IMG GID,,30,,,"$3,655.73",$0.00,1,0,1,20161001,
64479,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64480,CPT,NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV,,30,,,"$4,253.44",$0.00,1,0,1,20161001,
64483,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64484,CPT,NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV,,30,,,"$4,253.44",$0.00,1,0,1,20161001,
64486,CPT,TAP BLOCK UNILATERAL BY INJECTION(S),,30,,,"$2,030.05",$0.00,1,0,1,20161001,
64487,CPT,TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S),,30,,,"$2,030.05",$0.00,1,0,1,20161001,
64488,CPT,TAP BLOCK BILATERAL BY INJECTION(S),,30,,,"$2,030.05",$0.00,1,0,1,20161001,
64489,CPT,TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S),,30,,,"$2,030.05",$0.00,1,0,1,20161001,
64490,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64491,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL,,30,,,"$3,824.51",$0.00,1,0,1,20161001,
64492,CPT,NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL,,30,,,"$3,824.51",$0.00,1,0,1,20161001,
64493,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64494,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL,,30,,,"$3,824.51",$0.00,1,0,1,20161001,
64495,CPT,NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL,,30,,,"$3,824.51",$0.00,1,0,1,20161001,
64505,CPT,INJECTION ANES AGENT SPHENOPALATINE GANGLION,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64508,CPT,INJECTION ANESTHETIC AGENT CAROTID SINUS SPX,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64510,CPT,NJX ANES STELLATE GANGLION CRV SYMPATHETIC,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64517,CPT,INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS,,30,,,"$5,048.03",$0.00,1,0,1,20161001,
64520,CPT,INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64530,CPT,INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64550,CPT,APPLICATION SURFACE NEUROSTIMULATOR,,30,,,$676.68,$0.00,1,0,1,20161001,
64553,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64555,CPT,PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64561,CPT,PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64565,CPT,PRQ IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64566,CPT,POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64568,CPT,INC IMPLTJ CRNL NRV NSTIM ELTRDS & PULSE GENER,,30,,,"$53,493.40",$0.00,1,0,1,20161001,
64569,CPT,REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64570,CPT,REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64575,CPT,INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64580,CPT,INC IMPLTJ NSTIM ELTRD NEUROMUSCULAR,,30,,,"$34,569.16",$0.00,1,0,1,20161001,
64581,CPT,INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
64585,CPT,REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
64590,CPT,INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR,,30,,,"$34,569.16",$0.00,1,0,1,20161001,
64595,CPT,REVISION/RMVL PERIPHERAL/GASTRIC NPGR,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
64600,CPT,DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64605,CPT,DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64610,CPT,DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64611,CPT,CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64612,CPT,CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64615,CPT,CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64616,CPT,CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA,,30,,,"$1,748.92",$0.00,1,0,1,20161001,
64617,CPT,CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG,,30,,,"$3,655.73",$0.00,1,0,1,20161001,
64620,CPT,DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64630,CPT,DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64632,CPT,DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64633,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64634,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA,,30,,,"$2,432.19",$0.00,1,0,1,20161001,
64635,CPT,DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64636,CPT,DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL,,30,,,"$2,169.25",$0.00,1,0,1,20161001,
64640,CPT,DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64642,CPT,CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64644,CPT,CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64646,CPT,CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES,,30,,,"$1,757.91",$0.00,1,0,1,20161001,
64647,CPT,CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
64650,CPT,CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64653,CPT,CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
64680,CPT,DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64681,CPT,DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
64702,CPT,NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64704,CPT,NEUROPLASTY NERVE HAND/FOOT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64708,CPT,NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64712,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64713,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64714,CPT,NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64716,CPT,NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64718,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64719,CPT,NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64721,CPT,NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64722,CPT,DECOMPRESSION UNSPECIFIED NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64726,CPT,DECOMPRESSION PLANTAR DIGITAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64727,CPT,INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE,,30,,,"$5,467.77",$0.00,1,0,1,20161001,
64732,CPT,TRANSECTION/AVULSION SUPRAORBITAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64734,CPT,TRANSECTION/AVULSION INFRAORBITAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64736,CPT,TRANSECTION/AVULSION MENTAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64738,CPT,TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64740,CPT,TRANSECTION/AVULSION LINGUAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64742,CPT,TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64744,CPT,TRANSECTION/AVULSION GREATER OCCIPITAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64746,CPT,TRANSECTION/AVULSION PHRENIC NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64763,CPT,TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64766,CPT,TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64771,CPT,TRANSECTION/AVULSION OTH CRANIAL NRV XDRL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64772,CPT,TRANSECTION/AVULSION OTH SPINAL NRV XDRL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64774,CPT,EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64776,CPT,EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64778,CPT,EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT,,30,,,"$1,885.05",$0.00,1,0,1,20161001,
64782,CPT,EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64783,CPT,EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT,,30,,,"$9,280.23",$0.00,1,0,1,20161001,
64784,CPT,EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64786,CPT,EXCISION NEUROMA SCIATIC NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64787,CPT,IMPLANTATION NERVE END BONE/MUSCLE,,30,,,"$13,920.34",$0.00,1,0,1,20161001,
64788,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64790,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64792,CPT,EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64795,CPT,BIOPSY NERVE,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64802,CPT,SYMPATHECTOMY CERVICAL,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64804,CPT,SYMPATHECTOMY CERVICOTHORACIC,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64820,CPT,SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT,,30,,,"$8,377.18",$0.00,1,0,1,20161001,
64821,CPT,SYMPATHECTOMY RADIAL ARTERY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
64822,CPT,SYMPATHECTOMY ULNAR ARTERY,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
64823,CPT,SYMPATHECTOMY SUPERFICIAL PALMAR ARCH,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
64831,CPT,SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64832,CPT,SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV,,30,,,"$9,280.23",$0.00,1,0,1,20161001,
64834,CPT,SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64835,CPT,SUTURE 1 NERVE MEDIAN MOTOR THENAR,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64836,CPT,SUTURE 1 NERVE ULNAR MOTOR,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64837,CPT,SUTURE EACH ADDITIONAL NERVE HAND/FOOT,,30,,,"$8,120.20",$0.00,1,0,1,20161001,
64840,CPT,SUTURE POSTERIOR TIBIAL NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64856,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64857,CPT,SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64858,CPT,SUTURE SCIATIC NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64859,CPT,SUTURE EACH ADDITIONAL PERIPHERAL NERVE,,30,,,"$9,280.23",$0.00,1,0,1,20161001,
64861,CPT,SUTURE BRACHIAL PLEXUS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64862,CPT,SUTURE LUMBAR PLEXUS,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64864,CPT,SUTURE FACIAL NERVE EXTRACRANIAL,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64865,CPT,SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64872,CPT,SUTURE NERVE REQ SECONDARY/DELAYED SUTURE,,30,,,"$15,050.95",$0.00,1,0,1,20161001,
64874,CPT,SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE,,30,,,"$15,050.95",$0.00,1,0,1,20161001,
64876,CPT,SUTURE NERVE REQ SHORTENING BONE EXTREMITY,,30,,,"$15,050.95",$0.00,1,0,1,20161001,
64885,CPT,NERVE GRAFT HEAD/NECK </ 4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64886,CPT,NERVE GRAFT HEAD/NECK >4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64890,CPT,NERVE GRAFT 1 STRAND HAND/FOOT </4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64891,CPT,NRV GRF 1 STRAND HAND/FOOT >4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64892,CPT,NERVE GRAFT 1 STRAND ARM/LEG <4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64893,CPT,NERVE GRAFT 1 STRAND ARM/LEG >4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64895,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT </4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64896,CPT,NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64897,CPT,NERVE GRAFT MLT STRANDS ARM/LEG </4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64898,CPT,NERVE GRAFT MLT STRANDS ARM/LEG >4 CM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64901,CPT,NERVE GRAFT EACH NERVE 1 STRAND,,30,,,"$11,600.28",$0.00,1,0,1,20161001,
64902,CPT,NERVE GRAFT EACH NERVE MULTIPLE STRANDS,,30,,,"$13,920.34",$0.00,1,0,1,20161001,
64905,CPT,NERVE PEDICLE TRANSFER FIRST STAGE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64907,CPT,NERVE PEDICAL TRANSFER SECOND STAGE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64910,CPT,NERVE REPAIR W/CONDUIT EACH NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64911,CPT,NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
64999,CPT,UNLISTED PROCEDURE NERVOUS SYSTEM,,30,,,"$1,023.16",$0.00,1,0,1,20161001,
65091,CPT,EVISCERATION OCULAR CONTENTS W/O IMPLANT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65093,CPT,EVISCERATION OCULAR CONTENTS W/IMPLANT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65101,CPT,ENUCLEATION OF EYE W/O IMPLANT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65103,CPT,ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65105,CPT,ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65110,CPT,EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65112,CPT,EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65114,CPT,EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65125,CPT,MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65130,CPT,INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65135,CPT,INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65140,CPT,INSJ OC IMPLT AFTER ENCL MUSC ATTACHED,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65150,CPT,REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65155,CPT,REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65175,CPT,REMOVAL OCULAR IMPLANT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65205,CPT,REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL,,30,,,$425.53,$0.00,1,0,1,20161001,
65210,CPT,RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR,,30,,,$425.53,$0.00,1,0,1,20161001,
65220,CPT,RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP,,30,,,$425.53,$0.00,1,0,1,20161001,
65222,CPT,RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP,,30,,,$425.53,$0.00,1,0,1,20161001,
65235,CPT,RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65260,CPT,RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65265,CPT,RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65270,CPT,RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65272,CPT,RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65275,CPT,RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65280,CPT,RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65285,CPT,RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65286,CPT,RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65290,CPT,RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65400,CPT,EXCISION LESION CORNEA XCP PTERYGIUM,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
65410,CPT,BIOPSY CORNEA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65420,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65426,CPT,EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65430,CPT,CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE,,30,,,$425.53,$0.00,1,0,1,20161001,
65435,CPT,RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
65436,CPT,RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65450,CPT,DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
65600,CPT,MULTIPLE PUNCTURES ANTERIOR CORNEA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65710,CPT,KERATOPLASTY ANTERIOR LAMELLAR,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65730,CPT,KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65750,CPT,KERATOPLASTY PENETRAING APHAKIA,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65755,CPT,KERATOPLASTY PENETRATING PSEUDOPHAKIA,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65756,CPT,KERATOPLASTY ENDOTHELIAL,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65757,CPT,BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT,,30,,,"$10,902.44",$0.00,1,0,1,20161001,
65760,CPT,KERATOMILEUSIS,,30,,,"$10,902.44",$0.00,1,0,1,20161001,
65765,CPT,KERATOPHAKIA,,30,,,"$10,902.44",$0.00,1,0,1,20161001,
65767,CPT,EPIKERATOPLASTY,,30,,,"$10,902.44",$0.00,1,0,1,20161001,
65770,CPT,KERATOPROSTHESIS,,30,,,"$21,873.82",$0.00,1,0,1,20161001,
65771,CPT,RADIAL KERATOTOMY,,30,,,"$3,964.52",$0.00,1,0,1,20161001,
65772,CPT,CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
65775,CPT,CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
65778,CPT,PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
65779,CPT,PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65780,CPT,OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65781,CPT,OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65782,CPT,OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
65785,CPT,IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS,,30,,,"$16,856.92",$0.00,1,0,1,20161001,
65800,CPT,PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65810,CPT,PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65815,CPT,PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65820,CPT,GONIOTOMY,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
65850,CPT,TRABECULOTOMY AB EXTERNO,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65855,CPT,TRABECULOPLASTY BY LASER SURGERY,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
65860,CPT,SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
65865,CPT,SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65870,CPT,SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65875,CPT,SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65880,CPT,SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65900,CPT,RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65920,CPT,RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
65930,CPT,RMVL BLOOD CLOT ANTERIOR SEGMENT EYE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66020,CPT,INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66030,CPT,INJX ANTERIOR CHAMBER EYE MEDICATION SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66130,CPT,EXCISION LESION SCLERA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
66150,CPT,FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66155,CPT,FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66160,CPT,FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66170,CPT,FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66172,CPT,FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66174,CPT,TRLUML DILAT AQUEOUS CANAL W/O DEVICE/STENT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66175,CPT,TRLUML DILAT AQUEOUS CANAL W/DEVICE/STENT,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66179,CPT,AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66180,CPT,AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66183,CPT,INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66184,CPT,REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66185,CPT,REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66220,CPT,REPAIR SCLERAL STAPHYLOMA W/O GRAFT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66225,CPT,REPAIR SCLERAL STAPHYLOMA W/GRAFT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66250,CPT,REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT,,30,,,"$8,237.67",$0.00,1,0,1,20161001,
66500,CPT,IRIDOTOMY STAB INC SPX XCP TRANSFIXION,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66505,CPT,IRIDOTOMY STAB INC SPX TRANSFIXION,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66600,CPT,IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66605,CPT,IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66625,CPT,IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66630,CPT,IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66635,CPT,IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66680,CPT,REPAIR IRIS CILIARY BODY,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66682,CPT,SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66700,CPT,CILIARY BODY DESTRUCTION DIATHERMY,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66710,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
66711,CPT,CILIARY BODY DSTRJ CYCLOPHOTOCOAG ENDOSCOPIC,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66720,CPT,CILIARY BODY DESTRUCTION CRYOTHERAPY,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
66740,CPT,CILIARY BODY DESTRUCTION CYCLODIAL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
66761,CPT,IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
66762,CPT,IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
66770,CPT,DSTRJ CYST/LESION IRIS/CILIARY BODY,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
66820,CPT,DISCISSION SECONDARY MEMBRANOUS CATARACT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66821,CPT,POST-CATARACT LASER SURGERY,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
66825,CPT,REPOSITIONING IO LENS PROSTHESIS REQ INC SPX,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66830,CPT,RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66840,CPT,RMVL LENS MATERIAL ASPIR TQ 1/> STAGES,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66850,CPT,RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66852,CPT,RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66920,CPT,RMVL LENS MATERIAL INTRACAPSULAR,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66930,CPT,REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
66940,CPT,REMOVAL LENS MATERIAL EXTRACAPSULAR,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66982,CPT,XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66983,CPT,ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66984,CPT,CATARACT REMOVAL INSERTION OF LENS,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66985,CPT,INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
66986,CPT,EXCHANGE INTRAOCULAR LENS,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
66990,CPT,USE OPHTHALMIC ENDOSCOPE,,30,,,"$4,646.14",$0.00,1,0,1,20161001,
66999,CPT,UNLISTED PROCEDURE ANTERIOR SEGMENT EYE,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67005,CPT,RMVL VITREOUS ANT APPR PARTIAL REMOVAL,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67010,CPT,RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67015,CPT,ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67025,CPT,INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67027,CPT,IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS,,30,,,"$21,347.47",$0.00,1,0,1,20161001,
67028,CPT,INTRAVITREAL NJX PHARMACOLOGIC AGT SPX,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
67030,CPT,DISCISSION VITREOUS STRANS PARS PLANA APPROACH,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67031,CPT,SEVERING VITREOUS STRANS LASER 1/> STAGES,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67036,CPT,VITRECTOMY MECHANICAL PARS PLANA,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67039,CPT,VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67040,CPT,VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67041,CPT,VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67042,CPT,VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67043,CPT,VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67101,CPT,RPR RETINAL DTCHMNT 1/>SES CRYOTX/DTHRM INCL DRG,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67105,CPT,RPR RETINAL DTCHMNT 1/> SES PC INCL SUBRETI DRG,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67107,CPT,REPAIR RETINAL DETACHMENT SCLERAL BUCKLING,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67108,CPT,RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67110,CPT,RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67113,CPT,RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
67115,CPT,RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67120,CPT,RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67121,CPT,RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67141,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS CRTX DTHRM,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67145,CPT,PROPH RTA DTCHMNT W/O DRG 1/> SESS,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67208,CPT,DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67210,CPT,DSTRJ LOCLZD LESION RETINA 1/> SESS PC,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67218,CPT,DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67220,CPT,DSTRJ LESION CHOROID PC 1/> SESS,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67221,CPT,DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67225,CPT,DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67227,CPT,DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67228,CPT,TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67229,CPT,EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT,,30,,,"$2,637.79",$0.00,1,0,1,20161001,
67250,CPT,SCLERAL REINFORCEMENT SPX W/O GRAFT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67255,CPT,SCLERAL REINFORCEMENT SPX W/GRAFT,,30,,,"$9,991.94",$0.00,1,0,1,20161001,
67299,CPT,UNLISTED PROCEDURE POSTERIOR SEGMENT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
67311,CPT,STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67312,CPT,STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67314,CPT,STRABISMUS RECESSION/RESCJ 1 VER MUSC,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67316,CPT,STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67318,CPT,STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67320,CPT,TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67331,CPT,STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67332,CPT,STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67334,CPT,STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67335,CPT,PLACEMENT ADJUSTABLE SUTURE STRABISMUS,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67340,CPT,STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC,,30,,,"$6,626.09",$0.00,1,0,1,20161001,
67343,CPT,RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67345,CPT,CHEMODENERVATION EXTRAOCULAR MUSCLE,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67346,CPT,BIOPSY EXTRAOCULAR MUSCLE,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67399,CPT,UNLISTED PROCEDURE EXTRAOCULAR MUSCLE,,30,,,"$5,194.08",$0.00,1,0,1,20161001,
67400,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67405,CPT,ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67412,CPT,ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67413,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67414,CPT,ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67415,CPT,FINE NEEDLE ASPIRATION ORBITAL CONTENTS,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67420,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67430,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67440,CPT,ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67445,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67450,CPT,ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67500,CPT,RETROBULBAR INJECTION MEDICATION SPX,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67505,CPT,RETROBULBAR INJECTION ALCOHOL,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67515,CPT,INJECTION MEDICATION/OTHER SUBST TENON CAPSULE,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67550,CPT,ORBITAL IMPLANT INSERTION,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67560,CPT,ORBITAL IMPLANT REMOVAL/REVISION,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67570,CPT,OPTIC NERVE DECOMPRESSION,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67599,CPT,UNLISTED PROCEDURE ORBIT,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67700,CPT,BLEPHAROTOMY DRAINAGE ABSCESS EYELID,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67710,CPT,SEVERING TARSORRHAPHY,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67715,CPT,CANTHOTOMY SEPARATE PROCEDURE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67800,CPT,EXCISION CHALAZION SINGLE,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67801,CPT,EXCISION CHALAZION MULTIPLE SAME LID,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67805,CPT,EXCISION CHALAZION MULTIPLE DIFFERENT LIDS,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67808,CPT,EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67810,CPT,INCISIONAL BIOPSY EYELID SKIN & LID MARGIN,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67820,CPT,CORRECTION TRICHIASIS EPILATION FORCEPS ONLY,,30,,,$425.53,$0.00,1,0,1,20161001,
67825,CPT,CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67830,CPT,CORRECTION TRICHIASIS INCCISION LID MARGIN,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67835,CPT,CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67840,CPT,EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67850,CPT,DESTRUCTION LESION LID MARGIN </ 1 CM,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67875,CPT,TEMPORARY CLOSURE EYELIDS SUTURE,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
67880,CPT,CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67882,CPT,CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67900,CPT,REPAIR BROW PTOSIS,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67901,CPT,RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67902,CPT,RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67903,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67904,CPT,RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67906,CPT,RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67908,CPT,RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67909,CPT,REDUCTION OVERCORRECTION PTOSIS,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67911,CPT,CORRECTION LID RETRACTION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67912,CPT,CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67914,CPT,REPAIR ECTROPION SUTURE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67915,CPT,REPAIR ECTROPION THERMOCAUTERIZATION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67916,CPT,REPAIR ECTROPION EXCISION TARSAL WEDGE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67917,CPT,REPAIR ECTROPION EXTENSIVE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67921,CPT,REPAIR ENTROPION SUTURE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67922,CPT,REPAIR ENTROPION THERMOCAUTERIZATION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67923,CPT,REPAIR ENTROPION EXCISION TARSAL WEDGE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67924,CPT,REPAIR ENTROPION EXTENSIVE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67930,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67935,CPT,SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67938,CPT,REMOVAL EMBEDDED FOREIGN BODY EYELID,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
67950,CPT,CANTHOPLASTY,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67961,CPT,EXCISION & REPAIR EYELID > ONE-FOURTH LID MARGIN,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67966,CPT,EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67971,CPT,RCNSTJ EYELID FULL THICKNESS </TWO-THIRDS 1 STG,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67973,CPT,RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67974,CPT,RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
67975,CPT,RCNSTJ EYELID FULL THICKNESS SECOND STAGE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
67999,CPT,UNLISTED PROCEDURE EYELIDS,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68020,CPT,INCISION CONJUNCTIVA DRAINAGE OF CYST,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
68040,CPT,EXPRESSION CONJUNCTIVAL FOLLICLES,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68100,CPT,BIOPSY CONJUNCTIVA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68110,CPT,EXCISION LESION CONJUNCTIVA </1 CM,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68115,CPT,EXCISION LESION CONJUNCTIVA > 1 CM,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68130,CPT,EXCISION LESION CONJUNCTIVA ADJACENT SCLERA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68135,CPT,DESTRUCTION LESION CONJUNCTIVA,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68200,CPT,SUBCONJUNCTIVAL INJECTION,,30,,,$425.53,$0.00,1,0,1,20161001,
68320,CPT,CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68325,CPT,CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68326,CPT,CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68328,CPT,CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68330,CPT,RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT,,30,,,"$10,028.54",$0.00,1,0,1,20161001,
68335,CPT,RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68340,CPT,RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68360,CPT,CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68362,CPT,CONJUNCTIVAL FLAP TOTAL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68371,CPT,HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68399,CPT,UNLISTED PROCEDURE CONJUNCTIVA,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68400,CPT,INCISION DRAINAGE LACRIMAL GLAND,,30,,,"$4,350.72",$0.00,1,0,1,20161001,
68420,CPT,INCISION DRAINAGE LACRIMAL SAC,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68440,CPT,SNIP INCISION LACRIMAL PUNCTUM,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68500,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68505,CPT,EXCISION LACRIMAL GLAND XCPT TUMOR PRTL,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68510,CPT,BIOPSY LACRIMAL GLAND,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68520,CPT,EXCISION LACRIMAL SAC,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68525,CPT,BIOPSY LACRIMAL SAC,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68530,CPT,RMVL FB/DACRYOLITH LACRIMAL PASSAGES,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68540,CPT,EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68550,CPT,EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68700,CPT,PLASTIC REPAIR CANALICULI,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68705,CPT,CORRECTION EVERTED PUNCTUM CAUTERY,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68720,CPT,DACRYOCSTORHINOSTOMY,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68745,CPT,CONJUNCTIVORHINOSTOMY W/O TUBE,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68750,CPT,CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT,,30,,,"$13,630.85",$0.00,1,0,1,20161001,
68760,CPT,CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68761,CPT,CLSR LACRIMAL PUNCTUM PLUG EACH,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68770,CPT,CLOSURE LACRIMAL FISTULA SPX,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68801,CPT,DILATION LACRIMAL PUNCTUM W/WO IRRGATION,,30,,,$425.53,$0.00,1,0,1,20161001,
68810,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIGATION,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68811,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68815,CPT,PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68816,CPT,PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
68840,CPT,PROBE LACRIMAL CANALICULI W/WO IRRIGATION,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
68850,CPT,INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY,,30,,,$862.77,$0.00,1,0,1,20161001,
68899,CPT,UNLISTED PROCEDURE LACRIMAL SYSTEM,,30,,,"$1,072.20",$0.00,1,0,1,20161001,
69000,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
69005,CPT,DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX,,30,,,"$8,306.43",$0.00,1,0,1,20161001,
69020,CPT,DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS,,30,,,"$1,462.82",$0.00,1,0,1,20161001,
69100,CPT,BIOPSY EXTERNAL EAR,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
69105,CPT,BIOPSY EXTERNAL AUDITORY CANAL,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69110,CPT,EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
69120,CPT,EXCISION EXTERNAL EAR COMPLETE AMPUTATION,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69140,CPT,EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69145,CPT,EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL,,30,,,"$9,390.88",$0.00,1,0,1,20161001,
69150,CPT,RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69200,CPT,RMVL FB XTRNL AUDITORY CANAL W/O ANES,,30,,,$425.53,$0.00,1,0,1,20161001,
69205,CPT,RMVL FB XTRNL AUDITORY CANAL ANES,,30,,,"$5,767.31",$0.00,1,0,1,20161001,
69209,CPT,REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT,,30,,,$302.96,$0.00,1,0,1,20161001,
69210,CPT,REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,,30,,,$306.21,$0.00,1,0,1,20161001,
69220,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE,,30,,,$398.75,$0.00,1,0,1,20161001,
69222,CPT,DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
69300,CPT,OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69310,CPT,RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69320,CPT,RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69399,CPT,UNLISTED PROCEDURE EXTERNAL EAR,,30,,,$853.29,$0.00,1,0,1,20161001,
69420,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
69421,CPT,MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69424,CPT,VENTILATING TUBE RMVL REQUIRING GENERAL ANES,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69433,CPT,TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
69436,CPT,TYMPANOSTOMY GENERAL ANESTHESIA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69440,CPT,MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69450,CPT,TYMPANOLYSIS TRANSCANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69501,CPT,TRANSMASTOID ANTROTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69502,CPT,MASTOIDECTOMY COMPLETE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69505,CPT,MASTOIDECTOMY MODIFIED RADICAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69511,CPT,MASTOIDECTOMY RADICAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69530,CPT,PETROUS APICECTOMY RADICAL MASTOIDECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69540,CPT,EXCISION AURAL POLYP,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69550,CPT,EXCISION AURAL GLOMUS TUMOR TRANSCANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69552,CPT,EXCISION AURAL GLOMUS TUMOR TRANSMASTOID,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69601,CPT,REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69602,CPT,REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69603,CPT,REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69604,CPT,REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69605,CPT,REVJ MASTOIDECTOMY W/APICECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69610,CPT,TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69620,CPT,MYRINGOPLASTY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69631,CPT,TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69632,CPT,TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69633,CPT,TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69635,CPT,TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69636,CPT,TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69637,CPT,TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69641,CPT,TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69642,CPT,TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69643,CPT,TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69644,CPT,TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69645,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69646,CPT,TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69650,CPT,STAPES MOBILIZATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69660,CPT,STAPEDECTOMY/STAPEDOTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69661,CPT,STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69662,CPT,REVISION STAPEDECTOMY/STAPEDOTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69666,CPT,REPAIR OVAL WINDOW FISTULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69667,CPT,REPAIR ROUND WINDOW FISTULA,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69670,CPT,MASTOID OBLITERATION SEPARATE PROCEDURE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69676,CPT,TYMPANIC NEURECTOMY,,30,,,"$9,467.51",$0.00,1,0,1,20161001,
69700,CPT,CLOSURE POSTAURICULAR FISTULA MASTOID SPX,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
69710,CPT,IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE,,30,,,"$10,501.46",$0.00,1,0,1,20161001,
69711,CPT,RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69714,CPT,IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
69715,CPT,IMPLJ OSSEOINTEGRATED TEMPORAL BONE W/O MASTOID,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
69717,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
69718,CPT,RPLMCT OSSEOINTEGRATE IMPLNT W/MASTOIDECTOMY,,30,,,"$21,600.69",$0.00,1,0,1,20161001,
69720,CPT,DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69725,CPT,DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69740,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69745,CPT,SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69799,CPT,UNLISTED PROCEDURE MIDDLE EAR,,30,,,$853.29,$0.00,1,0,1,20161001,
69801,CPT,LABYRINTHOTOMY TRANSCANAL,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
69805,CPT,ENDOLYMPHATIC SAC W/O SHUNT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69806,CPT,ENDOLYMPHATIC SAC SHUNT,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69820,CPT,FENESTRATION SEMICIRCULAR CANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69840,CPT,REVISION FENESTRATION OPERATION,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69905,CPT,LABYRINTHECTOMY TRANSCANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69910,CPT,LABYRINTHECTOMY W/MASTOIDECTOMY,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69915,CPT,VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69930,CPT,COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY,,30,,,"$60,843.44",$0.00,1,0,1,20161001,
69949,CPT,UNLISTED PROCEDURE INNER EAR,,30,,,$853.29,$0.00,1,0,1,20161001,
69955,CPT,TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69960,CPT,DECOMPRESSION INTERNAL AUDITORY CANAL,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69970,CPT,REMOVAL TUMOR TEMPORAL BONE,,30,,,"$18,828.32",$0.00,1,0,1,20161001,
69979,CPT,UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA,,30,,,$853.29,$0.00,1,0,1,20161001,
69990,CPT,MICROSURG TQS REQ USE OPERATING MICROSCOPE,,30,,,"$3,159.05",$0.00,1,0,1,20161001,
70010,CPT,MYELOGRAPY POST FOSSA RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
70015,CPT,CISTERNOGRAPHY POSITIVE CONTRAST RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
70030,CPT,RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY,,30,,,$399.19,$0.00,1,0,1,20161001,
70100,CPT,RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
70110,CPT,RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
70120,CPT,RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE,,30,,,$399.19,$0.00,1,0,1,20161001,
70130,CPT,RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE,,30,,,$655.16,$0.00,1,0,1,20161001,
70134,CPT,RADEX INTERNAL AUDITORY MEATI COMPLETE,,30,,,$655.16,$0.00,1,0,1,20161001,
70140,CPT,RADEX FACIAL BONES < 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
70150,CPT,RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
70160,CPT,RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
70170,CPT,DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
70190,CPT,RADEX OPTIC FORAMINA,,30,,,$394.22,$0.00,1,0,1,20161001,
70200,CPT,RADEX ORBITS COMPLETE MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
70210,CPT,RADEX SINUSES PARANASAL <3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
70220,CPT,RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
70240,CPT,RADIOLOGIC EXAMINATION SELLA TURCICA,,30,,,$399.19,$0.00,1,0,1,20161001,
70250,CPT,RADIOLOGIC EXAMINATION SKULL 4/> VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
70260,CPT,RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
70300,CPT,RADIOLOGIC EXAMINATION TEETH 1 VIEW,,30,,,$399.19,$0.00,1,0,1,20161001,
70310,CPT,RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
70320,CPT,RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
70328,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT,,30,,,$399.19,$0.00,1,0,1,20161001,
70330,CPT,RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT,,30,,,$399.19,$0.00,1,0,1,20161001,
70332,CPT,TEMPOROMANDBLE JT ARTHROGRAPHY RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
70336,CPT,MRI TEMPOROMANDIBULAR JOINT,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70350,CPT,CEPHALOGRAM ORTHODONTIC,,30,,,$399.19,$0.00,1,0,1,20161001,
70355,CPT,ORTHOPANTOGRAM,,30,,,$399.19,$0.00,1,0,1,20161001,
70360,CPT,RADIOLOGIC EXAMINATION NECK SOFT TISSUE,,30,,,$399.19,$0.00,1,0,1,20161001,
70370,CPT,RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ,,30,,,$399.19,$0.00,1,0,1,20161001,
70371,CPT,CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC,,30,,,$655.16,$0.00,1,0,1,20161001,
70380,CPT,RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS,,30,,,$399.19,$0.00,1,0,1,20161001,
70390,CPT,SIALOGRAPHY RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
70450,CPT,CT HEAD/BRAIN W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
70460,CPT,CT HEAD/BRAIN W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70470,CPT,CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70480,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL,,30,,,$763.01,$0.00,1,0,1,20161001,
70481,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70482,CPT,CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70486,CPT,CT MAXILLOFACIAL W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
70487,CPT,CT MAXILLOFACIAL W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70488,CPT,CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70490,CPT,CT SOFT TISSUE NECK W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
70491,CPT,CT SOFT TISSUE NECK W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70492,CPT,CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70496,CPT,CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70498,CPT,CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
70540,CPT,MRI ORBIT FACE &/NECK W/O CONTRAST,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70542,CPT,MRI ORBIT FACE & NECK W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70543,CPT,MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70544,CPT,MRA HEAD W/O CONTRST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70545,CPT,MRA HEAD W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70546,CPT,MRA HEAD W/O & W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70547,CPT,MRA NECK W/O CONTRST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70548,CPT,MRA NECK W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70549,CPT,MRA NECK W/O &W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70551,CPT,MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70552,CPT,MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70553,CPT,MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70554,CPT,MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70555,CPT,MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70557,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
70558,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
70559,CPT,MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST,,30,,,"$14,368.31",$0.00,1,0,1,20161001,
71010,CPT,RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL,,30,,,$399.19,$0.00,1,0,1,20161001,
71015,CPT,RADIOLOGIC EXAMINATION CHEST STERO FRONTAL,,30,,,$399.19,$0.00,1,0,1,20161001,
71020,CPT,RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL,,30,,,$399.19,$0.00,1,0,1,20161001,
71021,CPT,RADEX CH 2 VIEWS FRNT & LAT APICAL LORDOTIC PX,,30,,,$399.19,$0.00,1,0,1,20161001,
71022,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL OBLIQUE PRJCJ,,30,,,$399.19,$0.00,1,0,1,20161001,
71023,CPT,RADEX CH 2 VIEWS FRONTAL & LATERAL W/FLUORO,,30,,,$655.16,$0.00,1,0,1,20161001,
71030,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
71034,CPT,RADEX CHEST COMPLETE MINIMUM 4 VIEWS W/FLUORO,,30,,,$655.16,$0.00,1,0,1,20161001,
71035,CPT,RADEX CHEST SPECIAL VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
71100,CPT,RADEX RIBS UNILATERAL 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
71101,CPT,RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
71110,CPT,RADEX RIBS BILATERAL 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
71111,CPT,RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
71120,CPT,RADEX STERNUM MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
71130,CPT,RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
71250,CPT,CT THORAX W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
71260,CPT,CT THORAX W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
71270,CPT,CT THORAX W/O & W/CONTRAST MATERIAL,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
71275,CPT,CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
71550,CPT,MRI CHEST W/O CONTRAST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
71551,CPT,MRI CHEST W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
71552,CPT,MRI CHEST W/O & W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
71555,CPT,MRA CHEST W/O & W/CONTRAST MATERIAL,,30,,,"$6,207.63",$0.00,1,0,1,20161001,
72020,CPT,RADEX SPINE 1 VIEW SPECIFY LEVEL,,30,,,$399.19,$0.00,1,0,1,20161001,
72040,CPT,RADEX SPINE CERVICAL 2 OR 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72050,CPT,RADEX SPINE CERVICAL 4 OR 5 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72052,CPT,RADEX SPINE CERVICAL 6 OR MORE VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72070,CPT,RADEX SPINE THORACIC 2 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72072,CPT,RADEX SPINE THORACIC 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72074,CPT,RADEX SPINE THORACIC MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72080,CPT,RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
72081,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW,,30,,,$394.22,$0.00,1,0,1,20161001,
72082,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW,,30,,,$651.05,$0.00,1,0,1,20161001,
72083,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
72084,CPT,RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
72100,CPT,RADEX SPINE LUMBOSACRAL 2/3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72110,CPT,RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72114,CPT,RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6,,30,,,$655.16,$0.00,1,0,1,20161001,
72120,CPT,RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
72125,CPT,CT CERVICAL SPINE W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
72126,CPT,CT CERVICAL SPINE W/CONTRAST MATERIAL,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
72127,CPT,CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72128,CPT,CT THORACIC SPINE W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
72129,CPT,CT THORACIC SPINE W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72130,CPT,CT THORACIC SPINE W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72131,CPT,CT LUMBAR SPINE W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
72132,CPT,CT LUMBAR SPINE W/CONTRAST MATERIAL,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
72133,CPT,CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72141,CPT,MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
72142,CPT,MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72146,CPT,MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
72147,CPT,MRI SPINAL CANAL THORACIC W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72148,CPT,MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
72149,CPT,MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72156,CPT,MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72157,CPT,MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72158,CPT,MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72159,CPT,MRA SPINAL CANAL W/WO CONTRAST MATERIAL,,30,,,"$6,760.52",$0.00,1,0,1,20161001,
72170,CPT,RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72190,CPT,RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72191,CPT,CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72192,CPT,CT PELVIS W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
72193,CPT,CT PELVIS W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72194,CPT,CT PELVIS W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
72195,CPT,MRI PELVIS W/O CONTRAST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
72196,CPT,MRI PELVIS W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72197,CPT,MRI PELVIS W/O & W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
72198,CPT,MRA PELVIS W/WO CONTRAST MATERIAL,,30,,,"$6,366.47",$0.00,1,0,1,20161001,
72200,CPT,RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS,,30,,,$651.05,$0.00,1,0,1,20161001,
72202,CPT,RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
72220,CPT,RADEX SACRUM & COCCYX MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
72240,CPT,MYELOGRAPHY CERVICAL RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
72255,CPT,MYELOGRAPHY THORACIC RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
72265,CPT,MYELOGRAPY LUMBOSACRAL RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
72270,CPT,MYELOGRAPY 2/MORE REGIONS RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
72275,CPT,EPIDUROGRAPY RS&I,,30,,,"$1,791.94",$0.00,1,0,1,20161001,
72285,CPT,DISKOGRAPY CERVICAL/THORACIC RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
72295,CPT,DISKOGRAPY LUMBAR RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
73000,CPT,RADEX CLAVICLE COMPLETE,,30,,,$399.19,$0.00,1,0,1,20161001,
73010,CPT,RADEX SCAPULA COMPLETE,,30,,,$399.19,$0.00,1,0,1,20161001,
73020,CPT,RADEX SHOULDER 1 VIEW,,30,,,$399.19,$0.00,1,0,1,20161001,
73030,CPT,RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73040,CPT,RADEX SHOULDER ARTHROGRAPHY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
73050,CPT,RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ,,30,,,$399.19,$0.00,1,0,1,20161001,
73060,CPT,RADEX HUMERUS MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73070,CPT,RADEX ELBOW 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73080,CPT,RADEX ELBOW COMPLETE MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73085,CPT,RADEX ELBOW ARTHROGRAPHY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
73090,CPT,RADEX FOREARM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73092,CPT,RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
73100,CPT,RADEX WRIST 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73110,CPT,RADEX WRIST COMPLETE MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73115,CPT,RADEX WRIST ARTHROGRAPHY RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
73120,CPT,RADEX HAND 2 VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
73130,CPT,RADEX HAND MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73140,CPT,RADEX FINGR MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73200,CPT,CT UPPER EXTREMITY W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
73201,CPT,CT UPPER EXTREMITY W/CONTRAST MATERIAL,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
73202,CPT,CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
73206,CPT,CT ANGIOGRAPHY UPPER EXTREMITY,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
73218,CPT,MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
73219,CPT,MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73220,CPT,MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73221,CPT,MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
73222,CPT,MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73223,CPT,MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73225,CPT,MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL,,30,,,"$4,153.24",$0.00,1,0,1,20161001,
73501,CPT,RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,,30,,,$394.22,$0.00,1,0,1,20161001,
73502,CPT,RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,,30,,,$394.22,$0.00,1,0,1,20161001,
73503,CPT,RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS,,30,,,$651.05,$0.00,1,0,1,20161001,
73521,CPT,RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,,30,,,$651.05,$0.00,1,0,1,20161001,
73522,CPT,RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,,30,,,$651.05,$0.00,1,0,1,20161001,
73523,CPT,RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
73525,CPT,RADEX HIP ARTHROGRAPHY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
73551,CPT,RADIOLOGIC EXAMINATION FEMUR 1 VIEW,,30,,,$394.22,$0.00,1,0,1,20161001,
73552,CPT,RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,,30,,,$394.22,$0.00,1,0,1,20161001,
73560,CPT,RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73562,CPT,RADIOLOGIC EXAMINATION KNEE 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73564,CPT,RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS,,30,,,$655.16,$0.00,1,0,1,20161001,
73565,CPT,RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST,,30,,,$399.19,$0.00,1,0,1,20161001,
73580,CPT,RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
73590,CPT,RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73592,CPT,RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73600,CPT,RADIOLOGIC EXAMINATION ANKLE 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73610,CPT,RADEX ANKLE COMPLETE MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73615,CPT,RADEX ANKLE ARTHROGRAPHY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
73620,CPT,RADIOLOGIC EXAMINATION FOOT 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73630,CPT,RADEX FOOT COMPLETE MINIMUM 3 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73650,CPT,RADEX CALCANEUS MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73660,CPT,RADEX TOE MINIMUM 2 VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
73700,CPT,CT LOWER EXTREMITY W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
73701,CPT,CT LOWER EXTREMITY W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
73702,CPT,CT LOWER EXTREMITY W/O & W/CONTRAST MATRL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
73706,CPT,CT ANGIOGRAPHY LOWER EXTREMITY,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
73718,CPT,MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
73719,CPT,MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73720,CPT,MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73721,CPT,MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
73722,CPT,MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73723,CPT,MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
73725,CPT,MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL,,30,,,"$4,538.16",$0.00,1,0,1,20161001,
74000,CPT,RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW,,30,,,$399.19,$0.00,1,0,1,20161001,
74010,CPT,RADEX ABD ANTEROPOST&ADDL OBLQ&CONE VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
74020,CPT,RADEX ABDOMEN COMPL W/DCBTS&/ERC VIEWS,,30,,,$399.19,$0.00,1,0,1,20161001,
74022,CPT,RADEX ABD COMPL AQT ABD W/S/E/D VIEWS 1 VIEW CH,,30,,,$655.16,$0.00,1,0,1,20161001,
74150,CPT,CT ABDOMEN W/O CONTRAST MATERIAL,,30,,,$763.01,$0.00,1,0,1,20161001,
74160,CPT,CT ABDOMEN W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
74170,CPT,CT ABDOMEN W/O & W/CONTRAST MATERIAL,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
74174,CPT,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
74175,CPT,CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
74176,CPT,CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74177,CPT,CT ABDOMEN & PELVIS W/CONTRAST MATERIAL,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
74178,CPT,CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE,,30,,,"$2,070.63",$0.00,1,0,1,20161001,
74181,CPT,MRI ABDOMEN W/O CONTRAST MATERIAL,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
74182,CPT,MRI ABDOMEN W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
74183,CPT,MRI ABDOMEN W/O & W/CONTRAST MATERIAL,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
74185,CPT,MRA ABDOMEN W/WO CONTRAST MATERIAL,,30,,,"$13,405.29",$0.00,1,0,1,20161001,
74190,CPT,PERITONEOGRAM RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
74210,CPT,RADEX PHARYNX&/CERVICAL ESOPHAGUS,,30,,,$655.16,$0.00,1,0,1,20161001,
74220,CPT,RADEX ESOPHAGUS,,30,,,$655.16,$0.00,1,0,1,20161001,
74230,CPT,SWALLOWING FUNCJ W/CINERADIOGRAPY/VIDRADIOG,,30,,,$655.16,$0.00,1,0,1,20161001,
74235,CPT,RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I,,30,,,"$1,543.97",$0.00,1,0,1,20161001,
74240,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/O KUB,,30,,,$655.16,$0.00,1,0,1,20161001,
74241,CPT,RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB,,30,,,$655.16,$0.00,1,0,1,20161001,
74245,CPT,RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74246,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB,,30,,,$655.16,$0.00,1,0,1,20161001,
74247,CPT,RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB,,30,,,$655.16,$0.00,1,0,1,20161001,
74249,CPT,RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74250,CPT,RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES,,30,,,$655.16,$0.00,1,0,1,20161001,
74251,CPT,RADEX SM INT W/MLT SRL IMGES VIA ENTEROCLSS TUBE,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74260,CPT,DUODENOGRAPY HYPOTONIC,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
74261,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST,,30,,,$726.75,$0.00,1,0,1,20161001,
74262,CPT,CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
74263,CPT,CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING,,30,,,$726.75,$0.00,1,0,1,20161001,
74270,CPT,RADEX COLON BARIUM ENEMA W/WO KUB,,30,,,$655.16,$0.00,1,0,1,20161001,
74280,CPT,RADEX COLON W/SPEC HI DNS BARIUM W/WO GLUCAGON,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74283,CPT,THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74290,CPT,CHOLECYSTOGRAPHY ORAL CONTRST,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
74300,CPT,CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I,,30,,,$690.73,$0.00,1,0,1,20161001,
74301,CPT,CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS,,30,,,$487.57,$0.00,1,0,1,20161001,
74328,CPT,ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I,,30,,,"$1,750.25",$0.00,1,0,1,20161001,
74329,CPT,ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I,,30,,,"$1,324.57",$0.00,1,0,1,20161001,
74330,CPT,CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I,,30,,,"$2,235.95",$0.00,1,0,1,20161001,
74340,CPT,INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I,,30,,,"$1,125.16",$0.00,1,0,1,20161001,
74355,CPT,PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I,,30,,,"$1,642.74",$0.00,1,0,1,20161001,
74360,CPT,INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I,,30,,,"$1,805.26",$0.00,1,0,1,20161001,
74363,CPT,PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I,,30,,,"$1,462.71",$0.00,1,0,1,20161001,
74400,CPT,UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74410,CPT,UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74415,CPT,UROGRAPY INFUSION DRIP &/BOLUS TECHQ W/WO TOMO,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74420,CPT,X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
74425,CPT,UROGRAPHY ANTEGRADE RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
74430,CPT,CYSTOGRAPHY MINIMUM 3 VIEWS RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74440,CPT,VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74445,CPT,CORPORA CAVERNOSOGRAPY RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
74450,CPT,URETHROCYSTOGRAPHY RETROGRADE RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
74455,CPT,URETHROCYSTOGRAPHY VOIDING RS&I,,30,,,"$2,033.10",$0.00,1,0,1,20161001,
74470,CPT,RADEX RENAL CYST STUDY TRANSLUMBAR RS&I,,30,,,"$2,033.10",$0.00,1,0,1,20161001,
74485,CPT,DILATION NEPHROSTOMY/URETER/URETHRA RS&I,,30,,,"$7,949.04",$0.00,1,0,1,20161001,
74710,CPT,PELVIMETRY W/WOPLACENTAL LOCALIZATION,,30,,,$399.19,$0.00,1,0,1,20161001,
74712,CPT,FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES,,30,,,"$1,747.34",$0.00,1,0,1,20161001,
74740,CPT,HYSTEROSALPINGOGRAPHY RS&I,,30,,,"$2,033.10",$0.00,1,0,1,20161001,
74742,CPT,TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I,,30,,,"$1,222.00",$0.00,1,0,1,20161001,
74775,CPT,PERINEOGRAM,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
75557,CPT,CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
75559,CPT,CARDIAC MRI W/O CONTRAST W/STRESS IMAGING,,30,,,"$2,785.94",$0.00,1,0,1,20161001,
75561,CPT,CARDIAC MRI W/WO CONTRAST & FURTHER SEQ,,30,,,"$2,925.81",$0.00,1,0,1,20161001,
75563,CPT,CARDIAC MRI W/W/O CONTRAST W/STRESS,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
75565,CPT,CARDIAC MRI FOR VELOCITY FLOW MAPPING,,30,,,"$1,309.73",$0.00,1,0,1,20161001,
75571,CPT,CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM,,30,,,$81.90,$0.00,1,0,1,20161001,
75572,CPT,CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH,,30,,,"$1,516.95",$0.00,1,0,1,20161001,
75573,CPT,CT HRT CONTRST CARDIAC STRUCT&MORPH CONG HRT D,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
75574,CPT,CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
75600,CPT,AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75605,CPT,AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75625,CPT,AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75630,CPT,AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75635,CPT,CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP,,30,,,"$1,563.84",$0.00,1,0,1,20161001,
75658,CPT,ANIOGRAPHY BRACHIAL RETROGRADE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75705,CPT,ANGIOGRAPHY SPINAL SELECTIVE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75710,CPT,ANGIOGRAPHY EXTREMITY UNILATERAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75716,CPT,ANGIOGRAPHY EXTREMITY BILATERAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75726,CPT,ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75731,CPT,ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75733,CPT,ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75736,CPT,ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75741,CPT,ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75743,CPT,ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75746,CPT,ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75756,CPT,ANGIOGRAPHY INTERNAL MAMMARY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75774,CPT,ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I,,30,,,"$3,497.86",$0.00,1,0,1,20161001,
75791,CPT,ANGIOGRPHY AV SHUNT COMPLETE EVAL FLUOR RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75801,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
75803,CPT,LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75805,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75807,CPT,LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I,,30,,,"$14,368.31",$0.00,1,0,1,20161001,
75809,CPT,SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I,,30,,,$655.16,$0.00,1,0,1,20161001,
75810,CPT,SPLENOPORTOGRAPY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75820,CPT,VENOGRAPHY EXTREMITY UNILATERAL RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75822,CPT,VENOGRAPHY EXTREMITY BILATERAL RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75825,CPT,VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75827,CPT,VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I,,30,,,"$4,147.82",$0.00,1,0,1,20161001,
75831,CPT,VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75833,CPT,VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75840,CPT,VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75842,CPT,VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75860,CPT,VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75870,CPT,VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I,,30,,,"$4,141.97",$0.00,1,0,1,20161001,
75872,CPT,VENOGRAPHY EPIDURAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75880,CPT,VENOGRAPHY ORBITAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75885,CPT,PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75887,CPT,PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP,,30,,,"$4,147.82",$0.00,1,0,1,20161001,
75889,CPT,HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75891,CPT,HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75893,CPT,VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&,,30,,,"$14,454.78",$0.00,1,0,1,20161001,
75894,CPT,TRANSCATHETER EMBOLIZATION ANY METH RS&I,,30,,,"$13,889.24",$0.00,1,0,1,20161001,
75898,CPT,ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS,,30,,,"$4,147.82",$0.00,1,0,1,20161001,
75901,CPT,MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I,,30,,,"$1,754.82",$0.00,1,0,1,20161001,
75902,CPT,MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I,,30,,,"$1,572.07",$0.00,1,0,1,20161001,
75962,CPT,TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI,,30,,,"$11,318.91",$0.00,1,0,1,20161001,
75964,CPT,TRLUML BALOON ANGIOP PERIPHER EA ADDL ART RS&I,,30,,,"$6,160.55",$0.00,1,0,1,20161001,
75966,CPT,TRLUML BALO ANGIOPLASTY RENAL/OTH VISC ART RS&I,,30,,,"$11,053.62",$0.00,1,0,1,20161001,
75968,CPT,TRLUML BALO ANGIOPLASTY EA VISCERAL ART RS&I,,30,,,"$6,160.55",$0.00,1,0,1,20161001,
75970,CPT,TRANSCATHETER BIOPSY RS&I,,30,,,"$7,242.33",$0.00,1,0,1,20161001,
75978,CPT,TRANSLUMINAL BALLOON ANGIOPLASTY VENOUS RS&I,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
75984,CPT,CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I,,30,,,"$1,670.32",$0.00,1,0,1,20161001,
75989,CPT,RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I,,30,,,"$2,725.38",$0.00,1,0,1,20161001,
76000,CPT,FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
76001,CPT,FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME,,30,,,"$1,691.49",$0.00,1,0,1,20161001,
76010,CPT,RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD,,30,,,"$1,233.34",$0.00,1,0,1,20161001,
76080,CPT,RADEX ABSCESS/FISTULA/SINUS TRACT RS&I,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
76098,CPT,RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
76100,CPT,RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY,,30,,,$655.16,$0.00,1,0,1,20161001,
76101,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI,,30,,,$651.05,$0.00,1,0,1,20161001,
76102,CPT,RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
76120,CPT,CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC,,30,,,$655.16,$0.00,1,0,1,20161001,
76125,CPT,CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION,,30,,,$480.66,$0.00,1,0,1,20161001,
76140,CPT,CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT,,30,,,$304.31,$0.00,1,0,1,20161001,
76376,CPT,3D RENDERING W/INTERP & POSTPROCESS SUPERVISION,,30,,,"$1,862.81",$0.00,1,0,1,20161001,
76377,CPT,3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION,,30,,,"$1,930.99",$0.00,1,0,1,20161001,
76380,CPT,CT LIMITED/LOCALIZED FOLLOW UP STUDY,,30,,,$399.19,$0.00,1,0,1,20161001,
76390,CPT,MRI SPECTROSCOPY,,30,,,"$6,110.61",$0.00,1,0,1,20161001,
76496,CPT,UNLISTED FLUOROSCOPIC PROCEDURE,,30,,,$399.19,$0.00,1,0,1,20161001,
76497,CPT,UNLISTED COMPUTED TOMOGRAPHY PROCEDURE,,30,,,$399.19,$0.00,1,0,1,20161001,
76498,CPT,UNLISTED MAGNETIC RESONANCE PROCEDURE,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
76499,CPT,UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE,,30,,,$399.19,$0.00,1,0,1,20161001,
76506,CPT,ECHOENCEPHALOGRAPHY REAL TIME IMAGING,,30,,,$686.47,$0.00,1,0,1,20161001,
76510,CPT,OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR,,30,,,$425.53,$0.00,1,0,1,20161001,
76511,CPT,OPHTHALMIC ULTRASOUND DX QUAN A-SCAN ONLY,,30,,,$686.47,$0.00,1,0,1,20161001,
76512,CPT,OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN,,30,,,$686.47,$0.00,1,0,1,20161001,
76513,CPT,OPH US DX ANT SGM US IMMERSION B-SCAN/HR BIOM,,30,,,$989.36,$0.00,1,0,1,20161001,
76514,CPT,OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI,,30,,,$156.54,$0.00,1,0,1,20161001,
76516,CPT,OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN,,30,,,$686.47,$0.00,1,0,1,20161001,
76519,CPT,OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL,,30,,,$686.47,$0.00,1,0,1,20161001,
76529,CPT,OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION,,30,,,$686.47,$0.00,1,0,1,20161001,
76536,CPT,US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM,,30,,,$989.36,$0.00,1,0,1,20161001,
76604,CPT,US CHEST REAL TIME W/IMAGE DOCUMENTATION,,30,,,$686.47,$0.00,1,0,1,20161001,
76641,CPT,US BREAST UNI REAL TIME WITH IMAGE COMPLETE,,30,,,$686.47,$0.00,1,0,1,20161001,
76642,CPT,US BREAST UNI REAL TIME WITH IMAGE LIMITED,,30,,,$686.47,$0.00,1,0,1,20161001,
76700,CPT,US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76705,CPT,US ABDOMINAL REAL TIME W/IMAGE LIMITED,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76770,CPT,US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76775,CPT,US RETROPERITONEAL REAL TIME W/IMAGE LIMITED,,30,,,$989.36,$0.00,1,0,1,20161001,
76776,CPT,US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76800,CPT,ULTRASOUND SPINAL CANAL & CONTENTS,,30,,,$686.47,$0.00,1,0,1,20161001,
76801,CPT,US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76802,CPT,US PREG UTERUS 14 WK TRANSABDL EACH GESTATION,,30,,,$403.13,$0.00,1,0,1,20161001,
76805,CPT,US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76810,CPT,US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO,,30,,,$387.01,$0.00,1,0,1,20161001,
76811,CPT,US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76812,CPT,US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT,,30,,,$566.81,$0.00,1,0,1,20161001,
76813,CPT,US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION,,30,,,$686.47,$0.00,1,0,1,20161001,
76814,CPT,US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION,,30,,,$381.37,$0.00,1,0,1,20161001,
76815,CPT,US PREGNANT UTERUS LIMITED 1/> FETUSES,,30,,,$989.36,$0.00,1,0,1,20161001,
76816,CPT,US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS,,30,,,$686.47,$0.00,1,0,1,20161001,
76817,CPT,US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG,,30,,,$989.36,$0.00,1,0,1,20161001,
76818,CPT,FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76819,CPT,FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76820,CPT,DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY,,30,,,$686.47,$0.00,1,0,1,20161001,
76821,CPT,DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART,,30,,,$686.47,$0.00,1,0,1,20161001,
76825,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
76826,CPT,ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
76827,CPT,DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76828,CPT,DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76830,CPT,US TRANSVAGINAL,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76831,CPT,SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76856,CPT,US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76857,CPT,US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U,,30,,,$686.47,$0.00,1,0,1,20161001,
76870,CPT,US SCROTUM & CONTENTS,,30,,,$989.36,$0.00,1,0,1,20161001,
76872,CPT,US TRANSRECTAL,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76873,CPT,US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76881,CPT,US EXTREMITY NON-VASC REAL-TIME IMG COMPL,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76882,CPT,US EXTREMITY NON-VASC REAL-TIME IMG LMTD,,30,,,$686.47,$0.00,1,0,1,20161001,
76885,CPT,US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ,,30,,,$686.47,$0.00,1,0,1,20161001,
76886,CPT,US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76930,CPT,US GUIDANCE PERICARDIOCENTESIS RS&I,,30,,,$726.37,$0.00,1,0,1,20161001,
76932,CPT,US ENDOMYOCARDIAL BIOPSY RS&I,,30,,,$721.29,$0.00,1,0,1,20161001,
76936,CPT,US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
76937,CPT,US VASC ACCESS SITS VSL PATENCY NDL ENTRY,,30,,,$213.66,$0.00,1,0,1,20161001,
76940,CPT,US &MNTR PARENCHYMAL TISSUE ABLATION,,30,,,$796.59,$0.00,1,0,1,20161001,
76941,CPT,US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I,,30,,,$537.78,$0.00,1,0,1,20161001,
76942,CPT,US GUIDANCE NEEDLE PLACEMENT IMG S&I,,30,,,"$1,194.89",$0.00,1,0,1,20161001,
76945,CPT,US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I,,30,,,$722.42,$0.00,1,0,1,20161001,
76946,CPT,US GUIDANCE AMNIOCENTESIS IMG S&I,,30,,,$786.11,$0.00,1,0,1,20161001,
76948,CPT,US GUIDANCE ASPIRATION OVA IMG S&I,,30,,,$755.88,$0.00,1,0,1,20161001,
76965,CPT,US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION,,30,,,"$2,451.06",$0.00,1,0,1,20161001,
76970,CPT,US STUDY FOLLOW UP,,30,,,$686.47,$0.00,1,0,1,20161001,
76975,CPT,GI ENDOSCOPIC US S&I,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
76977,CPT,US BONE DENSITY MEAS & INTERP PERIPH ANY METHO,,30,,,$156.54,$0.00,1,0,1,20161001,
76998,CPT,ULTRASONIC GUIDANCE INTRAOPERATIVE,,30,,,"$1,213.78",$0.00,1,0,1,20161001,
76999,CPT,UNLISTED US PROCEDURE,,30,,,$686.47,$0.00,1,0,1,20161001,
77001,CPT,FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT,,30,,,$767.25,$0.00,1,0,1,20161001,
77002,CPT,FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT,,30,,,$585.35,$0.00,1,0,1,20161001,
77003,CPT,FLUORO NEEDLE/CATH SPINE/PARASPINAL DX/THER,,30,,,$534.88,$0.00,1,0,1,20161001,
77011,CPT,CT GUIDANCE STEREOTACTIC LOCALIZATION,,30,,,"$3,521.78",$0.00,1,0,1,20161001,
77012,CPT,CT GUIDANCE NEEDLE PLACEMENT,,30,,,"$3,529.44",$0.00,1,0,1,20161001,
77013,CPT,CT GUIDANCE &MONITORING VISC TISS ABLATION,,30,,,"$4,582.19",$0.00,1,0,1,20161001,
77014,CPT,CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT,,30,,,"$1,471.44",$0.00,1,0,1,20161001,
77021,CPT,MR GUIDANCE NEEDLE PLACEMENT,,30,,,"$5,350.40",$0.00,1,0,1,20161001,
77022,CPT,MR GUIDANCE &MONITORING TISSUE ABLATION,,30,,,"$5,980.50",$0.00,1,0,1,20161001,
77053,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
77054,CPT,MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE,,30,,,"$1,282.31",$0.00,1,0,1,20161001,
77058,CPT,MRI BREAST UNILATERAL,,30,,,"$8,718.59",$0.00,1,0,1,20161001,
77059,CPT,MRI BREAST BILATERAL,,30,,,"$11,868.28",$0.00,1,0,1,20161001,
77061,CPT,DIGITAL BREAST TOMOSYNTHESIS UNILATERAL,,30,,,$478.92,$0.00,1,0,1,20161001,
77062,CPT,DIGITAL BREAST TOMOSYNTHESIS BILATERAL,,30,,,$478.92,$0.00,1,0,1,20161001,
77071,CPT,MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS,,30,,,$399.19,$0.00,1,0,1,20161001,
77072,CPT,BONE AGE STUDIES,,30,,,$655.16,$0.00,1,0,1,20161001,
77073,CPT,BONE LENGTH STUDIES,,30,,,$399.19,$0.00,1,0,1,20161001,
77074,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED,,30,,,$655.16,$0.00,1,0,1,20161001,
77075,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL,,30,,,$655.16,$0.00,1,0,1,20161001,
77076,CPT,RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT,,30,,,$655.16,$0.00,1,0,1,20161001,
77077,CPT,JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS,,30,,,$655.16,$0.00,1,0,1,20161001,
77078,CPT,CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE,,30,,,$399.19,$0.00,1,0,1,20161001,
77080,CPT,DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL,,30,,,$655.16,$0.00,1,0,1,20161001,
77081,CPT,DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL,,30,,,$399.19,$0.00,1,0,1,20161001,
77084,CPT,BONE MARROW BLOOD SUPPLY,,30,,,"$1,801.06",$0.00,1,0,1,20161001,
77085,CPT,DXA BONE DENSITY STUDY AXIAL SKELETON,,30,,,$655.16,$0.00,1,0,1,20161001,
77086,CPT,VERTEBRAL FRACTURE ASSESSMENT VIA DXA,,30,,,$399.19,$0.00,1,0,1,20161001,
77280,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE,,30,,,"$1,089.87",$0.00,1,0,1,20161001,
77285,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77290,CPT,THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77295,CPT,3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS,,30,,,"$6,357.83",$0.00,1,0,1,20161001,
77299,CPT,UNLIS PX THER RADIOL CLINICAL TX PLANNING,,30,,,$710.65,$0.00,1,0,1,20161001,
77300,CPT,BASIC RADIATION DOSIMETRY CALCULATION,,30,,,$710.65,$0.00,1,0,1,20161001,
77301,CPT,NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS,,30,,,"$6,357.83",$0.00,1,0,1,20161001,
77306,CPT,TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION,,30,,,"$1,072.58",$0.00,1,0,1,20161001,
77307,CPT,TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY,,30,,,"$1,861.39",$0.00,1,0,1,20161001,
77316,CPT,BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL,,30,,,$710.65,$0.00,1,0,1,20161001,
77317,CPT,BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77318,CPT,BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77321,CPT,SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77331,CPT,SPEC DOSIM ONLY PRESCRIBED TREATING PHYS,,30,,,$710.65,$0.00,1,0,1,20161001,
77332,CPT,TX DEVICES DESIGN & CONSTRUCTION SIMPLE,,30,,,$710.65,$0.00,1,0,1,20161001,
77333,CPT,TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE,,30,,,"$1,089.87",$0.00,1,0,1,20161001,
77334,CPT,TX DEVICES DESIGN & CONSTRUCTION COMPLEX,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77336,CPT,CONTINUING MEDICAL PHYSICS CONSLTJ PR WK,,30,,,$710.65,$0.00,1,0,1,20161001,
77338,CPT,MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN,,30,,,"$1,898.43",$0.00,1,0,1,20161001,
77370,CPT,SPEC MEDICAL RADJ PHYSICS CONSLTJ,,30,,,"$1,089.87",$0.00,1,0,1,20161001,
77371,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT,,30,,,"$23,491.71",$0.00,1,0,1,20161001,
77372,CPT,RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR,,30,,,"$23,491.71",$0.00,1,0,1,20161001,
77373,CPT,STEREOTACTIC BODY RADIATION DELIVERY,,30,,,"$9,625.24",$0.00,1,0,1,20161001,
77385,CPT,INTENSITY MODULATED RADIATION TX DLVR SIMPLE,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77386,CPT,INTENSITY MODULATED RADIATION TX DLVR COMPLEX,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77399,CPT,UNLIS MEDICAL RADJ DOSIM TX DEV SPEC SVCS,,30,,,$710.65,$0.00,1,0,1,20161001,
77401,CPT,RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA,,30,,,$673.77,$0.00,1,0,1,20161001,
77402,CPT,RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE,,30,,,$673.77,$0.00,1,0,1,20161001,
77407,CPT,RADIATION TX DELIVERY 1 MEV >= INTERMEDIATE,,30,,,$673.77,$0.00,1,0,1,20161001,
77412,CPT,RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX,,30,,,"$1,266.48",$0.00,1,0,1,20161001,
77417,CPT,THERAPEUTIC RADIOLOGY PORT IMAGES(S),,30,,,$407.58,$0.00,1,0,1,20161001,
77422,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1 TX AREA,,30,,,"$1,266.48",$0.00,1,0,1,20161001,
77423,CPT,HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER,,30,,,"$3,176.23",$0.00,1,0,1,20161001,
77424,CPT,INTRAOP RADIAJ TX DELIVER XRAY SINGLE TX SESSION,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
77425,CPT,INTRAOP RADIAJ TX DELIVER ELECTRONS SNGL TX SESS,,30,,,"$23,463.49",$0.00,1,0,1,20161001,
77435,CPT,STEREOTACTIC BODY RADIATION MANAGEMENT,,30,,,"$5,449.39",$0.00,1,0,1,20161001,
77470,CPT,SPECIAL TREATMENT PROCEDURE,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77499,CPT,UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT,,30,,,$507.68,$0.00,1,0,1,20161001,
77520,CPT,PROTON TX DELIVERY SIMPLE W/O COMPENSATION,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77522,CPT,PROTON TX DELIVERY SIMPLE W/COMPENSATION,,30,,,"$6,895.13",$0.00,1,0,1,20161001,
77523,CPT,PROTON TX DELIVERY INTERMEDIATE,,30,,,"$6,895.13",$0.00,1,0,1,20161001,
77525,CPT,PROTON TX DELIVERY COMPLEX,,30,,,"$6,895.13",$0.00,1,0,1,20161001,
77600,CPT,HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL,,30,,,"$1,266.48",$0.00,1,0,1,20161001,
77605,CPT,HYPERTHERMIA EXTERNAL GENERATED DEEP,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77610,CPT,HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77615,CPT,HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77620,CPT,HYPERTHERMIA INTRACAVITARY PROBES,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77750,CPT,NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE,,30,,,"$1,266.48",$0.00,1,0,1,20161001,
77761,CPT,INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE,,30,,,"$3,256.27",$0.00,1,0,1,20161001,
77762,CPT,INTRACAVITARY RADIATION SOURCE APPLIC INTERMED,,30,,,"$3,176.23",$0.00,1,0,1,20161001,
77763,CPT,INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77767,CPT,HDR RDNCL SKN SURF BRACHYTX LES </2CM/1 CHAN,,30,,,"$1,248.43",$0.00,1,0,1,20161001,
77768,CPT,HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES,,30,,,"$1,248.43",$0.00,1,0,1,20161001,
77770,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77771,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77772,CPT,HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77778,CPT,INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
77789,CPT,SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE,,30,,,$712.96,$0.00,1,0,1,20161001,
77790,CPT,SUPERVISION HANDLING LOADING RADIATION SOURCE,,30,,,$662.32,$0.00,1,0,1,20161001,
77799,CPT,UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY,,30,,,$673.77,$0.00,1,0,1,20161001,
78012,CPT,THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78013,CPT,THYROID IMAGING WITH VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78014,CPT,THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78015,CPT,THYROID CARCINOMA METASTASES IMG LMTD AREA,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78016,CPT,THYROID CARCINOMA METASTASES IMG ADDL STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78018,CPT,THYROID CARCINOMA METASTASES IMG WHOLE BODY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78020,CPT,THYROID CARCINOMA METASTASES UPTAKE,,30,,,$612.04,$0.00,1,0,1,20161001,
78070,CPT,PARATHYROID PLANAR IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78071,CPT,PARATHYROID PLANAR IMAGING W/WO SUBTRACTION,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78072,CPT,PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78075,CPT,ADRENAL IMAGING CORTEX &/MEDULLA,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78099,CPT,UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78102,CPT,BONE MARROW IMAGING LIMITED AREA,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78103,CPT,BONE MARROW IMAGING MULTIPLE AREAS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78104,CPT,BONE MARROW IMAGING WHOLE BODY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78110,CPT,PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78111,CPT,PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78120,CPT,RED CELL VOLUME DETERMINATION SPX 1 SAMPLING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78121,CPT,RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78122,CPT,WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78130,CPT,RED CELL SURVIVAL STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78135,CPT,RBC SURVIVAL STUDY DIFFERNTL ORGAN/TISS KINETICS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78140,CPT,LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78185,CPT,SPLEEN IMAGING ONLY W/WO VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78190,CPT,KINETICS PLATELET W/WO DIFFRNTL ORGAN/TIS LOCLZJ,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78191,CPT,PLATELET SURVIVAL STUDY,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78195,CPT,LYMPHATICS & LYMPH NODES IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78199,CPT,UNLIS HEMATOP RET/ENDO&LYMPHATIC DX NUC MED,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78201,CPT,LIVER IMAGING STATIC ONLY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78202,CPT,LIVER IMAGING W/VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78205,CPT,LIVER IMAGING SPECT,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78206,CPT,LIVER IMAGING SPECT W/VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78215,CPT,LIVER & SPLEEN IMAGING STATIC ONLY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78216,CPT,LIVER & SPLEEN IMAGING W/VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78226,CPT,HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78227,CPT,HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78230,CPT,SALIVARY GLAND IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78231,CPT,SALIVARY GLAND IMAGING SERIAL IMAGES,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78232,CPT,SALIVARY GLAND FUNCTION STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78258,CPT,ESOPHAGEAL MOTILITY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78261,CPT,GASTRIC MUCOSA IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78262,CPT,GASTROESOPHAGEAL REFLUX STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78264,CPT,GASTRIC EMPTYING IMAGING STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78265,CPT,GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78266,CPT,GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY,,30,,,"$2,785.94",$0.00,1,0,1,20161001,
78270,CPT,VITAMIN B-12 ABSRPJ STUDY W/O INTRINSIC FACTOR,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78271,CPT,VITAMIN B-12 ABSRPJ STUDY W/INTRINSIC FACTOR,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78272,CPT,VITAMIN B-12 ABSRPJ STDY W/WO INTRINSIC FACT,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78278,CPT,ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78282,CPT,GASTROINTESTINAL PROTEIN LOSS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78290,CPT,INTESTINE IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78291,CPT,PERITONEAL-VENOUS SHUNT PATENCY TEST,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78299,CPT,UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78300,CPT,BONE &/JOINT IMAGING LIMITED AREA,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78305,CPT,BONE &/JOINT IMAGING MULTIPLE AREAS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78306,CPT,BONE &/JOINT IMAGING WHOLE BODY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78315,CPT,BONE &/JOINT IMAGING 3 PHASE STUDY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78320,CPT,BONE &/JOINT IMAGING TOMOGRAPHIC SPECT,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78350,CPT,BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY,,30,,,$777.17,$0.00,1,0,1,20161001,
78351,CPT,BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR,,30,,,$851.70,$0.00,1,0,1,20161001,
78399,CPT,UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78414,CPT,CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78428,CPT,CARDIAC SHUNT DETECTION,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78445,CPT,NONCARDIAC VASCULAR FLOW IMAGING,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78451,CPT,MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78452,CPT,MYOCARDIAL SPECT MULTIPLE STUDIES,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78453,CPT,MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78454,CPT,MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78456,CPT,ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78457,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL,,30,,,"$2,785.94",$0.00,1,0,1,20161001,
78458,CPT,VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78459,CPT,MYOCARDIAL IMAGING PET METABOLIC EVALUATION,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78466,CPT,MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78468,CPT,MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78469,CPT,MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78472,CPT,CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78473,CPT,CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78481,CPT,CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78483,CPT,CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78491,CPT,MYOCRD IMAGE PET PERFUS SINGLE STUDY REST/STRESS,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78492,CPT,MYOCRD IMAGE PET PERFUS MULTPL STUDY REST/STRESS,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78494,CPT,CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78496,CPT,CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT,,30,,,"$1,633.13",$0.00,1,0,1,20161001,
78499,CPT,UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78579,CPT,PULMONARY VENTILATION IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78580,CPT,PULMONARY PERFUSION IMAGING PARTICULATE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78582,CPT,PULMONARY VENTILATION & PERFUSION IMAGING,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78597,CPT,QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78598,CPT,QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78599,CPT,UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78600,CPT,BRAIN IMAGING <4 STATIC VIEWS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78601,CPT,BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78605,CPT,BRAIN IMAGING MINIMUM 4 STATIC VIEWS,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78606,CPT,BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78607,CPT,BRAIN IMAGING TOMOGRAPHIC SPECT,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78608,CPT,BRAIN IMAGING PET METABOLIC EVALUATION,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78609,CPT,BRAIN IMAGING PET PERFUSION EVALUATION,,30,,,"$4,998.59",$0.00,1,0,1,20161001,
78610,CPT,BRAIN IMAGING VASCULAR FLOW ONLY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78630,CPT,CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78635,CPT,CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78645,CPT,CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78647,CPT,CEREBROSPINAL FLUID FLOW W/O MATL TOMOG SPECT,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78650,CPT,CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78660,CPT,RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78699,CPT,UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78700,CPT,KIDNEY IMAGING MORPHOLOGY,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78701,CPT,KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78707,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78708,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78709,CPT,KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78710,CPT,KIDNEY IMAGING MORPHOLOGY TOMOGRAPHIC,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78725,CPT,KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
78730,CPT,URINARY BLADDER RESIDUAL STUDY,,30,,,$774.58,$0.00,1,0,1,20161001,
78740,CPT,URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78761,CPT,TESTICULAR IMAGING WITH VASCULAR FLOW,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78799,CPT,UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78800,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT LIMITED AREA,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78801,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT MULTIPLE AREAS,,30,,,"$2,141.51",$0.00,1,0,1,20161001,
78802,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT WHOLE BDY 1 DAY,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78803,CPT,RP LOCLZJ TUMOR/DSTRBJ AGENT TOMOG SPECT,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78804,CPT,RP LOCLZJ TUMOR/DSTRBJ AGT WHOL BDY REQ 2/> DAY,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
78805,CPT,RP LOCLZJ INFLAMMATORY PROCESS LIMITED AREA,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78806,CPT,RP LOCLZJ INFLAMMATORY PROCESS WHOLE BODY,,30,,,"$6,663.20",$0.00,1,0,1,20161001,
78807,CPT,RP LOCLZJ INFLAMMATORY PROCESS TOMOG SPECT,,30,,,"$2,983.65",$0.00,1,0,1,20161001,
78808,CPT,NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
78811,CPT,PET IMAGING LIMITED AREA CHEST HEAD/NECK,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78812,CPT,PET IMAGING SKULL BASE TO MID-THIGH,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78813,CPT,PET IMAGING WHOLE BODY,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78814,CPT,PET IMAGING CT FOR ATTENUATION LIMITED AREA,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78815,CPT,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78816,CPT,PET IMAGING FOR CT ATTENUATION WHOLE BODY,,30,,,"$7,622.99",$0.00,1,0,1,20161001,
78999,CPT,UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE,,30,,,"$2,116.06",$0.00,1,0,1,20161001,
79005,CPT,RP THERAPY ORAL ADMINISTRATION,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79101,CPT,RP THERAPY INTRAVENOUS ADMINISTRATION,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79200,CPT,RP THERAPY INRACAVITARY ADMINISTRATION,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79300,CPT,RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79403,CPT,RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79440,CPT,RP THERAPY INTRA-ARTICULAR ADMINISTRATION,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79445,CPT,RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
79999,CPT,RP THERAPY UNLISTED PROCEDURE,,30,,,"$1,627.71",$0.00,1,0,1,20161001,
80047,CPT,BASIC METABOLIC PANEL CALCIUM IONIZED,,30,,,$265.31,$0.00,1,0,1,20161001,
80048,CPT,BASIC METABOLIC PANEL CALCIUM TOTAL,,30,,,$265.31,$0.00,1,0,1,20161001,
80050,CPT,GENERAL HEALTH PANEL,,30,,,$608.01,$0.00,1,0,1,20161001,
80051,CPT,ELECTROLYTE PANEL,,30,,,$221.09,$0.00,1,0,1,20161001,
80053,CPT,COMPREHENSIVE METABOLIC PANEL,,30,,,$309.53,$0.00,1,0,1,20161001,
80055,CPT,OBSTETRIC PANEL,,30,,,$884.38,$0.00,1,0,1,20161001,
80061,CPT,LIPID PANEL,,30,,,$353.75,$0.00,1,0,1,20161001,
80069,CPT,RENAL FUNCTION PANEL,,30,,,$331.64,$0.00,1,0,1,20161001,
80074,CPT,ACUTE HEPATITIS PANEL,,30,,,$994.92,$0.00,1,0,1,20161001,
80076,CPT,HEPATIC FUNCTION PANEL,,30,,,$276.37,$0.00,1,0,1,20161001,
80081,CPT,OBSTETRIC PANEL,,30,,,"$1,695.02",$0.00,1,0,1,20161001,
80150,CPT,DRUG SCREEN QUANTITATIVE AMIKACIN,,30,,,$530.63,$0.00,1,0,1,20161001,
80156,CPT,DRUG ASSAY CARBAMAZEPINE TOTAL,,30,,,$530.63,$0.00,1,0,1,20161001,
80157,CPT,DRUG ASSAY CARBAMAZEPINE FREE,,30,,,$486.41,$0.00,1,0,1,20161001,
80158,CPT,DRUG ASSAY CYCLOSPORINE,,30,,,$663.28,$0.00,1,0,1,20161001,
80162,CPT,DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL,,30,,,$497.46,$0.00,1,0,1,20161001,
80163,CPT,DRUG SCREEN QUANTITATIVE DIGOXIN FREE,,30,,,$490.60,$0.00,1,0,1,20161001,
80164,CPT,DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL,,30,,,$519.57,$0.00,1,0,1,20161001,
80165,CPT,DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE,,30,,,$512.41,$0.00,1,0,1,20161001,
80168,CPT,DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE,,30,,,$585.90,$0.00,1,0,1,20161001,
80170,CPT,DRUG SCREEN QUANTITATIVE GENTAMICIN,,30,,,$552.74,$0.00,1,0,1,20161001,
80173,CPT,DRUG SCREEN QUANTITATIVE HALOPRIDOL,,30,,,$486.41,$0.00,1,0,1,20161001,
80176,CPT,DRUG SCREEN QUANTITATIVE LIDOCAINE,,30,,,$375.86,$0.00,1,0,1,20161001,
80178,CPT,DRUG SCREEN QUANTITATIVE LITHIUM,,30,,,$331.64,$0.00,1,0,1,20161001,
80184,CPT,DRUG SCREEN QUANTITATIVE PHENOBARBITAL,,30,,,$442.19,$0.00,1,0,1,20161001,
80185,CPT,DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL,,30,,,$497.46,$0.00,1,0,1,20161001,
80186,CPT,DRUG SCREEN QUANTITATIVE PHENYTOIN FREE,,30,,,$541.68,$0.00,1,0,1,20161001,
80188,CPT,DRUG SCREEN QUANTITATIVE PRIMIDONE,,30,,,$619.06,$0.00,1,0,1,20161001,
80190,CPT,DRUG SCREEN QUANTITATIVE PROCAINAMIDE,,30,,,$619.06,$0.00,1,0,1,20161001,
80192,CPT,DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE,,30,,,$619.06,$0.00,1,0,1,20161001,
80194,CPT,DRUG SCREEN QUANTITATIVE QUINIDINE,,30,,,$530.63,$0.00,1,0,1,20161001,
80195,CPT,DRUG SCREEN QUANTITATIVE SIROLIMUS,,30,,,$685.39,$0.00,1,0,1,20161001,
80197,CPT,DRUG SCREEN QUANTITATIVE TACROLIMUS,,30,,,$685.39,$0.00,1,0,1,20161001,
80198,CPT,DRUG SCREEN QUANTITATIVE THEOPHYLLINE,,30,,,$519.57,$0.00,1,0,1,20161001,
80200,CPT,DRUG SCREEN QUANTITATIVE TOBRAMYCIN,,30,,,$552.74,$0.00,1,0,1,20161001,
80201,CPT,DRUG SCREEN QUANTITATIVE TOPIRAMATE,,30,,,$541.68,$0.00,1,0,1,20161001,
80202,CPT,DRUG SCREEN QUANTITATIVE VANCOMYCIN,,30,,,$497.46,$0.00,1,0,1,20161001,
80299,CPT,QUANTITATION DRUG NOT ELSEWHERE SPECIFIED,,30,,,$552.74,$0.00,1,0,1,20161001,
80300,CPT,DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES,,30,,,$398.52,$0.00,1,0,1,20161001,
80301,CPT,DRUG SCREEN LIST A SINGLE DRUG CLASS METHOD,,30,,,$212.70,$0.00,1,0,1,20161001,
80302,CPT,DRUG SCREEN PRESUMPTIVE 1 CLASS METHOD LIST B,,30,,,$295.95,$0.00,1,0,1,20161001,
80303,CPT,DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD TLC,,30,,,$325.54,$0.00,1,0,1,20161001,
80304,CPT,DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD,,30,,,$332.95,$0.00,1,0,1,20161001,
80320,CPT,DRUG SCREEN QUANTITATIVE ALCOHOLS,,30,,,$221.96,$0.00,1,0,1,20161001,
80321,CPT,DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2,,30,,,$221.96,$0.00,1,0,1,20161001,
80322,CPT,DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE,,30,,,$244.16,$0.00,1,0,1,20161001,
80323,CPT,ALKALOIDS NOT OTHERWISE SPECIFIED,,30,,,$332.95,$0.00,1,0,1,20161001,
80324,CPT,DRUG SCREEN QUANT AMPHETAMINES 1 OR 2,,30,,,$369.94,$0.00,1,0,1,20161001,
80325,CPT,DRUG SCREEN QUANT AMPHETAMINES 3 OR 4,,30,,,$406.93,$0.00,1,0,1,20161001,
80326,CPT,DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE,,30,,,$443.93,$0.00,1,0,1,20161001,
80327,CPT,DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2,,30,,,$443.93,$0.00,1,0,1,20161001,
80328,CPT,DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE,,30,,,$488.32,$0.00,1,0,1,20161001,
80329,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2,,30,,,$303.35,$0.00,1,0,1,20161001,
80330,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 3-5,,30,,,$333.68,$0.00,1,0,1,20161001,
80331,CPT,DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE,,30,,,$364.02,$0.00,1,0,1,20161001,
80332,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2,,30,,,$332.95,$0.00,1,0,1,20161001,
80333,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5,,30,,,$366.24,$0.00,1,0,1,20161001,
80334,CPT,ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE,,30,,,$399.54,$0.00,1,0,1,20161001,
80335,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2,,30,,,$632.34,$0.00,1,0,1,20161001,
80336,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5,,30,,,$695.57,$0.00,1,0,1,20161001,
80337,CPT,ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE,,30,,,$758.80,$0.00,1,0,1,20161001,
80338,CPT,ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED,,30,,,$332.95,$0.00,1,0,1,20161001,
80339,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3,,30,,,$523.31,$0.00,1,0,1,20161001,
80340,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6,,30,,,$575.64,$0.00,1,0,1,20161001,
80341,CPT,ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE,,30,,,$627.97,$0.00,1,0,1,20161001,
80345,CPT,DRUG SCREENING BARBITURATES,,30,,,$295.95,$0.00,1,0,1,20161001,
80346,CPT,DRUG SCREENING BENZODIAZEPINES 1-12,,30,,,$632.34,$0.00,1,0,1,20161001,
80347,CPT,DRUG SCREENING BENZODIAZEPINES 13 OR MORE,,30,,,$695.57,$0.00,1,0,1,20161001,
80348,CPT,DRUG SCREENING BUPRENORPHINE,,30,,,$332.95,$0.00,1,0,1,20161001,
80349,CPT,DRUG SCREENING CANNABINOIDS NATURAL,,30,,,$332.95,$0.00,1,0,1,20161001,
80350,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3,,30,,,$332.95,$0.00,1,0,1,20161001,
80351,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6,,30,,,$366.24,$0.00,1,0,1,20161001,
80352,CPT,DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE,,30,,,$399.54,$0.00,1,0,1,20161001,
80353,CPT,DRUG SCREENING COCAINE,,30,,,$355.14,$0.00,1,0,1,20161001,
80354,CPT,DRUG SCREENING FENTANYL,,30,,,$332.95,$0.00,1,0,1,20161001,
80356,CPT,DRUG SCREENING HEROIN METABOLITE,,30,,,$332.95,$0.00,1,0,1,20161001,
80357,CPT,DRUG SCREENING KETAMINE AND NORKETAMINE,,30,,,$332.95,$0.00,1,0,1,20161001,
80358,CPT,DRUG SCREENING METHADONE,,30,,,$325.54,$0.00,1,0,1,20161001,
80359,CPT,DRUG SCREENING METHYLENEDIOXYAMPHETAMINES,,30,,,$369.94,$0.00,1,0,1,20161001,
80360,CPT,DRUG SCREENING METHYLPHENIDATE,,30,,,$332.95,$0.00,1,0,1,20161001,
80361,CPT,DRUG SCREENING OPIATES 1 OR MORE,,30,,,$332.95,$0.00,1,0,1,20161001,
80362,CPT,DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2,,30,,,$332.95,$0.00,1,0,1,20161001,
80363,CPT,DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4,,30,,,$366.24,$0.00,1,0,1,20161001,
80364,CPT,DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE,,30,,,$399.54,$0.00,1,0,1,20161001,
80365,CPT,DRUG SCREENING OXYCODONE,,30,,,$332.95,$0.00,1,0,1,20161001,
80366,CPT,DRUG SCREENING PREGABALIN,,30,,,$332.95,$0.00,1,0,1,20161001,
80367,CPT,DRUG SCREENING PROPOXYPHENE,,30,,,$332.95,$0.00,1,0,1,20161001,
80368,CPT,DRUG SCREENING SEDATIVE HYPNOTICS,,30,,,$332.95,$0.00,1,0,1,20161001,
80369,CPT,DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2,,30,,,$332.95,$0.00,1,0,1,20161001,
80370,CPT,DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE,,30,,,$366.24,$0.00,1,0,1,20161001,
80371,CPT,DRUG SCREENING STIMULANTS SYNTHETIC,,30,,,$332.95,$0.00,1,0,1,20161001,
80372,CPT,DRUG SCREENING TAPENTADOL,,30,,,$332.95,$0.00,1,0,1,20161001,
80373,CPT,DRUG SCREENING TRAMADOL,,30,,,$332.95,$0.00,1,0,1,20161001,
80374,CPT,DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS,,30,,,$332.95,$0.00,1,0,1,20161001,
80375,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3,,30,,,$332.95,$0.00,1,0,1,20161001,
80376,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6,,30,,,$366.24,$0.00,1,0,1,20161001,
80377,CPT,DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE,,30,,,$399.54,$0.00,1,0,1,20161001,
80400,CPT,ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY,,30,,,"$1,039.14",$0.00,1,0,1,20161001,
80402,CPT,ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY,,30,,,"$1,691.37",$0.00,1,0,1,20161001,
80406,CPT,ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY,,30,,,"$1,779.81",$0.00,1,0,1,20161001,
80408,CPT,ALDOSTERONE SUPPRESSION EVALUATION PANEL,,30,,,"$1,934.57",$0.00,1,0,1,20161001,
80410,CPT,CALCITONIN STIMULATION PANEL,,30,,,"$1,602.93",$0.00,1,0,1,20161001,
80412,CPT,CORTICOTROPIC RELEASING HORM STIMJ PANEL,,30,,,"$4,974.62",$0.00,1,0,1,20161001,
80414,CPT,CHORNC GONAD STIMJ PANEL TSTOSTERONE RESPONSE,,30,,,$829.10,$0.00,1,0,1,20161001,
80415,CPT,CHORNC GONAD STIMJ PANEL ESTRADIOL RESPONSE,,30,,,$829.10,$0.00,1,0,1,20161001,
80417,CPT,PERIPHERAL VEIN RENIN STIMULATION PANEL,,30,,,"$1,061.25",$0.00,1,0,1,20161001,
80418,CPT,COMBINED RAPID ANT PITUITARY EVALUATION PANEL,,30,,,"$11,054.71",$0.00,1,0,1,20161001,
80420,CPT,DEXMETHASONE SUPPRESSION PANEL 48 HR,,30,,,"$1,381.84",$0.00,1,0,1,20161001,
80422,CPT,GLUCOSE TOLERANCE PANEL INSULINOMA,,30,,,$939.65,$0.00,1,0,1,20161001,
80424,CPT,GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA,,30,,,$939.65,$0.00,1,0,1,20161001,
80426,CPT,GONADOTROPIN RELEASING HORMONE STIMJ PANEL,,30,,,"$2,597.86",$0.00,1,0,1,20161001,
80428,CPT,GROWTH HORMONE STIMULATION PANEL,,30,,,"$1,437.11",$0.00,1,0,1,20161001,
80430,CPT,GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN,,30,,,"$1,437.11",$0.00,1,0,1,20161001,
80432,CPT,INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL,,30,,,"$2,818.95",$0.00,1,0,1,20161001,
80434,CPT,INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY,,30,,,"$1,768.75",$0.00,1,0,1,20161001,
80435,CPT,INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY,,30,,,"$1,879.30",$0.00,1,0,1,20161001,
80436,CPT,METYRAPONE PANEL,,30,,,"$1,824.03",$0.00,1,0,1,20161001,
80438,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR,,30,,,"$1,050.20",$0.00,1,0,1,20161001,
80439,CPT,THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR,,30,,,"$1,105.47",$0.00,1,0,1,20161001,
80500,CPT,CLINICAL PATHOLOGY CONSULTATION LIMITED,,30,,,$315.58,$0.00,1,0,1,20161001,
80502,CPT,CLINICAL PATHOLOGY CONSULTATION COMPREHENSIVE,,30,,,$315.58,$0.00,1,0,1,20161001,
81000,CPT,URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY,,30,,,$113.45,$0.00,1,0,1,20161001,
81001,CPT,URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY,,30,,,$113.45,$0.00,1,0,1,20161001,
81002,CPT,URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP,,30,,,$88.79,$0.00,1,0,1,20161001,
81003,CPT,URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY,,30,,,$93.72,$0.00,1,0,1,20161001,
81005,CPT,URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS,,30,,,$88.79,$0.00,1,0,1,20161001,
81007,CPT,URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK,,30,,,$108.52,$0.00,1,0,1,20161001,
81015,CPT,URINALYSIS MICROSCOPIC ONLY,,30,,,$88.79,$0.00,1,0,1,20161001,
81020,CPT,URINALYSIS 2/3 GLASS TEST,,30,,,$108.52,$0.00,1,0,1,20161001,
81025,CPT,URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS,,30,,,$167.71,$0.00,1,0,1,20161001,
81050,CPT,VOLUME MEASUREMENT TIMED COLLECTION EACH,,30,,,$88.79,$0.00,1,0,1,20161001,
81099,CPT,UNLISTED URINALYSIS PROCEDURE,,30,,,$34.00,$0.00,1,0,1,20161001,
81162,CPT,BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS,,30,,,"$6,836.57",$0.00,1,0,1,20161001,
81170,CPT,ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS,,30,,,"$2,076.18",$0.00,1,0,1,20161001,
81201,CPT,APC GENE ANALYSIS FULL GENE SEQUENCE,,30,,,"$8,663.13",$0.00,1,0,1,20161001,
81203,CPT,APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS,,30,,,"$3,066.77",$0.00,1,0,1,20161001,
81211,CPT,BRCA1&BRCA2 FULL SEQ ANALYS/COMM DUP/DEL BRCA,,30,,,"$5,190.44",$0.00,1,0,1,20161001,
81213,CPT,BRCA1&BRCA2 ANAL UNCOMMON DUP/DEL VARIANTS,,30,,,"$2,405.75",$0.00,1,0,1,20161001,
81218,CPT,CEBPA GENE ANALYSIS FULL GENE SEQUENCE,,30,,,"$2,076.18",$0.00,1,0,1,20161001,
81220,CPT,CFTR GENE ANALYSIS COMMON VARIANTS,,30,,,"$3,101.86",$0.00,1,0,1,20161001,
81235,CPT,EGFR GENE ANALYSIS COMMON VARIANTS,,30,,,"$2,076.18",$0.00,1,0,1,20161001,
81256,CPT,HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS,,30,,,$611.60,$0.00,1,0,1,20161001,
81257,CPT,HBA1/HBA2 ANALYSIS FOR COMMON DELETIONS/VARIANT,,30,,,"$1,287.56",$0.00,1,0,1,20161001,
81272,CPT,KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,,30,,,"$2,076.18",$0.00,1,0,1,20161001,
81314,CPT,PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS,,30,,,"$2,076.18",$0.00,1,0,1,20161001,
81324,CPT,PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,,30,,,"$2,905.27",$0.00,1,0,1,20161001,
81325,CPT,PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,,30,,,"$5,770.15",$0.00,1,0,1,20161001,
81417,CPT,EXOME RE-EVAL OF PREVIOUSLY OBTAINED EXOME SEQ,,30,,,$87.34,$0.00,1,0,1,20161001,
81420,CPT,FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS,,30,,,$468.09,$0.00,1,0,1,20161001,
81425,CPT,GENOME SEQUENCE ANALYSIS,,30,,,$87.34,$0.00,1,0,1,20161001,
81426,CPT,GENOME SEQUENCE ANALYSIS EACH COMPARATOR GENOME,,30,,,$87.34,$0.00,1,0,1,20161001,
81427,CPT,GENOME RE-EVALUATION OF PREC OBTAINED GENOME SEQ,,30,,,$87.34,$0.00,1,0,1,20161001,
81479,CPT,UNLISTED MOLELCULAR PATHOLOGY PROCEDURE,,30,,,$437.69,$0.00,1,0,1,20161001,
81490,CPT,AUTOIMMUNE RHEUMATOID ARTHRTS ANALYS 12 BIOMRKRS,,30,,,"$3,078.74",$0.00,1,0,1,20161001,
81503,CPT,ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS,,30,,,"$1,390.30",$0.00,1,0,1,20161001,
81508,CPT,FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS,,30,,,$231.82,$0.00,1,0,1,20161001,
81509,CPT,FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS,,30,,,$245.74,$0.00,1,0,1,20161001,
81511,CPT,FETAL CONGENITAL ABNOR ASSAY FOUR ANAL,,30,,,$450.14,$0.00,1,0,1,20161001,
81528,CPT,ONCOLOGY COLORECTAL SCREENING QUAN 10 DNA MARKRS,,30,,,$264.11,$0.00,1,0,1,20161001,
81535,CPT,ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP 1ST,,30,,,"$5,796.61",$0.00,1,0,1,20161001,
81536,CPT,ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP ADD,,30,,,$652.12,$0.00,1,0,1,20161001,
81538,CPT,ONCOLOGY LUNG MS 8-PROTEIN SIGNATURE,,30,,,"$2,716.54",$0.00,1,0,1,20161001,
81599,CPT,UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS,,30,,,"$1,894.74",$0.00,1,0,1,20161001,
82009,CPT,KETONE BODIES SERUM QUALITATIVE,,30,,,$113.19,$0.00,1,0,1,20161001,
82010,CPT,KETONE BODIES SERUM QUANTITATIVE,,30,,,$181.10,$0.00,1,0,1,20161001,
82013,CPT,ASSAY OF ACETYLCHOLINESTERASE,,30,,,$286.75,$0.00,1,0,1,20161001,
82016,CPT,ACYLCARNITINES QUALITATIVE EACH SPECIMEN,,30,,,$241.47,$0.00,1,0,1,20161001,
82017,CPT,ACYLCARNITINES QUANTIATIVE EACH SPECIMEN,,30,,,$369.75,$0.00,1,0,1,20161001,
82024,CPT,ADRENOCORTICOTROPIC HORMONE ACTH,,30,,,$679.13,$0.00,1,0,1,20161001,
82030,CPT,ADENOSINE 5-MONOPHOSPHATE CYCLIC,,30,,,$528.22,$0.00,1,0,1,20161001,
82040,CPT,ALBUMIN SERUM PLASMA/WHOLE BLOOD,,30,,,$75.46,$0.00,1,0,1,20161001,
82042,CPT,ALBUMIN URINE/OTHER SOURCE QUAN EACH SPECIMEN,,30,,,$120.74,$0.00,1,0,1,20161001,
82043,CPT,ALBUMIN URINE MICROALBUMIN QUANTIATIVE,,30,,,$264.11,$0.00,1,0,1,20161001,
82044,CPT,ALBUMIN URINE MICROALBUMIN SEMIQUANTITATIVE,,30,,,$128.28,$0.00,1,0,1,20161001,
82075,CPT,ASSAY OF ALCOHOL BREATH,,30,,,$128.28,$0.00,1,0,1,20161001,
82085,CPT,ASSAY OF ALDOLASE,,30,,,$211.29,$0.00,1,0,1,20161001,
82088,CPT,ASSAY OF ALDOSTERONE,,30,,,$603.68,$0.00,1,0,1,20161001,
82103,CPT,ALPHA-1-ANTITRYPSIN TOTAL,,30,,,$301.84,$0.00,1,0,1,20161001,
82104,CPT,ALPHA-1-ANTITRYPSIN PHENOTYPE,,30,,,$430.12,$0.00,1,0,1,20161001,
82105,CPT,ALPHA-FETOPROTEIN SERUM,,30,,,$354.66,$0.00,1,0,1,20161001,
82106,CPT,ALPHA-FETOPROTEIN AMNIOTIC FLUID,,30,,,$354.66,$0.00,1,0,1,20161001,
82107,CPT,AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO,,30,,,$415.03,$0.00,1,0,1,20161001,
82108,CPT,ASSAY OF ALUMINUM,,30,,,$437.66,$0.00,1,0,1,20161001,
82120,CPT,AMINES VAGINAL FLUID QUALITATIVE,,30,,,$63.16,$0.00,1,0,1,20161001,
82127,CPT,AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN,,30,,,$181.10,$0.00,1,0,1,20161001,
82128,CPT,AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN,,30,,,$188.65,$0.00,1,0,1,20161001,
82131,CPT,AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN,,30,,,$965.88,$0.00,1,0,1,20161001,
82135,CPT,AMINOLEVULINIC ACID DELTA,,30,,,$324.48,$0.00,1,0,1,20161001,
82136,CPT,AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC,,30,,,$965.88,$0.00,1,0,1,20161001,
82139,CPT,AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE,,30,,,$965.88,$0.00,1,0,1,20161001,
82140,CPT,ASSAY OF AMMONIA,,30,,,$188.65,$0.00,1,0,1,20161001,
82143,CPT,AMNIOTIC FLU SCAN,,30,,,$286.75,$0.00,1,0,1,20161001,
82150,CPT,ASSAY OF AMYLASE,,30,,,$128.28,$0.00,1,0,1,20161001,
82154,CPT,ANDROSTANEDIOL GLUCURONIDE,,30,,,$505.58,$0.00,1,0,1,20161001,
82157,CPT,ANDROSTENEDIONE,,30,,,$467.85,$0.00,1,0,1,20161001,
82160,CPT,ANDROSTERONE,,30,,,$452.76,$0.00,1,0,1,20161001,
82163,CPT,ANGIOTENSIN II,,30,,,$452.76,$0.00,1,0,1,20161001,
82164,CPT,ANGIOTENSIN I-CONVERTING ENZYME,,30,,,$377.30,$0.00,1,0,1,20161001,
82172,CPT,APOLIPOPROTEIN EACH,,30,,,$249.02,$0.00,1,0,1,20161001,
82175,CPT,ASSAY OF ARSENIC,,30,,,$377.30,$0.00,1,0,1,20161001,
82180,CPT,ASSAY OF ASCORBIC ACID BLOOD,,30,,,$241.47,$0.00,1,0,1,20161001,
82190,CPT,ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE,,30,,,$452.76,$0.00,1,0,1,20161001,
82232,CPT,BETA-2 MICROGLOBULIN,,30,,,$415.03,$0.00,1,0,1,20161001,
82239,CPT,BILE ACIDS TOTAL,,30,,,$256.56,$0.00,1,0,1,20161001,
82240,CPT,BILE ACIDS CHOLYLGLYCINE,,30,,,$513.12,$0.00,1,0,1,20161001,
82247,CPT,BILIRUBIN TOTAL,,30,,,$83.01,$0.00,1,0,1,20161001,
82248,CPT,BILIRUBIN DIRECT,,30,,,$83.01,$0.00,1,0,1,20161001,
82252,CPT,BILIRUBIN FECES QUALITATIVE,,30,,,$83.01,$0.00,1,0,1,20161001,
82261,CPT,BIOTINIDASE EACH SPECIMEN,,30,,,$83.01,$0.00,1,0,1,20161001,
82270,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER,,30,,,$75.46,$0.00,1,0,1,20161001,
82271,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES,,30,,,$75.46,$0.00,1,0,1,20161001,
82272,CPT,BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC,,30,,,$67.91,$0.00,1,0,1,20161001,
82274,CPT,BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3,,30,,,$264.11,$0.00,1,0,1,20161001,
82286,CPT,BRADYKININ,,30,,,$603.68,$0.00,1,0,1,20161001,
82300,CPT,CADMIUM,,30,,,$316.93,$0.00,1,0,1,20161001,
82306,CPT,25 HYDROXY INCLUDES FRACTIONS IF PERFORMED,,30,,,$565.95,$0.00,1,0,1,20161001,
82308,CPT,CALCITONIN,,30,,,$528.22,$0.00,1,0,1,20161001,
82310,CPT,CALCIUM TOTAL,,30,,,$90.55,$0.00,1,0,1,20161001,
82330,CPT,CALCIUM IONIZED,,30,,,$249.02,$0.00,1,0,1,20161001,
82331,CPT,CALCIUM AFTER CALCIUM INFUSION TEST,,30,,,$150.92,$0.00,1,0,1,20161001,
82340,CPT,CALCIUM URINE QUANTITATIVE TIMED SPECIMEN,,30,,,$120.74,$0.00,1,0,1,20161001,
82355,CPT,CALCULUS QUALITATIVE ANALYSIS,,30,,,$233.92,$0.00,1,0,1,20161001,
82360,CPT,CALCULUS QUANTITATIVE CHEMICAL,,30,,,$286.75,$0.00,1,0,1,20161001,
82365,CPT,CALCULUS INFRARED SPECTROSCOPY,,30,,,$271.65,$0.00,1,0,1,20161001,
82370,CPT,CALCULUS XRAY DIFFRACTION,,30,,,$279.20,$0.00,1,0,1,20161001,
82373,CPT,CARBOHYDRATE DEFICIENT TRANSFERRIN,,30,,,$415.03,$0.00,1,0,1,20161001,
82374,CPT,CARBON DIOXIDE BICARBONATE,,30,,,$83.01,$0.00,1,0,1,20161001,
82375,CPT,CARBOXYHEMOGLOBIN QUANTITATIVE,,30,,,$233.92,$0.00,1,0,1,20161001,
82376,CPT,CARBOXYHEMOGLOBIN QUALITATIVE,,30,,,$113.19,$0.00,1,0,1,20161001,
82378,CPT,CARCINOEMBRYONIC ANTIGEN CEA,,30,,,$392.39,$0.00,1,0,1,20161001,
82379,CPT,CARNITINE QUANTITATIVE EACH SPECIMEN,,30,,,$392.39,$0.00,1,0,1,20161001,
82380,CPT,CAROTENE,,30,,,$196.19,$0.00,1,0,1,20161001,
82382,CPT,CATECHOLAMINES TOTAL URINE,,30,,,$339.57,$0.00,1,0,1,20161001,
82383,CPT,CATECHOLAMINES BLOOD,,30,,,$415.03,$0.00,1,0,1,20161001,
82384,CPT,CATECHOLAMINES FRACTIONATED,,30,,,$528.22,$0.00,1,0,1,20161001,
82387,CPT,CATHEPSIN-D,,30,,,$528.22,$0.00,1,0,1,20161001,
82390,CPT,CERULOPLASMIN,,30,,,$241.47,$0.00,1,0,1,20161001,
82397,CPT,CHEMILUMINESCENT ASSAY,,30,,,$211.29,$0.00,1,0,1,20161001,
82415,CPT,CHLORAMPHENICOL,,30,,,$249.02,$0.00,1,0,1,20161001,
82435,CPT,CHLORIDE BLD,,30,,,$75.46,$0.00,1,0,1,20161001,
82436,CPT,CHLORIDE URINE,,30,,,$83.01,$0.00,1,0,1,20161001,
82438,CPT,CHLORIDE OTHER SOURCE,,30,,,$143.37,$0.00,1,0,1,20161001,
82441,CPT,CHLORINATED HYDROCARBONS SCREEN,,30,,,$226.38,$0.00,1,0,1,20161001,
82465,CPT,CHOLESTEROL SERUM/WHOLE BLOOD TOTAL,,30,,,$75.46,$0.00,1,0,1,20161001,
82480,CPT,CHOLINESTERASE SERUM,,30,,,$181.10,$0.00,1,0,1,20161001,
82482,CPT,CHOLINESTERASE RBC,,30,,,$233.92,$0.00,1,0,1,20161001,
82485,CPT,CHONDROITIN B SULFATE QUANTITATIVE,,30,,,$301.84,$0.00,1,0,1,20161001,
82495,CPT,ASSAY OF CHROMIUM,,30,,,$354.66,$0.00,1,0,1,20161001,
82507,CPT,ASSAY OF CITRATE,,30,,,$528.22,$0.00,1,0,1,20161001,
82523,CPT,COLLAGEN CROSS LINKS ANY METHOD,,30,,,$362.21,$0.00,1,0,1,20161001,
82525,CPT,ASSAY OF COPPER,,30,,,$226.38,$0.00,1,0,1,20161001,
82528,CPT,CORTICOSTERONE,,30,,,$415.03,$0.00,1,0,1,20161001,
82530,CPT,CORTISOL FREE,,30,,,$362.21,$0.00,1,0,1,20161001,
82533,CPT,CORTISOL TOTAL,,30,,,$354.66,$0.00,1,0,1,20161001,
82540,CPT,ASSAY OF CREATINE,,30,,,$135.83,$0.00,1,0,1,20161001,
82542,CPT,COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC,,30,,,$339.57,$0.00,1,0,1,20161001,
82550,CPT,CREATINE KINASE TOTAL,,30,,,$98.10,$0.00,1,0,1,20161001,
82552,CPT,CREATINE KINASE ISOENZYMES,,30,,,$271.65,$0.00,1,0,1,20161001,
82553,CPT,CREATINE KINASE MB FRACTION ONLY,,30,,,$173.56,$0.00,1,0,1,20161001,
82554,CPT,CREATINE KINASE ISOFORMS,,30,,,$256.56,$0.00,1,0,1,20161001,
82565,CPT,CREATININE BLOOD,,30,,,$75.46,$0.00,1,0,1,20161001,
82570,CPT,CREATININE OTHER SOURCE,,30,,,$120.74,$0.00,1,0,1,20161001,
82575,CPT,CREATININE CLEARANCE,,30,,,$218.83,$0.00,1,0,1,20161001,
82585,CPT,ASSAY OF CRYOFIBRN,,30,,,$173.56,$0.00,1,0,1,20161001,
82595,CPT,CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE,,30,,,$158.46,$0.00,1,0,1,20161001,
82600,CPT,ASSAY OF CYANIDE,,30,,,$332.02,$0.00,1,0,1,20161001,
82607,CPT,CYANOCOBALAMIN VITAMIN B-12,,30,,,$301.84,$0.00,1,0,1,20161001,
82608,CPT,CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY,,30,,,$316.93,$0.00,1,0,1,20161001,
82610,CPT,CYSTATIN C,,30,,,$199.26,$0.00,1,0,1,20161001,
82615,CPT,CSTINE&HOMOCSTINE URINE QUALITATIVE,,30,,,$226.38,$0.00,1,0,1,20161001,
82626,CPT,DEHYDROEPIANDROSTERONE,,30,,,$513.12,$0.00,1,0,1,20161001,
82627,CPT,DEHYDROEPIANDROSTERONE-SULFATE,,30,,,$452.76,$0.00,1,0,1,20161001,
82633,CPT,DESOXYCORTICOSTERONE 11-,,30,,,$490.49,$0.00,1,0,1,20161001,
82634,CPT,DEOXYCORTISOL 11-,,30,,,$490.49,$0.00,1,0,1,20161001,
82638,CPT,ASSAY OF DIBUCAINE NUMBER,,30,,,$211.29,$0.00,1,0,1,20161001,
82652,CPT,1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED,,30,,,$603.68,$0.00,1,0,1,20161001,
82656,CPT,ELASTASE PANCREATIC FECAL QUAL/SEMI-QUAN,,30,,,$446.70,$0.00,1,0,1,20161001,
82657,CPT,NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA,,30,,,$322.68,$0.00,1,0,1,20161001,
82658,CPT,NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA,,30,,,$452.76,$0.00,1,0,1,20161001,
82664,CPT,ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED,,30,,,$347.11,$0.00,1,0,1,20161001,
82668,CPT,ASSAY OF ERYTHROPOIETIN,,30,,,$490.49,$0.00,1,0,1,20161001,
82670,CPT,ASSAY OF ESTRADIOL,,30,,,$354.66,$0.00,1,0,1,20161001,
82671,CPT,ASSAY OF ESTROGENS FRACTIONATED,,30,,,$664.04,$0.00,1,0,1,20161001,
82672,CPT,ASSAY OF ESTROGENS TOTAL,,30,,,$452.76,$0.00,1,0,1,20161001,
82677,CPT,ASSAY OF ESTRIOL,,30,,,$324.48,$0.00,1,0,1,20161001,
82679,CPT,ASSAY OF ESTRONE,,30,,,$452.76,$0.00,1,0,1,20161001,
82693,CPT,ASSAY OF ETHYLENE GLYCOL,,30,,,$354.66,$0.00,1,0,1,20161001,
82696,CPT,ASSAY OF ETIOCHOLANOLONE,,30,,,$452.76,$0.00,1,0,1,20161001,
82705,CPT,FAT/LIPIDS FECES QUALITATIVE,,30,,,$166.01,$0.00,1,0,1,20161001,
82710,CPT,FAT/LIPIDS FECES QUANTITATIVE,,30,,,$369.75,$0.00,1,0,1,20161001,
82715,CPT,FAT DIFFIAL FECES QUANTITATIVE,,30,,,$181.10,$0.00,1,0,1,20161001,
82725,CPT,FATTY ACIDS NONESTERIFIED,,30,,,$150.92,$0.00,1,0,1,20161001,
82726,CPT,VERY LONG CHAIN FATTY ACIDS,,30,,,$649.95,$0.00,1,0,1,20161001,
82728,CPT,ASSAY OF FERRITIN,,30,,,$279.20,$0.00,1,0,1,20161001,
82731,CPT,FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN,,30,,,$452.76,$0.00,1,0,1,20161001,
82735,CPT,ASSAY OF FLUORIDE,,30,,,$309.38,$0.00,1,0,1,20161001,
82746,CPT,ASSAY OF FOLIC ACID SERUM,,30,,,$309.38,$0.00,1,0,1,20161001,
82747,CPT,ASSAY OF FOLIC ACID RBC,,30,,,$369.75,$0.00,1,0,1,20161001,
82757,CPT,ASSAY OF FRUCTOSE SEMEN,,30,,,$226.38,$0.00,1,0,1,20161001,
82759,CPT,ASSAY OF GALACTOKINASE RBC,,30,,,$286.75,$0.00,1,0,1,20161001,
82760,CPT,ASSAY OF GALACTOSE,,30,,,$181.10,$0.00,1,0,1,20161001,
82775,CPT,GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN,,30,,,$226.38,$0.00,1,0,1,20161001,
82776,CPT,GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN,,30,,,$98.10,$0.00,1,0,1,20161001,
82777,CPT,GALECTIN-3,,30,,,$148.88,$0.00,1,0,1,20161001,
82784,CPT,ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH,,30,,,$241.47,$0.00,1,0,1,20161001,
82785,CPT,ASSAY OF GAMMAGLOBULIN IGE,,30,,,$309.38,$0.00,1,0,1,20161001,
82787,CPT,GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES,,30,,,$679.13,$0.00,1,0,1,20161001,
82800,CPT,GASES BLOOD PH ONLY,,30,,,$158.46,$0.00,1,0,1,20161001,
82803,CPT,BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3,,30,,,$347.11,$0.00,1,0,1,20161001,
82805,CPT,GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY,,30,,,$354.66,$0.00,1,0,1,20161001,
82810,CPT,GASES BLOOD O2 SATURATION ONLY DIRECT MEAS,,30,,,$196.19,$0.00,1,0,1,20161001,
82820,CPT,HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN,,30,,,$233.92,$0.00,1,0,1,20161001,
82930,CPT,GASTRIC ACID ANALYIS W/PH EACH SPECIMEN,,30,,,$128.28,$0.00,1,0,1,20161001,
82938,CPT,GASTRIN AFTER SECRETIN STIMULATION,,30,,,$399.94,$0.00,1,0,1,20161001,
82941,CPT,ASSAY OF GASTRIN,,30,,,$354.66,$0.00,1,0,1,20161001,
82943,CPT,ASSAY OF GLUCAGON,,30,,,$407.48,$0.00,1,0,1,20161001,
82945,CPT,GLUCOSE BODY FLUID OTHER THAN BLOOD,,30,,,$249.02,$0.00,1,0,1,20161001,
82946,CPT,GLUCOSE TOLERANCE TEST,,30,,,$218.83,$0.00,1,0,1,20161001,
82947,CPT,GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP,,30,,,$98.10,$0.00,1,0,1,20161001,
82948,CPT,GLUCOSE BLOOD REAGENT STRIP,,30,,,$75.46,$0.00,1,0,1,20161001,
82950,CPT,GLUCOSE POST GLUCOSE DOSE,,30,,,$128.28,$0.00,1,0,1,20161001,
82951,CPT,GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS,,30,,,$271.65,$0.00,1,0,1,20161001,
82952,CPT,GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS,,30,,,$83.01,$0.00,1,0,1,20161001,
82955,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE,,30,,,$271.65,$0.00,1,0,1,20161001,
82960,CPT,GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN,,30,,,$143.37,$0.00,1,0,1,20161001,
82962,CPT,GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE,,30,,,$75.46,$0.00,1,0,1,20161001,
82963,CPT,ASSAY OF GLUCOSIDASE BETA,,30,,,$339.57,$0.00,1,0,1,20161001,
82965,CPT,ASSAY OF GLUTAMATE DEHYDROGENASE,,30,,,$105.64,$0.00,1,0,1,20161001,
82977,CPT,ASSAY OF GLUTAMYLTRASE GAMMA,,30,,,$83.01,$0.00,1,0,1,20161001,
82978,CPT,ASSAY OF GLUTATHIONE,,30,,,$249.02,$0.00,1,0,1,20161001,
82979,CPT,ASSAY OF GLUTATHIONE REDUCTASE RBC,,30,,,$218.83,$0.00,1,0,1,20161001,
82985,CPT,ASSAY OF GLYCATED PROTEIN,,30,,,$150.92,$0.00,1,0,1,20161001,
83001,CPT,GONADOTROPIN FOLLICLE STIMULATING HORMONE,,30,,,$377.30,$0.00,1,0,1,20161001,
83002,CPT,GONADOTROPIN LUTEINIZING HORMONE,,30,,,$377.30,$0.00,1,0,1,20161001,
83003,CPT,ASSAY OF GROWTH HORMONE HUMAN,,30,,,$362.21,$0.00,1,0,1,20161001,
83006,CPT,GROWTH STIMULATION EXPRESSED GENE 2,,30,,,$148.88,$0.00,1,0,1,20161001,
83009,CPT,HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE,,30,,,$438.66,$0.00,1,0,1,20161001,
83010,CPT,ASSAY OF HAPTOGLOBIN QUANTITATIVE,,30,,,$279.20,$0.00,1,0,1,20161001,
83012,CPT,ASSAY OF HAPTOGLOBIN PHENOTYPES,,30,,,$339.57,$0.00,1,0,1,20161001,
83013,CPT,HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE,,30,,,$484.51,$0.00,1,0,1,20161001,
83014,CPT,HPYLORI DRUG ADMINISTRATION,,30,,,$103.35,$0.00,1,0,1,20161001,
83015,CPT,HEAVY METAL SCREEN,,30,,,$437.66,$0.00,1,0,1,20161001,
83018,CPT,HEAVY METAL QUANTIATIVE EACH,,30,,,$437.66,$0.00,1,0,1,20161001,
83020,CPT,HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS,,30,,,$264.11,$0.00,1,0,1,20161001,
83021,CPT,HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY,,30,,,$339.57,$0.00,1,0,1,20161001,
83026,CPT,HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED,,30,,,$52.82,$0.00,1,0,1,20161001,
83030,CPT,HEMOGLOBIN F FETAL CHEMICAL,,30,,,$166.01,$0.00,1,0,1,20161001,
83033,CPT,HEMOGLOBIN F FETAL QUALITATIVE,,30,,,$120.74,$0.00,1,0,1,20161001,
83036,CPT,HEMOGLOBIN GLYCOSYLATED A1C,,30,,,$203.74,$0.00,1,0,1,20161001,
83037,CPT,HGB GLYCOSYLATED DEVICE CLEARED FDA HOME USE,,30,,,$181.10,$0.00,1,0,1,20161001,
83045,CPT,HEMOGLOBIN METHEMOGLOBIN QUALITATIVE,,30,,,$98.10,$0.00,1,0,1,20161001,
83050,CPT,HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE,,30,,,$128.28,$0.00,1,0,1,20161001,
83051,CPT,ASSAY OF HEMOGLOBIN PLASMA,,30,,,$128.28,$0.00,1,0,1,20161001,
83060,CPT,HEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVE,,30,,,$188.65,$0.00,1,0,1,20161001,
83065,CPT,HEMOGLOBIN THERMOLABILE,,30,,,$150.92,$0.00,1,0,1,20161001,
83068,CPT,HEMOGLOBIN UNSTABLE SCREEN,,30,,,$128.28,$0.00,1,0,1,20161001,
83069,CPT,ASSAY OF HEMOGLOBIN URINE,,30,,,$90.55,$0.00,1,0,1,20161001,
83070,CPT,ASSAY OF HEMOSIDERIN QUALITATIVE,,30,,,$105.64,$0.00,1,0,1,20161001,
83080,CPT,ASSAY OF B-HEXOSAMINIDASE EACH ASSAY,,30,,,$256.56,$0.00,1,0,1,20161001,
83088,CPT,ASSAY OF HISTAMINE,,30,,,$513.12,$0.00,1,0,1,20161001,
83090,CPT,ASSAY OF HOMOCYSTEINE,,30,,,$286.75,$0.00,1,0,1,20161001,
83150,CPT,ASSAY OF HOMOVANILLIC ACID,,30,,,$301.84,$0.00,1,0,1,20161001,
83491,CPT,HYDROXYCORTICOSTEROIDS 17,,30,,,$415.03,$0.00,1,0,1,20161001,
83497,CPT,ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA,,30,,,$332.02,$0.00,1,0,1,20161001,
83498,CPT,ASSAY OF HYDROXYPROGESTERONE 17-D,,30,,,$482.94,$0.00,1,0,1,20161001,
83499,CPT,ASSAY OF HYDROXYPROGESTERONE 20-,,30,,,$403.71,$0.00,1,0,1,20161001,
83500,CPT,ASSAY OF HYDROXYPROLINE FREE,,30,,,$369.75,$0.00,1,0,1,20161001,
83505,CPT,ASSAY OF HYDROXYPROLINE TOTAL,,30,,,$490.49,$0.00,1,0,1,20161001,
83516,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP,,30,,,$226.38,$0.00,1,0,1,20161001,
83518,CPT,IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP,,30,,,$150.92,$0.00,1,0,1,20161001,
83519,CPT,IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY,,30,,,$339.57,$0.00,1,0,1,20161001,
83520,CPT,IMMUNOASSAY ANALYTE QUANTITATIVE NOS,,30,,,$256.56,$0.00,1,0,1,20161001,
83525,CPT,ASSAY OF INSULIN TOTAL,,30,,,$286.75,$0.00,1,0,1,20161001,
83527,CPT,ASSAY OF INSULIN FREE,,30,,,$324.48,$0.00,1,0,1,20161001,
83528,CPT,ASSAY OF INTRINSIC FACTOR,,30,,,$377.30,$0.00,1,0,1,20161001,
83540,CPT,ASSAY OF IRON,,30,,,$83.01,$0.00,1,0,1,20161001,
83550,CPT,IRON BINDING CAPACITY,,30,,,$128.28,$0.00,1,0,1,20161001,
83570,CPT,ISOCITRIC DEHYDROGENASE,,30,,,$196.19,$0.00,1,0,1,20161001,
83582,CPT,ASSAY OF KETOGENIC STEROIDS FRACTIONATION,,30,,,$301.84,$0.00,1,0,1,20161001,
83586,CPT,ASSAY OF KETOSTEROIDS 17- TOTAL,,30,,,$301.84,$0.00,1,0,1,20161001,
83593,CPT,KETOSTEROIDS 17- FRACTIONATION,,30,,,$588.58,$0.00,1,0,1,20161001,
83605,CPT,ASSAY OF LACTATE,,30,,,$226.38,$0.00,1,0,1,20161001,
83615,CPT,LACTATE DEHYDROGENASE LDH,,30,,,$83.01,$0.00,1,0,1,20161001,
83625,CPT,LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN,,30,,,$279.20,$0.00,1,0,1,20161001,
83630,CPT,LACTOFERRIN FECAL QUALITATIVE,,30,,,$226.38,$0.00,1,0,1,20161001,
83631,CPT,LACTOFERRIN FECAL QUANTITATIVE,,30,,,$226.38,$0.00,1,0,1,20161001,
83632,CPT,LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN,,30,,,$482.94,$0.00,1,0,1,20161001,
83633,CPT,LACTOSE URINE QUALITATIVE,,30,,,$113.19,$0.00,1,0,1,20161001,
83655,CPT,ASSAY OF LEAD,,30,,,$188.65,$0.00,1,0,1,20161001,
83661,CPT,FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO,,30,,,$648.95,$0.00,1,0,1,20161001,
83662,CPT,FETAL LUNG MATURITY FOAM STABILITY TEST,,30,,,$211.29,$0.00,1,0,1,20161001,
83663,CPT,FETAL LUNG MATURITY FLUORESCENCE POLARIZATION,,30,,,$226.38,$0.00,1,0,1,20161001,
83664,CPT,FETAL LUNG MATURITY LAMELLAR BODY DENSITY,,30,,,$196.19,$0.00,1,0,1,20161001,
83670,CPT,LEUCINE AMINOPEPTIDASE LAP,,30,,,$294.29,$0.00,1,0,1,20161001,
83690,CPT,ASSAY OF LIPASE,,30,,,$166.01,$0.00,1,0,1,20161001,
83695,CPT,LIPOPROTEIN (A),,30,,,$173.56,$0.00,1,0,1,20161001,
83698,CPT,LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2,,30,,,$264.11,$0.00,1,0,1,20161001,
83700,CPT,LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN,,30,,,$233.92,$0.00,1,0,1,20161001,
83701,CPT,LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS,,30,,,$316.93,$0.00,1,0,1,20161001,
83704,CPT,LIPOPROTEIN BLOOD QUAN NUMBERS&SUBCLASSES,,30,,,$354.66,$0.00,1,0,1,20161001,
83718,CPT,LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL,,30,,,$143.37,$0.00,1,0,1,20161001,
83719,CPT,LIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROL,,30,,,$173.56,$0.00,1,0,1,20161001,
83721,CPT,LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL,,30,,,$150.92,$0.00,1,0,1,20161001,
83727,CPT,LUTEINIZING RELEASING FACTOR,,30,,,$415.03,$0.00,1,0,1,20161001,
83735,CPT,ASSAY OF MAGNESIUM,,30,,,$120.74,$0.00,1,0,1,20161001,
83775,CPT,ASSAY OF MALATE DEHYDROGENASE,,30,,,$173.56,$0.00,1,0,1,20161001,
83785,CPT,ASSAY OF MANGANESE,,30,,,$301.84,$0.00,1,0,1,20161001,
83789,CPT,MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA,,30,,,$339.57,$0.00,1,0,1,20161001,
83825,CPT,ASSAY OF MERCURY QUANTITATIVE,,30,,,$316.93,$0.00,1,0,1,20161001,
83835,CPT,METANEPHRINES,,30,,,$467.85,$0.00,1,0,1,20161001,
83857,CPT,METHEMALBUMIN,,30,,,$211.29,$0.00,1,0,1,20161001,
83861,CPT,MICROFLUIDIC ANALYSIS TEAR OSMOLARITY,,30,,,$52.59,$0.00,1,0,1,20161001,
83864,CPT,MUCOPOLYSACCHARIDES ACID QUANTITATIVE,,30,,,$392.39,$0.00,1,0,1,20161001,
83872,CPT,MUCIN SYNOVIAL FLUID ROPES TEST,,30,,,$135.83,$0.00,1,0,1,20161001,
83873,CPT,MYELIN BASIC PROTEIN CEREBROSPINAL FLUID,,30,,,$377.30,$0.00,1,0,1,20161001,
83874,CPT,MYOGLOBIN,,30,,,$271.65,$0.00,1,0,1,20161001,
83876,CPT,MYELOPEROXIDASE MPO,,30,,,$415.03,$0.00,1,0,1,20161001,
83880,CPT,NATRIURETIC PEPTIDE,,30,,,$452.76,$0.00,1,0,1,20161001,
83883,CPT,ASSAY OF NEPHELOMETRY EACH ANALYTE NES,,30,,,$279.20,$0.00,1,0,1,20161001,
83885,CPT,ASSAY OF NICKEL,,30,,,$256.56,$0.00,1,0,1,20161001,
83915,CPT,ASSAY OF NUCLEOTIDASE 5'-,,30,,,$241.47,$0.00,1,0,1,20161001,
83916,CPT,OLIGOCLONAL IMMUNE,,30,,,$415.03,$0.00,1,0,1,20161001,
83918,CPT,ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN,,30,,,$452.76,$0.00,1,0,1,20161001,
83919,CPT,ORGANIC ACIDS QUALITATIVE EACH SPECIMEN,,30,,,$339.57,$0.00,1,0,1,20161001,
83921,CPT,ORGANIC ACID 1 QUANTITATIVE,,30,,,$301.84,$0.00,1,0,1,20161001,
83930,CPT,ASSAY OF OSMOLALITY BLOOD,,30,,,$143.37,$0.00,1,0,1,20161001,
83935,CPT,ASSAY OF OSMOLALITY URINE,,30,,,$188.65,$0.00,1,0,1,20161001,
83937,CPT,ASSAY OF OSTEOCALCIN,,30,,,$565.95,$0.00,1,0,1,20161001,
83945,CPT,ASSAY OF OXALATE,,30,,,$226.38,$0.00,1,0,1,20161001,
83950,CPT,ONCOPROTEIN HER-2/NEU,,30,,,"$1,207.35",$0.00,1,0,1,20161001,
83951,CPT,ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP,,30,,,"$1,207.35",$0.00,1,0,1,20161001,
83970,CPT,ASSAY OF PARATHORMONE,,30,,,$686.68,$0.00,1,0,1,20161001,
83986,CPT,PH BODY FLUID NOT ELSEWHERE SPECIFIED,,30,,,$75.46,$0.00,1,0,1,20161001,
83987,CPT,PH EXHALED BREATH CONDENSATE,,30,,,$75.46,$0.00,1,0,1,20161001,
83992,CPT,ASSAY OF PHENCYCLIDINE,,30,,,$377.30,$0.00,1,0,1,20161001,
83993,CPT,ASSAY OF CALPROTECTIN FECAL,,30,,,$407.48,$0.00,1,0,1,20161001,
84030,CPT,ASSAY OF PHENYLALANINE BLOOD,,30,,,$120.74,$0.00,1,0,1,20161001,
84035,CPT,ASSAY OF PHENYLKETONES QUALITATIVE,,30,,,$86.78,$0.00,1,0,1,20161001,
84060,CPT,ASSAY OF PHOSPHATASE ACID TOTAL,,30,,,$218.83,$0.00,1,0,1,20161001,
84061,CPT,PHOSPHATASE ACID FORENSIC EXAMINATION,,30,,,$264.11,$0.00,1,0,1,20161001,
84066,CPT,ASSAY OF PHOSPHATASE ACID PROSTATIC,,30,,,$226.38,$0.00,1,0,1,20161001,
84075,CPT,ASSAY OF PHOSPHATASE ALKALINE,,30,,,$75.46,$0.00,1,0,1,20161001,
84078,CPT,ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE,,30,,,$196.19,$0.00,1,0,1,20161001,
84080,CPT,ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES,,30,,,$324.48,$0.00,1,0,1,20161001,
84081,CPT,PHOSPHATIDYLGLYCEROL,,30,,,$467.85,$0.00,1,0,1,20161001,
84085,CPT,PHOSPHOGLUCONATE 6-DEHYD RBC,,30,,,$188.65,$0.00,1,0,1,20161001,
84087,CPT,ASSAY OF PHOSPHOHEXOSE ISOMERASE,,30,,,$339.57,$0.00,1,0,1,20161001,
84100,CPT,ASSAY OF PHOSPHORUS INORGANIC,,30,,,$60.37,$0.00,1,0,1,20161001,
84105,CPT,ASSAY OF PHOSPHORUS INORGANIC URINE,,30,,,$120.74,$0.00,1,0,1,20161001,
84106,CPT,PORPHOBILINOGEN URINE QUALITATIVE,,30,,,$150.92,$0.00,1,0,1,20161001,
84110,CPT,ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE,,30,,,$218.83,$0.00,1,0,1,20161001,
84112,CPT,EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN,,30,,,$218.83,$0.00,1,0,1,20161001,
84119,CPT,PORPHYRINS URINE QUALITATAIVE,,30,,,$196.19,$0.00,1,0,1,20161001,
84120,CPT,PORPHYRINS URINE QUANTITATION & FRACTIONATION,,30,,,$354.66,$0.00,1,0,1,20161001,
84126,CPT,PORPHYRINS FECES QUANTITATIVE,,30,,,$399.94,$0.00,1,0,1,20161001,
84132,CPT,POTASSIUM SERUM PLASMA/WHOLE BLOOD,,30,,,$67.91,$0.00,1,0,1,20161001,
84133,CPT,POTASSIUM URINE,,30,,,$98.10,$0.00,1,0,1,20161001,
84134,CPT,PREALBUMIN,,30,,,$233.92,$0.00,1,0,1,20161001,
84135,CPT,PREGNANEDIOL,,30,,,$286.75,$0.00,1,0,1,20161001,
84138,CPT,PREGNANETRIOL,,30,,,$316.93,$0.00,1,0,1,20161001,
84140,CPT,PREGNENOLONE,,30,,,$399.94,$0.00,1,0,1,20161001,
84143,CPT,17-HYDROXYPREGNENOLONE,,30,,,$467.85,$0.00,1,0,1,20161001,
84144,CPT,ASSAY OF PROGESTERONE,,30,,,$377.30,$0.00,1,0,1,20161001,
84145,CPT,PROCALCITONIN (PCT),,30,,,$330.14,$0.00,1,0,1,20161001,
84146,CPT,ASSAY OF PROLACTIN,,30,,,$377.30,$0.00,1,0,1,20161001,
84150,CPT,ASSAY OF PROSTAGLNDIN EACH,,30,,,$226.38,$0.00,1,0,1,20161001,
84152,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED,,30,,,$226.38,$0.00,1,0,1,20161001,
84153,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL,,30,,,$362.21,$0.00,1,0,1,20161001,
84154,CPT,ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE,,30,,,$301.84,$0.00,1,0,1,20161001,
84155,CPT,PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD,,30,,,$83.01,$0.00,1,0,1,20161001,
84156,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY URINE,,30,,,$105.64,$0.00,1,0,1,20161001,
84157,CPT,PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC,,30,,,$98.10,$0.00,1,0,1,20161001,
84160,CPT,PROTEIN TOTAL REFRACTOMETRY ANY SRC,,30,,,$60.37,$0.00,1,0,1,20161001,
84163,CPT,PREGNANCY-ASSOCIATED PLASMA PROTEIN-A,,30,,,$151.58,$0.00,1,0,1,20161001,
84165,CPT,PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM,,30,,,$271.65,$0.00,1,0,1,20161001,
84166,CPT,PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI,,30,,,$286.75,$0.00,1,0,1,20161001,
84181,CPT,PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID,,30,,,$392.39,$0.00,1,0,1,20161001,
84182,CPT,PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL,,30,,,$633.86,$0.00,1,0,1,20161001,
84202,CPT,PROTOPORPHYRIN RBC QUANTITATIVE,,30,,,$264.11,$0.00,1,0,1,20161001,
84203,CPT,PROTOPORPHYRIN RBC SCREEN,,30,,,$143.37,$0.00,1,0,1,20161001,
84206,CPT,ASSAY OF PROINSULIN,,30,,,$581.04,$0.00,1,0,1,20161001,
84207,CPT,ASSAY OF PYRIDOXAL PHOSPHATE,,30,,,$565.95,$0.00,1,0,1,20161001,
84210,CPT,ASSAY OF PYRUVATE,,30,,,$249.02,$0.00,1,0,1,20161001,
84220,CPT,ASSAY OF PYRUVATE KINASE,,30,,,$196.19,$0.00,1,0,1,20161001,
84228,CPT,ASSAY OF QUININE,,30,,,$301.84,$0.00,1,0,1,20161001,
84233,CPT,ASSAY OF RECEPTOR ASSAY ESTROGEN,,30,,,$565.95,$0.00,1,0,1,20161001,
84234,CPT,ASSAY OF RECEPTOR ASSAY PROGESTERONE,,30,,,$565.95,$0.00,1,0,1,20161001,
84235,CPT,RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST,,30,,,$565.95,$0.00,1,0,1,20161001,
84238,CPT,RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR,,30,,,$830.05,$0.00,1,0,1,20161001,
84244,CPT,ASSAY OF RENIN,,30,,,$520.67,$0.00,1,0,1,20161001,
84252,CPT,ASSAY OF RIBOFLAVIN-VITAMIN B-2,,30,,,$339.57,$0.00,1,0,1,20161001,
84255,CPT,ASSAY OF SELENIUM,,30,,,$339.57,$0.00,1,0,1,20161001,
84260,CPT,ASSAY OF SEROTONIN,,30,,,$641.41,$0.00,1,0,1,20161001,
84270,CPT,ASSAY OF SEX HORMONE BINDING GLOBULIN,,30,,,$437.66,$0.00,1,0,1,20161001,
84275,CPT,ASSAY OF SIALIC ACID,,30,,,$264.11,$0.00,1,0,1,20161001,
84285,CPT,ASSAY OF SILICA,,30,,,$415.03,$0.00,1,0,1,20161001,
84295,CPT,SODIUM SERUM PLASMA OR WHOLE BLOOD,,30,,,$75.46,$0.00,1,0,1,20161001,
84300,CPT,ASSAY OF URINE SODIUM,,30,,,$105.64,$0.00,1,0,1,20161001,
84302,CPT,ASSAY OF SODIUM OTHER SOURCE,,30,,,$105.64,$0.00,1,0,1,20161001,
84305,CPT,ASSAY OF SOMATOMEDIN,,30,,,$603.68,$0.00,1,0,1,20161001,
84307,CPT,ASSAY OF SOMATOSTATIN,,30,,,$467.85,$0.00,1,0,1,20161001,
84311,CPT,SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED,,30,,,$158.46,$0.00,1,0,1,20161001,
84315,CPT,SPECIFIC GRAVITY EXCEPT URINE,,30,,,$67.91,$0.00,1,0,1,20161001,
84375,CPT,SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY,,30,,,$286.75,$0.00,1,0,1,20161001,
84376,CPT,SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC,,30,,,$97.61,$0.00,1,0,1,20161001,
84377,CPT,SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE,,30,,,$88.42,$0.00,1,0,1,20161001,
84378,CPT,SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC,,30,,,$218.56,$0.00,1,0,1,20161001,
84379,CPT,SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,,30,,,$939.91,$0.00,1,0,1,20161001,
84392,CPT,ASSAY OF SULFATE URINE,,30,,,$72.34,$0.00,1,0,1,20161001,
84402,CPT,ASSAY OF TESTOSTERONE FREE,,30,,,$422.57,$0.00,1,0,1,20161001,
84403,CPT,ASSAY OF TESTOSTERONE TOTAL,,30,,,$339.57,$0.00,1,0,1,20161001,
84425,CPT,ASSAY OF THIAMINE-VITAMIN B-1,,30,,,$384.84,$0.00,1,0,1,20161001,
84430,CPT,ASSAY OF THIOCYANATE,,30,,,$241.47,$0.00,1,0,1,20161001,
84431,CPT,THROMBOXANE METABOLITE W/WO THROMBOXANE URINE,,30,,,$159.70,$0.00,1,0,1,20161001,
84432,CPT,ASSAY OF THYROGLOBULIN,,30,,,$347.11,$0.00,1,0,1,20161001,
84436,CPT,ASSAY OF THYROXINE TOTAL,,30,,,$120.74,$0.00,1,0,1,20161001,
84437,CPT,ASSAY OF THYROXINE REQUIRING ELUTION,,30,,,$135.83,$0.00,1,0,1,20161001,
84439,CPT,ASSAY OF FREE THYROXINE,,30,,,$211.29,$0.00,1,0,1,20161001,
84442,CPT,ASSAY OF THYROXINE BINDING GLOBULIN,,30,,,$271.65,$0.00,1,0,1,20161001,
84443,CPT,ASSAY OF THYROID STIMULATING HORMONE TSH,,30,,,$301.84,$0.00,1,0,1,20161001,
84445,CPT,THYROID STIMULATING IMMUNE GLOBULINS TSI,,30,,,$920.61,$0.00,1,0,1,20161001,
84446,CPT,ASSAY OF TOCOPHEROL ALPHA VITAMIN E,,30,,,$241.47,$0.00,1,0,1,20161001,
84449,CPT,ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN,,30,,,$377.30,$0.00,1,0,1,20161001,
84450,CPT,TRANSFERASE ASPARTATE AMINO AST SGOT,,30,,,$83.01,$0.00,1,0,1,20161001,
84460,CPT,TRANSFERASE ALANINE AMINO ALT SGPT,,30,,,$83.01,$0.00,1,0,1,20161001,
84466,CPT,ASSAY OF L7383TRANSFERRIN,,30,,,$286.75,$0.00,1,0,1,20161001,
84478,CPT,ASSAY OF TRIGLYCERIDES,,30,,,$83.01,$0.00,1,0,1,20161001,
84479,CPT,THYROID HORM UPTK/THYROID HORMONE BINDING RATIO,,30,,,$135.83,$0.00,1,0,1,20161001,
84480,CPT,ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3,,30,,,$301.84,$0.00,1,0,1,20161001,
84481,CPT,ASSAY OF TRIIODOTHYRONINE T3 FREE,,30,,,$399.94,$0.00,1,0,1,20161001,
84482,CPT,TRIIODOTHYRONINE T3 REVERSE,,30,,,$377.30,$0.00,1,0,1,20161001,
84484,CPT,ASSAY OF TROPONIN QUANTITATIVE,,30,,,$295.12,$0.00,1,0,1,20161001,
84485,CPT,ASSAY OF TRYPSIN DUODENAL FLUID,,30,,,$226.38,$0.00,1,0,1,20161001,
84488,CPT,ASSAY OF TRYPSIN FECES QUALITATIVE,,30,,,$226.38,$0.00,1,0,1,20161001,
84490,CPT,TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION,,30,,,$135.83,$0.00,1,0,1,20161001,
84510,CPT,ASSAY OF TYROSINE,,30,,,$150.92,$0.00,1,0,1,20161001,
84512,CPT,ASSAY OF TROPONIN QUALITATIVE,,30,,,$172.47,$0.00,1,0,1,20161001,
84520,CPT,ASSAY OF UREA NITROGEN QUANTITATIVE,,30,,,$83.01,$0.00,1,0,1,20161001,
84525,CPT,ASSAY OF UREA NITROGEN SEMIQUANTITATIVE,,30,,,$90.55,$0.00,1,0,1,20161001,
84540,CPT,ASSAY OF UREA NITROGEN URINE,,30,,,$128.28,$0.00,1,0,1,20161001,
84545,CPT,UREA NITROGEN CLEARANCE,,30,,,$158.46,$0.00,1,0,1,20161001,
84550,CPT,ASSAY OF BLOOD/URIC ACID,,30,,,$83.01,$0.00,1,0,1,20161001,
84560,CPT,ASSAY OF URIC ACID OTHER SOURCE,,30,,,$120.74,$0.00,1,0,1,20161001,
84577,CPT,ASSAY OF UROBILINOGEN FECES QUANTITATIVE,,30,,,$135.83,$0.00,1,0,1,20161001,
84578,CPT,ASSAY OF UROBILINOGEN URINE QUALITATIVE,,30,,,$90.55,$0.00,1,0,1,20161001,
84580,CPT,UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN,,30,,,$135.83,$0.00,1,0,1,20161001,
84583,CPT,ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE,,30,,,$90.55,$0.00,1,0,1,20161001,
84585,CPT,ASSAY OF VANILLYLMANDELIC ACID URINE,,30,,,$339.57,$0.00,1,0,1,20161001,
84586,CPT,ASSAY OF VASOACTIVE INTESTINAL PEPTIDE,,30,,,$581.04,$0.00,1,0,1,20161001,
84588,CPT,ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE,,30,,,$603.68,$0.00,1,0,1,20161001,
84590,CPT,ASSAY OF VITAMIN A,,30,,,$339.57,$0.00,1,0,1,20161001,
84591,CPT,ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED,,30,,,$324.48,$0.00,1,0,1,20161001,
84597,CPT,ASSAY OF VITAMIN K,,30,,,$437.66,$0.00,1,0,1,20161001,
84600,CPT,ASSAY OF VOLATILES,,30,,,$233.92,$0.00,1,0,1,20161001,
84620,CPT,XYLOSE ABSORPTION TEST BLOOD &/URINE,,30,,,$309.38,$0.00,1,0,1,20161001,
84630,CPT,ASSAY OF ZINC,,30,,,$286.75,$0.00,1,0,1,20161001,
84681,CPT,ASSAY OF C-PEPTIDE,,30,,,$430.12,$0.00,1,0,1,20161001,
84702,CPT,GONADOTROPIN CHORIONIC QUANTITATIVE,,30,,,$286.75,$0.00,1,0,1,20161001,
84703,CPT,GONADOTROPIN CHORIONIC QUALITATIVE,,30,,,$173.56,$0.00,1,0,1,20161001,
84704,CPT,GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN,,30,,,$286.75,$0.00,1,0,1,20161001,
84830,CPT,OVULATION TEST VISUAL COLOR COMPARISON HLH,,30,,,$150.92,$0.00,1,0,1,20161001,
84999,CPT,UNLISTED CHEMISTRY PROCEDURE,,30,,,$643.39,$0.00,1,0,1,20161001,
85002,CPT,BLEEDING TIME TEST,,30,,,$166.85,$0.00,1,0,1,20161001,
85004,CPT,BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT,,30,,,$108.45,$0.00,1,0,1,20161001,
85007,CPT,BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT,,30,,,$100.11,$0.00,1,0,1,20161001,
85008,CPT,BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT,,30,,,$83.43,$0.00,1,0,1,20161001,
85009,CPT,BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT,,30,,,$100.11,$0.00,1,0,1,20161001,
85013,CPT,BLOOD COUNT SPUN MICROHEMATOCRIT,,30,,,$75.08,$0.00,1,0,1,20161001,
85014,CPT,BLOOD COUNT HEMATOCRIT,,30,,,$75.08,$0.00,1,0,1,20161001,
85018,CPT,BLOOD COUNT HEMOGLOBIN,,30,,,$75.08,$0.00,1,0,1,20161001,
85025,CPT,BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC,,30,,,$154.34,$0.00,1,0,1,20161001,
85027,CPT,BLOOD COUNT COMPLETE AUTOMATED,,30,,,$146.00,$0.00,1,0,1,20161001,
85032,CPT,BLOOD COUNT MANUAL CELL COUNT EACH,,30,,,$116.80,$0.00,1,0,1,20161001,
85041,CPT,BLOOD COUNT RED BLOOD CELL AUTOMATED,,30,,,$100.11,$0.00,1,0,1,20161001,
85044,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,30,,,$116.80,$0.00,1,0,1,20161001,
85045,CPT,BLOOD COUNT RETICULOCYTE AUTOMATED,,30,,,$125.14,$0.00,1,0,1,20161001,
85046,CPT,BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS,,30,,,$111.62,$0.00,1,0,1,20161001,
85048,CPT,BLOOD COUNT LEUKOCYTE WBC AUTOMATED,,30,,,$100.11,$0.00,1,0,1,20161001,
85049,CPT,BLOOD COUNT PLATELET AUTOMATED,,30,,,$100.11,$0.00,1,0,1,20161001,
85055,CPT,RETICULATED PLATELET ASSAY,,30,,,$159.62,$0.00,1,0,1,20161001,
85060,CPT,BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT,,30,,,$144.69,$0.00,1,0,1,20161001,
85097,CPT,BONE MARROW SMEAR INTERPRETATION,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
85130,CPT,CHROMOGENIC SUBSTRATE ASSAY,,30,,,$317.02,$0.00,1,0,1,20161001,
85170,CPT,BLOOD CLOT RETRACTION,,30,,,$100.11,$0.00,1,0,1,20161001,
85175,CPT,CLOT LYSIS TIME WHOLE BLOOD DILUTION,,30,,,$183.54,$0.00,1,0,1,20161001,
85210,CPT,CLOTTING FACTOR II PROTHROMBIN SPECIFIC,,30,,,$233.59,$0.00,1,0,1,20161001,
85220,CPT,CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR,,30,,,$500.56,$0.00,1,0,1,20161001,
85230,CPT,CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR,,30,,,$500.56,$0.00,1,0,1,20161001,
85240,CPT,CLOTTING FACTOR VIII AHG 1 STAGE,,30,,,$542.27,$0.00,1,0,1,20161001,
85244,CPT,CLOTTING FACTOR VIII RELATED ANTIGEN,,30,,,$625.70,$0.00,1,0,1,20161001,
85245,CPT,CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT,,30,,,$450.50,$0.00,1,0,1,20161001,
85246,CPT,CLOTTING FACTOR VIII VW FACTOR ANTIGEN,,30,,,$667.41,$0.00,1,0,1,20161001,
85247,CPT,CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS,,30,,,$684.10,$0.00,1,0,1,20161001,
85250,CPT,CLOTTING FACTOR IX PTC/CHRISTMAS,,30,,,$542.27,$0.00,1,0,1,20161001,
85260,CPT,CLOTTING FACTOR X STUART-PROWER,,30,,,$542.27,$0.00,1,0,1,20161001,
85270,CPT,CLOTTING FACTOR XI PTA,,30,,,$533.93,$0.00,1,0,1,20161001,
85280,CPT,CLOTTING FACTOR XII HAGEMAN,,30,,,$542.27,$0.00,1,0,1,20161001,
85290,CPT,CLOTTING FACTOR XIII FIBRIN STABILIZING,,30,,,$500.56,$0.00,1,0,1,20161001,
85291,CPT,CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB,,30,,,$333.71,$0.00,1,0,1,20161001,
85292,CPT,CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY,,30,,,$517.24,$0.00,1,0,1,20161001,
85293,CPT,CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY,,30,,,$500.56,$0.00,1,0,1,20161001,
85300,CPT,CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY,,30,,,$442.16,$0.00,1,0,1,20161001,
85301,CPT,CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY,,30,,,$433.82,$0.00,1,0,1,20161001,
85302,CPT,CLOTTING INHIBITORS PROTEIN C ANTIGEN,,30,,,$458.84,$0.00,1,0,1,20161001,
85303,CPT,CLOTTING INHIBITORS PROTEIN C ACTIVITY,,30,,,$517.24,$0.00,1,0,1,20161001,
85305,CPT,CLOTTING INHIBITORS PROTEIN S TOTAL,,30,,,$525.59,$0.00,1,0,1,20161001,
85306,CPT,CLOTTING INHIBITORS PROTEIN S FREE,,30,,,$542.27,$0.00,1,0,1,20161001,
85307,CPT,ACTIVATED PROTEIN C APC RESISTANCE ASSAY,,30,,,$475.53,$0.00,1,0,1,20161001,
85335,CPT,FACTOR INHIBITOR TEST,,30,,,$333.71,$0.00,1,0,1,20161001,
85337,CPT,THROMBOMODULIN,,30,,,$400.45,$0.00,1,0,1,20161001,
85345,CPT,COAGULATION TIME LEE AND WHITE,,30,,,$208.57,$0.00,1,0,1,20161001,
85347,CPT,COAGULATION TIME ACTIVATED,,30,,,$125.14,$0.00,1,0,1,20161001,
85348,CPT,COAGULATION TIME OTHER METHODS,,30,,,$133.48,$0.00,1,0,1,20161001,
85360,CPT,EUGLOBULIN LYSIS,,30,,,$283.65,$0.00,1,0,1,20161001,
85362,CPT,FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN,,30,,,$233.59,$0.00,1,0,1,20161001,
85366,CPT,FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ,,30,,,$250.28,$0.00,1,0,1,20161001,
85370,CPT,FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE,,30,,,$308.68,$0.00,1,0,1,20161001,
85378,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN,,30,,,$233.59,$0.00,1,0,1,20161001,
85379,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE,,30,,,$291.99,$0.00,1,0,1,20161001,
85380,CPT,FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE,,30,,,$291.99,$0.00,1,0,1,20161001,
85384,CPT,FIBRINOGEN ACTIVITY,,30,,,$208.57,$0.00,1,0,1,20161001,
85385,CPT,FIBRINOGEN ANTIGEN,,30,,,$241.94,$0.00,1,0,1,20161001,
85390,CPT,FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR,,30,,,$114.83,$0.00,1,0,1,20161001,
85396,CPT,COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY,,30,,,$482.30,$0.00,1,0,1,20161001,
85397,CPT,COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL,,30,,,$333.71,$0.00,1,0,1,20161001,
85400,CPT,FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN,,30,,,$375.42,$0.00,1,0,1,20161001,
85410,CPT,FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN,,30,,,$417.13,$0.00,1,0,1,20161001,
85415,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR,,30,,,$417.13,$0.00,1,0,1,20161001,
85420,CPT,FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS,,30,,,$375.42,$0.00,1,0,1,20161001,
85421,CPT,FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY,,30,,,$542.27,$0.00,1,0,1,20161001,
85441,CPT,HEINZ BODIES DIRECT,,30,,,$166.85,$0.00,1,0,1,20161001,
85445,CPT,HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE,,30,,,$141.82,$0.00,1,0,1,20161001,
85460,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS,,30,,,$241.94,$0.00,1,0,1,20161001,
85461,CPT,HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE,,30,,,$200.22,$0.00,1,0,1,20161001,
85475,CPT,HEMOLYSIN ACID,,30,,,$300.33,$0.00,1,0,1,20161001,
85520,CPT,HEPARIN ASSAY,,30,,,$383.76,$0.00,1,0,1,20161001,
85525,CPT,HEPARIN NEUTRALIZATION,,30,,,$308.68,$0.00,1,0,1,20161001,
85530,CPT,HEPARIN-PROTAMINE TOLERANCE TST,,30,,,$291.99,$0.00,1,0,1,20161001,
85536,CPT,IRON STAIN PERIPHERAL BLOOD,,30,,,$158.51,$0.00,1,0,1,20161001,
85540,CPT,WBC ALKALINE PHOSPHATASE COUNT,,30,,,$225.25,$0.00,1,0,1,20161001,
85547,CPT,MECHANICAL FRAGILITY RBC,,30,,,$175.20,$0.00,1,0,1,20161001,
85549,CPT,MURAMIDASE,,30,,,$375.42,$0.00,1,0,1,20161001,
85555,CPT,OSMOTIC FRAGILITY RBC UNINCUBATED,,30,,,$291.99,$0.00,1,0,1,20161001,
85557,CPT,OSMOTIC FRAGILITY RBC INCUBATED,,30,,,$400.45,$0.00,1,0,1,20161001,
85576,CPT,PLATELET AGGREGATION IN VITRO EACH AGENT,,30,,,$255.28,$0.00,1,0,1,20161001,
85597,CPT,PHOSPHOLIPID NEUTRALIZATION PLATELET,,30,,,$350.39,$0.00,1,0,1,20161001,
85598,CPT,PHOSPHOLIPID NEUTRALIZATION HEXAGONAL,,30,,,$350.39,$0.00,1,0,1,20161001,
85610,CPT,PROTHROMBIN TIME,,30,,,$100.11,$0.00,1,0,1,20161001,
85611,CPT,PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH,,30,,,$133.48,$0.00,1,0,1,20161001,
85612,CPT,RUSSELL VIPER VENON TIME UNDILUTED,,30,,,$283.65,$0.00,1,0,1,20161001,
85613,CPT,RUSSELL VIPER VENOM TIME DILUTED,,30,,,$258.62,$0.00,1,0,1,20161001,
85635,CPT,REPTILASE TEST,,30,,,$266.96,$0.00,1,0,1,20161001,
85651,CPT,SEDIMENTATION RATE RBC NON-AUTOMATED,,30,,,$104.28,$0.00,1,0,1,20161001,
85652,CPT,SEDIMENTATION RATE RBC AUTOMATED,,30,,,$100.11,$0.00,1,0,1,20161001,
85660,CPT,SICKLING RBC REDUCTION,,30,,,$129.31,$0.00,1,0,1,20161001,
85670,CPT,THROMBIN TIME PLASMA,,30,,,$175.20,$0.00,1,0,1,20161001,
85675,CPT,THROMBIN TIME TITER,,30,,,$191.88,$0.00,1,0,1,20161001,
85705,CPT,THROMBOPLASTIN INHIBITION TISSUE,,30,,,$333.71,$0.00,1,0,1,20161001,
85730,CPT,THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD,,30,,,$141.82,$0.00,1,0,1,20161001,
85732,CPT,THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA,,30,,,$183.54,$0.00,1,0,1,20161001,
85810,CPT,VISCOSITY,,30,,,$208.57,$0.00,1,0,1,20161001,
85999,CPT,UNLISTED HEMATOLOGY & COAGULATION PROCEDURE,,30,,,$104.50,$0.00,1,0,1,20161001,
86000,CPT,AGGLUTININS FEBRILE EACH ANTIGEN,,30,,,$156.56,$0.00,1,0,1,20161001,
86001,CPT,ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,,30,,,$82.01,$0.00,1,0,1,20161001,
86003,CPT,ALLERGEN SPECIFIC IGE QUAN/SEMIQUAN EA ALLERGEN,,30,,,$82.01,$0.00,1,0,1,20161001,
86005,CPT,ALLERGEN SPECIFIC IGE QUAL MULTIALLERGEN SCREEN,,30,,,$298.22,$0.00,1,0,1,20161001,
86021,CPT,ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES,,30,,,$447.32,$0.00,1,0,1,20161001,
86022,CPT,ANTIBODY IDENTIFICATION PLATELET ANTIBODIES,,30,,,$633.71,$0.00,1,0,1,20161001,
86023,CPT,ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY,,30,,,$410.05,$0.00,1,0,1,20161001,
86038,CPT,ANTINUCLEAR ANTIBODIES ANA,,30,,,$260.94,$0.00,1,0,1,20161001,
86039,CPT,ANTINUCLEAR ANTIBODIES ANA TITER,,30,,,$260.94,$0.00,1,0,1,20161001,
86060,CPT,ANTISTREPTOLYSIN O TITER,,30,,,$178.93,$0.00,1,0,1,20161001,
86063,CPT,ANTISTREPTOLYSIN O SCREEN,,30,,,$126.74,$0.00,1,0,1,20161001,
86077,CPT,BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REP,,30,,,$156.54,$0.00,1,0,1,20161001,
86078,CPT,BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT,,30,,,$424.20,$0.00,1,0,1,20161001,
86079,CPT,BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT,,30,,,$424.20,$0.00,1,0,1,20161001,
86140,CPT,C-REACTIVE PROTEIN,,30,,,$149.11,$0.00,1,0,1,20161001,
86141,CPT,C-REACTIVE PROTEIN HIGH SENSITIVITY,,30,,,$193.84,$0.00,1,0,1,20161001,
86146,CPT,BETA 2 GLYCOPROTEIN I ANTIBODY EACH,,30,,,$484.60,$0.00,1,0,1,20161001,
86147,CPT,CARDIOLIPIN ANTIBODY EACH IG CLASS,,30,,,$484.60,$0.00,1,0,1,20161001,
86148,CPT,ANTI-PHOSPHATIDYLSERINE ANTIBODY,,30,,,$206.70,$0.00,1,0,1,20161001,
86152,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC,,30,,,$32.21,$0.00,1,0,1,20161001,
86153,CPT,CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP,,30,,,$32.21,$0.00,1,0,1,20161001,
86155,CPT,CHEMOTAXIS ASSAY SPECIFY METHOD,,30,,,$231.12,$0.00,1,0,1,20161001,
86156,CPT,COLD AGGLUTININ SCREEN,,30,,,$141.65,$0.00,1,0,1,20161001,
86157,CPT,COLD AGGLUTININ TITER,,30,,,$171.47,$0.00,1,0,1,20161001,
86160,CPT,COMPLEMENT ANTIGEN EACH COMPONENT,,30,,,$305.67,$0.00,1,0,1,20161001,
86161,CPT,COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT,,30,,,$342.95,$0.00,1,0,1,20161001,
86162,CPT,COMPLEMENT TOTAL HEMOLYTIC,,30,,,$462.24,$0.00,1,0,1,20161001,
86171,CPT,COMPLEMENT FIXATION TESTS EACH ANTIGEN,,30,,,$216.21,$0.00,1,0,1,20161001,
86185,CPT,CNTERIMMUNOELECTROPHORESIS EACH ANTIGEN,,30,,,$186.39,$0.00,1,0,1,20161001,
86200,CPT,CYCLIC CITRULLINATED PEPTIDE ANTIBODY,,30,,,$313.13,$0.00,1,0,1,20161001,
86215,CPT,DEOXYRIBONUCLEASE ANTIBODY,,30,,,$290.76,$0.00,1,0,1,20161001,
86225,CPT,DNA ANTIBODY NATIVE/DOUBLE STRANDED,,30,,,$320.58,$0.00,1,0,1,20161001,
86226,CPT,DNA ANTIBODY SINGLE STRANDED,,30,,,$283.31,$0.00,1,0,1,20161001,
86235,CPT,EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD,,30,,,$283.31,$0.00,1,0,1,20161001,
86243,CPT,FC RECEPTOR,,30,,,$298.22,$0.00,1,0,1,20161001,
86255,CPT,FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY,,30,,,$117.42,$0.00,1,0,1,20161001,
86256,CPT,FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY,,30,,,$107.36,$0.00,1,0,1,20161001,
86277,CPT,GROWTH HORMONE HUMAN ANTIBODY,,30,,,$275.85,$0.00,1,0,1,20161001,
86280,CPT,HEMAGGLUTINATION INHIBITION TEST HAI,,30,,,$216.21,$0.00,1,0,1,20161001,
86294,CPT,IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE,,30,,,$372.77,$0.00,1,0,1,20161001,
86300,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3,,30,,,$372.77,$0.00,1,0,1,20161001,
86301,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9,,30,,,$357.86,$0.00,1,0,1,20161001,
86304,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125,,30,,,$372.77,$0.00,1,0,1,20161001,
86305,CPT,HUMAN EPIDIDYMIS PROTEIN 4 (HE4),,30,,,$358.28,$0.00,1,0,1,20161001,
86308,CPT,HETEROPHILE ANTIBODIES SCREEN,,30,,,$134.20,$0.00,1,0,1,20161001,
86309,CPT,HETEROPHILE ANTIBODIES TITER,,30,,,$186.39,$0.00,1,0,1,20161001,
86310,CPT,HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION,,30,,,$193.84,$0.00,1,0,1,20161001,
86316,CPT,IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE,,30,,,$387.68,$0.00,1,0,1,20161001,
86317,CPT,IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS,,30,,,$178.93,$0.00,1,0,1,20161001,
86318,CPT,IMMUNOASSAY NFCT AGT ANTB QUAL/SEMIQUAN 1 STEP,,30,,,$178.93,$0.00,1,0,1,20161001,
86320,CPT,IMMUNOELECTROPHORESIS SERUM,,30,,,$454.78,$0.00,1,0,1,20161001,
86325,CPT,IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION,,30,,,$387.68,$0.00,1,0,1,20161001,
86327,CPT,IMMUNOELECTROPHORESIS CROSSED,,30,,,$298.22,$0.00,1,0,1,20161001,
86329,CPT,IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED,,30,,,$305.67,$0.00,1,0,1,20161001,
86331,CPT,IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY,,30,,,$305.67,$0.00,1,0,1,20161001,
86332,CPT,IMMUNE COMPLEX ASSAY,,30,,,$410.05,$0.00,1,0,1,20161001,
86334,CPT,IMMUNOFIXJ ELECTROPHORESIS SERUM,,30,,,$322.07,$0.00,1,0,1,20161001,
86335,CPT,IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS,,30,,,$322.07,$0.00,1,0,1,20161001,
86336,CPT,INHIBIN A,,30,,,$372.77,$0.00,1,0,1,20161001,
86337,CPT,INSULIN ANTIBODIES,,30,,,$469.69,$0.00,1,0,1,20161001,
86340,CPT,INTRINSIC FACTOR ANTIBODIES,,30,,,$305.67,$0.00,1,0,1,20161001,
86341,CPT,ISLET CELL ANTIBODY,,30,,,$223.66,$0.00,1,0,1,20161001,
86343,CPT,LEUKOCYTE HISTAMINE RELEASE TEST LHR,,30,,,$350.40,$0.00,1,0,1,20161001,
86344,CPT,LEUKOCYTE PHAGOCYTOSIS,,30,,,$335.49,$0.00,1,0,1,20161001,
86352,CPT,CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE,,30,,,$662.59,$0.00,1,0,1,20161001,
86353,CPT,LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS,,30,,,$820.09,$0.00,1,0,1,20161001,
86355,CPT,B CELLS TOTAL COUNT,,30,,,$402.59,$0.00,1,0,1,20161001,
86356,CPT,MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA,,30,,,$372.77,$0.00,1,0,1,20161001,
86357,CPT,NATURAL KILLER CELLS TOTAL COUNT,,30,,,$447.32,$0.00,1,0,1,20161001,
86359,CPT,T CELLS TOTAL COUNT,,30,,,$372.77,$0.00,1,0,1,20161001,
86360,CPT,T CELLS ABSOLUTE CD4&CD8 COUNT RATIO,,30,,,$447.32,$0.00,1,0,1,20161001,
86361,CPT,T CELLS ABSOLUTE CD4 COUNT,,30,,,$469.69,$0.00,1,0,1,20161001,
86367,CPT,STEM CELLS TOTAL COUNT,,30,,,$469.69,$0.00,1,0,1,20161001,
86376,CPT,MICROSOMAL ANTIBODIES EACH,,30,,,$298.22,$0.00,1,0,1,20161001,
86378,CPT,MIGRATION INHIBITORY FACTOR TEST MIF,,30,,,$372.77,$0.00,1,0,1,20161001,
86382,CPT,NEUTRALIZATION TEST VIRAL,,30,,,$484.60,$0.00,1,0,1,20161001,
86384,CPT,NITROBLUE TETRAZOLIUM DYE TEST NTD,,30,,,$372.77,$0.00,1,0,1,20161001,
86386,CPT,NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE,,30,,,$162.03,$0.00,1,0,1,20161001,
86403,CPT,PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY,,30,,,$119.29,$0.00,1,0,1,20161001,
86406,CPT,PARTICLE AGGLUTINATION TITER EACH ANTIBODY,,30,,,$193.84,$0.00,1,0,1,20161001,
86430,CPT,RHEUMATOID FACTOR QUALITATIVE,,30,,,$141.65,$0.00,1,0,1,20161001,
86431,CPT,RHEUMATOID FACTOR QUANTITATIVE,,30,,,$149.11,$0.00,1,0,1,20161001,
86480,CPT,TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON,,30,,,$246.03,$0.00,1,0,1,20161001,
86481,CPT,TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP,,30,,,$246.03,$0.00,1,0,1,20161001,
86485,CPT,SKIN TEST CANDIDA,,30,,,$156.54,$0.00,1,0,1,20161001,
86486,CPT,SKIN TEST UNLISTED ANTIGEN EACH,,30,,,$81.90,$0.00,1,0,1,20161001,
86490,CPT,SKIN TEST COCCIDIOIDOMYCOSIS,,30,,,$306.21,$0.00,1,0,1,20161001,
86510,CPT,SKIN TEST HISTOPLASMOSIS,,30,,,$306.21,$0.00,1,0,1,20161001,
86580,CPT,SKIN TEST TUBERCULOSIS INTRADERMAL,,30,,,$81.90,$0.00,1,0,1,20161001,
86590,CPT,STREPTOKINASE ANTIBODY,,30,,,$141.65,$0.00,1,0,1,20161001,
86592,CPT,SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL,,30,,,$104.38,$0.00,1,0,1,20161001,
86593,CPT,SYPHILIS TEST QUANTITATIVE,,30,,,$104.38,$0.00,1,0,1,20161001,
86602,CPT,ANTIBODY ACTINOMYCES,,30,,,$260.94,$0.00,1,0,1,20161001,
86603,CPT,ANTIBODY ADENOVIRUS,,30,,,$260.94,$0.00,1,0,1,20161001,
86606,CPT,ANTIBODY ASPERGILLUS,,30,,,$260.94,$0.00,1,0,1,20161001,
86609,CPT,ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED,,30,,,$335.49,$0.00,1,0,1,20161001,
86611,CPT,ANTIBODY BARTONELLA,,30,,,$335.49,$0.00,1,0,1,20161001,
86612,CPT,ANTIBODY BLASTOMYCES,,30,,,$328.04,$0.00,1,0,1,20161001,
86615,CPT,ANTIBODY BORDETELLA,,30,,,$372.77,$0.00,1,0,1,20161001,
86617,CPT,ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST,,30,,,$395.14,$0.00,1,0,1,20161001,
86618,CPT,ANTIBODY BORRELIA BURGDORFERI LYME DISEASE,,30,,,$372.77,$0.00,1,0,1,20161001,
86619,CPT,ANTIBODY BORRELIA RELAPSING FEVER,,30,,,$298.22,$0.00,1,0,1,20161001,
86622,CPT,ANTIBODY BRUCELLA,,30,,,$223.66,$0.00,1,0,1,20161001,
86625,CPT,ANTIBODY CAMPYLOBACTER,,30,,,$350.40,$0.00,1,0,1,20161001,
86628,CPT,ANTIBODY CANDIDA,,30,,,$335.49,$0.00,1,0,1,20161001,
86631,CPT,ANTIBODY CHLAMYDIA,,30,,,$231.12,$0.00,1,0,1,20161001,
86632,CPT,ANTIBODY CHLAMYDIA IGM,,30,,,$260.94,$0.00,1,0,1,20161001,
86635,CPT,ANTIBODY COCCIDIOIDES,,30,,,$335.49,$0.00,1,0,1,20161001,
86638,CPT,ANTIBODY COXIELLA BURNETII Q FEVER,,30,,,$283.31,$0.00,1,0,1,20161001,
86641,CPT,ANTIBODY CRYPTOCOCCUS,,30,,,$223.66,$0.00,1,0,1,20161001,
86644,CPT,ANTIBODY CYTOMEGALOVIRUS CMV,,30,,,$342.95,$0.00,1,0,1,20161001,
86645,CPT,ANTIBODY CYTOMEGALOVIRUS CMV IGM,,30,,,$357.86,$0.00,1,0,1,20161001,
86648,CPT,ANTIBODY DIPHTHERIA,,30,,,$313.13,$0.00,1,0,1,20161001,
86651,CPT,ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE,,30,,,$268.39,$0.00,1,0,1,20161001,
86652,CPT,ANTIBODY ENCEPHALITIS EASTERN EQUINE,,30,,,$268.39,$0.00,1,0,1,20161001,
86653,CPT,ANTIBODY ENCEPHALITIS ST. LOUIS,,30,,,$268.39,$0.00,1,0,1,20161001,
86654,CPT,ANTIBODY ENCEPHALITIS WESTRN EQUINE,,30,,,$268.39,$0.00,1,0,1,20161001,
86658,CPT,ANTIBODY ENTEROVIRUS,,30,,,$268.39,$0.00,1,0,1,20161001,
86663,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA,,30,,,$342.95,$0.00,1,0,1,20161001,
86664,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA,,30,,,$342.95,$0.00,1,0,1,20161001,
86665,CPT,ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA,,30,,,$387.68,$0.00,1,0,1,20161001,
86666,CPT,ANTIBODY EHRLICHIA,,30,,,$342.95,$0.00,1,0,1,20161001,
86668,CPT,ANTIBODY FRANCISELLA TULARENSIS,,30,,,$268.39,$0.00,1,0,1,20161001,
86671,CPT,ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED,,30,,,$372.77,$0.00,1,0,1,20161001,
86674,CPT,ANTIBODY GIARDIA LAMBLIA,,30,,,$298.22,$0.00,1,0,1,20161001,
86677,CPT,ANTIBODY HELICOBACTER PYLORI,,30,,,$372.77,$0.00,1,0,1,20161001,
86682,CPT,ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED,,30,,,$372.77,$0.00,1,0,1,20161001,
86684,CPT,ANTIBODY HAEMOPHILUS INFLUENZA,,30,,,$372.77,$0.00,1,0,1,20161001,
86687,CPT,ANTIBODY HTLV-I,,30,,,$298.22,$0.00,1,0,1,20161001,
86688,CPT,ANTIBODY HTLV-II,,30,,,$283.31,$0.00,1,0,1,20161001,
86689,CPT,ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,,30,,,$395.14,$0.00,1,0,1,20161001,
86692,CPT,ANTIBODY HEP DELTA AGENT,,30,,,$395.14,$0.00,1,0,1,20161001,
86694,CPT,ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST,,30,,,$328.04,$0.00,1,0,1,20161001,
86695,CPT,ANTIBODY HERPES SMPLX TYPE 1,,30,,,$328.04,$0.00,1,0,1,20161001,
86696,CPT,ANTIBODY HERPES SMPLX TYPE 2,,30,,,$328.04,$0.00,1,0,1,20161001,
86698,CPT,ANTIBODY HISTOPLASMA,,30,,,$298.22,$0.00,1,0,1,20161001,
86701,CPT,ANTIBODY HIV-1,,30,,,$253.48,$0.00,1,0,1,20161001,
86702,CPT,ANTIBODY HIV-2,,30,,,$342.95,$0.00,1,0,1,20161001,
86703,CPT,ANTIBODY HIV-1&HIV-2 SINGLE RESULT,,30,,,$298.22,$0.00,1,0,1,20161001,
86704,CPT,HEPATITIS B CORE ANTIBODY HBCAB TOTAL,,30,,,$260.94,$0.00,1,0,1,20161001,
86705,CPT,HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY,,30,,,$283.31,$0.00,1,0,1,20161001,
86706,CPT,HEPATITIS B SURF ANTIBODY HBSAB,,30,,,$231.12,$0.00,1,0,1,20161001,
86707,CPT,HEPATITIS BE ANTIBODY HBEAB,,30,,,$253.48,$0.00,1,0,1,20161001,
86708,CPT,HEPATITIS A ANTIBODY HAAB,,30,,,$275.85,$0.00,1,0,1,20161001,
86709,CPT,HEPATITIS ANTIBODY HAAB IGM ANTIBODY,,30,,,$260.94,$0.00,1,0,1,20161001,
86710,CPT,ANTIBODY INFLUENZA VIRUS,,30,,,$246.03,$0.00,1,0,1,20161001,
86711,CPT,ANTIBODY JOHN CUNNINGHAM VIRUS,,30,,,$879.21,$0.00,1,0,1,20161001,
86713,CPT,ANTIBODY LEGIONELLA,,30,,,$298.22,$0.00,1,0,1,20161001,
86717,CPT,ANTIBODY LEISHMANIA,,30,,,$246.03,$0.00,1,0,1,20161001,
86720,CPT,ANTIBODY LEPTOSPIRA,,30,,,$246.03,$0.00,1,0,1,20161001,
86723,CPT,ANTIBODY LISTERIA MONOCYTOGENES,,30,,,$246.03,$0.00,1,0,1,20161001,
86727,CPT,ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS,,30,,,$246.03,$0.00,1,0,1,20161001,
86729,CPT,ANTIBODY LYMPHOGRANULOMA VENEREUM,,30,,,$246.03,$0.00,1,0,1,20161001,
86732,CPT,ANTIBODY MUCORMYCOSIS,,30,,,$328.04,$0.00,1,0,1,20161001,
86735,CPT,ANTIBODY MUMPS,,30,,,$298.22,$0.00,1,0,1,20161001,
86738,CPT,ANTIBODY MYCOPLSM,,30,,,$298.22,$0.00,1,0,1,20161001,
86741,CPT,ANTIBODY NEISSERIA MENINGITIDIS,,30,,,$298.22,$0.00,1,0,1,20161001,
86744,CPT,ANTIBODY NOCARDIA,,30,,,$298.22,$0.00,1,0,1,20161001,
86747,CPT,ANTIBODY PARVOVIRUS,,30,,,$350.40,$0.00,1,0,1,20161001,
86750,CPT,ANTIBODY PLASMODIUM MALARIA,,30,,,$328.04,$0.00,1,0,1,20161001,
86753,CPT,ANTIBODY PROTOZOA NES,,30,,,$372.77,$0.00,1,0,1,20161001,
86756,CPT,ANTIBODY RESPIRATORY SYNCTIAL VIRUS,,30,,,$298.22,$0.00,1,0,1,20161001,
86757,CPT,ANTIBODY RICKETTSIA,,30,,,$298.22,$0.00,1,0,1,20161001,
86759,CPT,ANTIBODY ROTAVIRUS,,30,,,$298.22,$0.00,1,0,1,20161001,
86762,CPT,ANTIBODY RUBELLA,,30,,,$178.93,$0.00,1,0,1,20161001,
86765,CPT,ANTIBODY RUBEOLA,,30,,,$313.13,$0.00,1,0,1,20161001,
86768,CPT,ANTIBODY SALMONELLA,,30,,,$246.03,$0.00,1,0,1,20161001,
86771,CPT,ANTIBODY SHIGELLA,,30,,,$246.03,$0.00,1,0,1,20161001,
86774,CPT,ANTIBODY TETANUS,,30,,,$335.49,$0.00,1,0,1,20161001,
86777,CPT,ANTIBODY TOXOPLASMA,,30,,,$246.03,$0.00,1,0,1,20161001,
86778,CPT,ANTIBODY TOXOPLASMA IGM,,30,,,$320.58,$0.00,1,0,1,20161001,
86780,CPT,ANTIBODY TREPONEMA PALLIDUM,,30,,,$253.48,$0.00,1,0,1,20161001,
86784,CPT,ANTIBODY TRICHINELLA,,30,,,$268.39,$0.00,1,0,1,20161001,
86787,CPT,ANTIBODY VARICELLA-ZOSTER,,30,,,$305.67,$0.00,1,0,1,20161001,
86788,CPT,ANTIBODY WEST NILE VIRUS IGM,,30,,,$320.58,$0.00,1,0,1,20161001,
86789,CPT,ANTIBODY WEST NILE VIRUS,,30,,,$320.58,$0.00,1,0,1,20161001,
86790,CPT,ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED,,30,,,$298.22,$0.00,1,0,1,20161001,
86793,CPT,ANTIBODY YERSINIA,,30,,,$260.94,$0.00,1,0,1,20161001,
86800,CPT,THYROGLOBULIN ANTIBODY,,30,,,$320.58,$0.00,1,0,1,20161001,
86803,CPT,HEPATITIS C ANTIBODY,,30,,,$365.31,$0.00,1,0,1,20161001,
86804,CPT,HEPATITIS C ANTIBODY CONFIRMATORY TEST,,30,,,$581.52,$0.00,1,0,1,20161001,
86805,CPT,LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ,,30,,,$894.65,$0.00,1,0,1,20161001,
86806,CPT,LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT,,30,,,$894.65,$0.00,1,0,1,20161001,
86807,CPT,SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH,,30,,,$596.43,$0.00,1,0,1,20161001,
86808,CPT,SERUM SCREENING % REACTIVE ANTIBODY QUICK METH,,30,,,$484.60,$0.00,1,0,1,20161001,
86812,CPT,HLA TYPING A/B/C SINGLE ANTIGEN,,30,,,$469.69,$0.00,1,0,1,20161001,
86813,CPT,HLA TYPING A/B/C MULTIPLE ANTIGENS,,30,,,$820.09,$0.00,1,0,1,20161001,
86816,CPT,HLA TYPING DR/DQ SINGLE ANTIGEN,,30,,,$633.71,$0.00,1,0,1,20161001,
86817,CPT,HLA TYPING DR/DQ MULTIPLE ANTIGENS,,30,,,"$1,714.74",$0.00,1,0,1,20161001,
86821,CPT,HLA TYPING LYMPHOCYTE CULTURE MIXED,,30,,,"$1,267.42",$0.00,1,0,1,20161001,
86822,CPT,HLA TYPING LYMPHOCYTE CULTURE PRIMED,,30,,,$521.88,$0.00,1,0,1,20161001,
86825,CPT,HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION,,30,,,$997.90,$0.00,1,0,1,20161001,
86826,CPT,HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION,,30,,,$352.54,$0.00,1,0,1,20161001,
86828,CPT,ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL,,30,,,$709.67,$0.00,1,0,1,20161001,
86829,CPT,ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL,,30,,,$486.89,$0.00,1,0,1,20161001,
86830,CPT,ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE,,30,,,$621.36,$0.00,1,0,1,20161001,
86831,CPT,ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL,,30,,,$501.82,$0.00,1,0,1,20161001,
86832,CPT,ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL,,30,,,"$1,248.23",$0.00,1,0,1,20161001,
86833,CPT,ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL,,30,,,"$1,234.45",$0.00,1,0,1,20161001,
86834,CPT,ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL,,30,,,"$2,476.13",$0.00,1,0,1,20161001,
86835,CPT,ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL,,30,,,"$1,876.37",$0.00,1,0,1,20161001,
86849,CPT,UNLISTED IMMUNOLOGY,,30,,,$329.43,$0.00,1,0,1,20161001,
86850,CPT,ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE,,30,,,$315.58,$0.00,1,0,1,20161001,
86860,CPT,ANTIBODY ELUTION RBC EACH ELUTION,,30,,,$226.03,$0.00,1,0,1,20161001,
86870,CPT,ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
86880,CPT,ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM,,30,,,$306.21,$0.00,1,0,1,20161001,
86885,CPT,ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL,,30,,,$226.03,$0.00,1,0,1,20161001,
86886,CPT,ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER,,30,,,$424.20,$0.00,1,0,1,20161001,
86890,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
86891,CPT,AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE,,30,,,"$2,780.86",$0.00,1,0,1,20161001,
86900,CPT,BLOOD TYPING SEROLOGIC ABO,,30,,,$306.21,$0.00,1,0,1,20161001,
86901,CPT,BLOOD TYPING SEROLOGIC RH (D),,30,,,$156.54,$0.00,1,0,1,20161001,
86902,CPT,BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH,,30,,,$226.03,$0.00,1,0,1,20161001,
86904,CPT,BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT,,30,,,$155.67,$0.00,1,0,1,20161001,
86905,CPT,BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH,,30,,,$226.03,$0.00,1,0,1,20161001,
86906,CPT,BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE,,30,,,$156.54,$0.00,1,0,1,20161001,
86910,CPT,BLOOD TYPING PATERNITY PR INDIV ABO RH&MN,,30,,,$164.02,$0.00,1,0,1,20161001,
86911,CPT,BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS,,30,,,$141.65,$0.00,1,0,1,20161001,
86920,CPT,COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE,,30,,,$226.03,$0.00,1,0,1,20161001,
86921,CPT,COMPATIBILITY EACH UNIT INCUBATION,,30,,,$226.03,$0.00,1,0,1,20161001,
86922,CPT,COMPATIBILITY EACH UNIT ANTIGLOBULIN,,30,,,$226.03,$0.00,1,0,1,20161001,
86923,CPT,COMPATIBILITY EACH UNIT ELECTRONIC,,30,,,$226.03,$0.00,1,0,1,20161001,
86927,CPT,FRESH FROZEN PLASMA THAWING EACH UNIT,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
86930,CPT,FROZEN BLOOD EACH UNIT FREEZING,,30,,,$226.03,$0.00,1,0,1,20161001,
86931,CPT,FROZEN BLOOD EACH UNIT THAWING,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
86932,CPT,FROZEN BLOOD EACH UNIT FREEZING & THAWING,,30,,,$156.54,$0.00,1,0,1,20161001,
86940,CPT,HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH,,30,,,$134.20,$0.00,1,0,1,20161001,
86941,CPT,HEMOLYSINS&AGGLUTININS INCUBATED,,30,,,$178.93,$0.00,1,0,1,20161001,
86945,CPT,IRRADIATION BLOOD PRODUCT EACH UNIT,,30,,,$156.54,$0.00,1,0,1,20161001,
86950,CPT,LEUKOCYTE TRANSFUSION,,30,,,$226.03,$0.00,1,0,1,20161001,
86960,CPT,VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT,,30,,,$226.03,$0.00,1,0,1,20161001,
86965,CPT,POOLING PLATELETS/OTHER BLOOD PRODUCTS,,30,,,$226.03,$0.00,1,0,1,20161001,
86970,CPT,PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA,,30,,,$155.67,$0.00,1,0,1,20161001,
86971,CPT,PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH,,30,,,$226.03,$0.00,1,0,1,20161001,
86972,CPT,PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP,,30,,,$226.03,$0.00,1,0,1,20161001,
86975,CPT,PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH,,30,,,$156.54,$0.00,1,0,1,20161001,
86976,CPT,PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION,,30,,,$156.54,$0.00,1,0,1,20161001,
86977,CPT,PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA,,30,,,$226.03,$0.00,1,0,1,20161001,
86978,CPT,PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ,,30,,,$82.55,$0.00,1,0,1,20161001,
86985,CPT,SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT,,30,,,$424.20,$0.00,1,0,1,20161001,
86999,CPT,UNLISTED TRANSFUSION MEDICINE PROCEDURE,,30,,,$81.90,$0.00,1,0,1,20161001,
87003,CPT,ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ,,30,,,$253.60,$0.00,1,0,1,20161001,
87015,CPT,CONCENTRATION INFECTIOUS AGENTS,,30,,,$152.16,$0.00,1,0,1,20161001,
87040,CPT,CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES,,30,,,$202.88,$0.00,1,0,1,20161001,
87045,CPT,CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL,,30,,,$202.88,$0.00,1,0,1,20161001,
87046,CPT,CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA,,30,,,$202.88,$0.00,1,0,1,20161001,
87070,CPT,CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL,,30,,,$195.64,$0.00,1,0,1,20161001,
87071,CPT,CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL,,30,,,$202.88,$0.00,1,0,1,20161001,
87073,CPT,CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL,,30,,,$217.37,$0.00,1,0,1,20161001,
87075,CPT,CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID,,30,,,$217.37,$0.00,1,0,1,20161001,
87076,CPT,CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL,,30,,,$217.37,$0.00,1,0,1,20161001,
87077,CPT,CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL,,30,,,$217.37,$0.00,1,0,1,20161001,
87081,CPT,CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ,,30,,,$130.42,$0.00,1,0,1,20161001,
87084,CPT,CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART,,30,,,$144.92,$0.00,1,0,1,20161001,
87086,CPT,CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE,,30,,,$181.14,$0.00,1,0,1,20161001,
87088,CPT,CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE,,30,,,$173.90,$0.00,1,0,1,20161001,
87101,CPT,CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL,,30,,,$181.14,$0.00,1,0,1,20161001,
87102,CPT,CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD,,30,,,$188.39,$0.00,1,0,1,20161001,
87103,CPT,CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD,,30,,,$188.39,$0.00,1,0,1,20161001,
87106,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST,,30,,,$195.64,$0.00,1,0,1,20161001,
87107,CPT,CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD,,30,,,$195.64,$0.00,1,0,1,20161001,
87109,CPT,CULTURE MYCOPLASMA ANY SOURCE,,30,,,$398.52,$0.00,1,0,1,20161001,
87110,CPT,CULTURE CHLAMYDIA ANY SOURCE,,30,,,$275.34,$0.00,1,0,1,20161001,
87116,CPT,CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL,,30,,,$217.37,$0.00,1,0,1,20161001,
87118,CPT,CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL,,30,,,$202.88,$0.00,1,0,1,20161001,
87140,CPT,CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM,,30,,,$152.16,$0.00,1,0,1,20161001,
87143,CPT,CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY,,30,,,$282.58,$0.00,1,0,1,20161001,
87147,CPT,CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES,,30,,,$115.93,$0.00,1,0,1,20161001,
87149,CPT,CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM,,30,,,$275.34,$0.00,1,0,1,20161001,
87150,CPT,CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM,,30,,,$289.83,$0.00,1,0,1,20161001,
87152,CPT,CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING,,30,,,$101.44,$0.00,1,0,1,20161001,
87153,CPT,CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE,,30,,,$304.32,$0.00,1,0,1,20161001,
87158,CPT,CULTURE TYPING OTHER METHODS,,30,,,$108.69,$0.00,1,0,1,20161001,
87164,CPT,DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION,,30,,,$43.47,$0.00,1,0,1,20161001,
87166,CPT,DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT,,30,,,$202.88,$0.00,1,0,1,20161001,
87168,CPT,MACROSCOPIC EXAMINATION ARTHROPOD,,30,,,$108.69,$0.00,1,0,1,20161001,
87169,CPT,MACROSCOPIC EXAMINATION PARASITE,,30,,,$108.69,$0.00,1,0,1,20161001,
87172,CPT,PINWORM EXAMINATION,,30,,,$108.69,$0.00,1,0,1,20161001,
87176,CPT,HOMOGENIZATION TISSUE CULTURE,,30,,,$130.42,$0.00,1,0,1,20161001,
87177,CPT,OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID,,30,,,$195.64,$0.00,1,0,1,20161001,
87181,CPT,SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ,,30,,,$108.69,$0.00,1,0,1,20161001,
87184,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD,,30,,,$144.92,$0.00,1,0,1,20161001,
87185,CPT,SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ,,30,,,$123.18,$0.00,1,0,1,20161001,
87186,CPT,SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ,,30,,,$166.65,$0.00,1,0,1,20161001,
87187,CPT,SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA,,30,,,$166.65,$0.00,1,0,1,20161001,
87188,CPT,SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,,30,,,$166.65,$0.00,1,0,1,20161001,
87190,CPT,SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD,,30,,,$115.93,$0.00,1,0,1,20161001,
87197,CPT,SERUM BACTERICIDAL TITER,,30,,,$231.86,$0.00,1,0,1,20161001,
87205,CPT,SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL,,30,,,$108.69,$0.00,1,0,1,20161001,
87206,CPT,SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT,,30,,,$130.42,$0.00,1,0,1,20161001,
87207,CPT,SMR PRIM SRC SPEC STAIN BODIES/PARASITS,,30,,,$202.88,$0.00,1,0,1,20161001,
87209,CPT,SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS,,30,,,$130.42,$0.00,1,0,1,20161001,
87210,CPT,SMR PRIM SRC WET MOUNT NFCT AGT,,30,,,$94.19,$0.00,1,0,1,20161001,
87220,CPT,TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT,,30,,,$108.69,$0.00,1,0,1,20161001,
87230,CPT,TOXIN/ANTITOXIN ASSAY TISSUE CULTURE,,30,,,$326.06,$0.00,1,0,1,20161001,
87250,CPT,VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ,,30,,,$362.29,$0.00,1,0,1,20161001,
87252,CPT,VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT,,30,,,$362.29,$0.00,1,0,1,20161001,
87253,CPT,VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE,,30,,,$362.29,$0.00,1,0,1,20161001,
87254,CPT,VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA,,30,,,$362.29,$0.00,1,0,1,20161001,
87255,CPT,VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC,,30,,,$362.29,$0.00,1,0,1,20161001,
87260,CPT,IAADI ADENOVIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87265,CPT,IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS,,30,,,$289.83,$0.00,1,0,1,20161001,
87267,CPT,IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY,,30,,,$289.83,$0.00,1,0,1,20161001,
87269,CPT,IAADI GIARDIA,,30,,,$289.83,$0.00,1,0,1,20161001,
87270,CPT,IAADI CHLAMYDIA TRACHOMATIS,,30,,,$289.83,$0.00,1,0,1,20161001,
87271,CPT,IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY,,30,,,$347.80,$0.00,1,0,1,20161001,
87272,CPT,IAADI CRYPTOSPORIDIUM,,30,,,$289.83,$0.00,1,0,1,20161001,
87273,CPT,IAADI HERPES SMPLX VIRUS TYPE 2,,30,,,$289.83,$0.00,1,0,1,20161001,
87274,CPT,IAADI HERPES SMPLX VIRUS TYPE 1,,30,,,$289.83,$0.00,1,0,1,20161001,
87275,CPT,IAADI INFLUENZA B VIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87276,CPT,IAADI INFFLUENZA A VIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87277,CPT,IAADI LEGIONELLA MICDADEI,,30,,,$253.60,$0.00,1,0,1,20161001,
87278,CPT,IAADI LEGIONELLA PNEUMOPHILA,,30,,,$289.83,$0.00,1,0,1,20161001,
87279,CPT,IAADI PARAINFLUENZA VIRUS EACH TYPE,,30,,,$289.83,$0.00,1,0,1,20161001,
87280,CPT,IAADI RESPIRATORY SYNCTIAL VIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87281,CPT,IAADI PNEUMOCUSTIS CARINII,,30,,,$289.83,$0.00,1,0,1,20161001,
87283,CPT,IAADI RUBEOLA,,30,,,$289.83,$0.00,1,0,1,20161001,
87285,CPT,IAADI TREPONEMA PALLIDUM,,30,,,$326.06,$0.00,1,0,1,20161001,
87290,CPT,IAADI VARICELLA ZOSTER VIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87299,CPT,IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM,,30,,,$318.81,$0.00,1,0,1,20161001,
87300,CPT,IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM,,30,,,$231.86,$0.00,1,0,1,20161001,
87301,CPT,IAAD IA ADENOVIRUS ENTERIC TYP 40/41,,30,,,$231.86,$0.00,1,0,1,20161001,
87305,CPT,IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS,,30,,,$231.86,$0.00,1,0,1,20161001,
87320,CPT,IAAD IA CHLAMYDIA TRACHOMATIS,,30,,,$231.86,$0.00,1,0,1,20161001,
87324,CPT,IAAD IA CLOSTRIDIUM DIFFICILE TOXIN,,30,,,$231.86,$0.00,1,0,1,20161001,
87327,CPT,IAAD IA CRYPTOCOCCUS NEOFORMANS,,30,,,$231.86,$0.00,1,0,1,20161001,
87328,CPT,IAAD IA CRYPTOSPORIDIUM,,30,,,$231.86,$0.00,1,0,1,20161001,
87329,CPT,IAAD IA GIARDIA,,30,,,$231.86,$0.00,1,0,1,20161001,
87332,CPT,IAAD IA CYTOMEGALOVIRUS,,30,,,$231.86,$0.00,1,0,1,20161001,
87335,CPT,IAAD IA ESCHERICHIA COLI 0157,,30,,,$231.86,$0.00,1,0,1,20161001,
87336,CPT,IAAD IA ENTAMOEBA HISTOLYTICA DISPAR GRP,,30,,,$231.86,$0.00,1,0,1,20161001,
87337,CPT,IAAD IA ENTAMOEBA HISTOLYTICA GRP,,30,,,$231.86,$0.00,1,0,1,20161001,
87338,CPT,IAAD IA HPYLORI STOOL,,30,,,$231.86,$0.00,1,0,1,20161001,
87339,CPT,IAAD IA HPYLORI,,30,,,$231.86,$0.00,1,0,1,20161001,
87340,CPT,IAAD IA HEPATITIS B SURFACE ANTIGEN,,30,,,$231.86,$0.00,1,0,1,20161001,
87341,CPT,IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION,,30,,,$231.86,$0.00,1,0,1,20161001,
87350,CPT,IAAD IA HEPATITIS BE ANTIGEN,,30,,,$246.36,$0.00,1,0,1,20161001,
87380,CPT,IAAD IA HEPATITIS DELTA ANTIGEN,,30,,,$326.06,$0.00,1,0,1,20161001,
87385,CPT,IAAD IA HISTOPLASM CAPSULATUM,,30,,,$231.86,$0.00,1,0,1,20161001,
87389,CPT,IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,,30,,,$247.18,$0.00,1,0,1,20161001,
87390,CPT,IAAD IA HIV-1,,30,,,$362.29,$0.00,1,0,1,20161001,
87391,CPT,IAAD IA HIV-2,,30,,,$340.55,$0.00,1,0,1,20161001,
87400,CPT,IAAD IA INFLUENZA A/B EACH,,30,,,$231.86,$0.00,1,0,1,20161001,
87420,CPT,IAAD IA RESPIRATORY SYNCTIAL VIRUS,,30,,,$231.86,$0.00,1,0,1,20161001,
87425,CPT,IAAD IA ROTAVIRUS,,30,,,$231.86,$0.00,1,0,1,20161001,
87427,CPT,IAAD IA SHIGA-LIKE TOXIN,,30,,,$231.86,$0.00,1,0,1,20161001,
87430,CPT,IAAD IA STREPTOCOCCUS GROUP A,,30,,,$173.90,$0.00,1,0,1,20161001,
87449,CPT,IAAD IA MULT STEP METHOD NOS EACH ORGANISM,,30,,,$231.86,$0.00,1,0,1,20161001,
87450,CPT,IAAD IA SINGLE STEP METHOD NOS EA ORGANISM,,30,,,$231.86,$0.00,1,0,1,20161001,
87451,CPT,IAAD IA POLYV MLT ORGANISMS EA POLYV ANTISERUM,,30,,,$231.86,$0.00,1,0,1,20161001,
87470,CPT,IADNA BARTONELLA DIRECT PROBE TECHNIQUE,,30,,,$289.83,$0.00,1,0,1,20161001,
87471,CPT,IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE,,30,,,$652.12,$0.00,1,0,1,20161001,
87472,CPT,IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ,,30,,,$579.66,$0.00,1,0,1,20161001,
87475,CPT,IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87476,CPT,IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ,,30,,,$760.81,$0.00,1,0,1,20161001,
87477,CPT,IADNA BORRELIA BURGDORFERI QUANTIFICATION,,30,,,$583.28,$0.00,1,0,1,20161001,
87480,CPT,IADNA CANDIDA SPECIES DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87481,CPT,IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87482,CPT,IADNA CANDIDA SPECIES QUANTIFICATION,,30,,,$507.20,$0.00,1,0,1,20161001,
87485,CPT,IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ,,30,,,$326.06,$0.00,1,0,1,20161001,
87486,CPT,IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87487,CPT,IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION,,30,,,$543.43,$0.00,1,0,1,20161001,
87490,CPT,IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87491,CPT,IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ,,30,,,$521.70,$0.00,1,0,1,20161001,
87492,CPT,IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION,,30,,,$543.43,$0.00,1,0,1,20161001,
87493,CPT,INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE,,30,,,$572.42,$0.00,1,0,1,20161001,
87495,CPT,IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ,,30,,,$543.43,$0.00,1,0,1,20161001,
87496,CPT,IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ,,30,,,$623.14,$0.00,1,0,1,20161001,
87497,CPT,IADNA CYTOMEGALOVIRUS QUANTIFICATION,,30,,,"$1,086.87",$0.00,1,0,1,20161001,
87498,CPT,IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP,,30,,,$797.03,$0.00,1,0,1,20161001,
87500,CPT,INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE,,30,,,$797.03,$0.00,1,0,1,20161001,
87501,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE,,30,,,$797.03,$0.00,1,0,1,20161001,
87502,CPT,INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES,,30,,,$797.03,$0.00,1,0,1,20161001,
87503,CPT,NFCT AGENT DNA/RNA INFLUENZA >2 TYPES EA ADDL,,30,,,$194.48,$0.00,1,0,1,20161001,
87505,CPT,NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN,,30,,,$613.81,$0.00,1,0,1,20161001,
87506,CPT,IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11,,30,,,"$1,016.66",$0.00,1,0,1,20161001,
87507,CPT,IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25,,30,,,"$2,021.61",$0.00,1,0,1,20161001,
87510,CPT,IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87511,CPT,IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87512,CPT,IADNA GARDNERELLA VAGINALIS QUANTIFICATION,,30,,,$543.43,$0.00,1,0,1,20161001,
87515,CPT,IADNA HEPATITIS B VIRUS DIRECT PROBE TECHNIQUE,,30,,,$434.75,$0.00,1,0,1,20161001,
87516,CPT,IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ,,30,,,$811.53,$0.00,1,0,1,20161001,
87517,CPT,IADNA HEPATITIS B VIRUS QUANTIFICATION,,30,,,$883.98,$0.00,1,0,1,20161001,
87520,CPT,IADNA HEPATITIS C DIRECT PROBE TECHNIQUE,,30,,,$434.75,$0.00,1,0,1,20161001,
87521,CPT,IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR,,30,,,$811.53,$0.00,1,0,1,20161001,
87522,CPT,IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION,,30,,,$811.53,$0.00,1,0,1,20161001,
87525,CPT,IADNA HEPATITIS G DIRECT PROBE TECHNIQUE,,30,,,$362.29,$0.00,1,0,1,20161001,
87526,CPT,IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE,,30,,,$652.12,$0.00,1,0,1,20161001,
87527,CPT,IADNA HEPATITIS G QUANTIFICATION,,30,,,$652.12,$0.00,1,0,1,20161001,
87528,CPT,IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87529,CPT,IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ,,30,,,$652.12,$0.00,1,0,1,20161001,
87530,CPT,IADNA HERPES SOMPLX VIRUS QUANTIFICATION,,30,,,$652.12,$0.00,1,0,1,20161001,
87531,CPT,IADNA HERPES VIRUS-6 DIRECT PROBE TQ,,30,,,$362.29,$0.00,1,0,1,20161001,
87532,CPT,IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ,,30,,,$652.12,$0.00,1,0,1,20161001,
87533,CPT,IADNA HERPES VIRUS-6 QUANTIFICATION,,30,,,$652.12,$0.00,1,0,1,20161001,
87534,CPT,IADNA HIV-1 DIRECT PROBE TECHNIQUE,,30,,,$362.29,$0.00,1,0,1,20161001,
87535,CPT,IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ,,30,,,$652.12,$0.00,1,0,1,20161001,
87536,CPT,IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION,,30,,,"$1,014.41",$0.00,1,0,1,20161001,
87537,CPT,IADNA HIV-2 DIRECT PROBE TECHNIQUE,,30,,,$362.29,$0.00,1,0,1,20161001,
87538,CPT,IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ,,30,,,$652.12,$0.00,1,0,1,20161001,
87539,CPT,IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION,,30,,,$724.58,$0.00,1,0,1,20161001,
87540,CPT,IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87541,CPT,IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87542,CPT,IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION,,30,,,$579.66,$0.00,1,0,1,20161001,
87550,CPT,IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87551,CPT,IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87552,CPT,IADNA MYCOBACTERIA SPECIES QUANTIFICATION,,30,,,$652.12,$0.00,1,0,1,20161001,
87555,CPT,IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB,,30,,,$362.29,$0.00,1,0,1,20161001,
87556,CPT,IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB,,30,,,$652.12,$0.00,1,0,1,20161001,
87557,CPT,IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION,,30,,,$583.28,$0.00,1,0,1,20161001,
87560,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB,,30,,,$289.83,$0.00,1,0,1,20161001,
87561,CPT,IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB,,30,,,$652.12,$0.00,1,0,1,20161001,
87562,CPT,IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT,,30,,,$652.12,$0.00,1,0,1,20161001,
87580,CPT,IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87581,CPT,IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ,,30,,,$652.12,$0.00,1,0,1,20161001,
87582,CPT,IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION,,30,,,$579.66,$0.00,1,0,1,20161001,
87590,CPT,IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87591,CPT,IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87592,CPT,IADNA NEISSERIA GONORRHOEAE QUANTIFICATION,,30,,,$583.28,$0.00,1,0,1,20161001,
87623,CPT,IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES,,30,,,$571.79,$0.00,1,0,1,20161001,
87624,CPT,IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES,,30,,,$571.79,$0.00,1,0,1,20161001,
87625,CPT,IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY,,30,,,$571.79,$0.00,1,0,1,20161001,
87631,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS,,30,,,$533.97,$0.00,1,0,1,20161001,
87632,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS,,30,,,"$1,395.22",$0.00,1,0,1,20161001,
87633,CPT,IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET,,30,,,"$1,973.98",$0.00,1,0,1,20161001,
87640,CPT,IADNA S AUREUS AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87641,CPT,IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87650,CPT,IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87651,CPT,IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87652,CPT,IADNA STREPTOCOCCUS GROUP A QUANTIFICATION,,30,,,$583.28,$0.00,1,0,1,20161001,
87653,CPT,IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ,,30,,,$579.66,$0.00,1,0,1,20161001,
87660,CPT,IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ,,30,,,$289.83,$0.00,1,0,1,20161001,
87797,CPT,IADNA NOS DIRECT PROBE TQ EACH ORGANISM,,30,,,$289.83,$0.00,1,0,1,20161001,
87798,CPT,IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM,,30,,,$579.66,$0.00,1,0,1,20161001,
87799,CPT,IADNA NOS QUANTIFICATION EACH ORGANISM,,30,,,$652.12,$0.00,1,0,1,20161001,
87800,CPT,IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ,,30,,,$283.66,$0.00,1,0,1,20161001,
87801,CPT,IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,,30,,,$355.98,$0.00,1,0,1,20161001,
87802,CPT,IAADIADOO STREPTOCOCCUS GROUP B,,30,,,$289.83,$0.00,1,0,1,20161001,
87803,CPT,IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN,,30,,,$289.83,$0.00,1,0,1,20161001,
87804,CPT,IAADIADOO INFLUENZA,,30,,,$253.60,$0.00,1,0,1,20161001,
87806,CPT,IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES,,30,,,$276.08,$0.00,1,0,1,20161001,
87807,CPT,IAADIADOO RESPIRATORY SYNCTIAL VIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87808,CPT,IAADIADOO TRICHOMONAS VAGINALIS,,30,,,$289.83,$0.00,1,0,1,20161001,
87809,CPT,INFECTIOUS AGENT IMMUNOASSAY OPTICAL ADENOVIRUS,,30,,,$289.83,$0.00,1,0,1,20161001,
87810,CPT,CHLAMYDIA TRACHOMATIS,,30,,,$289.83,$0.00,1,0,1,20161001,
87850,CPT,IAADIADOO NEISSERIA GONORRHOEAE,,30,,,$289.83,$0.00,1,0,1,20161001,
87880,CPT,IAADIADOO STREPTOCOCCUS GROUP A,,30,,,$253.60,$0.00,1,0,1,20161001,
87899,CPT,IAADIADOO NOT OTHERWISE SPECIFIED,,30,,,$253.60,$0.00,1,0,1,20161001,
87900,CPT,NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION,,30,,,$702.78,$0.00,1,0,1,20161001,
87901,CPT,NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS,,30,,,"$3,217.12",$0.00,1,0,1,20161001,
87902,CPT,NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS,,30,,,"$3,217.12",$0.00,1,0,1,20161001,
87903,CPT,NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS,,30,,,"$5,796.61",$0.00,1,0,1,20161001,
87904,CPT,NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG,,30,,,$652.12,$0.00,1,0,1,20161001,
87905,CPT,INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS,,30,,,$362.29,$0.00,1,0,1,20161001,
87906,CPT,NFCT GEXYP DNA/RNA HIV 1 OTHER REGION,,30,,,$362.29,$0.00,1,0,1,20161001,
87910,CPT,NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,,30,,,"$1,470.45",$0.00,1,0,1,20161001,
87912,CPT,NFCT AGENT GENOTYPE HEPATITIS B VIRUS,,30,,,"$1,909.67",$0.00,1,0,1,20161001,
87999,CPT,UNLISTED MICROBIOLOGY,,30,,,$221.26,$0.00,1,0,1,20161001,
88104,CPT,CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ,,30,,,$156.54,$0.00,1,0,1,20161001,
88106,CPT,CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ,,30,,,$156.54,$0.00,1,0,1,20161001,
88108,CPT,CYTP CONCENTRATION SMEARS & INTERPRETATION,,30,,,$156.54,$0.00,1,0,1,20161001,
88112,CPT,CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V,,30,,,$315.58,$0.00,1,0,1,20161001,
88120,CPT,CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88121,CPT,CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA,,30,,,$424.20,$0.00,1,0,1,20161001,
88125,CPT,CYTOPATHOLOGY FORENSIC,,30,,,$315.58,$0.00,1,0,1,20161001,
88130,CPT,SEX CHROMATIN IDENTIFICATION BARR BODIES,,30,,,$124.96,$0.00,1,0,1,20161001,
88140,CPT,SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR,,30,,,$87.47,$0.00,1,0,1,20161001,
88141,CPT,CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN,,30,,,$125.17,$0.00,1,0,1,20161001,
88142,CPT,CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN,,30,,,$106.21,$0.00,1,0,1,20161001,
88143,CPT,CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS,,30,,,$115.59,$0.00,1,0,1,20161001,
88147,CPT,CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV,,30,,,$110.90,$0.00,1,0,1,20161001,
88148,CPT,CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS,,30,,,$117.15,$0.00,1,0,1,20161001,
88150,CPT,CYTP SLIDES C/V MNL SCR UNDER PHYS,,30,,,$99.97,$0.00,1,0,1,20161001,
88152,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS,,30,,,$118.71,$0.00,1,0,1,20161001,
88153,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS,,30,,,$118.71,$0.00,1,0,1,20161001,
88154,CPT,CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&I,,30,,,$121.83,$0.00,1,0,1,20161001,
88155,CPT,CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL,,30,,,$74.98,$0.00,1,0,1,20161001,
88160,CPT,CYTP SMRS ANY OTH SRC SCR&INTERPJ,,30,,,$81.90,$0.00,1,0,1,20161001,
88161,CPT,CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ,,30,,,$156.54,$0.00,1,0,1,20161001,
88162,CPT,CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES,,30,,,$309.88,$0.00,1,0,1,20161001,
88164,CPT,CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV,,30,,,$106.21,$0.00,1,0,1,20161001,
88165,CPT,CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV,,30,,,$117.15,$0.00,1,0,1,20161001,
88166,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV,,30,,,$106.21,$0.00,1,0,1,20161001,
88167,CPT,CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I,,30,,,$137.45,$0.00,1,0,1,20161001,
88172,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST,,30,,,$424.20,$0.00,1,0,1,20161001,
88173,CPT,CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT,,30,,,$315.58,$0.00,1,0,1,20161001,
88174,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS,,30,,,$118.71,$0.00,1,0,1,20161001,
88175,CPT,CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS,,30,,,$121.83,$0.00,1,0,1,20161001,
88177,CPT,CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL,,30,,,$31.81,$0.00,1,0,1,20161001,
88182,CPT,FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,,30,,,$424.20,$0.00,1,0,1,20161001,
88184,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88185,CPT,FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA,,30,,,$256.16,$0.00,1,0,1,20161001,
88187,CPT,FLOW CYTOMETRY INTERPJ 2-8 MARKERS,,30,,,$281.34,$0.00,1,0,1,20161001,
88188,CPT,FLOW CYTOMETRY INTERPJ 9-15 MARKERS,,30,,,$325.30,$0.00,1,0,1,20161001,
88189,CPT,FLOW CYTOMETRY INTERPRETATION 16/> MARKERS,,30,,,$767.48,$0.00,1,0,1,20161001,
88199,CPT,UNLISTED CYTOPATHOLOGY PROCEDURE,,30,,,$315.58,$0.00,1,0,1,20161001,
88230,CPT,TISS CUL NON-NEO DISORDERS LYMPHOCYTE,,30,,,$718.51,$0.00,1,0,1,20161001,
88233,CPT,TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX,,30,,,$718.51,$0.00,1,0,1,20161001,
88235,CPT,TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS,,30,,,"$1,249.58",$0.00,1,0,1,20161001,
88237,CPT,TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS,,30,,,"$1,124.63",$0.00,1,0,1,20161001,
88239,CPT,TISS CUL NEO DISORDERS SOLID TUMOR,,30,,,$718.51,$0.00,1,0,1,20161001,
88240,CPT,CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE,,30,,,$624.79,$0.00,1,0,1,20161001,
88241,CPT,THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT,,30,,,$468.59,$0.00,1,0,1,20161001,
88245,CPT,CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL,,30,,,$843.47,$0.00,1,0,1,20161001,
88248,CPT,CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL,,30,,,"$1,499.50",$0.00,1,0,1,20161001,
88249,CPT,CHRMSM BREAKAGE SYNDS SCORE 100 CLL,,30,,,"$1,686.94",$0.00,1,0,1,20161001,
88261,CPT,CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING,,30,,,"$1,468.26",$0.00,1,0,1,20161001,
88262,CPT,CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING,,30,,,"$1,968.09",$0.00,1,0,1,20161001,
88263,CPT,CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE,,30,,,"$2,024.33",$0.00,1,0,1,20161001,
88264,CPT,CHRMSM ANALYZE 20-25 CELLS,,30,,,"$1,874.38",$0.00,1,0,1,20161001,
88267,CPT,CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE,,30,,,"$2,218.01",$0.00,1,0,1,20161001,
88269,CPT,CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP,,30,,,"$1,949.35",$0.00,1,0,1,20161001,
88271,CPT,MOLECULAR CYTOGENETICS DNA PROBE EACH,,30,,,$378.95,$0.00,1,0,1,20161001,
88272,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS,,30,,,$571.52,$0.00,1,0,1,20161001,
88273,CPT,MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL,,30,,,$451.29,$0.00,1,0,1,20161001,
88274,CPT,MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL,,30,,,$516.75,$0.00,1,0,1,20161001,
88275,CPT,MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL,,30,,,$575.31,$0.00,1,0,1,20161001,
88280,CPT,CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY,,30,,,$643.54,$0.00,1,0,1,20161001,
88283,CPT,CHRMSM ANALYSIS ADDL SPECIALIZED BANDING,,30,,,$562.31,$0.00,1,0,1,20161001,
88285,CPT,CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY,,30,,,$562.31,$0.00,1,0,1,20161001,
88289,CPT,CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY,,30,,,$468.59,$0.00,1,0,1,20161001,
88299,CPT,UNLISTED CYTOGENETIC STUDY,,30,,,$315.58,$0.00,1,0,1,20161001,
88300,CPT,LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY,,30,,,$156.54,$0.00,1,0,1,20161001,
88302,CPT,LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,30,,,$156.54,$0.00,1,0,1,20161001,
88304,CPT,LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,30,,,$315.58,$0.00,1,0,1,20161001,
88305,CPT,LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,30,,,$315.58,$0.00,1,0,1,20161001,
88307,CPT,LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88309,CPT,LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
88311,CPT,DECALCIFICATION PROCEDURE,,30,,,$65.29,$0.00,1,0,1,20161001,
88312,CPT,SPECIAL STAIN GROUP 1 MICROORGANISMS I&R,,30,,,$309.88,$0.00,1,0,1,20161001,
88313,CPT,SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT,,30,,,$315.58,$0.00,1,0,1,20161001,
88314,CPT,SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU,,30,,,$506.01,$0.00,1,0,1,20161001,
88319,CPT,SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
88321,CPT,CONSLTJ&REPRT SLIDES PREPARED ELSEWHERE,,30,,,$156.54,$0.00,1,0,1,20161001,
88323,CPT,CONSLTJ&REPRT MATERIAL REQUIRING PREPJ SLIDES,,30,,,$424.20,$0.00,1,0,1,20161001,
88325,CPT,CONSLTJ COMPRE REVIEW REPRT REFERRED MATRL,,30,,,$315.58,$0.00,1,0,1,20161001,
88329,CPT,PATHOLOGY CONSULTATION DURING SURGERY,,30,,,$156.54,$0.00,1,0,1,20161001,
88331,CPT,PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1 SPEC,,30,,,$424.20,$0.00,1,0,1,20161001,
88332,CPT,PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION,,30,,,$99.82,$0.00,1,0,1,20161001,
88333,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
88334,CPT,PATH CONSLTJ SURG CYTOLOGIC EXAM ADDL SITE,,30,,,$120.91,$0.00,1,0,1,20161001,
88341,CPT,IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE,,30,,,$185.67,$0.00,1,0,1,20161001,
88342,CPT,IMHISTOCHEM/CYTCHM 1ST ANTIBODY STAIN PROCEDURE,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88344,CPT,IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
88346,CPT,IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88348,CPT,ELECTRON MICROSCOPY DIAGNOSTIC,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
88355,CPT,MORPHOMETRIC ANALYSIS SKELETAL MUSCLE,,30,,,$424.20,$0.00,1,0,1,20161001,
88356,CPT,MORPHOMETRIC ANALYSIS NERVE,,30,,,$424.20,$0.00,1,0,1,20161001,
88358,CPT,MORPHOMETRIC ANALYSIS TUMOR,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88360,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88361,CPT,M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88362,CPT,NERVE TEASING PREPARATIONS,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
88363,CPT,EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI,,30,,,$81.90,$0.00,1,0,1,20161001,
88364,CPT,IN SITU HYBRIDIZATION EA ADDL PROBE STAIN,,30,,,$221.80,$0.00,1,0,1,20161001,
88365,CPT,IN SITU HYBRIDIZATION 1ST PROBE STAIN,,30,,,$424.20,$0.00,1,0,1,20161001,
88366,CPT,IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
88367,CPT,M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88368,CPT,M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
88369,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH,,30,,,$675.30,$0.00,1,0,1,20161001,
88371,CPT,PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO,,30,,,$580.39,$0.00,1,0,1,20161001,
88372,CPT,PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA,,30,,,$567.05,$0.00,1,0,1,20161001,
88373,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH,,30,,,$675.30,$0.00,1,0,1,20161001,
88374,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
88375,CPT,OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT,,30,,,$202.84,$0.00,1,0,1,20161001,
88377,CPT,M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB,,30,,,"$1,312.42",$0.00,1,0,1,20161001,
88380,CPT,MICRODISSECTION PREP IDENTIFIED TARGET LASER,,30,,,$700.47,$0.00,1,0,1,20161001,
88381,CPT,MICRODISSECTION PREP IDENTIFIED TARGET MANUAL,,30,,,"$1,065.71",$0.00,1,0,1,20161001,
88387,CPT,MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA,,30,,,$53.37,$0.00,1,0,1,20161001,
88388,CPT,MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE,,30,,,$28.35,$0.00,1,0,1,20161001,
88399,CPT,UNLISTED SURGICAL PATHOLOGY PROCEDURE,,30,,,$315.58,$0.00,1,0,1,20161001,
88720,CPT,BILIRUBIN TOTAL TRANSCUTANEOUS,,30,,,$48.23,$0.00,1,0,1,20161001,
88738,CPT,HGB QUANTITATIVE TRANSCUTANEOUS,,30,,,$53.11,$0.00,1,0,1,20161001,
88740,CPT,HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN,,30,,,$102.20,$0.00,1,0,1,20161001,
88749,CPT,UNLISTED IN VIVO LABORTORY SERVICE,,30,,,$27.19,$0.00,1,0,1,20161001,
89049,CPT,CAFFEINE HALOTHANE CONTRACTURE TEST,,30,,,$424.20,$0.00,1,0,1,20161001,
89050,CPT,CELL COUNT MISCELLANEOUS BODY FLUIDS,,30,,,$150.10,$0.00,1,0,1,20161001,
89051,CPT,CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT,,30,,,$158.44,$0.00,1,0,1,20161001,
89055,CPT,LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE,,30,,,$133.42,$0.00,1,0,1,20161001,
89060,CPT,CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID,,30,,,$58.37,$0.00,1,0,1,20161001,
89125,CPT,FAT STAIN FECES URINE/RESPIR SECRETIONS,,30,,,$150.10,$0.00,1,0,1,20161001,
89160,CPT,MEAT FIBERS FECES,,30,,,$100.07,$0.00,1,0,1,20161001,
89190,CPT,NASAL SMEAR EOSINOPHILS,,30,,,$116.74,$0.00,1,0,1,20161001,
89220,CPT,SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX,,30,,,$424.20,$0.00,1,0,1,20161001,
89230,CPT,SWEAT COLLECTION IONTOPHORESIS,,30,,,$315.58,$0.00,1,0,1,20161001,
89240,CPT,UNLIS MISC PATH,,30,,,$315.58,$0.00,1,0,1,20161001,
89250,CPT,CUL OOCYTE/EMBRYO <4 DAYS,,30,,,$424.20,$0.00,1,0,1,20161001,
89251,CPT,CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
89253,CPT,ASSTD EMBRYO HATCHING MICROTQS ANY METH,,30,,,$424.20,$0.00,1,0,1,20161001,
89254,CPT,OOCYTE ID FROM FOLLICULAR FLU,,30,,,$424.20,$0.00,1,0,1,20161001,
89255,CPT,PREPJ EMBRYO TR,,30,,,$424.20,$0.00,1,0,1,20161001,
89257,CPT,SPRM ID FROM ASPIR OTH/THN SEMINAL,,30,,,$315.58,$0.00,1,0,1,20161001,
89258,CPT,CRYOPRSRV EMBRYO,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
89259,CPT,CRYOPRSRV SPRM,,30,,,$424.20,$0.00,1,0,1,20161001,
89260,CPT,SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS,,30,,,$315.58,$0.00,1,0,1,20161001,
89261,CPT,SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS,,30,,,$315.58,$0.00,1,0,1,20161001,
89264,CPT,SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD,,30,,,$424.20,$0.00,1,0,1,20161001,
89268,CPT,INSEMINATION OOCYTES,,30,,,$424.20,$0.00,1,0,1,20161001,
89272,CPT,EXTND CUL OOCYTE/EMBRYO 4-7 DAYS,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
89280,CPT,ASSTD FERTILIZATION MICROTQ </EQUAL 10 OOCYTES,,30,,,"$2,777.26",$0.00,1,0,1,20161001,
89281,CPT,ASSTD FERTILIZATION MICROTQ > 10 OOCYTES,,30,,,$424.20,$0.00,1,0,1,20161001,
89290,CPT,BX OOCYTE MICROTQ </= 5 EMBRY,,30,,,$424.20,$0.00,1,0,1,20161001,
89291,CPT,BX OOCYTE MICROTQ >5 EMBRY,,30,,,$424.20,$0.00,1,0,1,20161001,
89300,CPT,SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER,,30,,,$291.86,$0.00,1,0,1,20161001,
89310,CPT,SEMEN ALYS MOTILITY&CNT X W/HUHNER TST,,30,,,$275.18,$0.00,1,0,1,20161001,
89320,CPT,SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT,,30,,,$525.35,$0.00,1,0,1,20161001,
89321,CPT,SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM,,30,,,$291.86,$0.00,1,0,1,20161001,
89322,CPT,SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA,,30,,,$583.72,$0.00,1,0,1,20161001,
89325,CPT,SPERM ANTIBODIES,,30,,,$583.72,$0.00,1,0,1,20161001,
89329,CPT,SPERM EVALUATION HAMSTER PENETRATION TEST,,30,,,"$1,501.01",$0.00,1,0,1,20161001,
89330,CPT,SPERM EVALUATION CERVICAL MUCOUS PENETRATION,,30,,,$500.34,$0.00,1,0,1,20161001,
89335,CPT,CRYOPRSRV REPRODUCTIVE TISSUE TESTICULAR,,30,,,$315.58,$0.00,1,0,1,20161001,
89337,CPT,CRYOPRESERVATION MATURE OOCYTE(S),,30,,,$424.20,$0.00,1,0,1,20161001,
89342,CPT,STORAGE PER YEAR EMBRYO,,30,,,$424.20,$0.00,1,0,1,20161001,
89343,CPT,STORAGE PER YEAR SPERM/SEMEN,,30,,,$424.20,$0.00,1,0,1,20161001,
89344,CPT,STORAGE PER YR REPRDTVE TISS TSTICULAR/OVARIAN,,30,,,$424.20,$0.00,1,0,1,20161001,
89346,CPT,STORAGE PER YEAR OOCYTE,,30,,,"$1,229.40",$0.00,1,0,1,20161001,
89352,CPT,THAWING CRYOPRESERVED EMBRYO,,30,,,$424.20,$0.00,1,0,1,20161001,
89353,CPT,THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT,,30,,,$315.58,$0.00,1,0,1,20161001,
89354,CPT,THAWING CRYOPRESERVED TESTICULAR/OVARIAN,,30,,,$424.20,$0.00,1,0,1,20161001,
89356,CPT,THAWING CRYOPRESERVED OOCYTES EACH ALIQUOT,,30,,,$424.20,$0.00,1,0,1,20161001,
89398,CPT,UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE,,30,,,$315.58,$0.00,1,0,1,20161001,
90281,CPT,IMMUNE GLOBULIN IG HUMAN IM USE,,30,,,$114.83,$0.00,1,0,1,20161001,
90283,CPT,IMMUNE GLOBULIN IGIV HUMAN IV USE,,30,,,"$3,996.18",$0.00,1,0,1,20161001,
90287,CPT,BOTULINUM ANTITOXIN EQUINE ANY ROUTE,,30,,,"$2,509.86",$0.00,1,0,1,20161001,
90291,CPT,CYTOMEGALOVIRUS IMMUNE GLOBULIN HUMAN IV,,30,,,$903.69,$0.00,1,0,1,20161001,
90371,CPT,HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM,,30,,,$675.89,$0.00,1,0,1,20161001,
90375,CPT,RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ,,30,,,"$1,588.94",$0.00,1,0,1,20161001,
90376,CPT,RABIES IG HEAT-TREATED HUMAN IM/SUBQ,,30,,,"$1,551.76",$0.00,1,0,1,20161001,
90378,CPT,RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E,,30,,,"$10,971.08",$0.00,1,0,1,20161001,
90384,CPT,RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM,,30,,,$438.66,$0.00,1,0,1,20161001,
90385,CPT,RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM,,30,,,$625.84,$0.00,1,0,1,20161001,
90386,CPT,RHO(D) IMMUNE GLOBULIN HUMAN IV,,30,,,$473.32,$0.00,1,0,1,20161001,
90389,CPT,TETANUS IMMUNE GLOBULIN TIG HUMAN IM,,30,,,$483.24,$0.00,1,0,1,20161001,
90393,CPT,VACCINIA IMMUNE GLOBULIN HUMAN IM,,30,,,$432.78,$0.00,1,0,1,20161001,
90396,CPT,VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM,,30,,,$807.59,$0.00,1,0,1,20161001,
90460,CPT,IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX,,30,,,$42.49,$0.00,1,0,1,20161001,
90461,CPT,IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT,,30,,,$21.82,$0.00,1,0,1,20161001,
90471,CPT,IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE,,30,,,$323.92,$0.00,1,0,1,20161001,
90472,CPT,IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE,,30,,,$64.31,$0.00,1,0,1,20161001,
90473,CPT,IM ADM INTRANSL/ORAL 1 VACCINE,,30,,,$323.92,$0.00,1,0,1,20161001,
90474,CPT,IM ADM INTRANSL/ORAL EA VACCINE,,30,,,$69.57,$0.00,1,0,1,20161001,
90581,CPT,ANTHRAX VACCINE SUBCUTANEOUS/IM USE,,30,,,$636.99,$0.00,1,0,1,20161001,
90585,CPT,BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ,,30,,,$787.34,$0.00,1,0,1,20161001,
90586,CPT,BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL,,30,,,$914.57,$0.00,1,0,1,20161001,
90620,CPT,MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM,,30,,,$889.39,$0.00,1,0,1,20161001,
90621,CPT,MENB RECOMBINANT LIPOPROTEIN VACCINE IM,,30,,,$792.14,$0.00,1,0,1,20161001,
90630,CPT,INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID,,30,,,$37.11,$0.00,1,0,1,20161001,
90632,CPT,HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE,,30,,,$226.22,$0.00,1,0,1,20161001,
90633,CPT,HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE,,30,,,$187.18,$0.00,1,0,1,20161001,
90634,CPT,HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE,,30,,,$107.46,$0.00,1,0,1,20161001,
90636,CPT,HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM,,30,,,$342.20,$0.00,1,0,1,20161001,
90647,CPT,HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE,,30,,,$112.28,$0.00,1,0,1,20161001,
90648,CPT,HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE,,30,,,$140.35,$0.00,1,0,1,20161001,
90649,CPT,4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,30,,,$537.42,$0.00,1,0,1,20161001,
90650,CPT,2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,30,,,"$1,002.20",$0.00,1,0,1,20161001,
90651,CPT,9VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE,,30,,,$474.48,$0.00,1,0,1,20161001,
90653,CPT,IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE,,30,,,$149.82,$0.00,1,0,1,20161001,
90654,CPT,INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID,,30,,,$34.69,$0.00,1,0,1,20161001,
90655,CPT,IIV3 VACC PRESRV FREE CHILD 6-35 MONTHS IM USE,,30,,,$39.04,$0.00,1,0,1,20161001,
90656,CPT,IIV3 VACC PRESERVATIVE FREE 3 YRS & OLDER IM USE,,30,,,$76.59,$0.00,1,0,1,20161001,
90657,CPT,IIV3 VACCINE TO CHILD 6-35 MONTHS FOR IM USE,,30,,,$67.75,$0.00,1,0,1,20161001,
90658,CPT,IIV3 VACCINE 3 YRS & OLDER FOR IM USE,,30,,,$62.01,$0.00,1,0,1,20161001,
90660,CPT,LAIV3 VACCINE LIVE FOR INTRANASAL USE,,30,,,$53.97,$0.00,1,0,1,20161001,
90661,CPT,CCIIV3 VACCINE PRESERVATIVE FREE FOR IM USE,,30,,,"$6,056.57",$0.00,1,0,1,20161001,
90662,CPT,IIV VACCINE PRESERV FREE INCREASED AG COUNT IM,,30,,,$70.05,$0.00,1,0,1,20161001,
90666,CPT,INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM,,30,,,$56.62,$0.00,1,0,1,20161001,
90668,CPT,IIV VACCINE PANDEMIC FOR INTRAMUSCULAR USE,,30,,,$35.07,$0.00,1,0,1,20161001,
90670,CPT,PCV13 VACCINE FOR INTRAMUSCULAR USE,,30,,,$498.05,$0.00,1,0,1,20161001,
90672,CPT,LAIV4 VACCINE FOR INTRANASAL USE,,30,,,$40.19,$0.00,1,0,1,20161001,
90675,CPT,RABIES VACCINE INTRAMUSCULAR,,30,,,"$1,520.23",$0.00,1,0,1,20161001,
90676,CPT,RABIES VACCINE INTRADERMAL,,30,,,"$1,108.50",$0.00,1,0,1,20161001,
90680,CPT,RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE,,30,,,$289.38,$0.00,1,0,1,20161001,
90681,CPT,RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE,,30,,,$389.28,$0.00,1,0,1,20161001,
90685,CPT,IIV4 PRESRV FREE VACC CHILD 6-35 MO FOR IM USE,,30,,,$37.89,$0.00,1,0,1,20161001,
90686,CPT,IIV4 VACC PRESRV FREE 3 YRS & OLDER IM USE,,30,,,$40.19,$0.00,1,0,1,20161001,
90687,CPT,IIV4 VACCINE CHILD 6-35 MO FOR IM USE,,30,,,$45.93,$0.00,1,0,1,20161001,
90688,CPT,IIV4 VACCINE 3 YRS & OLDER FOR IM USE,,30,,,$121.13,$0.00,1,0,1,20161001,
90690,CPT,TYPHOID VACCINE LIVE ORAL,,30,,,$146.28,$0.00,1,0,1,20161001,
90691,CPT,TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM,,30,,,$192.88,$0.00,1,0,1,20161001,
90696,CPT,DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE,,30,,,$158.47,$0.00,1,0,1,20161001,
90697,CPT,DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR,,30,,,$233.06,$0.00,1,0,1,20161001,
90698,CPT,DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE,,30,,,$318.13,$0.00,1,0,1,20161001,
90700,CPT,DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM,,30,,,$125.34,$0.00,1,0,1,20161001,
90702,CPT,DT VACCINE YOUNGER THAN 7 YRS FOR IM USE,,30,,,$269.86,$0.00,1,0,1,20161001,
90707,CPT,MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ,,30,,,$215.36,$0.00,1,0,1,20161001,
90710,CPT,MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ,,30,,,$480.35,$0.00,1,0,1,20161001,
90713,CPT,POLIOVIRUS VACCINE INACTIVATED SUBQ/IM,,30,,,$150.48,$0.00,1,0,1,20161001,
90714,CPT,TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE,,30,,,$185.46,$0.00,1,0,1,20161001,
90715,CPT,TDAP VACCINE 7 YRS/> IM,,30,,,$254.52,$0.00,1,0,1,20161001,
90716,CPT,VAR VACCINE LIVE FOR SUBCUTANEOUS USE,,30,,,$372.38,$0.00,1,0,1,20161001,
90717,CPT,YELLOW FEVER VACCINE LIVE SUBQ,,30,,,$288.23,$0.00,1,0,1,20161001,
90723,CPT,DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,,30,,,$271.01,$0.00,1,0,1,20161001,
90732,CPT,PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE,,30,,,$321.55,$0.00,1,0,1,20161001,
90733,CPT,MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE,,30,,,$688.27,$0.00,1,0,1,20161001,
90734,CPT,MENACWY CONJUGATE VACCINE GROUPS ACYW-135 IM USE,,30,,,$655.35,$0.00,1,0,1,20161001,
90736,CPT,ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE,,30,,,$342.79,$0.00,1,0,1,20161001,
90738,CPT,JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM,,30,,,$667.58,$0.00,1,0,1,20161001,
90739,CPT,HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE,,30,,,$196.34,$0.00,1,0,1,20161001,
90740,CPT,HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM,,30,,,"$1,662.32",$0.00,1,0,1,20161001,
90743,CPT,HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM,,30,,,$158.47,$0.00,1,0,1,20161001,
90744,CPT,HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM,,30,,,$141.11,$0.00,1,0,1,20161001,
90746,CPT,HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE,,30,,,$249.19,$0.00,1,0,1,20161001,
90747,CPT,HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM,,30,,,"$1,750.68",$0.00,1,0,1,20161001,
90748,CPT,HIB-HEPB VACCINE FOR INTRAMUSCULAR USE,,30,,,$258.37,$0.00,1,0,1,20161001,
90749,CPT,UNLISTED VACCINE/TOXOID,,30,,,$383.11,$0.00,1,0,1,20161001,
90785,CPT,PSYCHOTHERAPY COMPLEX INTERACTIVE,,30,,,$689.00,$0.00,1,0,1,20161001,
90791,CPT,PSYCHIATRIC DIAGNOSTIC EVALUATION,,30,,,$479.58,$0.00,1,0,1,20161001,
90792,CPT,PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES,,30,,,$479.58,$0.00,1,0,1,20161001,
90832,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 30 MINUTES,,30,,,$386.27,$0.00,1,0,1,20161001,
90833,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 30 MIN,,30,,,$386.27,$0.00,1,0,1,20161001,
90834,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES,,30,,,$479.58,$0.00,1,0,1,20161001,
90836,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 45 MIN,,30,,,$479.58,$0.00,1,0,1,20161001,
90837,CPT,PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES,,30,,,$479.58,$0.00,1,0,1,20161001,
90838,CPT,PSYCHOTHERAPY PT&/FAMILY W/E&M SRVCS 60 MIN,,30,,,$479.58,$0.00,1,0,1,20161001,
90839,CPT,PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES,,30,,,$479.58,$0.00,1,0,1,20161001,
90840,CPT,PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES,,30,,,$386.27,$0.00,1,0,1,20161001,
90845,CPT,PSYCHOANALYSIS,,30,,,$479.58,$0.00,1,0,1,20161001,
90846,CPT,FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT,,30,,,$512.50,$0.00,1,0,1,20161001,
90847,CPT,FAMILY PSYCHOTHERAPY W/PATIENT PRESENT,,30,,,$512.50,$0.00,1,0,1,20161001,
90849,CPT,MULTIPLE FAMILY GROUP PSYCHOTHERAPY,,30,,,$348.84,$0.00,1,0,1,20161001,
90853,CPT,GROUP PSYCHOTHERAPY,,30,,,$318.60,$0.00,1,0,1,20161001,
90863,CPT,PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY,,30,,,$314.72,$0.00,1,0,1,20161001,
90865,CPT,NARCOSYNTHESIS PSYC DX&THER PURPOSES,,30,,,$479.58,$0.00,1,0,1,20161001,
90867,CPT,REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
90868,CPT,THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
90869,CPT,REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
90870,CPT,ELECTROCONVULSIVE THERAPY,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
90875,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN,,30,,,$590.24,$0.00,1,0,1,20161001,
90876,CPT,INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN,,30,,,$312.87,$0.00,1,0,1,20161001,
90880,CPT,HYPNOTHERAPY,,30,,,$479.58,$0.00,1,0,1,20161001,
90882,CPT,ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT,,30,,,$107.02,$0.00,1,0,1,20161001,
90885,CPT,PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES,,30,,,$839.30,$0.00,1,0,1,20161001,
90887,CPT,INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY,,30,,,$424.95,$0.00,1,0,1,20161001,
90889,CPT,PREP REPORT PT PSYCH STATUS AGENCY/PAYER,,30,,,$217.00,$0.00,1,0,1,20161001,
90899,CPT,UNLISTED PSYCHIATRIC SERVICE/PROCEDURE,,30,,,$416.51,$0.00,1,0,1,20161001,
90901,CPT,BIOFEEDBACK TRAINING ANY MODALITY,,30,,,$133.33,$0.00,1,0,1,20161001,
90911,CPT,BIOFDBK TRNG PERINL MUSC ANORECT/URO SPHX W/EMG,,30,,,$746.33,$0.00,1,0,1,20161001,
90935,CPT,HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION,,30,,,"$2,673.75",$0.00,1,0,1,20161001,
90937,CPT,HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX,,30,,,"$1,264.78",$0.00,1,0,1,20161001,
90940,CPT,HEMODIALYSIS ACCESS FLOW STUDY,,30,,,$396.49,$0.00,1,0,1,20161001,
90945,CPT,DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL,,30,,,"$2,369.96",$0.00,1,0,1,20161001,
90947,CPT,DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS,,30,,,$731.25,$0.00,1,0,1,20161001,
90954,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS,,30,,,$861.90,$0.00,1,0,1,20161001,
90955,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS,,30,,,$490.69,$0.00,1,0,1,20161001,
90956,CPT,ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT,,30,,,$133.61,$0.00,1,0,1,20161001,
90960,CPT,ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS,,30,,,$813.02,$0.00,1,0,1,20161001,
90962,CPT,ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT,,30,,,"$4,162.69",$0.00,1,0,1,20161001,
90964,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD,,30,,,"$1,287.91",$0.00,1,0,1,20161001,
90966,CPT,ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD,,30,,,$552.91,$0.00,1,0,1,20161001,
90968,CPT,ESRD RELATED SVC <FULL MONTH 2-11 YR OLD,,30,,,"$3,401.35",$0.00,1,0,1,20161001,
90969,CPT,ESRD RELATED SVC <FULL MONTH 12-19 YR OLD,,30,,,"$2,135.89",$0.00,1,0,1,20161001,
90970,CPT,ESRD RELATED SVC <FULL MONTH 20/>YR OLD,,30,,,"$1,485.57",$0.00,1,0,1,20161001,
90989,CPT,DIALYSIS TRAINING PATIENT COMPLETED COURSE,,30,,,"$1,016.16",$0.00,1,0,1,20161001,
90993,CPT,DIALYSIS TRAINING PATIENT PER TRAINING SESSION,,30,,,"$4,288.62",$0.00,1,0,1,20161001,
90997,CPT,HEMOPERFUSION,,30,,,$52.38,$0.00,1,0,1,20161001,
90999,CPT,UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT,,30,,,"$3,805.56",$0.00,1,0,1,20161001,
91010,CPT,ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91013,CPT,ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION,,30,,,$217.58,$0.00,1,0,1,20161001,
91020,CPT,GASTRIC MOTILITY MANOMETRIC STUDIES,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91022,CPT,DUODENAL MOTILITY MANOMETRIC STUDY,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
91030,CPT,ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91034,CPT,GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91035,CPT,GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91037,CPT,GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
91038,CPT,ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG,,30,,,"$2,510.92",$0.00,1,0,1,20161001,
91040,CPT,ESOPHGL BALO DISTENSION DX STD W/PROVOCATION,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
91065,CPT,BREATH HYDROGEN/METHANE TEST,,30,,,$746.33,$0.00,1,0,1,20161001,
91110,CPT,GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
91111,CPT,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
91112,CPT,GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
91117,CPT,COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R,,30,,,"$1,305.73",$0.00,1,0,1,20161001,
91120,CPT,RECTAL SESATION TONE & COMPLIANCE TEST,,30,,,$666.94,$0.00,1,0,1,20161001,
91122,CPT,ANORECTAL MANOMETRY,,30,,,"$3,150.47",$0.00,1,0,1,20161001,
91132,CPT,ELECTROGASTROGRAPHY DX TRANSCUTANEOUS,,30,,,$746.33,$0.00,1,0,1,20161001,
91133,CPT,ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG,,30,,,$425.53,$0.00,1,0,1,20161001,
91200,CPT,LIVER ELASTOGRAPHY W/O IMAG W/I&R,,30,,,$989.36,$0.00,1,0,1,20161001,
91299,CPT,UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE,,30,,,$746.33,$0.00,1,0,1,20161001,
92002,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT,,30,,,$217.87,$0.00,1,0,1,20161001,
92004,CPT,OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST,,30,,,$217.87,$0.00,1,0,1,20161001,
92012,CPT,OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT,,30,,,$217.87,$0.00,1,0,1,20161001,
92014,CPT,OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>,,30,,,$217.87,$0.00,1,0,1,20161001,
92015,CPT,DETERMINATION REFRACTIVE STATE,,30,,,$57.60,$0.00,1,0,1,20161001,
92018,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
92019,CPT,OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD,,30,,,"$8,382.04",$0.00,1,0,1,20161001,
92020,CPT,GONIOSCOPY SEPARATE PROCEDURE,,30,,,$425.53,$0.00,1,0,1,20161001,
92025,CPT,COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI,,30,,,$306.21,$0.00,1,0,1,20161001,
92060,CPT,SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX,,30,,,$425.53,$0.00,1,0,1,20161001,
92065,CPT,ORTHOPTIC &/PLEOPTIC TRAINING W/MEDICAL DIRECTJ,,30,,,$425.53,$0.00,1,0,1,20161001,
92071,CPT,FIT CONTACT LENS TX OCULAR SURFACE DISEASE,,30,,,$168.80,$0.00,1,0,1,20161001,
92072,CPT,FITTING CONTACT LENS FOR MNGT OF KERATOCONUS,,30,,,$253.78,$0.00,1,0,1,20161001,
92081,CPT,VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM,,30,,,$425.53,$0.00,1,0,1,20161001,
92082,CPT,VISUAL FIELD XM UNI/BI W/INTERP INTERMED EXAM,,30,,,$306.21,$0.00,1,0,1,20161001,
92083,CPT,VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM,,30,,,$425.53,$0.00,1,0,1,20161001,
92100,CPT,SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRES,,30,,,$150.43,$0.00,1,0,1,20161001,
92132,CPT,CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI,,30,,,$306.21,$0.00,1,0,1,20161001,
92133,CPT,COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,,30,,,$306.21,$0.00,1,0,1,20161001,
92134,CPT,COMPUTERIZED OPHTHALMIC IMAGING RETINA,,30,,,$306.21,$0.00,1,0,1,20161001,
92136,CPT,OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL,,30,,,$425.53,$0.00,1,0,1,20161001,
92140,CPT,PROVOCATIVE TESTS GLAUCOMA I&R W/O TONOGRAPHY,,30,,,$425.53,$0.00,1,0,1,20161001,
92145,CPT,CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI,,30,,,$156.54,$0.00,1,0,1,20161001,
92225,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R 1ST,,30,,,$306.21,$0.00,1,0,1,20161001,
92226,CPT,OPHTHALMOSCPY EXTENDED RETINAL DRAWING I&R SBS,,30,,,$306.21,$0.00,1,0,1,20161001,
92227,CPT,REMOTE IMG DX RETINL DIS W/ALYS & REPORT UNI/B,,30,,,$156.54,$0.00,1,0,1,20161001,
92228,CPT,REMOTE IMAGING MGT RETINAL DISEASE W/I&R UNI/B,,30,,,$425.53,$0.00,1,0,1,20161001,
92230,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
92235,CPT,FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
92240,CPT,INDOCYANINE GREEN ANGIOGRAPHY W/INTERP & REPOR,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
92250,CPT,FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
92260,CPT,OPHTHALMODYNAMOMETRY,,30,,,$156.54,$0.00,1,0,1,20161001,
92265,CPT,NEEDLE OCULOGRAPHY 1/ XOC MUSC 1/BOTH EYE W/I&R,,30,,,$306.21,$0.00,1,0,1,20161001,
92270,CPT,ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
92275,CPT,ELECTRORETINOGRAPY W/INTERPRETATION & REPORT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
92283,CPT,COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV,,30,,,$425.53,$0.00,1,0,1,20161001,
92284,CPT,DARK ADAPTATION XM W/INTERPRETATION & REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
92285,CPT,XTRNL OCULAR PHOTOG W/I&R DOCMT MEDICAL PROGRE,,30,,,$425.53,$0.00,1,0,1,20161001,
92286,CPT,ANT SGM IMAGING W/MICROSCOPY ENDOTHELIAL ANALY,,30,,,$425.53,$0.00,1,0,1,20161001,
92287,CPT,ANT SGM IMAGING W/FLUOROSCEIN ANGIO & I&R,,30,,,$425.53,$0.00,1,0,1,20161001,
92310,CPT,RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK,,30,,,$232.07,$0.00,1,0,1,20161001,
92311,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA 1 EYE,,30,,,$425.53,$0.00,1,0,1,20161001,
92312,CPT,RX&FITG CONTACT CORNEAL LENS APHAKIA BOTH EYES,,30,,,$425.53,$0.00,1,0,1,20161001,
92313,CPT,RX&FITG CORNEOSCLERAL LENS,,30,,,$425.53,$0.00,1,0,1,20161001,
92314,CPT,RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA,,30,,,$55.59,$0.00,1,0,1,20161001,
92315,CPT,RX CONTACT CORNEAL LENS APHAKIA 1 EYE,,30,,,$425.53,$0.00,1,0,1,20161001,
92316,CPT,RX CONTACT CORNEAL LENS APHAKIA BOTH EYES,,30,,,$306.21,$0.00,1,0,1,20161001,
92317,CPT,RX CONTACT CORNEOSCLERAL LENS,,30,,,$156.54,$0.00,1,0,1,20161001,
92325,CPT,MODIFICAJ CONTACT LENX SPX SUPVJ ADAPTATION,,30,,,$425.53,$0.00,1,0,1,20161001,
92326,CPT,REPLACEMENT CONTACT LENS,,30,,,$306.21,$0.00,1,0,1,20161001,
92340,CPT,FITTING SPECTACLES XCPT APHAKIA MONOFOCAL,,30,,,$57.03,$0.00,1,0,1,20161001,
92341,CPT,FITTING SPECTACLES XCPT APHAKIA BIFOCAL,,30,,,$86.03,$0.00,1,0,1,20161001,
92352,CPT,FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL,,30,,,$306.21,$0.00,1,0,1,20161001,
92353,CPT,FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL,,30,,,$306.21,$0.00,1,0,1,20161001,
92354,CPT,FITTING SPECTACLE MOUNTED LW VIS AID 1 ELMNT,,30,,,$156.54,$0.00,1,0,1,20161001,
92355,CPT,FITTING SPECTACLE MOUNTED LW VIS AID TLSCP,,30,,,$156.54,$0.00,1,0,1,20161001,
92358,CPT,PROSTHESIS SERVICE APHAKIA TEMPORARY,,30,,,$306.21,$0.00,1,0,1,20161001,
92371,CPT,RPR&REFITG SPECTACLE PROSTHESIS APHAKIA,,30,,,$306.21,$0.00,1,0,1,20161001,
92499,CPT,UNLIVSTED OPHTHALMOLOGICAL SERVICE/PROCEDURE,,30,,,$81.90,$0.00,1,0,1,20161001,
92502,CPT,OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA,,30,,,"$1,960.00",$0.00,1,0,1,20161001,
92504,CPT,BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE,,30,,,$198.11,$0.00,1,0,1,20161001,
92511,CPT,NASOPHARYNGOSCOPY W/ENDOSCOPE SPX,,30,,,$578.94,$0.00,1,0,1,20161001,
92512,CPT,NASAL FUNCTION STUDIES,,30,,,$968.74,$0.00,1,0,1,20161001,
92516,CPT,FACIAL NERVE FUNCTION STUDIES,,30,,,$968.74,$0.00,1,0,1,20161001,
92520,CPT,LARYNGEAL FUNCTION STUDIES,,30,,,$425.53,$0.00,1,0,1,20161001,
92526,CPT,TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING,,30,,,$222.87,$0.00,1,0,1,20161001,
92531,CPT,SPONTANEOUS NYSTAGMUS W/GAZE,,30,,,$74.29,$0.00,1,0,1,20161001,
92532,CPT,POSITIONAL NYSTAGMUS TEST,,30,,,$86.67,$0.00,1,0,1,20161001,
92533,CPT,CALORIC VESTIBULAR TEST EACH IRRIGATION,,30,,,$140.33,$0.00,1,0,1,20161001,
92534,CPT,OPTOKINETIC NYSTAGMUS TEST,,30,,,$66.04,$0.00,1,0,1,20161001,
92537,CPT,CALORIC VESTIBULAR TEST W/REC BI BITHERMAL,,30,,,"$1,361.23",$0.00,1,0,1,20161001,
92538,CPT,CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL,,30,,,"$1,361.23",$0.00,1,0,1,20161001,
92540,CPT,VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK,,30,,,$968.74,$0.00,1,0,1,20161001,
92541,CPT,SPONTANEOUS NYSTAGMUS TEST,,30,,,$425.53,$0.00,1,0,1,20161001,
92542,CPT,POSITIONAL NYSTAGMUS TEST,,30,,,$425.53,$0.00,1,0,1,20161001,
92544,CPT,OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC,,30,,,$746.33,$0.00,1,0,1,20161001,
92545,CPT,OSCILLATING TRACKING TEST W/RECORDING,,30,,,$746.33,$0.00,1,0,1,20161001,
92546,CPT,SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING,,30,,,$746.33,$0.00,1,0,1,20161001,
92547,CPT,USE VERTICAL ELECTRODES,,30,,,$132.07,$0.00,1,0,1,20161001,
92548,CPT,COMPUTERIZED DYNAMIC POSTUROGRAPY,,30,,,$425.53,$0.00,1,0,1,20161001,
92550,CPT,TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS,,30,,,$666.94,$0.00,1,0,1,20161001,
92551,CPT,SCREENING TEST PURE TONE AIR ONLY,,30,,,$36.33,$0.00,1,0,1,20161001,
92552,CPT,PURE TONE AUDIOMETRY AIR ONLY,,30,,,$427.56,$0.00,1,0,1,20161001,
92553,CPT,PURE TONE AUDIOMETRY AIR & BONE,,30,,,$666.94,$0.00,1,0,1,20161001,
92555,CPT,SPEECH AUDIOMETRY THRESHOLD,,30,,,$155.67,$0.00,1,0,1,20161001,
92556,CPT,SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ,,30,,,$155.67,$0.00,1,0,1,20161001,
92557,CPT,COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ,,30,,,$666.94,$0.00,1,0,1,20161001,
92558,CPT,EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS,,30,,,$200.96,$0.00,1,0,1,20161001,
92560,CPT,BEKESY AUDIOMETRY SCREENING,,30,,,$205.22,$0.00,1,0,1,20161001,
92561,CPT,BEKESY AUDIOMETRY DIAGNOSTIC,,30,,,$427.56,$0.00,1,0,1,20161001,
92562,CPT,LOUDNESS BALANCE BINAURAL/MONAURAL,,30,,,$666.94,$0.00,1,0,1,20161001,
92563,CPT,TONE DECAY TEST,,30,,,$155.67,$0.00,1,0,1,20161001,
92564,CPT,SHORT INCREMENT SENSITIVITY INDEX,,30,,,$155.67,$0.00,1,0,1,20161001,
92565,CPT,STENGER TEST PURE TONE,,30,,,$155.67,$0.00,1,0,1,20161001,
92567,CPT,TYMPANOMETRY,,30,,,$155.67,$0.00,1,0,1,20161001,
92568,CPT,ACOUSTIC REFLEX THRESHOLD,,30,,,$156.54,$0.00,1,0,1,20161001,
92570,CPT,ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY,,30,,,$666.94,$0.00,1,0,1,20161001,
92571,CPT,FILTERED SPEECH TEST,,30,,,$155.67,$0.00,1,0,1,20161001,
92572,CPT,STAGGERED SPONDAIC WORD,,30,,,$666.94,$0.00,1,0,1,20161001,
92575,CPT,SENSORINEURAL ACUITY LEVEL,,30,,,$155.67,$0.00,1,0,1,20161001,
92576,CPT,SYNTHETIC SENTENCE IDENTIFICATION TEST,,30,,,$155.67,$0.00,1,0,1,20161001,
92577,CPT,STENGER TEST SPEECH,,30,,,"$2,510.92",$0.00,1,0,1,20161001,
92579,CPT,VISUAL REINFORCEMENT AUDIOMETRY,,30,,,$666.94,$0.00,1,0,1,20161001,
92582,CPT,CONDITIONING PLAY AUDIOMETRY,,30,,,$666.94,$0.00,1,0,1,20161001,
92583,CPT,SELECT PICTURE AUDIOMETRY,,30,,,$155.67,$0.00,1,0,1,20161001,
92584,CPT,ELECTROCOCHLEOGRAPHY,,30,,,$666.94,$0.00,1,0,1,20161001,
92585,CPT,AUDITORY EVOKED POTENTIALS COMPREHENSIVE,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
92586,CPT,AUDITORY EVOKED POTENTIALS LIMITED,,30,,,$666.94,$0.00,1,0,1,20161001,
92587,CPT,DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD,,30,,,$968.74,$0.00,1,0,1,20161001,
92588,CPT,DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL,,30,,,$968.74,$0.00,1,0,1,20161001,
92590,CPT,HEARING AID EXAMINATION & SELECTION MONAURAL,,30,,,$169.56,$0.00,1,0,1,20161001,
92591,CPT,HEARING AID EXAMINATION & SELECTION BINAURAL,,30,,,$291.42,$0.00,1,0,1,20161001,
92592,CPT,HEARING AID CHECK MONAURAL,,30,,,$83.68,$0.00,1,0,1,20161001,
92593,CPT,HEARING AID CHECK BINAURAL,,30,,,$144.06,$0.00,1,0,1,20161001,
92594,CPT,ELECTROACOUS EVAL HEARING AID MONAURAL,,30,,,$24.76,$0.00,1,0,1,20161001,
92595,CPT,ELECTROACOUS EVAL HEARING AID BINAURAL,,30,,,$93.00,$0.00,1,0,1,20161001,
92596,CPT,EAR PROTECTOR ATTENUATION MEASUREMENTS,,30,,,$155.67,$0.00,1,0,1,20161001,
92601,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG,,30,,,$666.94,$0.00,1,0,1,20161001,
92602,CPT,ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG,,30,,,$666.94,$0.00,1,0,1,20161001,
92603,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG,,30,,,$666.94,$0.00,1,0,1,20161001,
92604,CPT,ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG,,30,,,$666.94,$0.00,1,0,1,20161001,
92620,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN,,30,,,$666.94,$0.00,1,0,1,20161001,
92621,CPT,EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN,,30,,,$158.25,$0.00,1,0,1,20161001,
92625,CPT,ASSESSMENT TINNITUS,,30,,,$666.94,$0.00,1,0,1,20161001,
92626,CPT,EVALUATION AUDITORY REHAB STATUS 1ST HR,,30,,,$666.94,$0.00,1,0,1,20161001,
92627,CPT,EVALUATION AUDITORY REHAB STATUS EA 15 MIN,,30,,,$123.06,$0.00,1,0,1,20161001,
92630,CPT,AUDITORY REHABILITATION PRELINGUAL HEARING LOSS,,30,,,$386.68,$0.00,1,0,1,20161001,
92633,CPT,AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS,,30,,,$329.57,$0.00,1,0,1,20161001,
92640,CPT,ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR,,30,,,$666.94,$0.00,1,0,1,20161001,
92700,CPT,UNLISTED OTORHINOLARYNGOLOGICAL SERVICE,,30,,,$82.55,$0.00,1,0,1,20161001,
92920,CPT,PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
92921,CPT,PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH,,30,,,"$3,409.31",$0.00,1,0,1,20161001,
92924,CPT,PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92925,CPT,PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH,,30,,,"$3,546.23",$0.00,1,0,1,20161001,
92928,CPT,PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92929,CPT,PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH,,30,,,"$6,990.16",$0.00,1,0,1,20161001,
92933,CPT,PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
92934,CPT,PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH,,30,,,"$6,990.16",$0.00,1,0,1,20161001,
92937,CPT,PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92938,CPT,PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL,,30,,,"$11,078.53",$0.00,1,0,1,20161001,
92941,CPT,PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92943,CPT,PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92944,CPT,PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL,,30,,,"$11,078.53",$0.00,1,0,1,20161001,
92950,CPT,CARDIOPULMONARY RESUSCITATION,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
92953,CPT,TEMPORARY TRANSCUTANEOUS PACING,,30,,,"$2,962.78",$0.00,1,0,1,20161001,
92960,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL,,30,,,"$2,962.78",$0.00,1,0,1,20161001,
92961,CPT,CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX,,30,,,"$2,962.78",$0.00,1,0,1,20161001,
92973,CPT,PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY,,30,,,"$9,891.70",$0.00,1,0,1,20161001,
92974,CPT,TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX,,30,,,"$7,448.89",$0.00,1,0,1,20161001,
92977,CPT,THROMBOLYSIS CORONARY INTRAVENOUS INFUSION,,30,,,"$1,302.06",$0.00,1,0,1,20161001,
92978,CPT,INTRAVASC US CORONARY INTERP&RPT INITIAL VESSE,,30,,,"$5,906.79",$0.00,1,0,1,20161001,
92979,CPT,INTRAVASC US CORONARY INTERP&RPT ADDL VESSEL,,30,,,"$2,621.84",$0.00,1,0,1,20161001,
92986,CPT,PRQ BALLOON VALVULOPLASTY AORTIC VALVE,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
92987,CPT,PRQ BALLOON VALVULOPLASTY MITRAL VALVE,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92990,CPT,PRQ BALLOON VALVULOPLASTY PULMONARY VALVE,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92997,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
92998,CPT,PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL,,30,,,"$8,982.22",$0.00,1,0,1,20161001,
93005,CPT,ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R,,30,,,$306.21,$0.00,1,0,1,20161001,
93017,CPT,CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
93024,CPT,ERGONOVINE PROVOCATION TST,,30,,,$425.53,$0.00,1,0,1,20161001,
93025,CPT,MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS,,30,,,$666.94,$0.00,1,0,1,20161001,
93041,CPT,RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R,,30,,,$156.54,$0.00,1,0,1,20161001,
93050,CPT,ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE,,30,,,$155.67,$0.00,1,0,1,20161001,
93225,CPT,XTRNL ECG & 48 HR RECORDING,,30,,,$425.53,$0.00,1,0,1,20161001,
93226,CPT,EXTERNAL ECG SCANNING ANALYSIS REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
93228,CPT,XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS,,30,,,$401.91,$0.00,1,0,1,20161001,
93229,CPT,XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
93260,CPT,PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM,,30,,,$221.12,$0.00,1,0,1,20161001,
93261,CPT,INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB,,30,,,$221.12,$0.00,1,0,1,20161001,
93270,CPT,XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS,,30,,,$221.12,$0.00,1,0,1,20161001,
93271,CPT,XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS,,30,,,$429.61,$0.00,1,0,1,20161001,
93278,CPT,SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG,,30,,,$306.21,$0.00,1,0,1,20161001,
93279,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER,,30,,,$221.12,$0.00,1,0,1,20161001,
93280,CPT,PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER,,30,,,$221.12,$0.00,1,0,1,20161001,
93281,CPT,PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER,,30,,,$221.12,$0.00,1,0,1,20161001,
93282,CPT,PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB,,30,,,$221.12,$0.00,1,0,1,20161001,
93283,CPT,PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB,,30,,,$221.12,$0.00,1,0,1,20161001,
93284,CPT,PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB,,30,,,$221.12,$0.00,1,0,1,20161001,
93285,CPT,PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM,,30,,,$221.12,$0.00,1,0,1,20161001,
93286,CPT,PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM,,30,,,$288.21,$0.00,1,0,1,20161001,
93287,CPT,PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB,,30,,,$406.62,$0.00,1,0,1,20161001,
93288,CPT,INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM,,30,,,$221.12,$0.00,1,0,1,20161001,
93289,CPT,INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB,,30,,,$221.12,$0.00,1,0,1,20161001,
93290,CPT,INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS,,30,,,$221.12,$0.00,1,0,1,20161001,
93291,CPT,INTERROGATION EVALUATION IN PERSON ILR SYSTEM,,30,,,$156.54,$0.00,1,0,1,20161001,
93292,CPT,INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR,,30,,,$221.12,$0.00,1,0,1,20161001,
93293,CPT,TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL,,30,,,$221.12,$0.00,1,0,1,20161001,
93296,CPT,INTERROGATION REMOTE </90 D TECHNICIAN REVIEW,,30,,,$221.12,$0.00,1,0,1,20161001,
93299,CPT,INTERROGATION EVAL REMOTE </30 D TECH REVIEW,,30,,,$221.12,$0.00,1,0,1,20161001,
93303,CPT,COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93304,CPT,F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
93306,CPT,ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
93307,CPT,ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
93308,CPT,ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93312,CPT,ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93313,CPT,ECHO R-T 2D W/PROBE PLACEMENT ONLY,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93314,CPT,ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY,,30,,,"$4,021.52",$0.00,1,0,1,20161001,
93315,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93316,CPT,ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93317,CPT,ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT,,30,,,"$2,159.70",$0.00,1,0,1,20161001,
93318,CPT,ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ,,30,,,"$4,328.90",$0.00,1,0,1,20161001,
93320,CPT,DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY,,30,,,"$1,708.40",$0.00,1,0,1,20161001,
93321,CPT,DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD,,30,,,"$1,018.78",$0.00,1,0,1,20161001,
93325,CPT,DOP ECHOCARD COLOR FLOW VELOCITY MAPPING,,30,,,"$2,562.60",$0.00,1,0,1,20161001,
93350,CPT,ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
93351,CPT,ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG,,30,,,"$2,635.53",$0.00,1,0,1,20161001,
93352,CPT,USE OF ECHO CONTRAST AGENT DURING STRESS ECHO,,30,,,$595.78,$0.00,1,0,1,20161001,
93451,CPT,RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93452,CPT,L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93453,CPT,R & L HRT CATH W/NJX L VENTRICULOG IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93454,CPT,CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93455,CPT,CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93456,CPT,CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93457,CPT,CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93458,CPT,CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93459,CPT,CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93460,CPT,R & L HRT CATH WINJX HRT ART& L VENTR IMG,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93461,CPT,R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93462,CPT,LEFT HEART CATH BY TRANSEPTAL PUNCTURE,,30,,,"$10,241.37",$0.00,1,0,1,20161001,
93463,CPT,MEDICATION ADMIN & HEMODYNAMIC MEASURMENT,,30,,,"$2,956.18",$0.00,1,0,1,20161001,
93464,CPT,PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU,,30,,,"$1,671.46",$0.00,1,0,1,20161001,
93503,CPT,INSERTION FLOW DIRECTED CATHETER FOR MONITORING,,30,,,"$5,431.93",$0.00,1,0,1,20161001,
93505,CPT,ENDOMYOCARDIAL BIOPSY,,30,,,"$12,354.57",$0.00,1,0,1,20161001,
93530,CPT,R HRT CATHETERIZATION CONGENITAL CARDIAC ANOMALY,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93531,CPT,CMBN R HRT & RETROGRADE L HRT CATHJ CGEN ANOMA,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93532,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ NTC SEPTUM CGEN,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93533,CPT,CMBN R HRT T-SEPTAL L HRT CATHJ SEPTAL OPNG CGEN,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
93561,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ W/OUTP MEAS,,30,,,$342.57,$0.00,1,0,1,20161001,
93562,CPT,INDIC DIL STD ARTL&/OR VEN CATHJ SBSQ OUTP MEA,,30,,,$221.63,$0.00,1,0,1,20161001,
93563,CPT,NJX SEL HRT ART CONGENITAL HRT CATH W/S&I,,30,,,"$4,209.83",$0.00,1,0,1,20161001,
93564,CPT,NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I,,30,,,"$2,012.66",$0.00,1,0,1,20161001,
93565,CPT,NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I,,30,,,"$3,155.07",$0.00,1,0,1,20161001,
93566,CPT,NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I,,30,,,"$4,535.61",$0.00,1,0,1,20161001,
93567,CPT,NJX SUPRAVALV AORTOG HRT CATH W/S&I,,30,,,"$2,639.43",$0.00,1,0,1,20161001,
93568,CPT,NJX PULMONARY ANGIO HRT CATH W/S&I,,30,,,"$4,907.86",$0.00,1,0,1,20161001,
93571,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL,,30,,,"$1,878.20",$0.00,1,0,1,20161001,
93572,CPT,IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL,,30,,,$939.40,$0.00,1,0,1,20161001,
93580,CPT,PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
93581,CPT,PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
93582,CPT,PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
93600,CPT,BUNDLE OF HIS RECORDING,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93602,CPT,INTRA-ATRIAL RECORDING,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93603,CPT,RIGHT VENTRICULAR RECORDING,,30,,,"$3,410.71",$0.00,1,0,1,20161001,
93609,CPT,INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA,,30,,,"$3,524.04",$0.00,1,0,1,20161001,
93610,CPT,INTRA-ATRIAL PACING,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93612,CPT,INTRAVENTRICULAR PACING,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93613,CPT,INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING,,30,,,"$11,924.24",$0.00,1,0,1,20161001,
93615,CPT,ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS,,30,,,"$3,410.71",$0.00,1,0,1,20161001,
93616,CPT,ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG,,30,,,"$3,410.71",$0.00,1,0,1,20161001,
93618,CPT,INDUCTION ARRHYTHMIA ELECTRICAL PACING,,30,,,"$3,410.71",$0.00,1,0,1,20161001,
93619,CPT,COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93620,CPT,COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93621,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC,,30,,,"$1,586.27",$0.00,1,0,1,20161001,
93622,CPT,COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC,,30,,,"$1,362.85",$0.00,1,0,1,20161001,
93623,CPT,PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS,,30,,,"$1,340.51",$0.00,1,0,1,20161001,
93624,CPT,ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93631,CPT,INTRAOP EPICAR& ENDOCAR PACG& MAPG,,30,,,$927.23,$0.00,1,0,1,20161001,
93640,CPT,EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE,,30,,,"$9,517.59",$0.00,1,0,1,20161001,
93641,CPT,EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN,,30,,,"$8,575.51",$0.00,1,0,1,20161001,
93642,CPT,EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS,,30,,,"$3,410.71",$0.00,1,0,1,20161001,
93644,CPT,EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR,,30,,,"$3,244.67",$0.00,1,0,1,20161001,
93650,CPT,ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION,,30,,,"$20,750.47",$0.00,1,0,1,20161001,
93653,CPT,EPHYS EVAL W/ABLATION SUPRAVENT ARRHYTHMIA,,30,,,"$31,127.86",$0.00,1,0,1,20161001,
93654,CPT,EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA,,30,,,"$31,127.86",$0.00,1,0,1,20161001,
93655,CPT,ICAR CATHETER ABLATION ARRHYTHMIA ADD ON,,30,,,"$13,467.60",$0.00,1,0,1,20161001,
93656,CPT,EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN,,30,,,"$31,127.86",$0.00,1,0,1,20161001,
93657,CPT,ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN,,30,,,"$16,387.14",$0.00,1,0,1,20161001,
93660,CPT,CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
93662,CPT,INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I,,30,,,"$1,984.69",$0.00,1,0,1,20161001,
93668,CPT,PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION,,30,,,"$1,675.63",$0.00,1,0,1,20161001,
93701,CPT,BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS,,30,,,$425.53,$0.00,1,0,1,20161001,
93702,CPT,BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT,,30,,,$746.33,$0.00,1,0,1,20161001,
93724,CPT,ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM,,30,,,$973.44,$0.00,1,0,1,20161001,
93740,CPT,TEMPRATURE GRADIENT STUDY,,30,,,$746.33,$0.00,1,0,1,20161001,
93745,CPT,1ST SET-UP & PRGRMG PHYS/QHP OF WEARABLE CVDFB,,30,,,$973.44,$0.00,1,0,1,20161001,
93750,CPT,INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS,,30,,,$429.61,$0.00,1,0,1,20161001,
93770,CPT,DERMINATION OF VENOUS PRESSUE,,30,,,$29.79,$0.00,1,0,1,20161001,
93786,CPT,BL BLD PRESS W/TAPE&/DISK 24/> HR REC ONL,,30,,,$425.53,$0.00,1,0,1,20161001,
93788,CPT,AMBL BLD PRESS W/TAPE/DISK 24/>HR ALYS W/REPRT,,30,,,$425.53,$0.00,1,0,1,20161001,
93797,CPT,OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR,,30,,,$308.06,$0.00,1,0,1,20161001,
93798,CPT,OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING,,30,,,$308.06,$0.00,1,0,1,20161001,
93799,CPT,UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE,,30,,,$746.33,$0.00,1,0,1,20161001,
93880,CPT,DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93882,CPT,DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93886,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93888,CPT,TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93890,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY,,30,,,$989.36,$0.00,1,0,1,20161001,
93892,CPT,TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT,,30,,,$686.47,$0.00,1,0,1,20161001,
93893,CPT,TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ,,30,,,$686.47,$0.00,1,0,1,20161001,
93895,CPT,CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI,,30,,,$542.12,$0.00,1,0,1,20161001,
93922,CPT,NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL,,30,,,$425.53,$0.00,1,0,1,20161001,
93923,CPT,NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS,,30,,,$746.33,$0.00,1,0,1,20161001,
93924,CPT,N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI,,30,,,$666.94,$0.00,1,0,1,20161001,
93925,CPT,DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93926,CPT,DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93930,CPT,DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93931,CPT,DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93965,CPT,N-INVAS PHYSIOLOGIC STD XTR VEINS COMPL BI STD,,30,,,$746.33,$0.00,1,0,1,20161001,
93970,CPT,DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93971,CPT,DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93975,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93976,CPT,DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93978,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93979,CPT,DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD,,30,,,$989.36,$0.00,1,0,1,20161001,
93980,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93981,CPT,DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
93982,CPT,IMPLANT WIRELESS PRESS SENSOR STUDY ANEURYSM SAC,,30,,,$306.21,$0.00,1,0,1,20161001,
93990,CPT,DUPLEX SCAN HEMODIALYSIS ACCESS,,30,,,$686.47,$0.00,1,0,1,20161001,
93998,CPT,UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY,,30,,,$306.21,$0.00,1,0,1,20161001,
94002,CPT,VENTILATION ASSIST & MGMT INPATIENT 1ST DAY,,30,,,"$2,787.08",$0.00,1,0,1,20161001,
94003,CPT,VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA,,30,,,"$2,787.08",$0.00,1,0,1,20161001,
94004,CPT,VENTILATION ASSIST & MGMT NURSING FAC PR DAY,,30,,,$741.00,$0.00,1,0,1,20161001,
94010,CPT,SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ,,30,,,$746.33,$0.00,1,0,1,20161001,
94011,CPT,MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y,,30,,,$746.33,$0.00,1,0,1,20161001,
94012,CPT,MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94013,CPT,MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS,,30,,,"$2,510.92",$0.00,1,0,1,20161001,
94014,CPT,PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I,,30,,,$425.53,$0.00,1,0,1,20161001,
94015,CPT,PATIENT-INITIATED SPIROMETRIC RECORDING,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94060,CPT,BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94070,CPT,BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94150,CPT,VITAL CAPACITY TOTAL SEPARATE PROCEDURE,,30,,,$746.33,$0.00,1,0,1,20161001,
94200,CPT,MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ,,30,,,$425.53,$0.00,1,0,1,20161001,
94250,CPT,EXPIRED GAS COLLECTION QUANT 1 PROCEDURE SPX,,30,,,$306.21,$0.00,1,0,1,20161001,
94375,CPT,RESPIRATORY FLOW VOLUME LOOP,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94400,CPT,BREATHING RESPONSE TO CO2,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94450,CPT,BREATHING RESPONSE TO HYPOXIA,,30,,,$746.33,$0.00,1,0,1,20161001,
94452,CPT,HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
94453,CPT,HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION,,30,,,$425.53,$0.00,1,0,1,20161001,
94610,CPT,INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP,,30,,,$238.49,$0.00,1,0,1,20161001,
94620,CPT,PULMONARY STRESS TESTING SIMPLE,,30,,,$425.53,$0.00,1,0,1,20161001,
94621,CPT,PULMONARY STRESS TESTING COMPLEX,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94640,CPT,PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT,,30,,,$238.49,$0.00,1,0,1,20161001,
94642,CPT,PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH,,30,,,$238.49,$0.00,1,0,1,20161001,
94644,CPT,CONTINUOUS INHALATION TREATMENT 1ST HR,,30,,,$425.53,$0.00,1,0,1,20161001,
94645,CPT,CONTINUOUS INHALATION TREATMENT EA ADDL HR,,30,,,$339.91,$0.00,1,0,1,20161001,
94660,CPT,CPAP VENTILATION CPAP INITIATION&MGMT,,30,,,$238.49,$0.00,1,0,1,20161001,
94662,CPT,CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM,,30,,,"$2,787.08",$0.00,1,0,1,20161001,
94664,CPT,DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP,,30,,,$238.49,$0.00,1,0,1,20161001,
94667,CPT,MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL,,30,,,$425.53,$0.00,1,0,1,20161001,
94668,CPT,MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ,,30,,,$306.21,$0.00,1,0,1,20161001,
94669,CPT,MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION,,30,,,$238.49,$0.00,1,0,1,20161001,
94680,CPT,O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP,,30,,,$746.33,$0.00,1,0,1,20161001,
94681,CPT,O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94690,CPT,O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX,,30,,,$156.54,$0.00,1,0,1,20161001,
94726,CPT,PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94727,CPT,GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V,,30,,,$746.33,$0.00,1,0,1,20161001,
94728,CPT,AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94729,CPT,CO DIFFUSING CAPACITY,,30,,,$904.41,$0.00,1,0,1,20161001,
94750,CPT,PULMONARY COMPLIANCE STUDY,,30,,,$746.33,$0.00,1,0,1,20161001,
94760,CPT,NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER,,30,,,$156.56,$0.00,1,0,1,20161001,
94761,CPT,NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER,,30,,,$260.94,$0.00,1,0,1,20161001,
94762,CPT,NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR,,30,,,$746.33,$0.00,1,0,1,20161001,
94770,CPT,CARBON DIOXIDE EXP GAS DETER INFRARED ANALYZER,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
94772,CPT,CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
94775,CPT,PEDIATRIC APNEA MONITOR ATTACHMENT,,30,,,$746.33,$0.00,1,0,1,20161001,
94776,CPT,PEDIATRIC APNEA MONITOR ANALYSES COMPUTER,,30,,,$746.33,$0.00,1,0,1,20161001,
94780,CPT,CAR SEAT/BED TESTING W/INTERP & REPORT 60 MIN,,30,,,$156.54,$0.00,1,0,1,20161001,
94781,CPT,CAR SEAT/BED TESTNG W/INTERP & REPORT ADDL 30MIN,,30,,,$236.20,$0.00,1,0,1,20161001,
94799,CPT,UNLISTED PULMONARY SERVICE/PROCEDURE,,30,,,$746.33,$0.00,1,0,1,20161001,
95004,CPT,PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,30,,,$425.53,$0.00,1,0,1,20161001,
95012,CPT,NITRIC OXIDE EXPIRED GAS DETERMINATION,,30,,,$156.54,$0.00,1,0,1,20161001,
95017,CPT,ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R,,30,,,$156.54,$0.00,1,0,1,20161001,
95018,CPT,ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R,,30,,,$156.54,$0.00,1,0,1,20161001,
95024,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS,,30,,,$306.21,$0.00,1,0,1,20161001,
95027,CPT,INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE,,30,,,$156.54,$0.00,1,0,1,20161001,
95028,CPT,IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING,,30,,,$156.54,$0.00,1,0,1,20161001,
95044,CPT,PATCH/APPLICATION TEST SPECIFY NUMBER TESTS,,30,,,$425.53,$0.00,1,0,1,20161001,
95052,CPT,PHOTO PATCH TEST SPECIFY NUMBER TSTS,,30,,,$156.54,$0.00,1,0,1,20161001,
95056,CPT,PHOTO TESTS,,30,,,$306.21,$0.00,1,0,1,20161001,
95060,CPT,OPHTHALMIC MUCOUS MEMBRANE TESTS,,30,,,$425.53,$0.00,1,0,1,20161001,
95065,CPT,DIRECT NASAL MUCOUS MEMBRANE TEST,,30,,,$156.54,$0.00,1,0,1,20161001,
95070,CPT,INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95071,CPT,INHLJ BRNCL CHALLENGE TSTG W/AGS/GASES,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95076,CPT,INGESTION CHALLENGE TEST INITIAL 120 MINUTES,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95079,CPT,INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES,,30,,,$414.58,$0.00,1,0,1,20161001,
95115,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX,,30,,,$223.07,$0.00,1,0,1,20161001,
95117,CPT,PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS,,30,,,$223.07,$0.00,1,0,1,20161001,
95120,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX,,30,,,$79.15,$0.00,1,0,1,20161001,
95125,CPT,PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX,,30,,,$83.46,$0.00,1,0,1,20161001,
95130,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT,,30,,,$33.46,$0.00,1,0,1,20161001,
95131,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 2 STING INSECT,,30,,,$69.77,$0.00,1,0,1,20161001,
95132,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 3 STING INSECT,,30,,,$89.11,$0.00,1,0,1,20161001,
95133,CPT,PROF SVCS ALLG IMMNTX W/PRV XTRC 4 STING INSECT,,30,,,$101.28,$0.00,1,0,1,20161001,
95144,CPT,PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO,,30,,,$223.07,$0.00,1,0,1,20161001,
95145,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT,,30,,,$223.07,$0.00,1,0,1,20161001,
95146,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT,,30,,,$200.57,$0.00,1,0,1,20161001,
95147,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT,,30,,,$274.68,$0.00,1,0,1,20161001,
95148,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT,,30,,,$323.92,$0.00,1,0,1,20161001,
95149,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT,,30,,,$323.92,$0.00,1,0,1,20161001,
95165,CPT,PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN,,30,,,$223.07,$0.00,1,0,1,20161001,
95170,CPT,PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE,,30,,,$323.92,$0.00,1,0,1,20161001,
95180,CPT,RAPID DESENSITIZATION PROCEDURE EACH HOUR,,30,,,$425.53,$0.00,1,0,1,20161001,
95199,CPT,UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SRVC/PX,,30,,,$81.90,$0.00,1,0,1,20161001,
95250,CPT,GLUC MNTR CONT REC FROM INTERSTITIAL TISS FLUID,,30,,,$217.87,$0.00,1,0,1,20161001,
95782,CPT,POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
95783,CPT,POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95800,CPT,SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME,,30,,,$746.33,$0.00,1,0,1,20161001,
95801,CPT,SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL,,30,,,$425.53,$0.00,1,0,1,20161001,
95803,CPT,ACTIGRAPHY TESTING RECORDING ANALYSIS I&R,,30,,,$425.53,$0.00,1,0,1,20161001,
95805,CPT,MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
95806,CPT,SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT,,30,,,$666.94,$0.00,1,0,1,20161001,
95807,CPT,SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95808,CPT,POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95810,CPT,POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95811,CPT,POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95812,CPT,ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95813,CPT,ELECTROENCEPHALOGRAM EXTND MNTR >1 HR,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95816,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95819,CPT,ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95822,CPT,ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95824,CPT,ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95827,CPT,ELECTROENCEPHALOGRAM ALL NIGHT RECORDING,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95830,CPT,INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP,,30,,,$348.99,$0.00,1,0,1,20161001,
95831,CPT,MUSC TSTG MNL W/REPRT XTR EX HAND/TRNK,,30,,,$203.25,$0.00,1,0,1,20161001,
95832,CPT,MUSC TSTG MNL W/REPRT HAND W/WO CMPRSN NRML SIDE,,30,,,$171.22,$0.00,1,0,1,20161001,
95833,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY EX HANDS,,30,,,$177.96,$0.00,1,0,1,20161001,
95834,CPT,MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS,,30,,,$323.83,$0.00,1,0,1,20161001,
95851,CPT,ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI,,30,,,$117.55,$0.00,1,0,1,20161001,
95852,CPT,ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID,,30,,,$117.55,$0.00,1,0,1,20161001,
95857,CPT,CHOLINESTERASE INHIBITOR CHALLENGE TEST,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95860,CPT,NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS,,30,,,$425.53,$0.00,1,0,1,20161001,
95861,CPT,NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS,,30,,,$425.53,$0.00,1,0,1,20161001,
95863,CPT,NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS,,30,,,$746.33,$0.00,1,0,1,20161001,
95864,CPT,NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS,,30,,,$746.33,$0.00,1,0,1,20161001,
95865,CPT,NEEDLE ELECTROMYOGRAPHY LARYNX,,30,,,$425.53,$0.00,1,0,1,20161001,
95866,CPT,NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM,,30,,,$746.33,$0.00,1,0,1,20161001,
95867,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI,,30,,,$746.33,$0.00,1,0,1,20161001,
95868,CPT,NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI,,30,,,$746.33,$0.00,1,0,1,20161001,
95869,CPT,NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12,,30,,,$746.33,$0.00,1,0,1,20161001,
95870,CPT,NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI,,30,,,$425.53,$0.00,1,0,1,20161001,
95872,CPT,NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER,,30,,,$746.33,$0.00,1,0,1,20161001,
95873,CPT,ELECTRICAL STIMULATION GUID W/CHEMODENERVATION,,30,,,$335.22,$0.00,1,0,1,20161001,
95874,CPT,NEEDLE EMG GUID W/CHEMODENERVATION,,30,,,$329.14,$0.00,1,0,1,20161001,
95875,CPT,ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB,,30,,,$746.33,$0.00,1,0,1,20161001,
95885,CPT,NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED,,30,,,"$1,322.06",$0.00,1,0,1,20161001,
95886,CPT,NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE,,30,,,"$2,071.64",$0.00,1,0,1,20161001,
95887,CPT,NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION,,30,,,"$1,845.94",$0.00,1,0,1,20161001,
95905,CPT,MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB,,30,,,$425.53,$0.00,1,0,1,20161001,
95907,CPT,NERVE CONDUCTION STUDIES 1-2 STUDIES,,30,,,$746.33,$0.00,1,0,1,20161001,
95908,CPT,NERVE CONDUCTION STUDIES 3-4 STUDIES,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95909,CPT,NERVE CONDUCTION STUDIES 5-6 STUDIES,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95910,CPT,NERVE CONDUCTION STUDIES 7-8 STUDIES,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95911,CPT,NERVE CONDUCTION STUDIES 9-10 STUDIES,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95912,CPT,NERVE CONDUCTION STUDIES 11-12 STUDIES,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95913,CPT,NERVE CONDUCTION STUDIES 13/> STUDIES,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95921,CPT,TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP,,30,,,$746.33,$0.00,1,0,1,20161001,
95922,CPT,TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ,,30,,,$425.53,$0.00,1,0,1,20161001,
95923,CPT,TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION,,30,,,$425.53,$0.00,1,0,1,20161001,
95924,CPT,TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95925,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95926,CPT,SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95927,CPT,SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95928,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95929,CPT,CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
95930,CPT,VISUAL EP TSTG CNS CHECKERBOARD/FLASH,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95933,CPT,ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST,,30,,,$306.21,$0.00,1,0,1,20161001,
95937,CPT,NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH,,30,,,$746.33,$0.00,1,0,1,20161001,
95938,CPT,SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95939,CPT,CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95940,CPT,IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES,,30,,,$351.39,$0.00,1,0,1,20161001,
95941,CPT,IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR,,30,,,"$1,446.89",$0.00,1,0,1,20161001,
95943,CPT,PARASYMP & SYMP NRV FUNCJ HRT RATE VARIABILITY,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
95950,CPT,MONITOR ID& LATERALIZATION SEIZURE FOCUS EEG,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95951,CPT,LOCALIZE CEREBRAL SEIZURE CABLE/RADIO EEG/VIDEO,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95953,CPT,LOCALIZE CEREBRAL SEIZURE CPTR PORTABLE EEG,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95954,CPT,RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95955,CPT,EEG NONINTRACRANIAL SURGERY,,30,,,"$1,645.71",$0.00,1,0,1,20161001,
95956,CPT,MNTR SEIZURE CMPTR 16CHAN EEG ATND EA 24 HR,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
95957,CPT,DIGITAL ANALYSIS ELECTROENCEPHALOGRAM,,30,,,"$1,414.53",$0.00,1,0,1,20161001,
95958,CPT,WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95961,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
95962,CPT,FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR,,30,,,"$1,068.93",$0.00,1,0,1,20161001,
95965,CPT,MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95966,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
95967,CPT,MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL,,30,,,"$5,998.57",$0.00,1,0,1,20161001,
95970,CPT,ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM,,30,,,$425.53,$0.00,1,0,1,20161001,
95971,CPT,ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG,,30,,,$429.61,$0.00,1,0,1,20161001,
95972,CPT,ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG,,30,,,$429.61,$0.00,1,0,1,20161001,
95974,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR,,30,,,$429.61,$0.00,1,0,1,20161001,
95975,CPT,ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN,,30,,,$881.63,$0.00,1,0,1,20161001,
95978,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN 1ST HR,,30,,,$429.61,$0.00,1,0,1,20161001,
95979,CPT,ELEC ALYS NSTIM PLS GEN CPLX DP BRN EA 30 MIN,,30,,,$881.63,$0.00,1,0,1,20161001,
95981,CPT,ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG,,30,,,$306.21,$0.00,1,0,1,20161001,
95982,CPT,ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG,,30,,,$221.12,$0.00,1,0,1,20161001,
95990,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN,,30,,,"$1,527.90",$0.00,1,0,1,20161001,
95991,CPT,RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP,,30,,,$851.10,$0.00,1,0,1,20161001,
95992,CPT,CANALITH REPOSITIONING PROCEDURE,,30,,,$587.75,$0.00,1,0,1,20161001,
95999,CPT,UNLIS NEUROLOGICAL/NEUROMUSCULAR DX PX,,30,,,$746.33,$0.00,1,0,1,20161001,
96000,CPT,COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS,,30,,,"$2,581.69",$0.00,1,0,1,20161001,
96001,CPT,COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
96002,CPT,DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96003,CPT,DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC,,30,,,$871.03,$0.00,1,0,1,20161001,
96020,CPT,TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP,,30,,,"$7,592.75",$0.00,1,0,1,20161001,
96040,CPT,MEDICAL GENETICS COUNSELING EACH 30 MINUTES,,30,,,$360.58,$0.00,1,0,1,20161001,
96101,CPT,PSYCHOLOGICAL TESTING PR HR WITH PATIENT,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96102,CPT,PSYCHOLOGICAL TESTING ADMN BY TECH PR HR,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96103,CPT,PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R,,30,,,$425.53,$0.00,1,0,1,20161001,
96105,CPT,ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR,,30,,,$640.77,$0.00,1,0,1,20161001,
96110,CPT,DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM,,30,,,$230.81,$0.00,1,0,1,20161001,
96111,CPT,DEVELOPMENTAL TESTING W/INTERP & REPORT,,30,,,$666.94,$0.00,1,0,1,20161001,
96116,CPT,NUBHVL STATUS XM PR HR W/PT INTERPJ&PREPJ,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96118,CPT,NUROPSYC TESTING PR HR W/PT & INTERPJ TIME,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96119,CPT,NEUROPSYC TSTG W/PROF I&R ADMN BY TECH PR HR,,30,,,"$1,355.75",$0.00,1,0,1,20161001,
96120,CPT,NEUROPSYCHOLOG TESTING COMPUTER W/PROF I&R,,30,,,$746.33,$0.00,1,0,1,20161001,
96127,CPT,BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT,,30,,,$81.90,$0.00,1,0,1,20161001,
96150,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT 1ST ASSMT,,30,,,$287.49,$0.00,1,0,1,20161001,
96151,CPT,HLTH&BEHAVIOR ASSMT EA 15 MIN W/PT RE-ASSMT,,30,,,$287.49,$0.00,1,0,1,20161001,
96152,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN INDIV,,30,,,$287.49,$0.00,1,0,1,20161001,
96153,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN GRP 2/>PTS,,30,,,$108.34,$0.00,1,0,1,20161001,
96154,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/PT,,30,,,$287.49,$0.00,1,0,1,20161001,
96155,CPT,HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT,,30,,,$132.06,$0.00,1,0,1,20161001,
96360,CPT,IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR,,30,,,$451.93,$0.00,1,0,1,20161001,
96361,CPT,IV INFUSION HYDRATION EACH ADDITIONAL HOUR,,30,,,$223.07,$0.00,1,0,1,20161001,
96365,CPT,IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR,,30,,,$851.10,$0.00,1,0,1,20161001,
96366,CPT,IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR,,30,,,$223.07,$0.00,1,0,1,20161001,
96367,CPT,IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR,,30,,,$323.92,$0.00,1,0,1,20161001,
96368,CPT,IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS,,30,,,$276.82,$0.00,1,0,1,20161001,
96369,CPT,SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP,,30,,,$851.10,$0.00,1,0,1,20161001,
96370,CPT,SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR,,30,,,$223.07,$0.00,1,0,1,20161001,
96371,CPT,SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE,,30,,,$220.36,$0.00,1,0,1,20161001,
96372,CPT,THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM,,30,,,$323.92,$0.00,1,0,1,20161001,
96373,CPT,THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL,,30,,,$451.93,$0.00,1,0,1,20161001,
96374,CPT,THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG,,30,,,$451.93,$0.00,1,0,1,20161001,
96375,CPT,THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG,,30,,,$274.68,$0.00,1,0,1,20161001,
96376,CPT,THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC,,30,,,$239.38,$0.00,1,0,1,20161001,
96379,CPT,UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,,30,,,$223.07,$0.00,1,0,1,20161001,
96401,CPT,CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO,,30,,,$451.93,$0.00,1,0,1,20161001,
96402,CPT,CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO,,30,,,$323.92,$0.00,1,0,1,20161001,
96405,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7,,30,,,$323.92,$0.00,1,0,1,20161001,
96406,CPT,CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7,,30,,,$851.10,$0.00,1,0,1,20161001,
96409,CPT,CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG,,30,,,$851.10,$0.00,1,0,1,20161001,
96411,CPT,CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG,,30,,,$451.93,$0.00,1,0,1,20161001,
96413,CPT,CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
96415,CPT,CHEMOTHERAPY ADMN IV INFUSION TQ EA HR,,30,,,$323.92,$0.00,1,0,1,20161001,
96416,CPT,CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
96417,CPT,CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR,,30,,,$323.92,$0.00,1,0,1,20161001,
96420,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ,,30,,,"$1,527.90",$0.00,1,0,1,20161001,
96422,CPT,CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS </1 HR,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
96423,CPT,CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR,,30,,,$274.68,$0.00,1,0,1,20161001,
96425,CPT,CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
96440,CPT,CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS,,30,,,"$1,527.90",$0.00,1,0,1,20161001,
96446,CPT,CHEMOTX ADMN PRTL CAVITY PORT/CATH,,30,,,"$1,527.90",$0.00,1,0,1,20161001,
96450,CPT,CHEMOTX ADMN CNS REQ SPINAL PUNCTURE,,30,,,"$1,532.23",$0.00,1,0,1,20161001,
96521,CPT,REFILLING & MAINTENANCE PORTABLE PUMP,,30,,,$851.10,$0.00,1,0,1,20161001,
96522,CPT,REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC,,30,,,$851.10,$0.00,1,0,1,20161001,
96523,CPT,IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST,,30,,,$306.21,$0.00,1,0,1,20161001,
96542,CPT,CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT,,30,,,$844.33,$0.00,1,0,1,20161001,
96549,CPT,UNLISTED CHEMOTHERAPY PROCEDURE,,30,,,$223.07,$0.00,1,0,1,20161001,
96567,CPT,PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX,,30,,,$398.75,$0.00,1,0,1,20161001,
96570,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN,,30,,,$443.96,$0.00,1,0,1,20161001,
96571,CPT,PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN,,30,,,$221.98,$0.00,1,0,1,20161001,
96900,CPT,ACTINOTHERAPY ULTRAVIOLET LIGHT,,30,,,$156.54,$0.00,1,0,1,20161001,
96904,CPT,WHOLE BODY INTEGUMENTARY PHOTOGRAPHY,,30,,,$519.04,$0.00,1,0,1,20161001,
96910,CPT,PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB,,30,,,$306.21,$0.00,1,0,1,20161001,
96912,CPT,PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA,,30,,,$306.21,$0.00,1,0,1,20161001,
96913,CPT,PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
96920,CPT,LASER SKIN DISEASE PSORIASIS TOT AREA <250 SQ CM,,30,,,$398.75,$0.00,1,0,1,20161001,
96921,CPT,LASER SKIN DISEASE PSORIASIS 250-500 SQ CM,,30,,,$398.75,$0.00,1,0,1,20161001,
96922,CPT,LASER SKIN DISEASE PSORIASIS >500 SQ CM,,30,,,$398.75,$0.00,1,0,1,20161001,
96932,CPT,RCM CELULR & SUBCELULR SKN IMGNG IMG ACQUISITION,,30,,,$155.67,$0.00,1,0,1,20161001,
96999,CPT,UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PROCED,,30,,,$398.75,$0.00,1,0,1,20161001,
97005,CPT,ATHLETIC TRAINING EVALUATION,,30,,,$108.95,$0.00,1,0,1,20161001,
97006,CPT,ATHLETIC TRAINING RE-EVALUATION,,30,,,$72.63,$0.00,1,0,1,20161001,
97014,CPT,APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED,,30,,,$72.63,$0.00,1,0,1,20161001,
97597,CPT,DEBRIDEMENT OPEN WOUND 20 SQ CM/<,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
97598,CPT,DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
97602,CPT,RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS,,30,,,$398.75,$0.00,1,0,1,20161001,
97605,CPT,NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM,,30,,,$398.75,$0.00,1,0,1,20161001,
97606,CPT,NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM,,30,,,$398.75,$0.00,1,0,1,20161001,
97607,CPT,NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
97608,CPT,NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
97610,CPT,LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY,,30,,,$398.75,$0.00,1,0,1,20161001,
97810,CPT,ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN,,30,,,$123.33,$0.00,1,0,1,20161001,
97811,CPT,ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN,,30,,,$102.20,$0.00,1,0,1,20161001,
97813,CPT,ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN,,30,,,$128.61,$0.00,1,0,1,20161001,
97814,CPT,ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ,,30,,,$118.28,$0.00,1,0,1,20161001,
98925,CPT,OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98926,CPT,OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98927,CPT,OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98928,CPT,OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98929,CPT,OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98940,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98941,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98942,CPT,CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS,,30,,,$124.62,$0.00,1,0,1,20161001,
98943,CPT,CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION,,30,,,$62.10,$0.00,1,0,1,20161001,
98960,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT,,30,,,$108.43,$0.00,1,0,1,20161001,
98961,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS,,30,,,$86.99,$0.00,1,0,1,20161001,
98962,CPT,EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS,,30,,,$107.66,$0.00,1,0,1,20161001,
99000,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB,,30,,,$24.38,$0.00,1,0,1,20161001,
99001,CPT,HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB,,30,,,$49.38,$0.00,1,0,1,20161001,
99002,CPT,HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP,,30,,,$188.40,$0.00,1,0,1,20161001,
99024,CPT,POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX,,30,,,$202.04,$0.00,1,0,1,20161001,
99026,CPT,HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR,,30,,,$65.08,$0.00,1,0,1,20161001,
99050,CPT,SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS,,30,,,$86.40,$0.00,1,0,1,20161001,
99051,CPT,SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS,,30,,,$186.96,$0.00,1,0,1,20161001,
99053,CPT,SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACI,,30,,,$72.55,$0.00,1,0,1,20161001,
99056,CPT,SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT,,30,,,$18.37,$0.00,1,0,1,20161001,
99058,CPT,SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS,,30,,,$34.96,$0.00,1,0,1,20161001,
99060,CPT,SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC,,30,,,"$1,592.73",$0.00,1,0,1,20161001,
99070,CPT,SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP,,30,,,$557.17,$0.00,1,0,1,20161001,
99071,CPT,EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST,,30,,,$97.61,$0.00,1,0,1,20161001,
99078,CPT,PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING,,30,,,$473.11,$0.00,1,0,1,20161001,
99080,CPT,SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG,,30,,,$5.74,$0.00,1,0,1,20161001,
99082,CPT,UNUSUAL TRAVEL,,30,,,$140.43,$0.00,1,0,1,20161001,
99090,CPT,ANALYSIS CLINICAL DATA STORED IN COMPUTERS,,30,,,$244.52,$0.00,1,0,1,20161001,
99091,CPT,COLLJ&INTERPJ PHYS/QHP PHYSIO COMPUTR DATA 30 MI,,30,,,$53.40,$0.00,1,0,1,20161001,
99100,CPT,ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/<,,30,,,$319.81,$0.00,1,0,1,20161001,
99140,CPT,ANES COMPLICJ EMERGENCY CONDITIONS SPECIFY,,30,,,$473.97,$0.00,1,0,1,20161001,
99143,CPT,MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN,,30,,,$682.68,$0.00,1,0,1,20161001,
99144,CPT,MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN,,30,,,$556.32,$0.00,1,0,1,20161001,
99145,CPT,MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN,,30,,,$215.14,$0.00,1,0,1,20161001,
99148,CPT,MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN,,30,,,$536.27,$0.00,1,0,1,20161001,
99149,CPT,MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN,,30,,,$451.07,$0.00,1,0,1,20161001,
99150,CPT,MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN,,30,,,$258.99,$0.00,1,0,1,20161001,
99170,CPT,ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG,,30,,,$916.02,$0.00,1,0,1,20161001,
99172,CPT,VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM,,30,,,$283.54,$0.00,1,0,1,20161001,
99173,CPT,SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT,,30,,,$90.72,$0.00,1,0,1,20161001,
99174,CPT,INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT,,30,,,$82.68,$0.00,1,0,1,20161001,
99175,CPT,IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED,,30,,,$287.08,$0.00,1,0,1,20161001,
99183,CPT,PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION,,30,,,"$2,517.14",$0.00,1,0,1,20161001,
99195,CPT,PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE,,30,,,$425.53,$0.00,1,0,1,20161001,
99199,CPT,UNLISTED SPECIAL SERVICE PROCEDURE/REPORT,,30,,,$287.08,$0.00,1,0,1,20161001,
99201,CPT,OFFICE OUTPATIENT NEW 10 MINUTES,,30,,,$163.44,$0.00,1,0,1,20161001,
99202,CPT,OFFICE OUTPATIENT NEW 20 MINUTES,,30,,,$203.97,$0.00,1,0,1,20161001,
99203,CPT,OFFICE OUTPATIENT NEW 30 MINUTES,,30,,,$310.41,$0.00,1,0,1,20161001,
99204,CPT,OFFICE OUTPATIENT NEW 45 MINUTES,,30,,,$388.83,$0.00,1,0,1,20161001,
99205,CPT,OFFICE OUTPATIENT NEW 60 MINUTES,,30,,,$562.36,$0.00,1,0,1,20161001,
99211,CPT,OFFICE OUTPATIENT VISIT 5 MINUTES,,30,,,$159.38,$0.00,1,0,1,20161001,
99212,CPT,OFFICE OUTPATIENT VISIT 10 MINUTES,,30,,,$196.75,$0.00,1,0,1,20161001,
99213,CPT,OFFICE OUTPATIENT VISIT 15 MINUTES,,30,,,$254.77,$0.00,1,0,1,20161001,
99214,CPT,OFFICE OUTPATIENT VISIT 25 MINUTES,,30,,,$333.05,$0.00,1,0,1,20161001,
99215,CPT,OFFICE OUTPATIENT VISIT 40 MINUTES,,30,,,$399.90,$0.00,1,0,1,20161001,
99217,CPT,OBSERVATION CARE DISCHARGE MANAGEMENT,,30,,,$114.12,$0.00,1,1,1,20161001,
99218,CPT,INITIAL OBSERVATION CARE/DAY 30 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99219,CPT,INITIAL OBSERVATION CARE/DAY 50 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99220,CPT,INITIAL OBSERVATION CARE/DAY 70 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99224,CPT,SBSQ OBSERVATION CARE/DAY 15 MINUTES,,30,,,$114.12,$0.00,1,1,1,20161001,
99225,CPT,SBSQ OBSERVATION CARE/DAY 25 MINUTES,,30,,,$114.12,$0.00,1,1,1,20161001,
99226,CPT,SBSQ OBSERVATION CARE/DAY 35 MINUTES,,30,,,$114.12,$0.00,1,1,1,20161001,
99231,CPT,SBSQ HOSPITAL CARE/DAY 15 MINUTES,,30,,,$39.48,$0.00,1,0,1,20161001,
99232,CPT,SBSQ HOSPITAL CARE/DAY 25 MINUTES,,30,,,$155.69,$0.00,1,0,1,20161001,
99233,CPT,SBSQ HOSPITAL CARE/DAY 35 MINUTES,,30,,,$243.45,$0.00,1,0,1,20161001,
99234,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99235,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99236,CPT,OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES,,30,,,$114.12,$356.52,2,1,1,20161001,
99238,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<,,30,,,$288.35,$0.00,1,0,1,20161001,
99239,CPT,HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN,,30,,,$341.63,$0.00,1,0,1,20161001,
99241,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN,,30,,,$190.62,$0.00,1,0,1,20161001,
99242,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN,,30,,,$331.21,$0.00,1,0,1,20161001,
99243,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,,30,,,$409.95,$0.00,1,0,1,20161001,
99244,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,,30,,,$493.78,$0.00,1,0,1,20161001,
99245,CPT,OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN,,30,,,"$1,055.31",$0.00,1,0,1,20161001,
99252,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 40 MIN,,30,,,$574.16,$0.00,1,0,1,20161001,
99253,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 55 MIN,,30,,,$725.47,$0.00,1,0,1,20161001,
99254,CPT,INITIAL INPATIENT CONSULT NEW/ESTAB PT 80 MIN,,30,,,$887.58,$0.00,1,0,1,20161001,
99281,CPT,EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB,,30,,,$243.35,$0.00,1,1,1,20161001,
99282,CPT,EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY,,30,,,$675.16,$0.00,1,1,1,20161001,
99283,CPT,EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY,,30,,,"$1,249.49",$0.00,1,1,1,20161001,
99284,CPT,EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY,,30,,,"$1,780.04",$0.00,1,1,1,20161001,
99285,CPT,EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ,,30,,,"$2,731.45",$0.00,1,1,1,20161001,
99288,CPT,PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS,,30,,,$311.20,$0.00,1,1,1,20161001,
99291,CPT,CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN,,30,,,"$3,980.92",$0.00,1,1,1,20161001,
99292,CPT,CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN,,30,,,"$4,542.04",$0.00,1,1,1,20161001,
99304,CPT,INITIAL NURSING FACILITY CARE/DAY 25 MINUTES,,30,,,$186.03,$0.00,1,0,1,20161001,
99305,CPT,INITIAL NURSING FACILITY CARE/DAY 35 MINUTES,,30,,,$222.78,$0.00,1,0,1,20161001,
99306,CPT,INITIAL NURSING FACILITY CARE/DAY 45 MINUTES,,30,,,$311.20,$0.00,1,0,1,20161001,
99307,CPT,SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN,,30,,,$103.35,$0.00,1,0,1,20161001,
99308,CPT,SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN,,30,,,$146.99,$0.00,1,0,1,20161001,
99309,CPT,SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN,,30,,,$197.51,$0.00,1,0,1,20161001,
99310,CPT,SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN,,30,,,$271.01,$0.00,1,0,1,20161001,
99315,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,30,,,$161.91,$0.00,1,0,1,20161001,
99316,CPT,NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES,,30,,,$219.33,$0.00,1,0,1,20161001,
99318,CPT,E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN,,30,,,$204.40,$0.00,1,0,1,20161001,
99324,CPT,DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN,,30,,,$138.60,$0.00,1,0,1,20161001,
99325,CPT,DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN,,30,,,$218.18,$0.00,1,0,1,20161001,
99326,CPT,DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES,,30,,,$235.41,$0.00,1,0,1,20161001,
99334,CPT,DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES,,30,,,$133.21,$0.00,1,0,1,20161001,
99335,CPT,DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES,,30,,,$177.76,$0.00,1,0,1,20161001,
99336,CPT,DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES,,30,,,$252.63,$0.00,1,0,1,20161001,
99337,CPT,DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES,,30,,,$361.15,$0.00,1,0,1,20161001,
99341,CPT,HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES,,30,,,$128.62,$0.00,1,0,1,20161001,
99342,CPT,HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES,,30,,,$166.93,$0.00,1,0,1,20161001,
99343,CPT,HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES,,30,,,$259.97,$0.00,1,0,1,20161001,
99344,CPT,HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES,,30,,,$415.96,$0.00,1,0,1,20161001,
99345,CPT,HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN,,30,,,$503.53,$0.00,1,0,1,20161001,
99347,CPT,HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES,,30,,,$127.67,$0.00,1,0,1,20161001,
99348,CPT,HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES,,30,,,$178.74,$0.00,1,0,1,20161001,
99349,CPT,HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES,,30,,,$285.99,$0.00,1,0,1,20161001,
99350,CPT,HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS,,30,,,$380.47,$0.00,1,0,1,20161001,
99354,CPT,PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR,,30,,,$124.98,$0.00,1,0,1,20161001,
99355,CPT,PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30,,30,,,$523.64,$0.00,1,0,1,20161001,
99358,CPT,PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR,,30,,,"$1,446.89",$0.00,1,0,1,20161001,
99359,CPT,PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES,,30,,,"$1,766.05",$0.00,1,0,1,20161001,
99360,CPT,PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES,,30,,,$299.52,$0.00,1,0,1,20161001,
99363,CPT,ANTICOAGULANT MGMT OUTPATIENT INIT 90 DAYS,,30,,,$158.25,$0.00,1,0,1,20161001,
99364,CPT,ANTICOAGULANT MGMT OUTPATIENT EA SBSQ 90 DAYS,,30,,,$129.76,$0.00,1,0,1,20161001,
99366,CPT,TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN,,30,,,$229.67,$0.00,1,0,1,20161001,
99367,CPT,TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN,,30,,,$290.53,$0.00,1,0,1,20161001,
99368,CPT,TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN,,30,,,$315.79,$0.00,1,0,1,20161001,
99375,CPT,SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>,,30,,,$128.44,$0.00,1,0,1,20161001,
99381,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR,,30,,,$230.81,$0.00,1,0,1,20161001,
99382,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS,,30,,,$264.12,$0.00,1,0,1,20161001,
99383,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS,,30,,,$263.20,$0.00,1,0,1,20161001,
99384,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR,,30,,,$297.42,$0.00,1,0,1,20161001,
99385,CPT,INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS,,30,,,$253.78,$0.00,1,0,1,20161001,
99386,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS,,30,,,$362.11,$0.00,1,0,1,20161001,
99387,CPT,INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>,,30,,,$338.76,$0.00,1,0,1,20161001,
99391,CPT,PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y,,30,,,$198.66,$0.00,1,0,1,20161001,
99392,CPT,PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS,,30,,,$230.81,$0.00,1,0,1,20161001,
99393,CPT,PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS,,30,,,$230.81,$0.00,1,0,1,20161001,
99394,CPT,PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS,,30,,,$264.12,$0.00,1,0,1,20161001,
99395,CPT,PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS,,30,,,$214.74,$0.00,1,0,1,20161001,
99396,CPT,PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS,,30,,,$243.45,$0.00,1,0,1,20161001,
99397,CPT,PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER,,30,,,$284.79,$0.00,1,0,1,20161001,
99401,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 15 MIN,,30,,,$251.78,$0.00,1,0,1,20161001,
99402,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 30 MIN,,30,,,$229.67,$0.00,1,0,1,20161001,
99403,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 45 MIN,,30,,,$458.18,$0.00,1,0,1,20161001,
99404,CPT,PREVENT MED COUNSEL&/RISK FACTOR REDJ SPX 60 MIN,,30,,,$574.16,$0.00,1,0,1,20161001,
99406,CPT,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,,30,,,$108.34,$0.00,1,0,1,20161001,
99407,CPT,TOBACCO USE CESSATION INTENSIVE >10 MINUTES,,30,,,$108.34,$0.00,1,0,1,20161001,
99408,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN,,30,,,$114.83,$0.00,1,0,1,20161001,
99409,CPT,ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN,,30,,,$289.31,$0.00,1,0,1,20161001,
99411,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M,,30,,,$57.42,$0.00,1,0,1,20161001,
99412,CPT,PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M,,30,,,$95.71,$0.00,1,0,1,20161001,
99420,CPT,ADMN & INTERPJ HEALTH RISK ASSESSMENT INSTRUMENT,,30,,,$57.42,$0.00,1,0,1,20161001,
99429,CPT,UNLISTED PREVENTIVE MEDICINE SERVICE,,30,,,$47.08,$0.00,1,0,1,20161001,
99446,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10,,30,,,$118.71,$0.00,1,0,1,20161001,
99447,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 11-20,,30,,,$169.85,$0.00,1,0,1,20161001,
99448,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 21-30,,30,,,$222.03,$0.00,1,0,1,20161001,
99449,CPT,INTERPROF PHONE/INTERNET ASSESS/MANAGE 31/>,,30,,,$266.60,$0.00,1,0,1,20161001,
99456,CPT,WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,,30,,,$157.32,$0.00,1,0,1,20161001,
99460,CPT,1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB,,30,,,$217.87,$0.00,1,0,1,20161001,
99461,CPT,1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER,,30,,,$268.71,$0.00,1,0,1,20161001,
99463,CPT,1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT,,30,,,$217.87,$0.00,1,0,1,20161001,
99465,CPT,DELIVERY/BIRTHING ROOM RESUSCITATION,,30,,,"$2,962.78",$0.00,1,0,1,20161001,
99490,CPT,CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH,,30,,,$134.54,$0.00,1,0,1,20161001,
99495,CPT,TRANSITIONAL CARE MANAGE SRVC 14 DAY DISCHARGE,,30,,,$217.87,$0.00,1,0,1,20161001,
99496,CPT,TRANSITIONAL CARE MANAGE SRVC 7 DAY DISCHARGE,,30,,,$217.87,$0.00,1,0,1,20161001,
99497,CPT,ADVANCE CARE PLANNING FIRST 30 MINS,,30,,,$131.68,$0.00,1,0,1,20161001,
99499,CPT,UNLISTED EVALUATION AND MANAGEMENT SERVICE,,30,,,$210.21,$0.00,1,0,1,20161001,
99500,CPT,HOME VISIT PRENATAL MONITORING & ASSESSMENT,,30,,,$844.43,$0.00,1,0,1,20161001,
99501,CPT,HOME VISIT POSTNATAL ASSMT&F-UP CARE,,30,,,$344.50,$0.00,1,0,1,20161001,
99502,CPT,HOME VISIT NEWBORN CARE & ASSESSMENT,,30,,,$218.18,$0.00,1,0,1,20161001,
99503,CPT,HOME VISIT RESPIRATORY THERAPY CARE,,30,,,$229.67,$0.00,1,0,1,20161001,
99505,CPT,HOME VISIT STOMA CARE&MAINT CLST&CSTOST,,30,,,$194.16,$0.00,1,0,1,20161001,
99506,CPT,HOME VISIT INTRAMUSCULAR INJECTIONS,,30,,,$401.91,$0.00,1,0,1,20161001,
99507,CPT,HOME VISIT CARE&MAINT CATH,,30,,,$172.25,$0.00,1,0,1,20161001,
99509,CPT,HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE,,30,,,$287.08,$0.00,1,0,1,20161001,
99510,CPT,HOME VISIT INDIV FAM/MARRIAGE COUNSELING,,30,,,$321.53,$0.00,1,0,1,20161001,
99512,CPT,HOME VISIT HEMODIALYSIS,,30,,,"$3,582.78",$0.00,1,0,1,20161001,
99600,CPT,UNLISTED HOME VISIT SERVICE/PROCEDURE,,30,,,$246.89,$0.00,1,0,1,20161001,
99601,CPT,HOME NFS/SPECTY DRUG ADMN PR VST </2 HR,,30,,,$321.53,$0.00,1,0,1,20161001,
99602,CPT,HOME NFS/SPECTY DRUG ADMN PR VST </2 HR EA HR,,30,,,$235.41,$0.00,1,0,1,20161001,
99605,CPT,MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT,,30,,,$221.86,$0.00,1,0,1,20161001,
99606,CPT,MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT,,30,,,$206.00,$0.00,1,0,1,20161001,
99607,CPT,MEDICATION THERAPY EACH ADDITIONAL 15 MIN,,30,,,$216.10,$0.00,1,0,1,20161001,
0042T,CPT,CEREBRAL PERFUSION ANALYS CT W/BLOOD FLOW&VOLUME,,30,,,"$3,526.52",$0.00,1,0,1,20161001,
0054T,CPT,CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES,,30,,,$394.02,$0.00,1,0,1,20161001,
0055T,CPT,CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI,,30,,,"$2,050.81",$0.00,1,0,1,20161001,
0058T,CPT,CRYOPRESERVATION REPRODUCTIVE TISSUE OVARIAN,,30,,,$424.20,$0.00,1,0,1,20161001,
0071T,CPT,US ABLATJ UTERINE LEIOMYOMATA < 200 CC TISSUE,,30,,,"$10,555.96",$0.00,1,0,1,20161001,
0072T,CPT,US ABLATJ UTERINE LEIOMYOMAT >/EQUAL 200 CC TISS,,30,,,"$10,555.96",$0.00,1,0,1,20161001,
0085T,CPT,BREATH TEST HEART TRANSPLANT REJECTION,,30,,,$75.48,$0.00,1,0,1,20161001,
0100T,CPT,PLMT SCJNCL RTA PROSTH&PLS&IMPLTJ INTRA-OC RTA,,30,,,"$190,000.00",$0.00,1,0,1,20161001,
0101T,CPT,EXTRCORPL SHOCK WAVE MUSCSKELE NOS HIGH ENERGY,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
0102T,CPT,EXTRCRPL SHOCK WAVE W/ANES LAT HUMERL EPICONDYLE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
0106T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/TOUCH STIMULI,,30,,,$156.54,$0.00,1,0,1,20161001,
0107T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/VIBRJ STIMULI,,30,,,$156.54,$0.00,1,0,1,20161001,
0108T,CPT,QUANT SENSORY TEST&INTERPJ/XTR W/COOL STIMULI,,30,,,$306.21,$0.00,1,0,1,20161001,
0109T,CPT,QUANT SENAORY TEST&INTERPJ/XTR W/HT-PN STIMULI,,30,,,$156.54,$0.00,1,0,1,20161001,
0110T,CPT,QUANT SENSORY TEST&INTERPJ/XTR OTHER STIMULI,,30,,,$425.53,$0.00,1,0,1,20161001,
0126T,CPT,COMMON CAROTID INTIMA MEDIA THICKNESS STUDY,,30,,,$156.54,$0.00,1,0,1,20161001,
0159T,CPT,COMPUTER AIDED DETECTION BREAST MRI,,30,,,$429.47,$0.00,1,0,1,20161001,
0171T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR 1 LVL,,30,,,"$21,075.80",$0.00,1,0,1,20161001,
0172T,CPT,PST SPINOUS PROCESS DEVICE INSERT LMBR EA LVL,,30,,,"$25,892.17",$0.00,1,0,1,20161001,
0174T,CPT,CAD CHEST RADIOGRAPH CONCURRENT W/INTERPRETATION,,30,,,$30.06,$0.00,1,0,1,20161001,
0179T,CPT,64 LEAD ECG W/TRACING & GRAPHICS,,30,,,$156.54,$0.00,1,0,1,20161001,
0184T,CPT,RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC,,30,,,"$17,638.18",$0.00,1,0,1,20161001,
0190T,CPT,INTRAOCULAR RADIATION SRC APPLICATOR PLACEMENT,,30,,,"$9,145.21",$0.00,1,0,1,20161001,
0191T,CPT,ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
0198T,CPT,MEAS OCULAR BLOOD FLOW REPEAT IO PRES SAMP W/I&R,,30,,,$306.21,$0.00,1,0,1,20161001,
0200T,CPT,PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
0201T,CPT,PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
0206T,CPT,CPTR DBS ALYS MLT CYCLS CAR ELEC DTA 2/> ECG LDS,,30,,,$306.21,$0.00,1,0,1,20161001,
0207T,CPT,EVAC MEIBOMIAN GLNDS AUTO HT& INTMT PRESS UNI,,30,,,$427.56,$0.00,1,0,1,20161001,
0208T,CPT,PURE TONE AUDIOMETRY AUTOMATED AIR ONLY,,30,,,$155.67,$0.00,1,0,1,20161001,
0209T,CPT,PURE TONE AUDIOMETRY AUTOMATED AIR & BONE,,30,,,$155.67,$0.00,1,0,1,20161001,
0210T,CPT,SPEECH AUDIOMETRY THRESHOLD AUTOMATED,,30,,,$155.67,$0.00,1,0,1,20161001,
0211T,CPT,SPEECH AUDIOM THRESHLD AUTO W/SPEECH RECOGNITION,,30,,,$155.67,$0.00,1,0,1,20161001,
0212T,CPT,COMPRE AUDIOM THRESHOLD EVAL & SPEECH RECOG,,30,,,$666.94,$0.00,1,0,1,20161001,
0213T,CPT,NJX DX/THER PARAVER FCT JT W/US CER/THOR 1 LVL,,30,,,"$5,048.03",$0.00,1,0,1,20161001,
0214T,CPT,NJX DX/THER PARAVER FCT JT W/US CER/THOR 2ND LVL,,30,,,"$1,139.95",$0.00,1,0,1,20161001,
0215T,CPT,NJX PARAVERTBRL FACET JT W/US CER/THOR 3RD&> LVL,,30,,,"$1,139.95",$0.00,1,0,1,20161001,
0216T,CPT,NJX DX/THER PARAVER FCT JT W/US LUMB/SAC 1 LVL,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
0217T,CPT,NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2,,30,,,"$1,139.95",$0.00,1,0,1,20161001,
0218T,CPT,NJX PARAVERTBRL FCT JT W/US LUMB/SAC 3RD&> LVL,,30,,,"$1,139.95",$0.00,1,0,1,20161001,
0221T,CPT,PLMT POST FACET IMPLT UNI/BI W/IMG & GRFT LUMB,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
0222T,CPT,PLACE POSTERIOR INTRAFACET IMPLANT ADDL SEGMENT,,30,,,"$14,369.34",$0.00,1,0,1,20161001,
0228T,CPT,NJX ANES/STEROID TFRML EDRL W/US CER/THOR 1 LVL,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
0229T,CPT,NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL,,30,,,"$1,822.13",$0.00,1,0,1,20161001,
0230T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC 1 LVL,,30,,,"$5,395.03",$0.00,1,0,1,20161001,
0231T,CPT,NJX ANES/STEROID TFRML EDRL W/US LUM/SAC EA ADDL,,30,,,"$1,822.13",$0.00,1,0,1,20161001,
0232T,CPT,NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION,,30,,,$425.53,$0.00,1,0,1,20161001,
0234T,CPT,TRLUML PERIPHERAL ATHERECTOMY RENAL ARTERY EA,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
0236T,CPT,TRLUML PERIPH ATHRC W/RS&I ABDOM AORTA,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
0237T,CPT,TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
0238T,CPT,TRLUML PERIPHERAL ATHERECTOMY ILIAC ARTERY EA,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
0249T,CPT,LIGATION HEMORRHOID BUNDLE W/US,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
0253T,CPT,INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR,,30,,,"$14,374.95",$0.00,1,0,1,20161001,
0263T,CPT,AUTO BONE MARRW CELL RX COMPLT BONE MARRW HARVST,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
0264T,CPT,AUTO BONE MARRW CELL RX COMP W/O BONE MAR HARVST,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
0265T,CPT,BONE MAR HARVST ONLY FOR INTMUSC AUTOLO CELL RX,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
0267T,CPT,IM/REPL CARTD SINS BAROREFLX ACTIV DEV LEAD ONLY,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0268T,CPT,IM/REPL CARTD SINS BARREFLX ACT DEV PLS GEN ONLY,,30,,,"$34,569.16",$0.00,1,0,1,20161001,
0269T,CPT,REV/REMVL CARTD SINS BARREFLX ACT DEV TOT SYSTEM,,30,,,"$17,171.61",$0.00,1,0,1,20161001,
0270T,CPT,REV/REMVL CARTD SINS BARREFLX ACT DEV LEAD ONLY,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0271T,CPT,REV/REM CARTD SINS BARREFLX ACT DEV PLS GEN ONLY,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0272T,CPT,INTRGORTION DEV EVAL CARTD SINS BARREFLX W/I&R,,30,,,$746.33,$0.00,1,0,1,20161001,
0273T,CPT,INTROGATION DEV EVAL CARTD SINS BARREFLX W/PRGRM,,30,,,$746.33,$0.00,1,0,1,20161001,
0274T,CPT,PERC LAMINO-/LAMINECTOMY IMAGE GUIDE CERV/THORAC,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
0275T,CPT,PERC LAMINO-/LAMINECTOMY INDIR IMAG GUIDE LUMBAR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
0278T,CPT,TRNSCUT ELECT MODLATION PAIN REPROCES EA TX SESS,,30,,,$746.33,$0.00,1,0,1,20161001,
0282T,CPT,PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ TRIAL,,30,,,"$21,925.21",$0.00,1,0,1,20161001,
0283T,CPT,PERC/OPEN IMPLNT NEUROSTIM ELECTRODE SUBQ PERM,,30,,,"$53,493.40",$0.00,1,0,1,20161001,
0284T,CPT,REV/REMVL PG/ELCTRODES IMAGNG ADDN NEW ELCTRODES,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0285T,CPT,ELEC ANLYS IMPLANT SUBQ FIELD STIM PG REPROGRAMM,,30,,,"$5,383.20",$0.00,1,0,1,20161001,
0288T,CPT,ANSCPY W/DELVRY THERMAL ENERGY MUSCLE ANAL CANAL,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
0291T,CPT,INTRAV OPTCL CHERNCE TMGRPHY W/S&I INTL VESL,,30,,,"$6,297.43",$0.00,1,0,1,20161001,
0296T,CPT,EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD,,30,,,$425.53,$0.00,1,0,1,20161001,
0297T,CPT,EXT ECG > 48HR TO 21 DAY SCAN ANALYSIS W/REPORT,,30,,,$425.53,$0.00,1,0,1,20161001,
0298T,CPT,EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN,,30,,,$135.05,$0.00,1,0,1,20161001,
0299T,CPT,ESW HI ENERGY W/TOPCAL APP &DRESNG CARE 1ST WND,,30,,,"$1,129.82",$0.00,1,0,1,20161001,
0300T,CPT,ESW HI ENERGY W/TOPCAL APP &DRESNG CARE ADL WND,,30,,,$632.75,$0.00,1,0,1,20161001,
0301T,CPT,DEST/REDUC MALIG BRST TUMR W/US THRMORX GUIDANCE,,30,,,"$12,086.70",$0.00,1,0,1,20161001,
0302T,CPT,INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS COMPL,,30,,,"$21,356.85",$0.00,1,0,1,20161001,
0303T,CPT,INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS ELTRD,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
0304T,CPT,INSJ/RMVL RPLCMT ICAR ISCHM MNTRNG SYS DEVICE,,30,,,"$23,405.61",$0.00,1,0,1,20161001,
0305T,CPT,PROGRAM EVAL ICAR ISCHM MNTRNG SYS,,30,,,$221.12,$0.00,1,0,1,20161001,
0306T,CPT,INTERROGATION EVAL ICAR ISCHM MNTRNG SYS,,30,,,$221.12,$0.00,1,0,1,20161001,
0307T,CPT,RMVL INTRACARDIAC ISCHEMIA MONITORING DEVICE,,30,,,"$13,414.72",$0.00,1,0,1,20161001,
0308T,CPT,INSJ OC TLSCP PROSTH RMVL CRYSTALLINE/IO LENS,,30,,,"$35,101.66",$0.00,1,0,1,20161001,
0310T,CPT,MOTOR FUNCTION MAPPING NAVIGATED TMS TX PLAN,,30,,,$746.33,$0.00,1,0,1,20161001,
0312T,CPT,LAPS IMPLTJ NSTIM ELTRD ARRAY&PLS GEN VAGUS NRV,,30,,,"$53,456.78",$0.00,1,0,1,20161001,
0313T,CPT,LAPS REVJ/REPLCMT NSTIM ELTRD ARRAY VAGUS NRV,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0314T,CPT,LAPS RMVL NSTIM ELTRD ARRAY & PLS GEN VAGUS NRV,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0315T,CPT,REMOVAL PULSE GENERATOR VAGUS NERVE,,30,,,"$12,149.27",$0.00,1,0,1,20161001,
0316T,CPT,REPLACEMENT PULSE GENERATOR VAGUS NERVE,,30,,,"$53,456.78",$0.00,1,0,1,20161001,
0317T,CPT,ELEC ALYS NSTIM PLS GEN VAGUS NRV W/REPRGRMG,,30,,,$221.12,$0.00,1,0,1,20161001,
0330T,CPT,TEAR FILM IMAGING UNILATERAL OR BILATERAL W/I&R,,30,,,$156.54,$0.00,1,0,1,20161001,
0331T,CPT,MYOCRD SYMPATHETIC INNERVAJ IMG PLNR QUAL&QUANT,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
0332T,CPT,MYOCRD SYMP INNERVAJ IMG PLNR QUAL&QUANT W/SPECT,,30,,,"$7,015.43",$0.00,1,0,1,20161001,
0335T,CPT,EXTRA-OSSEOUS JOINT IMPLANT TALOTARSAL STABILIZE,,30,,,"$13,296.11",$0.00,1,0,1,20161001,
0336T,CPT,LAPS ABLATJ UTERINE FIBROIDS W/INTRAOP US GDNC,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
0337T,CPT,ENDOTHELIAL FUNCTION ASSESSMENT NON-INVASIVE,,30,,,$306.21,$0.00,1,0,1,20161001,
0338T,CPT,TRANSCATHETER RENAL SYMPATH DENERVATION UNILAT,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
0339T,CPT,TRANSCATHETER RENAL SYMPATH DENERVATION BILAT,,30,,,"$20,486.16",$0.00,1,0,1,20161001,
0340T,CPT,ABLATE PULM TUMORS W/PLEURA/CHEST WALL EXTSN,,30,,,"$19,258.15",$0.00,1,0,1,20161001,
0342T,CPT,THERAPEUTIC APHERESIS W/SELECTIVE HDL DELIP,,30,,,"$15,645.14",$0.00,1,0,1,20161001,
0347T,CPT,PLACE INTERSTITIAL DEVICE(S) IN BONE FOR RSA,,30,,,$306.21,$0.00,1,0,1,20161001,
0348T,CPT,RADIOSTEREOMETRIC ANALYSIS SPINE EXAM,,30,,,$655.16,$0.00,1,0,1,20161001,
0349T,CPT,RADIOSTEREOMETRIC ANALYSIS UPPER EXTREMITY EXAM,,30,,,$655.16,$0.00,1,0,1,20161001,
0350T,CPT,RADIOSTEREOMETRIC ANALYSIS LOWER EXTREMITY EXAM,,30,,,$399.19,$0.00,1,0,1,20161001,
0355T,CPT,GI TRACT IMAGING INTRALUMINAL COLON WITH I&R,,30,,,"$4,669.88",$0.00,1,0,1,20161001,
0356T,CPT,INSERT DRUG IMPLANT INTO LACRIMAL CANAL FOR IOP,,30,,,$306.21,$0.00,1,0,1,20161001,
0357T,CPT,CRYOPRESERVATION IMMATURE OOCYTE(S),,30,,,$424.20,$0.00,1,0,1,20161001,
0358T,CPT,BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R,,30,,,$156.54,$0.00,1,0,1,20161001,
0359T,CPT,BEHAVIORAL IDENTIFICATION ASSESSMENT,,30,,,$217.87,$0.00,1,0,1,20161001,
0360T,CPT,OBSERVATIONAL BEHAV ASSESSMENT FIRST 30 MIN,,30,,,$217.87,$0.00,1,0,1,20161001,
0361T,CPT,OBSERVATIONAL BEHAV ASSESSMENT ADDL 30 MIN,,30,,,$209.50,$0.00,1,0,1,20161001,
0362T,CPT,EXPOSURE BEHAV ASSESSMENT FIRST 30 MIN,,30,,,$217.87,$0.00,1,0,1,20161001,
0363T,CPT,EXPOSURE BEHAV ASSESSMENT ADDL 30 MIN,,30,,,$209.50,$0.00,1,0,1,20161001,
0364T,CPT,ADAPTIVE BEHAVIOR TX BY PROTOCOL FIRST 30 MIN,,30,,,$411.86,$0.00,1,0,1,20161001,
0365T,CPT,ADAPTIVE BEHAVIOR TX BY PROTOCOL ADDL 30 MIN,,30,,,$420.74,$0.00,1,0,1,20161001,
0366T,CPT,GROUP BEHAVIOR TREATMENT FIRST 30 MIN,,30,,,$351.69,$0.00,1,0,1,20161001,
0367T,CPT,GROUP BEHAVIOR TREATMENT ADDL 30 MIN,,30,,,$346.76,$0.00,1,0,1,20161001,
0368T,CPT,BEHAVIOR TX WITH MODIFICATION FIRST 30 MIN,,30,,,$411.86,$0.00,1,0,1,20161001,
0369T,CPT,BEHAVIOR TREATMENT WITH MODIFICATION ADDL 30 MIN,,30,,,$420.74,$0.00,1,0,1,20161001,
0370T,CPT,FAMILY BEHAVIOR TREATMENT GUIDANCE,,30,,,$501.07,$0.00,1,0,1,20161001,
0371T,CPT,MULTIPLE FAMILY GROUP BEHAV TREATMENT GUIDANCE,,30,,,$501.07,$0.00,1,0,1,20161001,
0372T,CPT,BEHAVIOR TREATMENT SOCIAL SKILLS TRAINING GROUP,,30,,,$351.69,$0.00,1,0,1,20161001,
0373T,CPT,EXPOSURE BEHAVIOR TREATMENT FIRST 60 MIN,,30,,,$479.14,$0.00,1,0,1,20161001,
0374T,CPT,EXPOSURE BEHAVIOR TREATMENT ADDL 30 MIN,,30,,,$286.35,$0.00,1,0,1,20161001,
0377T,CPT,ANOSCOPY W/BULKING AGENT INJ FOR FECAL INCONT,,30,,,"$12,930.47",$0.00,1,0,1,20161001,
0379T,CPT,VISUAL FIELD ASSESSMENT TECH SUPPORT W/INSTRUCT,,30,,,$156.54,$0.00,1,0,1,20161001,
0380T,CPT,COMP ANIMATION RETINA IMAGE TIME SERIES ANALYSIS,,30,,,$156.54,$0.00,1,0,1,20161001,
0387T,CPT,TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
0388T,CPT,TRANSCATH REMOVAL LEADLESS PM VENTRICULAR,,30,,,"$12,538.22",$0.00,1,0,1,20161001,
0389T,CPT,PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM,,30,,,$221.12,$0.00,1,0,1,20161001,
0391T,CPT,INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST,,30,,,$221.12,$0.00,1,0,1,20161001,
0392T,CPT,LAPS ESOPHGL SPHINCTER AUGMENT PROC PLACE DEVICE,,30,,,"$23,460.56",$0.00,1,0,1,20161001,
0393T,CPT,ESOPHGL SPHINCTER AUGMENT DEVICE REMOVAL,,30,,,"$16,186.33",$0.00,1,0,1,20161001,
0394T,CPT,HDR ELECTRONIC BRACHYTHERAPY SKIN SURFACE,,30,,,"$1,248.43",$0.00,1,0,1,20161001,
0395T,CPT,HDR ELECTRONIC BRACHYTHERAPY NTRSTL/INTRCAV,,30,,,"$4,314.55",$0.00,1,0,1,20161001,
0402T,CPT,COLLAGEN CROSS-LINKING OF CORNEA,,30,,,"$4,317.49",$0.00,1,0,1,20161001,
0404T,CPT,TRANSCERVICAL UTERINE FIBROID ABLTJ W/US GDN RF,,30,,,"$22,455.71",$0.00,1,0,1,20161001,
A0380,HCPCS,BLS MILEAGE (PER MILE),,30,,,$19.19,$0.00,4,1,1,20161001,
A0390,HCPCS,ALS MILEAGE (PER MILE),,30,,,$19.19,$0.00,4,1,1,20161001,
A0425,HCPCS,"GROUND MILEAGE, PER STATUTE MILE",,30,,,$19.19,$0.00,4,1,1,20161001,
A0426,HCPCS,"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)",,30,,,"$1,138.59",$0.00,1,1,1,20161001,
A0427,HCPCS,"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)",,30,,,"$1,401.25",$0.00,1,1,1,20161001,
A0428,HCPCS,"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON-EMERGENCY TRANSPORT, (BLS)",,30,,,$798.09,$0.00,1,1,1,20161001,
A0429,HCPCS,"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS-EMERGENCY)",,30,,,$947.37,$0.00,1,1,1,20161001,
A0430,HCPCS,"AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING)",,30,,,"$20,850.51",$0.00,1,1,1,20161001,
A0431,HCPCS,"AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING)",,30,,,"$23,019.98",$0.00,1,1,1,20161001,
A0433,HCPCS,"ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)",,30,,,"$1,641.80",$0.00,1,1,1,20161001,
A0434,HCPCS,SPECIALTY CARE TRANSPORT (SCT),,30,,,"$2,836.37",$0.00,1,1,1,20161001,
A0435,HCPCS,"FIXED WING AIR MILEAGE, PER STATUTE MILE",,30,,,$168.04,$0.00,4,1,1,20161001,
A0436,HCPCS,"ROTARY WING AIR MILEAGE, PER STATUTE MILE",,30,,,$284.75,$0.00,4,1,1,20161001,
A4641,HCPCS,RADIOPHARM DX AGENT NOC,,30,,,$41.71,$0.00,1,0,1,20161001,
A4642,HCPCS,IN111 SATUMOMAB,,30,,,$27.86,$0.00,1,0,1,20161001,
A4648,HCPCS,IMPLANTABLE TISSUE MARKER,,30,,,$283.00,$0.00,1,0,1,20161001,
A9150,HCPCS,MISC/EXPER NON-PRESCRIPT DRU,,30,,,$20.35,$0.00,1,0,1,20161001,
A9152,HCPCS,SINGLE VITAMIN NOS,,30,,,$27.58,$0.00,1,0,1,20161001,
A9153,HCPCS,MULTI-VITAMIN NOS,,30,,,$26.89,$0.00,1,0,1,20161001,
A9500,HCPCS,TC99M SESTAMIBI,,30,,,$283.00,$0.00,1,0,1,20161001,
A9502,HCPCS,TC99M TETROFOSMIN,,30,,,$297.64,$0.00,1,0,1,20161001,
A9503,HCPCS,TC99M MEDRONATE,,30,,,$56.60,$0.00,1,0,1,20161001,
A9505,HCPCS,TL201 THALLIUM,,30,,,$168.10,$0.00,1,0,1,20161001,
A9507,HCPCS,IN111 CAPROMAB,,30,,,"$5,041.47",$0.00,1,0,1,20161001,
A9508,HCPCS,"I131 IODOBENGUATE, DX",,30,,,$47.26,$0.00,1,0,1,20161001,
A9509,HCPCS,IODINE I-123 SOD IODIDE MIL,,30,,,$137.42,$0.00,1,0,1,20161001,
A9510,HCPCS,TC99M DISOFENIN,,30,,,$95.51,$0.00,1,0,1,20161001,
A9512,HCPCS,TC99M PERTECHNETATE,,30,,,$5.66,$0.00,1,0,1,20161001,
A9516,HCPCS,IODINE I-123 SOD IODIDE MIC,,30,,,$121.69,$0.00,1,0,1,20161001,
A9517,HCPCS,"I131 IODIDE CAP, RX",,30,,,$264.26,$0.00,1,0,1,20161001,
A9520,HCPCS,TC99 TILMANOCEPT DIAG 0.5MCI,,30,,,"$1,608.95",$0.00,1,0,1,20161001,
A9521,HCPCS,TC99M EXAMETAZIME,,30,,,"$1,198.71",$0.00,1,0,1,20161001,
A9524,HCPCS,"I131 SERUM ALBUMIN, DX",,30,,,$241.38,$0.00,1,0,1,20161001,
A9526,HCPCS,NITROGEN N-13 AMMONIA,,30,,,$707.49,$0.00,1,0,1,20161001,
A9527,HCPCS,IODINE I-125 SODIUM IODIDE,,30,,,$46.41,$0.00,1,0,1,20161001,
A9528,HCPCS,"IODINE I-131 IODIDE CAP, DX",,30,,,$365.68,$0.00,1,0,1,20161001,
A9529,HCPCS,"I131 IODIDE SOL, DX",,30,,,$74.61,$0.00,1,0,1,20161001,
A9530,HCPCS,"I131 IODIDE SOL, RX",,30,,,$66.82,$0.00,1,0,1,20161001,
A9531,HCPCS,I131 MAX 100UCI,,30,,,$17.26,$0.00,1,0,1,20161001,
A9537,HCPCS,TC99M MEBROFENIN,,30,,,$100.46,$0.00,1,0,1,20161001,
A9538,HCPCS,TC99M PYROPHOSPHATE,,30,,,$106.12,$0.00,1,0,1,20161001,
A9539,HCPCS,TC99M PENTETATE,,30,,,$70.75,$0.00,1,0,1,20161001,
A9540,HCPCS,TC99M MAA,,30,,,$36.79,$0.00,1,0,1,20161001,
A9541,HCPCS,TC99M SULFUR COLLOID,,30,,,$134.42,$0.00,1,0,1,20161001,
A9542,HCPCS,"IN111 IBRITUMOMAB, DX",,30,,,"$14,904.07",$0.00,1,0,1,20161001,
A9543,HCPCS,"Y90 IBRITUMOMAB, RX",,30,,,"$90,752.18",$0.00,1,0,1,20161001,
A9545,HCPCS,"I131 TOSITUMOMAB, RX",,30,,,"$65,462.68",$0.00,1,0,1,20161001,
A9547,HCPCS,IN111 OXYQUINOLINE,,30,,,"$1,142.92",$0.00,1,0,1,20161001,
A9548,HCPCS,IN111 PENTETATE,,30,,,$685.75,$0.00,1,0,1,20161001,
A9551,HCPCS,TC99M SUCCIMER,,30,,,$409.62,$0.00,1,0,1,20161001,
A9552,HCPCS,F18 FDG,,30,,,$778.24,$0.00,1,0,1,20161001,
A9553,HCPCS,CR51 CHROMATE,,30,,,"$2,943.11",$0.00,1,0,1,20161001,
A9554,HCPCS,"I125 IOTHALAMATE, DX",,30,,,"$1,379.61",$0.00,1,0,1,20161001,
A9555,HCPCS,RB82 RUBIDIUM,,30,,,$848.99,$0.00,1,0,1,20161001,
A9556,HCPCS,GA67 GALLIUM,,30,,,$85.67,$0.00,1,0,1,20161001,
A9557,HCPCS,TC99M BICISATE,,30,,,$365.73,$0.00,1,0,1,20161001,
A9558,HCPCS,XE133 XENON 10MCI,,30,,,$124.57,$0.00,1,0,1,20161001,
A9560,HCPCS,TC99M LABELED RBC,,30,,,$226.40,$0.00,1,0,1,20161001,
A9561,HCPCS,TC99M OXIDRONATE,,30,,,$71.95,$0.00,1,0,1,20161001,
A9562,HCPCS,TC99M MERTIATIDE,,30,,,$438.24,$0.00,1,0,1,20161001,
A9563,HCPCS,P32 NA PHOSPHATE,,30,,,"$1,369.97",$0.00,1,0,1,20161001,
A9564,HCPCS,P32 CHROMIC PHOSPHATE,,30,,,"$5,532.45",$0.00,1,0,1,20161001,
A9567,HCPCS,TECHNETIUM TC-99M AEROSOL,,30,,,$59.43,$0.00,1,0,1,20161001,
A9568,HCPCS,TECHNETIUM TC99M ARCITUMOMAB,,30,,,$245.74,$0.00,1,0,1,20161001,
A9569,HCPCS,TECHNETIUM TC-99M AUTO WBC,,30,,,$3.45,$0.00,1,0,1,20161001,
A9570,HCPCS,INDIUM IN-111 AUTO WBC,,30,,,$338.90,$0.00,1,0,1,20161001,
A9572,HCPCS,INDIUM IN-111 PENTETREOTIDE,,30,,,"$5,398.15",$0.00,1,0,1,20161001,
A9576,HCPCS,INJ PROHANCE MULTIPACK,,30,,,$5.66,$0.00,1,0,1,20161001,
A9577,HCPCS,INJ MULTIHANCE,,30,,,$8.49,$0.00,1,0,1,20161001,
A9578,HCPCS,INJ MULTIHANCE MULTIPACK,,30,,,$8.49,$0.00,1,0,1,20161001,
A9579,HCPCS,"GAD-BASE MR CONTRAST NOS,1ML",,30,,,$8.49,$0.00,1,0,1,20161001,
A9580,HCPCS,SODIUM FLUORIDE F-18,,30,,,$690.51,$0.00,1,0,1,20161001,
A9582,HCPCS,IODINE I-123 IOBENGUANE,,30,,,"$4,192.45",$0.00,1,0,1,20161001,
A9583,HCPCS,GADOFOSVESET TRISODIUM INJ,,30,,,$39.62,$0.00,1,0,1,20161001,
A9584,HCPCS,IODINE I-123 IOFLUPANE,,30,,,"$3,361.99",$0.00,1,0,1,20161001,
A9585,HCPCS,GADOBUTROL INJECTION,,30,,,$1.56,$0.00,1,0,1,20161001,
A9586,HCPCS,FLORBETAPIR F18,,30,,,"$14,518.53",$0.00,1,0,1,20161001,
A9599,HCPCS,RADIOPHA DX BETA AMYLOID PET,,30,,,$32.86,$0.00,1,0,1,20161001,
A9600,HCPCS,SR89 STRONTIUM,,30,,,"$7,035.60",$0.00,1,0,1,20161001,
A9604,HCPCS,SM 153 LEXIDRONAM,,30,,,"$22,779.51",$0.00,1,0,0,20161001,
A9606,HCPCS,RADIUM RA223 DICHLORIDE THER,,30,,,$627.35,$0.00,1,0,1,20161001,
A9698,HCPCS,NON-RAD CONTRAST MATERIALNOC,,30,,,$32.47,$0.00,1,0,1,20161001,
A9699,HCPCS,RADIOPHARM RX AGENT NOC,,30,,,$32.47,$0.00,1,0,1,20161001,
A9700,HCPCS,ECHOCARDIOGRAPHY CONTRAST,,30,,,$426.65,$0.00,1,0,1,20161001,
B4100,HCPCS,FOOD THICKENER ORAL,,30,,,$0.92,$0.00,1,0,1,20161001,
B4102,HCPCS,EF ADULT FLUIDS AND ELECTRO,,30,,,$3.80,$0.00,1,0,1,20161001,
B4103,HCPCS,EF PED FLUID AND ELECTROLYTE,,30,,,$12.97,$0.00,1,0,1,20161001,
B4104,HCPCS,ADDITIVE FOR ENTERAL FORMULA,,30,,,$10.05,$0.00,1,0,1,20161001,
B4149,HCPCS,EF BLENDERIZED FOODS,,30,,,$2.93,$0.00,1,0,1,20161001,
B4150,HCPCS,EF COMPLET W/INTACT NUTRIENT,,30,,,$0.85,$0.00,1,0,1,20161001,
B4152,HCPCS,EF CALORIE DENSE>/=1.5KCAL,,30,,,$0.69,$0.00,1,0,1,20161001,
B4153,HCPCS,EF HYDROLYZED/AMINO ACIDS,,30,,,$3.72,$0.00,1,0,1,20161001,
B4154,HCPCS,EF SPEC METABOLIC NONINHERIT,,30,,,$2.10,$0.00,1,0,1,20161001,
B4155,HCPCS,EF INCOMPLETE/MODULAR,,30,,,$1.46,$0.00,1,0,1,20161001,
B4157,HCPCS,EF SPECIAL METABOLIC INHERIT,,30,,,$10.14,$0.00,1,0,1,20161001,
B4158,HCPCS,EF PED COMPLETE INTACT NUT,,30,,,$4.47,$0.00,1,0,1,20161001,
B4159,HCPCS,EF PED COMPLETE SOY BASED,,30,,,$4.97,$0.00,1,0,1,20161001,
B4160,HCPCS,EF PED CALORIC DENSE>/=0.7KC,,30,,,$4.18,$0.00,1,0,1,20161001,
B4161,HCPCS,EF PED HYDROLYZED/AMINO ACID,,30,,,$9.34,$0.00,1,0,1,20161001,
B4162,HCPCS,EF PED SPECMETABOLIC INHERIT,,30,,,$15.44,$0.00,1,0,1,20161001,
B4164,HCPCS,PARENTERAL 50% DEXTROSE SOLU,,30,,,$43.93,$0.00,1,0,1,20161001,
B4168,HCPCS,PARENTERAL SOL AMINO ACID 3.,,30,,,$64.40,$0.00,1,0,1,20161001,
B4172,HCPCS,PARENTERAL SOL AMINO ACID 5.,,30,,,$118.95,$0.00,1,0,1,20161001,
B4176,HCPCS,PARENTERAL SOL AMINO ACID 7-,,30,,,$125.32,$0.00,1,0,1,20161001,
B4178,HCPCS,PARENTERAL SOL AMINO ACID >,,30,,,$150.58,$0.00,1,0,1,20161001,
B4180,HCPCS,PARENTERAL SOL CARB > 50%,,30,,,$63.39,$0.00,1,0,1,20161001,
B4185,HCPCS,PARENTERAL SOL 10 GM LIPIDS,,30,,,$28.80,$0.00,1,0,1,20161001,
B4189,HCPCS,PARENTERAL SOL AMINO ACID &,,30,,,$466.74,$0.00,1,0,1,20161001,
B4193,HCPCS,PARENTERAL SOL 52-73 GM PROT,,30,,,$603.30,$0.00,1,0,1,20161001,
B4197,HCPCS,PARENTERAL SOL 74-100 GM PRO,,30,,,$734.66,$0.00,1,0,1,20161001,
B4199,HCPCS,PARENTERAL SOL > 100GM PROTE,,30,,,$839.57,$0.00,1,0,1,20161001,
B5000,HCPCS,PARENTERAL SOL RENAL-AMIROSY,,30,,,$30.51,$0.00,1,0,1,20161001,
B5100,HCPCS,PARENTERAL SOLUTION HEPATIC,,30,,,$11.46,$0.00,1,0,1,20161001,
B5200,HCPCS,PARENTERAL SOL HEPATIC FREAM,,30,,,$604.83,$0.00,1,0,1,20161001,
C1716,HCPCS,"BRACHYTX, NON-STR, GOLD-198",,30,,,$289.98,$0.00,1,0,1,20161001,
C1717,HCPCS,"BRACHYTX, NON-STR,HDR IR-192",,30,,,"$1,743.60",$0.00,1,0,1,20161001,
C1719,HCPCS,"BRACHYTX, NS, NON-HDRIR-192",,30,,,$593.02,$0.00,1,0,1,20161001,
C1749,HCPCS,"ENDO, COLON, RETRO IMAGING",,30,,,"$4,235.04",$0.00,1,0,1,20161001,
C1773,HCPCS,"RET DEV, INSERTABLE",,30,,,"$1,600.65",$0.00,1,0,1,20161001,
C1814,HCPCS,"RETINAL TAMP, SILICONE OIL",,30,,,"$2,339.14",$0.00,1,0,1,20161001,
C1819,HCPCS,TISSUE LOCALIZATION-EXCISION,,30,,,"$1,320.18",$0.00,1,0,1,20161001,
C1886,HCPCS,"CATHETER, ABLATION",,30,,,"$5,028.53",$0.00,1,0,1,20161001,
C2616,HCPCS,"BRACHYTX, NON-STR,YTTRIUM-90",,30,,,"$31,706.80",$0.00,1,0,1,20161001,
C2629,HCPCS,"INTRO/SHEATH, LASER",,30,,,$590.44,$0.00,1,0,1,20161001,
C2630,HCPCS,"CATH, EP, COOL-TIP",,30,,,"$9,508.16",$0.00,1,0,1,20161001,
C2634,HCPCS,"BRACHYTX, NON-STR, HA, I-125",,30,,,$506.36,$0.00,1,0,1,20161001,
C2635,HCPCS,"BRACHYTX, NON-STR, HA, P-103",,30,,,$197.01,$0.00,1,0,1,20161001,
C2636,HCPCS,"BRACHY LINEAR, NON-STR,P-103",,30,,,$80.91,$0.00,1,0,1,20161001,
C2638,HCPCS,"BRACHYTX, STRANDED, I-125",,30,,,$238.35,$0.00,1,0,1,20161001,
C2639,HCPCS,"BRACHYTX, NON-STRANDED,I-125",,30,,,$220.72,$0.00,1,0,1,20161001,
C2640,HCPCS,"BRACHYTX, STRANDED, P-103",,30,,,$408.52,$0.00,1,0,1,20161001,
C2641,HCPCS,"BRACHYTX, NON-STRANDED,P-103",,30,,,$412.37,$0.00,1,0,1,20161001,
C2642,HCPCS,"BRACHYTX, STRANDED, C-131",,30,,,$507.57,$0.00,1,0,1,20161001,
C2643,HCPCS,"BRACHYTX, NON-STRANDED,C-131",,30,,,$296.47,$0.00,1,0,1,20161001,
C2644,HCPCS,BRACHYTX CESIUM-131 CHLORIDE,,30,,,$73.95,$0.00,1,0,1,20161001,
C2698,HCPCS,"BRACHYTX, STRANDED, NOS",,30,,,$238.35,$0.00,1,0,1,20161001,
C2699,HCPCS,"BRACHYTX, NON-STRANDED, NOS",,30,,,$197.01,$0.00,1,0,1,20161001,
C5271,HCPCS,LOW COST SKIN SUBSTITUTE APP,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
C5273,HCPCS,LOW COST SKIN SUBSTITUTE APP,,30,,,"$11,957.43",$0.00,1,0,1,20161001,
C5275,HCPCS,LOW COST SKIN SUBSTITUTE APP,,30,,,"$2,409.56",$0.00,1,0,1,20161001,
C5277,HCPCS,LOW COST SKIN SUBSTITUTE APP,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
C8900,HCPCS,"MRA W/CONT, ABD",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8901,HCPCS,"MRA W/O CONT, ABD",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8902,HCPCS,"MRA W/O FOL W/CONT, ABD",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8903,HCPCS,"MRI W/CONT, BREAST,  UNI",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8904,HCPCS,"MRI W/O CONT, BREAST, UNI",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8905,HCPCS,"MRI W/O FOL W/CONT, BRST, UN",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8906,HCPCS,"MRI W/CONT, BREAST,  BI",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8907,HCPCS,"MRI W/O CONT, BREAST, BI",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8908,HCPCS,"MRI W/O FOL W/CONT, BREAST,",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8909,HCPCS,"MRA W/CONT, CHEST",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8910,HCPCS,"MRA W/O CONT, CHEST",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8911,HCPCS,"MRA W/O FOL W/CONT, CHEST",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8912,HCPCS,"MRA W/CONT, LWR EXT",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8913,HCPCS,"MRA W/O CONT, LWR EXT",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8914,HCPCS,"MRA W/O FOL W/CONT, LWR EXT",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8918,HCPCS,"MRA W/CONT, PELVIS",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8919,HCPCS,"MRA W/O CONT, PELVIS",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8920,HCPCS,"MRA W/O FOL W/CONT, PELVIS",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8921,HCPCS,"TTE W OR W/O FOL W/CONT, COM",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8922,HCPCS,"TTE W OR W/O FOL W/CONT, F/U",,30,,,"$1,832.61",$0.00,1,0,1,20161001,
C8923,HCPCS,"2D TTE W OR W/O FOL W/CON,CO",,30,,,"$1,832.61",$0.00,1,0,1,20161001,
C8924,HCPCS,"2D TTE W OR W/O FOL W/CON,FU",,30,,,"$1,832.61",$0.00,1,0,1,20161001,
C8925,HCPCS,"2D TEE W OR W/O FOL W/CON,IN",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8926,HCPCS,"TEE W OR W/O FOL W/CONT,CONG",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8927,HCPCS,"TEE W OR W/O FOL W/CONT, MON",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8928,HCPCS,"TTE W OR W/O FOL W/CON,STRES",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8929,HCPCS,"TTE W OR WO FOL WCON,DOPPLER",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8930,HCPCS,"TTE W OR W/O CONTR, CONT ECG",,30,,,"$3,948.25",$0.00,1,0,1,20161001,
C8931,HCPCS,"MRA, W/DYE, SPINAL CANAL",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8932,HCPCS,"MRA, W/O DYE, SPINAL CANAL",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8933,HCPCS,"MRA, W/O&W/DYE, SPINAL CANAL",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8934,HCPCS,"MRA, W/DYE, UPPER EXTREMITY",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8935,HCPCS,"MRA, W/O DYE, UPPER EXTR",,30,,,"$1,801.06",$0.00,1,0,1,20161001,
C8936,HCPCS,"MRA, W/O&W/DYE, UPPER EXTR",,30,,,"$2,925.81",$0.00,1,0,1,20161001,
C8957,HCPCS,"PROLONGED IV INF, REQ PUMP",,30,,,"$1,532.23",$0.00,1,0,1,20161001,
C9113,HCPCS,"INJ PANTOPRAZOLE SODIUM, VIA",,30,,,$184.03,$0.00,1,0,1,20161001,
C9121,HCPCS,"INJECTION, ARGATROBAN",,30,,,$91.16,$0.00,1,0,1,20161001,
C9132,HCPCS,"KCENTRA, PER I.U.",,30,,,$9.05,$0.00,1,0,1,20161001,
C9248,HCPCS,"INJ, CLEVIDIPINE BUTYRATE",,30,,,$24.96,$0.00,1,0,1,20161001,
C9250,HCPCS,ARTISS FIBRIN SEALANT,,30,,,$775.94,$0.00,1,0,1,20161001,
C9254,HCPCS,"INJECTION, LACOSAMIDE",,30,,,$1.21,$0.00,1,0,1,20161001,
C9257,HCPCS,BEVACIZUMAB INJECTION,,30,,,$9.55,$0.00,1,0,1,20161001,
C9275,HCPCS,HEXAMINOLEVULINATE HCL,,30,,,"$4,001.92",$0.00,1,0,1,20161001,
C9285,HCPCS,"PATCH, LIDOCAINE/TETRACAINE",,30,,,$100.18,$0.00,1,0,1,20161001,
C9290,HCPCS,"INJ, BUPIVACAINE LIPOSOME",,30,,,$7.75,$0.00,1,0,1,20161001,
C9293,HCPCS,"INJECTION, GLUCARPIDASE",,30,,,"$1,439.30",$0.00,1,0,1,20161001,
C9349,HCPCS,"PURAPLY, PURAPLY ANTIMIC",,30,,,$656.98,$0.00,1,0,1,20161001,
C9352,HCPCS,"NEURAGEN NERVE GUIDE, PER CM",,30,,,"$6,739.46",$0.00,1,0,1,20161001,
C9353,HCPCS,"NEURAWRAP NERVE PROTECTOR,CM",,30,,,"$8,140.79",$0.00,1,0,1,20161001,
C9354,HCPCS,"VERITAS COLLAGEN MATRIX, CM2",,30,,,"$5,520.01",$0.00,1,0,1,20161001,
C9356,HCPCS,"TENOGLIDE TENDON PROT, CM2",,30,,,"$7,801.74",$0.00,1,0,1,20161001,
C9447,HCPCS,"INJ, PHENYLEPHRINE KETOROLAC",,30,,,"$3,099.81",$0.00,1,0,1,20161001,
C9460,HCPCS,"INJECTION, CANGRELOR",,30,,,$103.22,$0.00,1,0,1,20161001,
C9497,HCPCS,"LOXAPINE, INHALATION POWDER",,30,,,$901.71,$0.00,1,0,1,20161001,
C9600,HCPCS,PERC DRUG-EL COR STENT SING,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
C9601,HCPCS,PERC DRUG-EL COR STENT BRAN,,30,,,"$23,829.36",$0.00,1,0,1,20161001,
C9602,HCPCS,PERC D-E COR STENT ATHER S,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
C9603,HCPCS,PERC D-E COR STENT ATHER BR,,30,,,"$25,510.10",$0.00,1,0,1,20161001,
C9604,HCPCS,PERC D-E COR REVASC T CABG S,,30,,,"$20,838.57",$0.00,1,0,1,20161001,
C9605,HCPCS,PERC D-E COR REVASC T CABG B,,30,,,"$25,510.10",$0.00,1,0,1,20161001,
C9606,HCPCS,PERC D-E COR REVASC W AMI S,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
C9607,HCPCS,PERC D-E COR REVASC CHRO SIN,,30,,,"$29,536.30",$0.00,1,0,1,20161001,
C9608,HCPCS,PERC D-E COR REVASC CHRO ADD,,30,,,"$25,510.10",$0.00,1,0,1,20161001,
C9725,HCPCS,PLACE ENDORECTAL APP,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
C9726,HCPCS,RXT BREAST APPL PLACE/REMOV,,30,,,"$25,674.33",$0.00,1,0,1,20161001,
C9727,HCPCS,INSERT PALATE IMPLANTS,,30,,,"$4,229.51",$0.00,1,0,1,20161001,
C9728,HCPCS,"PLACE DEVICE/MARKER, NON PRO",,30,,,"$6,357.83",$0.00,1,0,1,20161001,
C9733,HCPCS,NON-OPHTHALMIC FVA,,30,,,"$2,033.10",$0.00,1,0,1,20161001,
C9734,HCPCS,"U/S TRTMT, NOT LEIOMYOMATA",,30,,,"$13,009.40",$0.00,1,0,1,20161001,
C9739,HCPCS,CYSTOSCOPY PROSTATIC IMP 1-3,,30,,,"$16,901.70",$0.00,1,0,1,20161001,
C9740,HCPCS,CYSTO IMPL 4 OR MORE,,30,,,"$21,750.00",$0.00,1,0,1,20161001,
C9741,HCPCS,IMPL PRESSURE SENSOR W/ANGIO         ,,30,,,"$13,781.56",$0.00,1,0,1,20161001,
C9742,HCPCS,LARYNGOSCOPY WITH INJECTION,,30,,,"$6,100.92",$0.00,1,0,1,20161001,
C9800,HCPCS,DERMAL FILLER INJ PX/SUPPL,,30,,,"$6,915.53",$0.00,1,0,1,20161001,
C9898,HCPCS,INPNT STAY RADIOLABELED ITEM,,30,,,$1.15,$0.00,1,0,1,20161001,
G0008,HCPCS,ADMIN INFLUENZA VIRUS VAC,,30,,,$223.07,$0.00,1,0,1,20161001,
G0009,HCPCS,ADMIN PNEUMOCOCCAL VACCINE,,30,,,$223.07,$0.00,1,0,1,20161001,
G0010,HCPCS,ADMIN HEPATITIS B VACCINE,,30,,,$274.68,$0.00,1,0,1,20161001,
G0027,HCPCS,SEMEN ANALYSIS,,30,,,$34.45,$0.00,1,0,1,20161001,
G0101,HCPCS,CA SCREEN;PELVIC/BREAST EXAM,,30,,,$134.54,$0.00,1,0,1,20161001,
G0102,HCPCS,PROSTATE CA SCREENING; DRE,,30,,,$57.42,$0.00,1,0,1,20161001,
G0103,HCPCS,PSA SCREENING,,30,,,$192.59,$0.00,1,0,1,20161001,
G0104,HCPCS,CA SCREEN;FLEXI SIGMOIDSCOPE,,30,,,"$3,147.16",$0.00,1,0,1,20161001,
G0105,HCPCS,COLORECTAL SCRN; HI RISK IND,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
G0106,HCPCS,COLON CA SCREEN;BARIUM ENEMA,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
G0117,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,30,,,$156.54,$0.00,1,0,1,20161001,
G0118,HCPCS,GLAUCOMA SCRN HGH RISK DIREC,,30,,,$156.54,$0.00,1,0,1,20161001,
G0120,HCPCS,COLON CA SCRN; BARIUM ENEMA,,30,,,"$2,155.12",$0.00,1,0,1,20161001,
G0121,HCPCS,COLON CA SCRN NOT HI RSK IND,,30,,,"$4,726.49",$0.00,1,0,1,20161001,
G0123,HCPCS,SCREEN CERV/VAG THIN LAYER,,30,,,$150.43,$0.00,1,0,1,20161001,
G0124,HCPCS,SCREEN C/V THIN LAYER BY MD,,30,,,$106.51,$0.00,1,0,1,20161001,
G0127,HCPCS,TRIM NAIL(S),,30,,,$306.21,$0.00,1,0,1,20161001,
G0128,HCPCS,CORF SKILLED NURSING SERVICE,,30,,,$75.81,$0.00,1,0,1,20161001,
G0130,HCPCS,SINGLE ENERGY X-RAY STUDY,,30,,,$399.19,$0.00,1,0,1,20161001,
G0141,HCPCS,"SCR C/V CYTO,AUTOSYS AND MD",,30,,,$141.87,$0.00,1,0,1,20161001,
G0143,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,30,,,$218.18,$0.00,1,0,1,20161001,
G0144,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,30,,,$68.90,$0.00,1,0,1,20161001,
G0145,HCPCS,"SCR C/V CYTO,THINLAYER,RESCR",,30,,,$227.37,$0.00,1,0,1,20161001,
G0147,HCPCS,"SCR C/V CYTO, AUTOMATED SYS",,30,,,$133.21,$0.00,1,0,1,20161001,
G0148,HCPCS,"SCR C/V CYTO, AUTOSYS, RESCR",,30,,,$143.54,$0.00,1,0,1,20161001,
G0151,HCPCS,"HHCP-SERV OF PT,EA 15 MIN",,30,,,$57.42,$0.00,1,0,1,20161001,
G0152,HCPCS,"HHCP-SERV OF OT,EA 15 MIN",,30,,,$55.69,$0.00,1,0,1,20161001,
G0153,HCPCS,"HHCP-SVS OF S/L PATH,EA 15MN",,30,,,$53.11,$0.00,1,0,1,20161001,
G0155,HCPCS,"HHCP-SVS OF CSW,EA 15 MIN",,30,,,$66.03,$0.00,1,0,1,20161001,
G0156,HCPCS,"HHCP-SVS OF AIDE,EA 15 MIN",,30,,,$22.97,$0.00,1,0,1,20161001,
G0157,HCPCS,HHC PT ASSISTANT EA 15,,30,,,$189.47,$0.00,1,0,1,20161001,
G0158,HCPCS,HHC OT ASSISTANT EA 15,,30,,,$223.92,$0.00,1,0,1,20161001,
G0159,HCPCS,HHC PT MAINT EA 15 MIN,,30,,,$229.67,$0.00,1,0,1,20161001,
G0160,HCPCS,HHC OCCUP THERAPY EA 15,,30,,,$200.96,$0.00,1,0,1,20161001,
G0161,HCPCS,HHC SLP EA 15 MIN,,30,,,$143.54,$0.00,1,0,1,20161001,
G0162,HCPCS,"HHC RN E&M PLAN SVS, 15 MIN",,30,,,$181.44,$0.00,1,0,1,20161001,
G0163,HCPCS,HHC LPN/RN OBS/ASSES EA 15,,30,,,$183.73,$0.00,1,0,1,20161001,
G0164,HCPCS,HHC LIS NURSE TRAIN EA 15,,30,,,$172.25,$0.00,1,0,1,20161001,
G0166,HCPCS,"EXTRNL COUNTERPULSE, PER TX",,30,,,$425.53,$0.00,1,0,1,20161001,
G0168,HCPCS,WOUND CLOSURE BY ADHESIVE,,30,,,$298.75,$0.00,1,0,1,20161001,
G0175,HCPCS,"OPPS SERVICE,SCHED TEAM CONF",,30,,,"$2,369.96",$0.00,1,0,1,20161001,
G0177,HCPCS,OPPS/PHP; TRAIN & EDUC SERV,,30,,,$284.79,$0.00,1,0,1,20161001,
G0179,HCPCS,MD RECERTIFICATION HHA PT,,30,,,$213.59,$0.00,1,0,1,20161001,
G0180,HCPCS,MD CERTIFICATION HHA PATIENT,,30,,,$196.89,$0.00,1,0,1,20161001,
G0182,HCPCS,HOSPICE CARE SUPERVISION,,30,,,$227.08,$0.00,1,0,1,20161001,
G0186,HCPCS,"DSTRY EYE LESN,FDR VSSL TECH",,30,,,"$2,637.79",$0.00,1,0,1,20161001,
G0204,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,30,,,$617.80,$0.00,1,0,1,20161001,
G0206,HCPCS,DIAGNOSTICMAMMOGRAPHYDIGITAL,,30,,,$471.96,$0.00,1,0,1,20161001,
G0219,HCPCS,PET IMG WHOLBOD MELANO NONCO,,30,,,"$2,406.74",$0.00,1,0,1,20161001,
G0235,HCPCS,PET NOT OTHERWISE SPECIFIED,,30,,,"$4,502.60",$0.00,1,0,1,20161001,
G0237,HCPCS,THERAPEUTIC PROCD STRG ENDUR,,30,,,$425.53,$0.00,1,0,1,20161001,
G0238,HCPCS,"OTH RESP PROC, INDIV",,30,,,$306.21,$0.00,1,0,1,20161001,
G0239,HCPCS,"OTH RESP PROC, GROUP",,30,,,$156.54,$0.00,1,0,1,20161001,
G0245,HCPCS,INITIAL FOOT EXAM PT LOPS,,30,,,$217.87,$0.00,1,0,1,20161001,
G0246,HCPCS,FOLLOWUP EVAL OF FOOT PT LOP,,30,,,$217.87,$0.00,1,0,1,20161001,
G0247,HCPCS,ROUTINE FOOTCARE PT W LOPS,,30,,,$398.75,$0.00,1,0,1,20161001,
G0248,HCPCS,DEMONSTRATE USE HOME INR MON,,30,,,$217.87,$0.00,1,0,1,20161001,
G0249,HCPCS,PROVIDE INR TEST MATER/EQUIP,,30,,,$217.87,$0.00,1,0,1,20161001,
G0250,HCPCS,MD INR TEST REVIE INTER MGMT,,30,,,$59.89,$0.00,1,0,1,20161001,
G0257,HCPCS,UNSCHED DIALYSIS ESRD PT HOS,,30,,,"$2,673.75",$0.00,1,0,1,20161001,
G0259,HCPCS,INJECT FOR SACROILIAC JOINT,,30,,,"$2,032.54",$0.00,1,0,1,20161001,
G0260,HCPCS,INJ FOR SACROILIAC JT ANESTH,,30,,,"$3,758.87",$0.00,1,0,1,20161001,
G0268,HCPCS,REMOVAL OF IMPACTED WAX MD,,30,,,$303.14,$0.00,1,0,1,20161001,
G0269,HCPCS,OCCLUSIVE DEVICE IN VEIN ART,,30,,,"$1,147.16",$0.00,1,0,1,20161001,
G0276,HCPCS,PILD/PLACEBO CONTROL CLIN TR,,30,,,"$20,802.20",$0.00,1,0,1,20161001,
G0277,HCPCS,"HBOT, FULL BODY CHAMBER, 30M",,30,,,$665.04,$0.00,1,0,1,20161001,
G0278,HCPCS,"ILIAC ART ANGIO,CARDIAC CATH",,30,,,"$3,272.74",$0.00,1,0,1,20161001,
G0282,HCPCS,ELECT STIM WOUND CARE NOT PD,,30,,,$227.66,$0.00,1,0,1,20161001,
G0288,HCPCS,"RECON, CTA FOR SURG PLAN",,30,,,"$2,721.25",$0.00,1,0,1,20161001,
G0289,HCPCS,"ARTHRO, LOOSE BODY + CHONDRO",,30,,,"$4,988.34",$0.00,1,0,1,20161001,
G0293,HCPCS,"NON-COV SURG PROC,CLIN TRIAL",,30,,,$156.54,$0.00,1,0,1,20161001,
G0294,HCPCS,"NON-COV PROC, CLINICAL TRIAL",,30,,,$156.54,$0.00,1,0,1,20161001,
G0296,HCPCS,VISIT TO DETERM LDCT ELIG,,30,,,$300.64,$0.00,1,0,1,20161001,
G0297,HCPCS,LDCT FOR LUNG CA SCREEN,,30,,,$726.75,$0.00,1,0,1,20161001,
G0299,HCPCS,HHS/HOSPICE OF RN EA 15 MIN,,30,,,$222.78,$0.00,1,0,1,20161001,
G0300,HCPCS,HHS/HOSPICE OF LPN EA 15 MIN,,30,,,$222.78,$0.00,1,0,1,20161001,
G0302,HCPCS,PRE-OP SERVICE LVRS COMPLETE,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
G0303,HCPCS,PRE-OP SERVICE LVRS 10-15DOS,,30,,,$746.33,$0.00,1,0,1,20161001,
G0304,HCPCS,PRE-OP SERVICE LVRS 1-9 DOS,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
G0305,HCPCS,POST OP SERVICE LVRS MIN 6,,30,,,"$5,245.62",$0.00,1,0,1,20161001,
G0306,HCPCS,CBC/DIFFWBC W/O PLATELET,,30,,,$125.79,$0.00,1,0,1,20161001,
G0307,HCPCS,CBC WITHOUT PLATELET,,30,,,$91.67,$0.00,1,0,1,20161001,
G0328,HCPCS,FECAL BLOOD SCRN IMMUNOASSAY,,30,,,$102.20,$0.00,1,0,1,20161001,
G0339,HCPCS,"ROBOT LIN-RADSURG COM, FIRST",,30,,,"$38,024.60",$0.00,1,0,1,20161001,
G0340,HCPCS,ROBT LIN-RADSURG FRACTX 2-5,,30,,,"$26,211.74",$0.00,1,0,1,20161001,
G0364,HCPCS,BONE MARROW ASPIRATE &BIOPSY,,30,,,$614.13,$0.00,1,0,1,20161001,
G0365,HCPCS,VESSEL MAPPING HEMO ACCESS,,30,,,"$1,024.59",$0.00,1,0,1,20161001,
G0378,HCPCS,HOSPITAL OBSERVATION PER HR,,30,,,$114.12,$0.00,1,1,1,20161001,
G0379,HCPCS,DIRECT REFER HOSPITAL OBSERV,,30,,,$114.12,$0.00,1,1,1,20161001,
G0380,HCPCS,LEV 1 HOSP TYPE B ED VISIT,,30,,,$433.17,$0.00,1,1,1,20161001,
G0381,HCPCS,LEV 2 HOSP TYPE B ED VISIT,,30,,,$447.16,$0.00,1,1,1,20161001,
G0382,HCPCS,LEV 3 HOSP TYPE B ED VISIT,,30,,,$763.39,$0.00,1,1,1,20161001,
G0383,HCPCS,LEV 4 HOSP TYPE B ED VISIT,,30,,,"$1,135.97",$0.00,1,1,1,20161001,
G0384,HCPCS,LEV 5 HOSP TYPE B ED VISIT,,30,,,"$1,824.60",$0.00,1,1,1,20161001,
G0389,HCPCS,ULTRASOUND EXAM AAA SCREEN,,30,,,$686.47,$0.00,1,0,1,20161001,
G0390,HCPCS,TRAUMA RESPONS W/HOSP CRITI,,30,,,"$2,460.65",$0.00,1,1,1,20161001,
G0396,HCPCS,ALCOHOL/SUBS INTERV 15-30MN,,30,,,$287.49,$0.00,1,0,1,20161001,
G0397,HCPCS,ALCOHOL/SUBS INTERV >30 MIN,,30,,,$416.51,$0.00,1,0,1,20161001,
G0398,HCPCS,HOME SLEEP TEST/TYPE 2 PORTA,,30,,,$666.94,$0.00,1,0,1,20161001,
G0399,HCPCS,HOME SLEEP TEST/TYPE 3 PORTA,,30,,,$746.33,$0.00,1,0,1,20161001,
G0400,HCPCS,HOME SLEEP TEST/TYPE 4 PORTA,,30,,,$666.94,$0.00,1,0,1,20161001,
G0402,HCPCS,INITIAL PREVENTIVE EXAM,,30,,,$217.87,$0.00,1,0,1,20161001,
G0404,HCPCS,EKG TRACING FOR INITIAL PREV,,30,,,$81.90,$0.00,1,0,1,20161001,
G0405,HCPCS,EKG INTERPRET & REPORT PREVE,,30,,,$129.76,$0.00,1,0,1,20161001,
G0409,HCPCS,CORF RELATED SERV 15 MINS EA,,30,,,$57.42,$0.00,1,0,1,20161001,
G0413,HCPCS,PELVIC RING FRACTURE UNI/BIL,,30,,,"$7,815.00",$0.00,1,0,1,20161001,
G0416,HCPCS,"PROSTATE BIOPSY, ANY MTHD",,30,,,"$1,229.40",$0.00,1,0,1,20161001,
G0422,HCPCS,INTENS CARDIAC REHAB W/EXERC,,30,,,$307.45,$0.00,1,0,1,20161001,
G0423,HCPCS,INTENS CARDIAC REHAB NO EXER,,30,,,$307.45,$0.00,1,0,1,20161001,
G0424,HCPCS,PULMONARY REHAB W EXER,,30,,,$306.21,$0.00,1,0,1,20161001,
G0432,HCPCS,EIA HIV-1/HIV-2 SCREEN,,30,,,$130.16,$0.00,1,0,1,20161001,
G0433,HCPCS,ELISA HIV-1/HIV-2 SCREEN,,30,,,$221.63,$0.00,1,0,1,20161001,
G0435,HCPCS,ORAL HIV-1/HIV-2 SCREEN,,30,,,$229.67,$0.00,1,0,1,20161001,
G0436,HCPCS,TOBACCO-USE COUNSEL 3-10 MIN,,30,,,$108.34,$0.00,1,0,1,20161001,
G0437,HCPCS,TOBACCO-USE COUNSEL>10MIN,,30,,,$287.49,$0.00,1,0,1,20161001,
G0442,HCPCS,ANNUAL ALCOHOL SCREEN 15 MIN,,30,,,$287.49,$0.00,1,0,1,20161001,
G0443,HCPCS,BRIEF ALCOHOL MISUSE COUNSEL,,30,,,$287.49,$0.00,1,0,1,20161001,
G0444,HCPCS,DEPRESSION SCREEN ANNUAL,,30,,,$108.34,$0.00,1,0,1,20161001,
G0445,HCPCS,HIGH INTEN BEH COUNS STD 30M,,30,,,$108.34,$0.00,1,0,1,20161001,
G0446,HCPCS,INTENS BEHAVE THER CARDIO DX,,30,,,$108.34,$0.00,1,0,1,20161001,
G0447,HCPCS,BEHAVIOR COUNSEL OBESITY 15M,,30,,,$287.49,$0.00,1,0,1,20161001,
G0451,HCPCS,DEVLOPMENT TEST INTERPT&REP,,30,,,$287.49,$0.00,1,0,1,20161001,
G0452,HCPCS,MOLECULAR PATHOLOGY INTERPR,,30,,,$258.19,$0.00,1,0,1,20161001,
G0453,HCPCS,CONT INTRAOP NEURO MONITOR,,30,,,$219.33,$0.00,1,0,1,20161001,
G0454,HCPCS,MD DOCUMENT VISIT BY NPP,,30,,,$160.12,$0.00,1,0,1,20161001,
G0455,HCPCS,FECAL MICROBIOTA PREP INSTIL,,30,,,$425.53,$0.00,1,0,1,20161001,
G0459,HCPCS,TELEHEALTH INPT PHARM MGMT,,30,,,$194.00,$0.00,1,0,1,20161001,
G0460,HCPCS,AUTOLOGOUS PRP FOR ULCERS,,30,,,"$6,908.09",$0.00,1,0,1,20161001,
G0463,HCPCS,HOSPITAL OUTPT CLINIC VISIT,,30,,,$217.87,$0.00,1,0,1,20161001,
G0473,HCPCS,GROUP BEHAVE COUNS 2-10,,30,,,$280.17,$0.00,1,0,1,20161001,
G3001,HCPCS,"ADMIN + SUPPLY, TOSITUMOMAB",,30,,,"$11,108.85",$0.00,1,0,1,20161001,
G6001,HCPCS,ECHO GUIDANCE RADIOTHERAPY,,30,,,$676.95,$0.00,1,0,1,20161001,
G6002,HCPCS,STEREOSCOPIC X-RAY GUIDANCE,,30,,,"$2,031.87",$0.00,1,0,1,20161001,
G6003,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,$690.25,$0.00,1,0,1,20161001,
G6004,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,$690.25,$0.00,1,0,1,20161001,
G6005,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,$690.25,$0.00,1,0,1,20161001,
G6006,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6007,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,$690.25,$0.00,1,0,1,20161001,
G6008,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6009,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6010,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6011,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6012,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6013,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6014,HCPCS,RADIATION TREATMENT DELIVERY,,30,,,"$1,319.90",$0.00,1,0,1,20161001,
G6015,HCPCS,RADIATION TX DELIVERY IMRT,,30,,,"$3,386.02",$0.00,1,0,1,20161001,
G6016,HCPCS,DELIVERY COMP IMRT,,30,,,"$3,386.02",$0.00,1,0,1,20161001,
G6017,HCPCS,INTRAFRACTION TRACK MOTION,,30,,,$696.78,$0.00,1,0,1,20161001,
G8978,HCPCS,MOBILITY CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8979,HCPCS,MOBILITY GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8980,HCPCS,MOBILITY D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8981,HCPCS,BODY POS CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8982,HCPCS,BODY POS GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8983,HCPCS,BODY POS D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8984,HCPCS,CARRY CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8985,HCPCS,CARRY GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8986,HCPCS,CARRY D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8987,HCPCS,SELF CARE CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8988,HCPCS,SELF CARE GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8989,HCPCS,SELF CARE D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8990,HCPCS,OTHER PT/OT CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8991,HCPCS,OTHER PT/OT GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8992,HCPCS,OTHER PT/OT  D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8993,HCPCS,SUB PT/OT CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8994,HCPCS,SUB PT/OT GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8995,HCPCS,SUB PT/OT D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8996,HCPCS,SWALLOW CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8997,HCPCS,SWALLOW GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8998,HCPCS,SWALLOW D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G8999,HCPCS,MOTOR SPEECH CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9157,HCPCS,TRANSESOPH DOPPL CARDIAC MON,,30,,,$478.35,$0.00,1,0,1,20161001,
G9158,HCPCS,MOTOR SPEECH D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9159,HCPCS,LANG COMP CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9160,HCPCS,LANG COMP GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9161,HCPCS,LANG COMP D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9162,HCPCS,LANG EXPRESS CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9163,HCPCS,LANG EXPRESS GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9164,HCPCS,LANG EXPRESS D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9165,HCPCS,ATTEN CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9166,HCPCS,ATTEN GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9167,HCPCS,ATTEN D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9168,HCPCS,MEMORY CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9169,HCPCS,MEMORY GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9170,HCPCS,MEMORY D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9171,HCPCS,VOICE CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9172,HCPCS,VOICE GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9173,HCPCS,VOICE D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9174,HCPCS,SPEECH LANG CURRENT STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9175,HCPCS,SPEECH LANG GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9176,HCPCS,SPEECH LANG D/C STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
G9186,HCPCS,MOTOR SPEECH GOAL STATUS,,30,,,$0.01,$0.00,1,0,0,20161001,
J0120,HCPCS,TETRACYCLIN INJECTION,,30,,,$633.58,$0.00,1,0,0,20161001,
J0129,HCPCS,ABATACEPT INJECTION,,30,,,$226.82,$0.00,1,0,0,20161001,
J0130,HCPCS,ABCIXIMAB INJECTION,,30,,,"$5,057.72",$0.00,1,0,0,20161001,
J0131,HCPCS,ACETAMINOPHEN INJECTION,,30,,,$0.73,$0.00,1,0,0,20161001,
J0132,HCPCS,ACETYLCYSTEINE INJECTION,,30,,,$13.65,$0.00,1,0,0,20161001,
J0133,HCPCS,ACYCLOVIR INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J0135,HCPCS,ADALIMUMAB INJECTION,,30,,,"$4,093.30",$0.00,1,0,0,20161001,
J0153,HCPCS,ADENOSINE INJ 1MG,,30,,,$8.32,$0.00,1,0,0,20161001,
J0171,HCPCS,ADRENALIN EPINEPHRINE INJECT,,30,,,$2.80,$0.00,1,0,0,20161001,
J0178,HCPCS,AFLIBERCEPT INJECTION,,30,,,"$5,950.60",$0.00,1,0,0,20161001,
J0180,HCPCS,AGALSIDASE BETA INJECTION,,30,,,$981.46,$0.00,1,0,0,20161001,
J0200,HCPCS,ALATROFLOXACIN MESYLATE,,30,,,$36.25,$0.00,1,0,0,20161001,
J0202,HCPCS,"INJECTION, ALEMTUZUMAB",,30,,,"$9,732.12",$0.00,1,0,0,20161001,
J0205,HCPCS,ALGLUCERASE INJECTION,,30,,,$87.02,$0.00,1,0,0,20161001,
J0207,HCPCS,AMIFOSTINE,,30,,,"$2,296.54",$0.00,1,0,0,20161001,
J0210,HCPCS,METHYLDOPATE HCL INJECTION,,30,,,$109.50,$0.00,1,0,0,20161001,
J0215,HCPCS,ALEFACEPT,,30,,,$270.35,$0.00,1,0,0,20161001,
J0220,HCPCS,ALGLUCOSIDASE ALFA INJECTION,,30,,,"$1,326.16",$0.00,1,0,0,20161001,
J0221,HCPCS,LUMIZYME INJECTION,,30,,,$989.55,$0.00,1,0,0,20161001,
J0256,HCPCS,ALPHA 1 PROTEINASE INHIBITOR,,30,,,$28.15,$0.00,1,0,0,20161001,
J0257,HCPCS,GLASSIA INJECTION,,30,,,$26.13,$0.00,1,0,0,20161001,
J0270,HCPCS,ALPROSTADIL FOR INJECTION,,30,,,$12.64,$0.00,1,0,0,20161001,
J0275,HCPCS,ALPROSTADIL URETHRAL SUPPOS,,30,,,$62.23,$0.00,1,0,0,20161001,
J0278,HCPCS,AMIKACIN SULFATE INJECTION,,30,,,$7.45,$0.00,1,0,0,20161001,
J0280,HCPCS,AMINOPHYLLIN 250 MG INJ,,30,,,$14.37,$0.00,1,0,0,20161001,
J0282,HCPCS,AMIODARONE HCL,,30,,,$5.59,$0.00,1,0,0,20161001,
J0285,HCPCS,AMPHOTERICIN B,,30,,,$47.24,$0.00,1,0,0,20161001,
J0287,HCPCS,AMPHOTERICIN B LIPID COMPLEX,,30,,,$75.73,$0.00,1,0,0,20161001,
J0288,HCPCS,AMPHO B CHOLESTERYL SULFATE,,30,,,$195.98,$0.00,1,0,0,20161001,
J0289,HCPCS,AMPHOTERICIN B LIPOSOME INJ,,30,,,$111.15,$0.00,1,0,0,20161001,
J0290,HCPCS,AMPICILLIN 500 MG INJ,,30,,,$7.45,$0.00,1,0,0,20161001,
J0295,HCPCS,AMPICILLIN SODIUM PER 1.5 GM,,30,,,$9.03,$0.00,1,0,0,20161001,
J0300,HCPCS,AMOBARBITAL 125 MG INJ,,30,,,"$1,247.86",$0.00,1,0,0,20161001,
J0330,HCPCS,SUCCINYCHOLINE CHLORIDE INJ,,30,,,$5.59,$0.00,1,0,0,20161001,
J0348,HCPCS,ANIDULAFUNGIN INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J0360,HCPCS,HYDRALAZINE HCL INJECTION,,30,,,$12.64,$0.00,1,0,0,20161001,
J0365,HCPCS,"APROTONIN, 10,000 KIU",,30,,,$596.75,$0.00,1,0,0,20161001,
J0380,HCPCS,INJ METARAMINOL BITARTRATE,,30,,,$6.74,$0.00,1,0,0,20161001,
J0395,HCPCS,ARBUTAMINE HCL INJECTION,,30,,,$30.33,$0.00,1,0,0,20161001,
J0401,HCPCS,INJ ARIPIPRAZOLE EXT REL 1MG,,30,,,$25.87,$0.00,1,0,0,20161001,
J0456,HCPCS,AZITHROMYCIN,,30,,,$13.51,$0.00,1,0,0,20161001,
J0461,HCPCS,ATROPINE SULFATE INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J0475,HCPCS,BACLOFEN 10 MG INJECTION,,30,,,"$1,092.67",$0.00,1,0,0,20161001,
J0476,HCPCS,BACLOFEN INTRATHECAL TRIAL,,30,,,$495.47,$0.00,1,0,0,20161001,
J0480,HCPCS,BASILIXIMAB,,30,,,"$14,366.56",$0.00,1,0,0,20161001,
J0485,HCPCS,BELATACEPT INJECTION,,30,,,$24.70,$0.00,1,0,0,20161001,
J0490,HCPCS,BELIMUMAB INJECTION,,30,,,$259.86,$0.00,1,0,0,20161001,
J0500,HCPCS,DICYCLOMINE INJECTION,,30,,,$105.18,$0.00,1,0,0,20161001,
J0515,HCPCS,INJ BENZTROPINE MESYLATE,,30,,,$54.15,$0.00,1,0,0,20161001,
J0558,HCPCS,PENG BENZATHINE/PROCAINE INJ,,30,,,$19.56,$0.00,1,0,0,20161001,
J0561,HCPCS,PENICILLIN G BENZATHINE INJ,,30,,,$22.16,$0.00,1,0,0,20161001,
J0583,HCPCS,BIVALIRUDIN,,30,,,$22.75,$0.00,1,0,0,20161001,
J0585,HCPCS,"INJECTION,ONABOTULINUMTOXINA",,30,,,$36.21,$0.00,1,0,0,20161001,
J0586,HCPCS,ABOBOTULINUMTOXINA,,30,,,$51.68,$0.00,1,0,0,20161001,
J0587,HCPCS,"INJ, RIMABOTULINUMTOXINB",,30,,,$73.39,$0.00,1,0,0,20161001,
J0588,HCPCS,INCOBOTULINUMTOXIN A,,30,,,$29.97,$0.00,1,0,0,20161001,
J0592,HCPCS,BUPRENORPHINE HYDROCHLORIDE,,30,,,$13.51,$0.00,1,0,0,20161001,
J0594,HCPCS,BUSULFAN INJECTION,,30,,,$215.87,$0.00,1,0,0,20161001,
J0595,HCPCS,BUTORPHANOL TARTRATE 1 MG,,30,,,$9.03,$0.00,1,0,0,20161001,
J0596,HCPCS,"INJECTION, RUCONEST",,30,,,$151.39,$0.00,1,0,0,20161001,
J0597,HCPCS,"C-1 ESTERASE, BERINERT",,30,,,$250.47,$0.00,1,0,0,20161001,
J0598,HCPCS,"C-1 ESTERASE, CINRYZE",,30,,,$336.72,$0.00,1,0,0,20161001,
J0600,HCPCS,EDETATE CALCIUM DISODIUM INJ,,30,,,"$19,992.50",$0.00,1,0,0,20161001,
J0610,HCPCS,CALCIUM GLUCONATE INJECTION,,30,,,$8.75,$0.00,1,0,0,20161001,
J0620,HCPCS,CALCIUM GLYCER & LACT/10 ML,,30,,,$35.99,$0.00,1,0,0,20161001,
J0630,HCPCS,CALCITONIN SALMON INJECTION,,30,,,$468.28,$0.00,1,0,0,20161001,
J0636,HCPCS,INJ CALCITRIOL PER 0.1 MCG,,30,,,$2.80,$0.00,1,0,0,20161001,
J0637,HCPCS,CASPOFUNGIN ACETATE,,30,,,$76.96,$0.00,1,0,0,20161001,
J0638,HCPCS,CANAKINUMAB INJECTION,,30,,,$589.37,$0.00,1,0,0,20161001,
J0640,HCPCS,LEUCOVORIN CALCIUM INJECTION,,30,,,$16.10,$0.00,1,0,0,20161001,
J0641,HCPCS,LEVOLEUCOVORIN INJECTION,,30,,,$11.70,$0.00,1,0,0,20161001,
J0670,HCPCS,INJ MEPIVACAINE HCL/10 ML,,30,,,$12.64,$0.00,1,0,0,20161001,
J0690,HCPCS,CEFAZOLIN SODIUM INJECTION,,30,,,$6.02,$0.00,1,0,0,20161001,
J0692,HCPCS,CEFEPIME HCL FOR INJECTION,,30,,,$12.64,$0.00,1,0,0,20161001,
J0694,HCPCS,CEFOXITIN SODIUM INJECTION,,30,,,$18.70,$0.00,1,0,0,20161001,
J0695,HCPCS,INJ CEFTOLOZANE TAZOBACTAM,,30,,,$2.34,$0.00,1,0,0,20161001,
J0696,HCPCS,CEFTRIAXONE SODIUM INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J0697,HCPCS,STERILE CEFUROXIME INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J0698,HCPCS,CEFOTAXIME SODIUM INJECTION,,30,,,$9.03,$0.00,1,0,0,20161001,
J0702,HCPCS,BETAMETHASONE ACET&SOD PHOSP,,30,,,$20.43,$0.00,1,0,0,20161001,
J0706,HCPCS,CAFFEINE CITRATE INJECTION,,30,,,$14.37,$0.00,1,0,0,20161001,
J0710,HCPCS,CEPHAPIRIN SODIUM INJECTION,,30,,,$16.05,$0.00,1,0,0,20161001,
J0712,HCPCS,CEFTAROLINE FOSAMIL INJ,,30,,,$11.95,$0.00,1,0,0,20161001,
J0713,HCPCS,INJ CEFTAZIDIME PER 500 MG,,30,,,$11.78,$0.00,1,0,0,20161001,
J0714,HCPCS,CEFTAZIDIME AND AVIBACTAM,,30,,,$421.68,$0.00,1,0,0,20161001,
J0715,HCPCS,CEFTIZOXIME SODIUM / 500 MG,,30,,,$36.34,$0.00,1,0,0,20161001,
J0716,HCPCS,CENTRUROIDES IMMUNE F(AB),,30,,,"$17,710.23",$0.00,1,0,0,20161001,
J0717,HCPCS,CERTOLIZUMAB PEGOL INJ 1MG,,30,,,$33.79,$0.00,1,0,0,20161001,
J0720,HCPCS,CHLORAMPHENICOL SODIUM INJEC,,30,,,$83.56,$0.00,1,0,0,20161001,
J0725,HCPCS,CHORIONIC GONADOTROPIN/1000U,,30,,,$125.97,$0.00,1,0,0,20161001,
J0735,HCPCS,CLONIDINE HYDROCHLORIDE,,30,,,$59.34,$0.00,1,0,0,20161001,
J0740,HCPCS,CIDOFOVIR INJECTION,,30,,,"$3,462.84",$0.00,1,0,0,20161001,
J0743,HCPCS,CILASTATIN SODIUM INJECTION,,30,,,$18.70,$0.00,1,0,0,20161001,
J0744,HCPCS,CIPROFLOXACIN IV,,30,,,$6.74,$0.00,1,0,0,20161001,
J0745,HCPCS,INJ CODEINE PHOSPHATE /30 MG,,30,,,$6.74,$0.00,1,0,0,20161001,
J0770,HCPCS,COLISTIMETHATE SODIUM INJ,,30,,,$34.26,$0.00,1,0,0,20161001,
J0775,HCPCS,"COLLAGENASE, CLOST HIST INJ",,30,,,$249.50,$0.00,1,0,0,20161001,
J0780,HCPCS,PROCHLORPERAZINE INJECTION,,30,,,$40.32,$0.00,1,0,0,20161001,
J0795,HCPCS,CORTICORELIN OVINE TRIFLUTAL,,30,,,$50.31,$0.00,1,0,0,20161001,
J0800,HCPCS,CORTICOTROPIN INJECTION,,30,,,"$16,714.96",$0.00,1,0,0,20161001,
J0833,HCPCS,COSYNTROPIN INJECTION NOS,,30,,,$657.40,$0.00,1,0,0,20161001,
J0834,HCPCS,COSYNTROPIN CORTROSYN INJ,,30,,,$120.74,$0.00,1,0,0,20161001,
J0840,HCPCS,CROTALIDAE POLY IMMUNE FAB,,30,,,"$13,429.35",$0.00,1,0,0,20161001,
J0850,HCPCS,CYTOMEGALOVIRUS IMM IV /VIAL,,30,,,"$6,137.86",$0.00,1,0,0,20161001,
J0875,HCPCS,"INJECTION, DALBAVANCIN",,30,,,$79.72,$0.00,1,0,0,20161001,
J0878,HCPCS,DAPTOMYCIN INJECTION,,30,,,$4.62,$0.00,1,0,0,20161001,
J0881,HCPCS,"DARBEPOETIN ALFA, NON-ESRD",,30,,,$24.25,$0.00,1,0,0,20161001,
J0882,HCPCS,"DARBEPOETIN ALFA, ESRD USE",,30,,,$22.70,$0.00,1,0,0,20161001,
J0885,HCPCS,"EPOETIN ALFA, NON-ESRD",,30,,,$76.96,$0.00,1,0,0,20161001,
J0887,HCPCS,EPOETIN BETA ESRD USE,,30,,,$63.03,$0.00,1,0,0,20161001,
J0890,HCPCS,PEGINESATIDE INJECTION,,30,,,$26.00,$0.00,1,0,0,20161001,
J0894,HCPCS,DECITABINE INJECTION,,30,,,$169.70,$0.00,1,0,0,20161001,
J0895,HCPCS,DEFEROXAMINE MESYLATE INJ,,30,,,$28.21,$0.00,1,0,0,20161001,
J0897,HCPCS,DENOSUMAB INJECTION,,30,,,$73.78,$0.00,1,0,0,20161001,
J1000,HCPCS,DEPO-ESTRADIOL CYPIONATE INJ,,30,,,$33.40,$0.00,1,0,0,20161001,
J1020,HCPCS,METHYLPREDNISOLONE 20 MG INJ,,30,,,$15.24,$0.00,1,0,0,20161001,
J1030,HCPCS,METHYLPREDNISOLONE 40 MG INJ,,30,,,$14.37,$0.00,1,0,0,20161001,
J1040,HCPCS,METHYLPREDNISOLONE 80 MG INJ,,30,,,$21.29,$0.00,1,0,0,20161001,
J1050,HCPCS,MEDROXYPROGESTERONE ACETATE,,30,,,$2.80,$0.00,1,0,0,20161001,
J1071,HCPCS,INJ TESTOSTERONE CYPIONATE,,30,,,$3.19,$0.00,1,0,0,20161001,
J1094,HCPCS,INJ DEXAMETHASONE ACETATE,,30,,,$2.80,$0.00,1,0,0,20161001,
J1100,HCPCS,DEXAMETHASONE SODIUM PHOS,,30,,,$2.80,$0.00,1,0,0,20161001,
J1110,HCPCS,INJ DIHYDROERGOTAMINE MESYLT,,30,,,$136.31,$0.00,1,0,0,20161001,
J1120,HCPCS,ACETAZOLAMID SODIUM INJECTIO,,30,,,$58.48,$0.00,1,0,0,20161001,
J1160,HCPCS,DIGOXIN INJECTION,,30,,,$29.08,$0.00,1,0,0,20161001,
J1162,HCPCS,DIGOXIN IMMUNE FAB (OVINE),,30,,,"$12,859.75",$0.00,1,0,0,20161001,
J1165,HCPCS,PHENYTOIN SODIUM INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J1170,HCPCS,HYDROMORPHONE INJECTION,,30,,,$11.78,$0.00,1,0,0,20161001,
J1190,HCPCS,DEXRAZOXANE HCL INJECTION,,30,,,$887.22,$0.00,1,0,0,20161001,
J1200,HCPCS,DIPHENHYDRAMINE HCL INJECTIO,,30,,,$5.59,$0.00,1,0,0,20161001,
J1205,HCPCS,CHLOROTHIAZIDE SODIUM INJ,,30,,,$789.20,$0.00,1,0,0,20161001,
J1212,HCPCS,DIMETHYL SULFOXIDE 50% 50 ML,,30,,,$221.06,$0.00,1,0,0,20161001,
J1230,HCPCS,METHADONE INJECTION,,30,,,$29.08,$0.00,1,0,0,20161001,
J1240,HCPCS,DIMENHYDRINATE INJECTION,,30,,,$19.56,$0.00,1,0,0,20161001,
J1245,HCPCS,DIPYRIDAMOLE INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J1250,HCPCS,INJ DOBUTAMINE HCL/250 MG,,30,,,$22.16,$0.00,1,0,0,20161001,
J1260,HCPCS,DOLASETRON MESYLATE,,30,,,$32.08,$0.00,1,0,0,20161001,
J1265,HCPCS,DOPAMINE INJECTION,,30,,,$4.88,$0.00,1,0,0,20161001,
J1267,HCPCS,DORIPENEM INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J1270,HCPCS,"INJECTION, DOXERCALCIFEROL",,30,,,$10.05,$0.00,1,0,0,20161001,
J1290,HCPCS,ECALLANTIDE INJECTION,,30,,,"$2,383.10",$0.00,1,0,0,20161001,
J1300,HCPCS,ECULIZUMAB INJECTION,,30,,,"$1,359.42",$0.00,1,0,0,20161001,
J1322,HCPCS,"ELOSULFASE ALFA, INJECTION",,30,,,"$1,421.69",$0.00,1,0,0,20161001,
J1324,HCPCS,ENFUVIRTIDE INJECTION,,30,,,$121.10,$0.00,1,0,0,20161001,
J1325,HCPCS,EPOPROSTENOL INJECTION,,30,,,$43.78,$0.00,1,0,0,20161001,
J1327,HCPCS,EPTIFIBATIDE INJECTION,,30,,,$189.55,$0.00,1,0,0,20161001,
J1330,HCPCS,ERGONOVINE MALEATE INJECTION,,30,,,$7.91,$0.00,1,0,0,20161001,
J1335,HCPCS,ERTAPENEM INJECTION,,30,,,$94.80,$0.00,1,0,0,20161001,
J1364,HCPCS,ERYTHRO LACTOBIONATE /500 MG,,30,,,$112.96,$0.00,1,0,0,20161001,
J1380,HCPCS,ESTRADIOL VALERATE 10 MG INJ,,30,,,$29.08,$0.00,1,0,0,20161001,
J1410,HCPCS,INJ ESTROGEN CONJUGATE 25 MG,,30,,,"$1,225.04",$0.00,1,0,0,20161001,
J1430,HCPCS,ETHANOLAMINE OLEATE 100 MG,,30,,,"$2,557.48",$0.00,1,0,0,20161001,
J1435,HCPCS,INJECTION ESTRONE PER 1 MG,,30,,,$2.80,$0.00,1,0,0,20161001,
J1438,HCPCS,ETANERCEPT INJECTION,,30,,,"$1,927.57",$0.00,1,0,0,20161001,
J1439,HCPCS,INJ FERRIC CARBOXYMALTOS 1MG,,30,,,$6.96,$0.00,1,0,0,20161001,
J1442,HCPCS,INJ FILGRASTIM EXCL BIOSIMIL,,30,,,$6.44,$0.00,1,0,0,20161001,
J1443,HCPCS,INJ FERRIC PYROPHOSPHATE CIT,,30,,,$2.95,$0.00,1,0,0,20161001,
J1447,HCPCS,INJ TBO FILGRASTIM 1 MICROG,,30,,,$25.09,$0.00,1,0,0,20161001,
J1450,HCPCS,FLUCONAZOLE,,30,,,$16.10,$0.00,1,0,0,20161001,
J1451,HCPCS,"FOMEPIZOLE, 15 MG",,30,,,$45.57,$0.00,1,0,0,20161001,
J1452,HCPCS,INTRAOCULAR FOMIVIRSEN NA,,30,,,"$2,419.09",$0.00,1,0,0,20161001,
J1453,HCPCS,FOSAPREPITANT INJECTION,,30,,,$11.25,$0.00,1,0,0,20161001,
J1455,HCPCS,FOSCARNET SODIUM INJECTION,,30,,,$57.61,$0.00,1,0,0,20161001,
J1457,HCPCS,GALLIUM NITRATE INJECTION,,30,,,$7.89,$0.00,1,0,0,20161001,
J1458,HCPCS,GALSULFASE INJECTION,,30,,,"$2,300.25",$0.00,1,0,0,20161001,
J1459,HCPCS,INJ IVIG PRIVIGEN 500 MG,,30,,,$243.21,$0.00,1,0,0,20161001,
J1460,HCPCS,GAMMA GLOBULIN 1 CC INJ,,30,,,$76.64,$0.00,1,0,0,20161001,
J1556,HCPCS,"INJ, IMM GLOB BIVIGAM, 500MG",,30,,,$236.09,$0.00,1,0,0,20161001,
J1557,HCPCS,GAMMAPLEX INJECTION,,30,,,$236.28,$0.00,1,0,0,20161001,
J1559,HCPCS,HIZENTRA INJECTION,,30,,,$53.17,$0.00,1,0,0,20161001,
J1560,HCPCS,GAMMA GLOBULIN > 10 CC INJ,,30,,,$705.35,$0.00,1,0,0,20161001,
J1561,HCPCS,GAMUNEX-C/GAMMAKED,,30,,,$259.15,$0.00,1,0,0,20161001,
J1562,HCPCS,"VIVAGLOBIN, INJ",,30,,,$30.81,$0.00,1,0,0,20161001,
J1566,HCPCS,"IMMUNE GLOBULIN, POWDER",,30,,,$188.12,$0.00,1,0,0,20161001,
J1568,HCPCS,OCTAGAM INJECTION,,30,,,$263.29,$0.00,1,0,0,20161001,
J1569,HCPCS,GAMMAGARD LIQUID INJECTION,,30,,,$254.61,$0.00,1,0,0,20161001,
J1570,HCPCS,GANCICLOVIR SODIUM INJECTION,,30,,,$189.06,$0.00,1,0,0,20161001,
J1571,HCPCS,HEPAGAM B IM INJECTION,,30,,,$349.39,$0.00,1,0,0,20161001,
J1572,HCPCS,FLEBOGAMMA INJECTION,,30,,,$230.84,$0.00,1,0,0,20161001,
J1573,HCPCS,"HEPAGAM B INTRAVENOUS, INJ",,30,,,$349.39,$0.00,1,0,0,20161001,
J1575,HCPCS,HYQVIA 100MG IMMUNEGLOBULIN,,30,,,$71.24,$0.00,1,0,0,20161001,
J1580,HCPCS,GARAMYCIN GENTAMICIN INJ,,30,,,$7.17,$0.00,1,0,0,20161001,
J1590,HCPCS,GATIFLOXACIN INJECTION,,30,,,$2.92,$0.00,1,0,0,20161001,
J1595,HCPCS,INJECTION GLATIRAMER ACETATE,,30,,,"$1,200.44",$0.00,1,0,0,20161001,
J1599,HCPCS,"IVIG NON-LYOPHILIZED, NOS",,30,,,$152.65,$0.00,1,0,0,20161001,
J1600,HCPCS,GOLD SODIUM THIOMALEATE INJ,,30,,,$42.05,$0.00,1,0,0,20161001,
J1602,HCPCS,GOLIMUMAB FOR IV USE 1MG,,30,,,$157.30,$0.00,1,0,0,20161001,
J1610,HCPCS,GLUCAGON HYDROCHLORIDE/1 MG,,30,,,"$1,224.66",$0.00,1,0,0,20161001,
J1620,HCPCS,GONADORELIN HYDROCH/ 100 MCG,,30,,,$683.93,$0.00,1,0,0,20161001,
J1626,HCPCS,GRANISETRON HCL INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J1630,HCPCS,HALOPERIDOL INJECTION,,30,,,$10.33,$0.00,1,0,0,20161001,
J1631,HCPCS,HALOPERIDOL DECANOATE INJ,,30,,,$51.56,$0.00,1,0,0,20161001,
J1640,HCPCS,"HEMIN, 1 MG",,30,,,$134.75,$0.00,1,0,0,20161001,
J1642,HCPCS,INJ HEPARIN SODIUM PER 10 U,,30,,,$2.80,$0.00,1,0,0,20161001,
J1644,HCPCS,INJ HEPARIN SODIUM PER 1000U,,30,,,$2.80,$0.00,1,0,0,20161001,
J1645,HCPCS,DALTEPARIN SODIUM,,30,,,$37.72,$0.00,1,0,0,20161001,
J1650,HCPCS,INJ ENOXAPARIN SODIUM,,30,,,$10.05,$0.00,1,0,0,20161001,
J1652,HCPCS,FONDAPARINUX SODIUM,,30,,,$16.10,$0.00,1,0,0,20161001,
J1670,HCPCS,TETANUS IMMUNE GLOBULIN INJ,,30,,,"$1,632.36",$0.00,1,0,0,20161001,
J1700,HCPCS,HYDROCORTISONE ACETATE INJ,,30,,,$1.24,$0.00,1,0,0,20161001,
J1710,HCPCS,HYDROCORTISONE SODIUM PH INJ,,30,,,$21.81,$0.00,1,0,0,20161001,
J1720,HCPCS,HYDROCORTISONE SODIUM SUCC I,,30,,,$22.16,$0.00,1,0,0,20161001,
J1725,HCPCS,HYDROXYPROGESTERONE CAPROATE,,30,,,$17.16,$0.00,1,0,0,20161001,
J1730,HCPCS,DIAZOXIDE INJECTION,,30,,,$269.49,$0.00,1,0,0,20161001,
J1740,HCPCS,IBANDRONATE SODIUM INJECTION,,30,,,$801.23,$0.00,1,0,0,20161001,
J1741,HCPCS,IBUPROFEN INJECTION,,30,,,$11.53,$0.00,1,0,0,20161001,
J1742,HCPCS,IBUTILIDE FUMARATE INJECTION,,30,,,$409.07,$0.00,1,0,0,20161001,
J1743,HCPCS,IDURSULFASE INJECTION,,30,,,"$3,128.86",$0.00,1,0,0,20161001,
J1744,HCPCS,ICATIBANT INJECTION,,30,,,"$1,764.94",$0.00,1,0,0,20161001,
J1745,HCPCS,INFLIXIMAB INJECTION,,30,,,$399.99,$0.00,1,0,0,20161001,
J1750,HCPCS,INJ IRON DEXTRAN,,30,,,$78.78,$0.00,1,0,0,20161001,
J1756,HCPCS,IRON SUCROSE INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J1786,HCPCS,IMUGLUCERASE INJECTION,,30,,,$272.68,$0.00,1,0,0,20161001,
J1790,HCPCS,DROPERIDOL INJECTION,,30,,,$11.78,$0.00,1,0,0,20161001,
J1800,HCPCS,PROPRANOLOL INJECTION,,30,,,$8.19,$0.00,1,0,0,20161001,
J1810,HCPCS,DROPERIDOL/FENTANYL INJ,,30,,,$130.84,$0.00,1,0,0,20161001,
J1815,HCPCS,INSULIN INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J1817,HCPCS,INSULIN FOR INSULIN PUMP USE,,30,,,$19.56,$0.00,1,0,0,20161001,
J1826,HCPCS,INTERFERON BETA-1A INJ,,30,,,"$1,512.21",$0.00,1,0,0,20161001,
J1830,HCPCS,INTERFERON BETA-1B / .25 MG,,30,,,"$2,238.36",$0.00,1,0,0,20161001,
J1833,HCPCS,"INJECTION, ISAVUCONAZONIUM",,30,,,$3.80,$0.00,1,0,0,20161001,
J1835,HCPCS,ITRACONAZOLE INJECTION,,30,,,"$2,438.41",$0.00,1,0,0,20161001,
J1840,HCPCS,KANAMYCIN SULFATE 500 MG INJ,,30,,,$24.75,$0.00,1,0,0,20161001,
J1885,HCPCS,KETOROLAC TROMETHAMINE INJ,,30,,,$2.80,$0.00,1,0,0,20161001,
J1890,HCPCS,CEPHALOTHIN SODIUM INJECTION,,30,,,$28.39,$0.00,1,0,0,20161001,
J1930,HCPCS,LANREOTIDE INJECTION,,30,,,$302.90,$0.00,1,0,0,20161001,
J1931,HCPCS,LARONIDASE INJECTION,,30,,,$191.37,$0.00,1,0,0,20161001,
J1940,HCPCS,FUROSEMIDE INJECTION,,30,,,$17.83,$0.00,1,0,0,20161001,
J1945,HCPCS,LEPIRUDIN,,30,,,"$1,508.51",$0.00,1,0,0,20161001,
J1950,HCPCS,LEUPROLIDE ACETATE /3.75 MG,,30,,,"$4,997.68",$0.00,1,0,0,20161001,
J1953,HCPCS,LEVETIRACETAM INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J1955,HCPCS,INJ LEVOCARNITINE PER 1 GM,,30,,,$27.35,$0.00,1,0,0,20161001,
J1956,HCPCS,LEVOFLOXACIN INJECTION,,30,,,$11.78,$0.00,1,0,0,20161001,
J1980,HCPCS,HYOSCYAMINE SULFATE INJ,,30,,,$51.56,$0.00,1,0,0,20161001,
J2001,HCPCS,LIDOCAINE INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J2010,HCPCS,LINCOMYCIN INJECTION,,30,,,$29.94,$0.00,1,0,0,20161001,
J2020,HCPCS,LINEZOLID INJECTION,,30,,,$205.44,$0.00,1,0,0,20161001,
J2060,HCPCS,LORAZEPAM INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J2150,HCPCS,MANNITOL INJECTION,,30,,,$10.91,$0.00,1,0,0,20161001,
J2170,HCPCS,MECASERMIN INJECTION,,30,,,$24.75,$0.00,1,0,0,20161001,
J2175,HCPCS,MEPERIDINE HYDROCHL /100 MG,,30,,,$18.70,$0.00,1,0,0,20161001,
J2180,HCPCS,MEPERIDINE/PROMETHAZINE INJ,,30,,,$26.48,$0.00,1,0,0,20161001,
J2185,HCPCS,MEROPENEM,,30,,,$6.74,$0.00,1,0,0,20161001,
J2210,HCPCS,METHYLERGONOVIN MALEATE INJ,,30,,,$18.70,$0.00,1,0,0,20161001,
J2212,HCPCS,METHYLNALTREXONE INJECTION,,30,,,$0.90,$0.00,1,0,0,20161001,
J2248,HCPCS,MICAFUNGIN SODIUM INJECTION,,30,,,$6.74,$0.00,1,0,0,20161001,
J2250,HCPCS,INJ MIDAZOLAM HYDROCHLORIDE,,30,,,$2.80,$0.00,1,0,0,20161001,
J2260,HCPCS,INJ MILRINONE LACTATE / 5 MG,,30,,,$14.37,$0.00,1,0,0,20161001,
J2265,HCPCS,MINOCYCLINE HYDROCHLORIDE,,30,,,$1.38,$0.00,1,0,0,20161001,
J2270,HCPCS,MORPHINE SULFATE INJECTION,,30,,,$10.91,$0.00,1,0,0,20161001,
J2274,HCPCS,IN MORPHINE PRESERVATIV FREE,,30,,,$29.08,$0.00,1,0,0,20161001,
J2278,HCPCS,ZICONOTIDE INJECTION,,30,,,$45.31,$0.00,1,0,0,20161001,
J2280,HCPCS,"INJ, MOXIFLOXACIN 100 MG",,30,,,$19.56,$0.00,1,0,0,20161001,
J2300,HCPCS,INJ NALBUPHINE HYDROCHLORIDE,,30,,,$12.64,$0.00,1,0,0,20161001,
J2310,HCPCS,INJ NALOXONE HYDROCHLORIDE,,30,,,$93.07,$0.00,1,0,0,20161001,
J2315,HCPCS,"NALTREXONE, DEPOT FORM",,30,,,$19.31,$0.00,1,0,0,20161001,
J2320,HCPCS,NANDROLONE DECANOATE 50 MG,,30,,,$685.83,$0.00,1,0,0,20161001,
J2323,HCPCS,NATALIZUMAB INJECTION,,30,,,$102.83,$0.00,1,0,0,20161001,
J2325,HCPCS,NESIRITIDE INJECTION,,30,,,$429.78,$0.00,1,0,0,20161001,
J2353,HCPCS,"OCTREOTIDE INJECTION, DEPOT",,30,,,$932.67,$0.00,1,0,0,20161001,
J2354,HCPCS,"OCTREOTIDE INJ, NON-DEPOT",,30,,,$6.74,$0.00,1,0,0,20161001,
J2355,HCPCS,OPRELVEKIN INJECTION,,30,,,"$2,641.60",$0.00,1,0,0,20161001,
J2357,HCPCS,OMALIZUMAB INJECTION,,30,,,$187.09,$0.00,1,0,0,20161001,
J2358,HCPCS,OLANZAPINE LONG-ACTING INJ,,30,,,$18.98,$0.00,1,0,0,20161001,
J2360,HCPCS,ORPHENADRINE INJECTION,,30,,,$20.43,$0.00,1,0,0,20161001,
J2370,HCPCS,PHENYLEPHRINE HCL INJECTION,,30,,,$14.37,$0.00,1,0,0,20161001,
J2400,HCPCS,CHLOROPROCAINE HCL INJECTION,,30,,,$47.24,$0.00,1,0,0,20161001,
J2405,HCPCS,ONDANSETRON HCL INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J2407,HCPCS,"INJECTION, ORITAVANCIN",,30,,,$162.95,$0.00,1,0,0,20161001,
J2410,HCPCS,OXYMORPHONE HCL INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J2425,HCPCS,PALIFERMIN INJECTION,,30,,,$101.47,$0.00,1,0,0,20161001,
J2426,HCPCS,PALIPERIDONE PALMITATE INJ,,30,,,$52.85,$0.00,1,0,0,20161001,
J2430,HCPCS,PAMIDRONATE DISODIUM /30 MG,,30,,,$37.72,$0.00,1,0,0,20161001,
J2440,HCPCS,PAPAVERIN HCL INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J2469,HCPCS,PALONOSETRON HCL,,30,,,$129.68,$0.00,1,0,0,20161001,
J2501,HCPCS,PARICALCITOL,,30,,,$10.05,$0.00,1,0,0,20161001,
J2502,HCPCS,"INJ, PASIREOTIDE LONG ACTING",,30,,,"$1,402.77",$0.00,1,0,0,20161001,
J2503,HCPCS,PEGAPTANIB SODIUM INJECTION,,30,,,"$6,286.63",$0.00,1,0,0,20161001,
J2504,HCPCS,"PEGADEMASE BOVINE, 25 IU",,30,,,"$1,758.99",$0.00,1,0,0,20161001,
J2505,HCPCS,"INJECTION, PEGFILGRASTIM 6MG",,30,,,"$15,560.09",$0.00,1,0,0,20161001,
J2507,HCPCS,PEGLOTICASE INJECTION,,30,,,"$7,375.80",$0.00,1,0,0,20161001,
J2510,HCPCS,PENICILLIN G PROCAINE INJ,,30,,,$49.83,$0.00,1,0,0,20161001,
J2515,HCPCS,PENTOBARBITAL SODIUM INJ,,30,,,$93.07,$0.00,1,0,0,20161001,
J2540,HCPCS,PENICILLIN G POTASSIUM INJ,,30,,,$5.59,$0.00,1,0,0,20161001,
J2543,HCPCS,PIPERACILLIN/TAZOBACTAM,,30,,,$7.89,$0.00,1,0,0,20161001,
J2545,HCPCS,PENTAMIDINE NON-COMP UNIT,,30,,,$241.82,$0.00,1,0,0,20161001,
J2547,HCPCS,"INJECTION, PERAMIVIR",,30,,,$9.38,$0.00,1,0,0,20161001,
J2550,HCPCS,PROMETHAZINE HCL INJECTION,,30,,,$7.89,$0.00,1,0,0,20161001,
J2560,HCPCS,PHENOBARBITAL SODIUM INJ,,30,,,$63.67,$0.00,1,0,0,20161001,
J2562,HCPCS,PLERIXAFOR INJECTION,,30,,,"$1,937.74",$0.00,1,0,0,20161001,
J2590,HCPCS,OXYTOCIN INJECTION,,30,,,$16.10,$0.00,1,0,0,20161001,
J2597,HCPCS,INJ DESMOPRESSIN ACETATE,,30,,,$58.31,$0.00,1,0,0,20161001,
J2650,HCPCS,PREDNISOLONE ACETATE INJ,,30,,,$7.53,$0.00,1,0,0,20161001,
J2670,HCPCS,TOTAZOLINE HCL INJECTION,,30,,,"$9,265.18",$0.00,1,0,0,20161001,
J2675,HCPCS,INJ PROGESTERONE PER 50 MG,,30,,,$7.17,$0.00,1,0,0,20161001,
J2680,HCPCS,FLUPHENAZINE DECANOATE 25 MG,,30,,,$62.80,$0.00,1,0,0,20161001,
J2690,HCPCS,PROCAINAMIDE HCL INJECTION,,30,,,$144.96,$0.00,1,0,0,20161001,
J2700,HCPCS,OXACILLIN SODIUM INJECITON,,30,,,$9.03,$0.00,1,0,0,20161001,
J2710,HCPCS,NEOSTIGMINE METHYLSLFTE INJ,,30,,,$2.80,$0.00,1,0,0,20161001,
J2720,HCPCS,INJ PROTAMINE SULFATE/10 MG,,30,,,$6.74,$0.00,1,0,0,20161001,
J2724,HCPCS,PROTEIN C CONCENTRATE,,30,,,$98.15,$0.00,1,0,0,20161001,
J2725,HCPCS,INJ PROTIRELIN PER 250 MCG,,30,,,$88.98,$0.00,1,0,0,20161001,
J2730,HCPCS,PRALIDOXIME CHLORIDE INJ,,30,,,$218.47,$0.00,1,0,0,20161001,
J2760,HCPCS,PHENTOLAINE MESYLATE INJ,,30,,,"$1,023.89",$0.00,1,0,0,20161001,
J2765,HCPCS,METOCLOPRAMIDE HCL INJECTION,,30,,,$5.59,$0.00,1,0,0,20161001,
J2770,HCPCS,QUINUPRISTIN/DALFOPRISTIN,,30,,,"$1,676.24",$0.00,1,0,0,20161001,
J2778,HCPCS,RANIBIZUMAB INJECTION,,30,,,"$2,504.89",$0.00,1,0,0,20161001,
J2780,HCPCS,RANITIDINE HYDROCHLORIDE INJ,,30,,,$6.74,$0.00,1,0,0,20161001,
J2783,HCPCS,RASBURICASE,,30,,,"$1,431.79",$0.00,1,0,0,20161001,
J2785,HCPCS,REGADENOSON INJECTION,,30,,,$133.72,$0.00,1,0,0,20161001,
J2788,HCPCS,RHO D IMMUNE GLOBULIN 50 MCG,,30,,,$69.72,$0.00,1,0,0,20161001,
J2790,HCPCS,RHO D IMMUNE GLOBULIN INJ,,30,,,$207.22,$0.00,1,0,0,20161001,
J2791,HCPCS,RHOPHYLAC INJECTION,,30,,,$17.83,$0.00,1,0,0,20161001,
J2792,HCPCS,"RHO(D) IMMUNE GLOBULIN H, SD",,30,,,$122.85,$0.00,1,0,0,20161001,
J2793,HCPCS,RILONACEPT INJECTION,,30,,,$156.59,$0.00,1,0,0,20161001,
J2794,HCPCS,"RISPERIDONE, LONG ACTING",,30,,,$42.45,$0.00,1,0,0,20161001,
J2795,HCPCS,ROPIVACAINE HCL INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J2796,HCPCS,ROMIPLOSTIM INJECTION,,30,,,$358.50,$0.00,1,0,0,20161001,
J2800,HCPCS,METHOCARBAMOL INJECTION,,30,,,$119.01,$0.00,1,0,0,20161001,
J2805,HCPCS,SINCALIDE INJECTION,,30,,,$216.74,$0.00,1,0,0,20161001,
J2810,HCPCS,INJ THEOPHYLLINE PER 40 MG,,30,,,$2.80,$0.00,1,0,0,20161001,
J2820,HCPCS,SARGRAMOSTIM INJECTION,,30,,,$206.34,$0.00,1,0,0,20161001,
J2850,HCPCS,INJ SECRETIN SYNTHETIC HUMAN,,30,,,$225.92,$0.00,1,0,0,20161001,
J2860,HCPCS,"INJECTION, SILTUXIMAB",,30,,,$49.69,$0.00,1,0,0,20161001,
J2916,HCPCS,NA FERRIC GLUCONATE COMPLEX,,30,,,$13.51,$0.00,1,0,0,20161001,
J2920,HCPCS,METHYLPREDNISOLONE INJECTION,,30,,,$9.47,$0.00,1,0,0,20161001,
J2930,HCPCS,METHYLPREDNISOLONE INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J2940,HCPCS,SOMATREM INJECTION,,30,,,$135.89,$0.00,1,0,0,20161001,
J2941,HCPCS,SOMATROPIN INJECTION,,30,,,$495.02,$0.00,1,0,0,20161001,
J2950,HCPCS,PROMAZINE HCL INJECTION,,30,,,$35.69,$0.00,1,0,0,20161001,
J2993,HCPCS,RETEPLASE INJECTION,,30,,,"$12,597.94",$0.00,1,0,0,20161001,
J2997,HCPCS,ALTEPLASE RECOMBINANT,,30,,,$370.04,$0.00,1,0,0,20161001,
J3000,HCPCS,STREPTOMYCIN INJECTION,,30,,,$36.86,$0.00,1,0,0,20161001,
J3010,HCPCS,FENTANYL CITRATE INJECITON,,30,,,$4.88,$0.00,1,0,0,20161001,
J3030,HCPCS,SUMATRIPTAN SUCCINATE / 6 MG,,30,,,$144.96,$0.00,1,0,0,20161001,
J3060,HCPCS,"INJ, TALIGLUCERACE ALFA 10 U",,30,,,$228.83,$0.00,1,0,0,20161001,
J3070,HCPCS,PENTAZOCINE INJECTION,,30,,,$761.99,$0.00,1,0,0,20161001,
J3095,HCPCS,TELAVANCIN INJECTION,,30,,,$29.58,$0.00,1,0,0,20161001,
J3101,HCPCS,TENECTEPLASE INJECTION,,30,,,$557.98,$0.00,1,0,0,20161001,
J3105,HCPCS,TERBUTALINE SULFATE INJ,,30,,,$17.83,$0.00,1,0,0,20161001,
J3110,HCPCS,TERIPARATIDE INJECTION,,30,,,$27.35,$0.00,1,0,0,20161001,
J3121,HCPCS,INJ TESTOSTERO ENANTHATE 1MG,,30,,,$3.37,$0.00,1,0,0,20161001,
J3145,HCPCS,TESTOSTERONE UNDECANOATE 1MG,,30,,,$7.54,$0.00,1,0,0,20161001,
J3230,HCPCS,CHLORPROMAZINE HCL INJECTION,,30,,,$64.53,$0.00,1,0,0,20161001,
J3240,HCPCS,THYROTROPIN INJECTION,,30,,,"$8,338.66",$0.00,1,0,0,20161001,
J3243,HCPCS,TIGECYCLINE INJECTION,,30,,,$13.52,$0.00,1,0,0,20161001,
J3246,HCPCS,TIROFIBAN HCL,,30,,,$57.20,$0.00,1,0,0,20161001,
J3250,HCPCS,TRIMETHOBENZAMIDE HCL INJ,,30,,,$56.75,$0.00,1,0,0,20161001,
J3260,HCPCS,TOBRAMYCIN SULFATE INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J3262,HCPCS,TOCILIZUMAB INJECTION,,30,,,$24.51,$0.00,1,0,0,20161001,
J3265,HCPCS,INJECTION TORSEMIDE 10 MG/ML,,30,,,$15.07,$0.00,1,0,0,20161001,
J3285,HCPCS,TREPROSTINIL INJECTION,,30,,,$397.06,$0.00,1,0,0,20161001,
J3300,HCPCS,TRIAMCINOLONE A INJ PRS-FREE,,30,,,$24.18,$0.00,1,0,0,20161001,
J3301,HCPCS,TRIAMCINOLONE ACET INJ NOS,,30,,,$9.03,$0.00,1,0,0,20161001,
J3302,HCPCS,TRIAMCINOLONE DIACETATE INJ,,30,,,$2.80,$0.00,1,0,0,20161001,
J3303,HCPCS,TRIAMCINOLONE HEXACETONL INJ,,30,,,$9.47,$0.00,1,0,0,20161001,
J3305,HCPCS,INJ TRIMETREXATE GLUCORONATE,,30,,,$113.73,$0.00,1,0,0,20161001,
J3315,HCPCS,TRIPTORELIN PAMOATE,,30,,,"$1,158.62",$0.00,1,0,0,20161001,
J3320,HCPCS,SPECTINOMYCN DI-HCL INJ,,30,,,$91.72,$0.00,1,0,0,20161001,
J3350,HCPCS,UREA INJECTION,,30,,,$31.85,$0.00,1,0,0,20161001,
J3355,HCPCS,"UROFOLLITROPIN, 75 IU",,30,,,$380.21,$0.00,1,0,0,20161001,
J3357,HCPCS,USTEKINUMAB INJECTION,,30,,,"$1,052.34",$0.00,1,0,0,20161001,
J3360,HCPCS,DIAZEPAM INJECTION,,30,,,$17.83,$0.00,1,0,0,20161001,
J3364,HCPCS,UROKINASE 5000 IU INJECTION,,30,,,$25.17,$0.00,1,0,0,20161001,
J3365,HCPCS,"UROKINASE 250,000 IU INJ",,30,,,"$1,239.30",$0.00,1,0,0,20161001,
J3370,HCPCS,VANCOMYCIN HCL INJECTION,,30,,,$11.78,$0.00,1,0,0,20161001,
J3385,HCPCS,VELAGLUCERASE ALFA,,30,,,"$2,227.34",$0.00,1,0,0,20161001,
J3396,HCPCS,VERTEPORFIN INJECTION,,30,,,$70.79,$0.00,1,0,0,20161001,
J3410,HCPCS,HYDROXYZINE HCL INJECTION,,30,,,$2.80,$0.00,1,0,0,20161001,
J3411,HCPCS,THIAMINE HCL 100 MG,,30,,,$15.24,$0.00,1,0,0,20161001,
J3415,HCPCS,PYRIDOXINE HCL 100 MG,,30,,,$23.89,$0.00,1,0,0,20161001,
J3420,HCPCS,VITAMIN B12 INJECTION,,30,,,$11.48,$0.00,1,0,0,20161001,
J3430,HCPCS,VITAMIN K PHYTONADIONE INJ,,30,,,$8.90,$0.00,1,0,0,20161001,
J3465,HCPCS,"INJECTION, VORICONAZOLE",,30,,,$24.12,$0.00,1,0,0,20161001,
J3470,HCPCS,HYALURONIDASE INJECTION,,30,,,$67.99,$0.00,1,0,0,20161001,
J3471,HCPCS,"OVINE, UP TO 999 USP UNITS",,30,,,$2.80,$0.00,1,0,0,20161001,
J3472,HCPCS,"OVINE, 1000 USP UNITS",,30,,,$291.11,$0.00,1,0,0,20161001,
J3473,HCPCS,HYALURONIDASE RECOMBINANT,,30,,,$2.80,$0.00,1,0,0,20161001,
J3475,HCPCS,INJ MAGNESIUM SULFATE,,30,,,$2.80,$0.00,1,0,0,20161001,
J3480,HCPCS,INJ POTASSIUM CHLORIDE,,30,,,$2.80,$0.00,1,0,0,20161001,
J3485,HCPCS,ZIDOVUDINE,,30,,,$7.89,$0.00,1,0,0,20161001,
J3486,HCPCS,ZIPRASIDONE MESYLATE,,30,,,$36.86,$0.00,1,0,0,20161001,
J3489,HCPCS,ZOLEDRONIC ACID 1MG,,30,,,$213.55,$0.00,1,0,0,20161001,
J3490,HCPCS,DRUGS UNCLASSIFIED INJECTION,,30,,,$0.69,$0.00,1,0,0,20161001,
J3535,HCPCS,METERED DOSE INHALER DRUG,,30,,,$12.85,$0.00,1,0,0,20161001,
J3590,HCPCS,UNCLASSIFIED BIOLOGICS,,30,,,$109.03,$0.00,1,0,0,20161001,
J7030,HCPCS,NORMAL SALINE SOLUTION INFUS,,30,,,$7.89,$0.00,1,0,0,20161001,
J7040,HCPCS,NORMAL SALINE SOLUTION INFUS,,30,,,$5.59,$0.00,1,0,0,20161001,
J7042,HCPCS,5% DEXTROSE/NORMAL SALINE,,30,,,$5.59,$0.00,1,0,0,20161001,
J7050,HCPCS,NORMAL SALINE SOLUTION INFUS,,30,,,$2.80,$0.00,1,0,0,20161001,
J7060,HCPCS,5% DEXTROSE/WATER,,30,,,$7.17,$0.00,1,0,0,20161001,
J7070,HCPCS,D5W INFUSION,,30,,,$12.64,$0.00,1,0,0,20161001,
J7100,HCPCS,DEXTRAN 40 INFUSION,,30,,,$49.83,$0.00,1,0,0,20161001,
J7110,HCPCS,DEXTRAN 75 INFUSION,,30,,,$95.25,$0.00,1,0,0,20161001,
J7120,HCPCS,RINGERS LACTATE INFUSION,,30,,,$7.17,$0.00,1,0,0,20161001,
J7131,HCPCS,HYPERTONIC SALINE SOL,,30,,,$6.18,$0.00,1,0,0,20161001,
J7178,HCPCS,HUMAN FIBRINOGEN CONC INJ,,30,,,$6.57,$0.00,1,0,0,20161001,
J7180,HCPCS,FACTOR XIII ANTI-HEM FACTOR,,30,,,$45.83,$0.00,1,0,0,20161001,
J7181,HCPCS,FACTOR XIII RECOMB A-SUBUNIT,,30,,,$89.25,$0.00,1,0,0,20161001,
J7183,HCPCS,WILATE INJECTION,,30,,,$6.37,$0.00,1,0,0,20161001,
J7185,HCPCS,XYNTHA INJ,,30,,,$9.23,$0.00,1,0,0,20161001,
J7186,HCPCS,ANTIHEMOPHILIC VIII/VWF COMP,,30,,,$6.24,$0.00,1,0,0,20161001,
J7187,HCPCS,"HUMATE-P, INJ",,30,,,$6.44,$0.00,1,0,0,20161001,
J7188,HCPCS,FACTOR VIII RECOMB OBIZUR,,30,,,$31.85,$0.00,1,0,0,20161001,
J7189,HCPCS,FACTOR VIIA,,30,,,$11.44,$0.00,1,0,0,20161001,
J7190,HCPCS,FACTOR VIII,,30,,,$6.11,$0.00,1,0,0,20161001,
J7191,HCPCS,FACTOR VIII (PORCINE),,30,,,$6.64,$0.00,1,0,0,20161001,
J7192,HCPCS,FACTOR VIII RECOMBINANT NOS,,30,,,$7.48,$0.00,1,0,0,20161001,
J7193,HCPCS,FACTOR IX NON-RECOMBINANT,,30,,,$6.83,$0.00,1,0,0,20161001,
J7194,HCPCS,FACTOR IX COMPLEX,,30,,,$7.35,$0.00,1,0,0,20161001,
J7195,HCPCS,FACTOR IX RECOMBINANT NOS,,30,,,$8.91,$0.00,1,0,0,20161001,
J7196,HCPCS,ANTITHROMBIN RECOMBINANT,,30,,,$668.12,$0.00,1,0,0,20161001,
J7197,HCPCS,ANTITHROMBIN III INJECTION,,30,,,$21.26,$0.00,1,0,0,20161001,
J7198,HCPCS,ANTI-INHIBITOR,,30,,,$11.51,$0.00,1,0,0,20161001,
J7199,HCPCS,HEMOPHILIA CLOT FACTOR NOC,,30,,,$1.45,$0.00,1,0,0,20161001,
J7200,HCPCS,FACTOR IX RECOMBINAN RIXUBIS,,30,,,$8.06,$0.00,1,0,0,20161001,
J7201,HCPCS,FACTOR IX FC FUSION RECOMB,,30,,,$18.33,$0.00,1,0,0,20161001,
J7205,HCPCS,FACTOR VIII FC FUSION RECOMB,,30,,,$12.35,$0.00,1,0,0,20161001,
J7297,HCPCS,LEVONORGESTREL IU 52MG 3 YR,,30,,,"$2,421.82",$0.00,1,0,0,20161001,
J7298,HCPCS,LEVONORGESTREL IU 52MG 5 YR,,30,,,"$2,421.82",$0.00,1,0,0,20161001,
J7300,HCPCS,INTRAUT COPPER CONTRACEPTIVE,,30,,,$971.71,$0.00,1,0,0,20161001,
J7301,HCPCS,LEVONORGESTREL IU 13.5 MG,,30,,,"$1,452.52",$0.00,1,0,0,20161001,
J7306,HCPCS,LEVONORGESTREL IMPLANT SYS,,30,,,"$1,011.49",$0.00,1,0,0,20161001,
J7307,HCPCS,ETONOGESTREL IMPLANT SYSTEM,,30,,,"$1,373.82",$0.00,1,0,0,20161001,
J7308,HCPCS,AMINOLEVULINIC ACID HCL TOP,,30,,,"$1,876.26",$0.00,1,0,0,20161001,
J7309,HCPCS,"METHYL AMINOLEVULINATE, TOP",,30,,,$541.77,$0.00,1,0,0,20161001,
J7310,HCPCS,GANCICLOVIR LONG ACT IMPLANT,,30,,,"$33,920.00",$0.00,1,0,0,20161001,
J7311,HCPCS,FLUOCINOLONE ACETONIDE IMPLT,,30,,,"$39,421.46",$0.00,1,0,0,20161001,
J7312,HCPCS,DEXAMETHASONE INTRA IMPLANT,,30,,,"$1,291.87",$0.00,1,0,0,20161001,
J7313,HCPCS,FLUOCINOL ACET INTRAVIT IMP,,30,,,"$3,087.98",$0.00,1,0,0,20161001,
J7315,HCPCS,OPHTHALMIC MITOMYCIN,,30,,,$553.22,$0.00,1,0,0,20161001,
J7316,HCPCS,"INJ, OCRIPLASMIN, 0.125 MG",,30,,,"$6,321.39",$0.00,1,0,0,20161001,
J7321,HCPCS,HYALGAN/SUPARTZ INJ PER DOSE,,30,,,$577.28,$0.00,1,0,0,20161001,
J7323,HCPCS,EUFLEXXA INJ PER DOSE,,30,,,$957.04,$0.00,1,0,0,20161001,
J7324,HCPCS,ORTHOVISC INJ PER DOSE,,30,,,"$1,138.81",$0.00,1,0,0,20161001,
J7325,HCPCS,SYNVISC OR SYNVISC-ONE,,30,,,$82.29,$0.00,1,0,0,20161001,
J7326,HCPCS,GEL-ONE,,30,,,"$3,513.43",$0.00,1,0,0,20161001,
J7327,HCPCS,MONOVISC INJ PER DOSE,,30,,,"$5,942.22",$0.00,1,0,0,20161001,
J7336,HCPCS,CAPSAICIN 8% PATCH,,30,,,$16.43,$0.00,1,0,0,20161001,
J7340,HCPCS,CARBIDOPA LEVODOPA ENTERAL,,30,,,$11.95,$0.00,1,0,0,20161001,
J7500,HCPCS,AZATHIOPRINE ORAL 50MG,,30,,,$2.80,$0.00,1,0,0,20161001,
J7501,HCPCS,AZATHIOPRINE PARENTERAL,,30,,,"$1,393.60",$0.00,1,0,0,20161001,
J7502,HCPCS,CYCLOSPORINE ORAL 100 MG,,30,,,$15.24,$0.00,1,0,0,20161001,
J7504,HCPCS,LYMPHOCYTE IMMUNE GLOBULIN,,30,,,"$5,502.83",$0.00,1,0,0,20161001,
J7505,HCPCS,MONOCLONAL ANTIBODIES,,30,,,"$2,328.58",$0.00,1,0,0,20161001,
J7507,HCPCS,TACROLIMUS IMME REL ORAL 1MG,,30,,,$7.45,$0.00,1,0,0,20161001,
J7508,HCPCS,TACROL ASTAGRAF EX REL ORAL,,30,,,$2.18,$0.00,1,0,0,20161001,
J7509,HCPCS,METHYLPREDNISOLONE ORAL,,30,,,$4.16,$0.00,1,0,0,20161001,
J7510,HCPCS,PREDNISOLONE ORAL PER 5 MG,,30,,,$2.80,$0.00,1,0,0,20161001,
J7511,HCPCS,ANTITHYMOCYTE GLOBULN RABBIT,,30,,,"$3,708.88",$0.00,1,0,0,20161001,
J7513,HCPCS,"DACLIZUMAB, PARENTERAL",,30,,,"$1,008.89",$0.00,1,0,0,20161001,
J7515,HCPCS,CYCLOSPORINE ORAL 25 MG,,30,,,$5.59,$0.00,1,0,0,20161001,
J7516,HCPCS,CYCLOSPORIN PARENTERAL 250MG,,30,,,$86.15,$0.00,1,0,0,20161001,
J7517,HCPCS,MYCOPHENOLATE MOFETIL ORAL,,30,,,$7.89,$0.00,1,0,0,20161001,
J7518,HCPCS,MYCOPHENOLIC ACID,,30,,,$14.37,$0.00,1,0,0,20161001,
J7520,HCPCS,"SIROLIMUS, ORAL",,30,,,$48.10,$0.00,1,0,0,20161001,
J7525,HCPCS,TACROLIMUS INJECTION,,30,,,$960.87,$0.00,1,0,0,20161001,
J7527,HCPCS,ORAL EVEROLIMUS,,30,,,$23.02,$0.00,1,0,0,20161001,
J7599,HCPCS,IMMUNOSUPPRESSIVE DRUG NOC,,30,,,$8.39,$0.00,1,0,0,20161001,
J7606,HCPCS,"FORMOTEROL FUMARATE, INH",,30,,,$25.62,$0.00,1,0,0,20161001,
J7607,HCPCS,LEVALBUTEROL COMP CON,,30,,,$34.89,$0.00,1,0,0,20161001,
J7608,HCPCS,ACETYLCYSTEINE NON-COMP UNIT,,30,,,$19.56,$0.00,1,0,0,20161001,
J7609,HCPCS,ALBUTEROL COMP UNIT,,30,,,$14.54,$0.00,1,0,0,20161001,
J7610,HCPCS,ALBUTEROL COMP CON,,30,,,$14.54,$0.00,1,0,0,20161001,
J7611,HCPCS,ALBUTEROL NON-COMP CON,,30,,,$2.80,$0.00,1,0,0,20161001,
J7612,HCPCS,LEVALBUTEROL NON-COMP CON,,30,,,$2.80,$0.00,1,0,0,20161001,
J7613,HCPCS,ALBUTEROL NON-COMP UNIT,,30,,,$2.80,$0.00,1,0,0,20161001,
J7614,HCPCS,LEVALBUTEROL NON-COMP UNIT,,30,,,$2.80,$0.00,1,0,0,20161001,
J7615,HCPCS,LEVALBUTEROL COMP UNIT,,30,,,$11.78,$0.00,1,0,0,20161001,
J7620,HCPCS,ALBUTEROL IPRATROP NON-COMP,,30,,,$2.80,$0.00,1,0,0,20161001,
J7626,HCPCS,BUDESONIDE NON-COMP UNIT,,30,,,$19.56,$0.00,1,0,0,20161001,
J7627,HCPCS,BUDESONIDE COMP UNIT,,30,,,$18.70,$0.00,1,0,0,20161001,
J7633,HCPCS,BUDESONIDE NON-COMP CON,,30,,,$28.36,$0.00,1,0,0,20161001,
J7636,HCPCS,ATROPINE COMP UNIT,,30,,,$28.77,$0.00,1,0,0,20161001,
J7637,HCPCS,DEXAMETHASONE COMP CON,,30,,,$1.07,$0.00,1,0,0,20161001,
J7638,HCPCS,DEXAMETHASONE COMP UNIT,,30,,,$1.07,$0.00,1,0,0,20161001,
J7639,HCPCS,DORNASE ALFA NON-COMP UNIT,,30,,,$93.07,$0.00,1,0,0,20161001,
J7642,HCPCS,GLYCOPYRROLATE COMP CON,,30,,,$0.79,$0.00,1,0,0,20161001,
J7643,HCPCS,GLYCOPYRROLATE COMP UNIT,,30,,,$0.79,$0.00,1,0,0,20161001,
J7644,HCPCS,IPRATROPIUM BROMIDE NON-COMP,,30,,,$2.80,$0.00,1,0,0,20161001,
J7645,HCPCS,IPRATROPIUM BROMIDE COMP,,30,,,$7.27,$0.00,1,0,0,20161001,
J7649,HCPCS,ISOETHARINE NON-COMP UNIT,,30,,,$2.26,$0.00,1,0,0,20161001,
J7658,HCPCS,ISOPROTERENOL NON-COMP CON,,30,,,$12.49,$0.00,1,0,0,20161001,
J7659,HCPCS,ISOPROTERENOL NON-COMP UNIT,,30,,,$12.49,$0.00,1,0,0,20161001,
J7660,HCPCS,ISOPROTERENOL COMP UNIT,,30,,,$1.51,$0.00,1,0,0,20161001,
J7665,HCPCS,MANNITOL FOR INHALER,,30,,,$5.59,$0.00,1,0,0,20161001,
J7674,HCPCS,"METHACHOLINE CHLORIDE, NEB",,30,,,$2.80,$0.00,1,0,0,20161001,
J7676,HCPCS,PENTAMIDINE COMP UNIT DOSE,,30,,,$549.78,$0.00,1,0,0,20161001,
J7680,HCPCS,TERBUTALINE SULF COMP CON,,30,,,$40.32,$0.00,1,0,0,20161001,
J7682,HCPCS,TOBRAMYCIN NON-COMP UNIT,,30,,,$222.79,$0.00,1,0,0,20161001,
J7699,HCPCS,INHALATION SOLUTION FOR DME,,30,,,$5.21,$0.00,1,0,0,20161001,
J7799,HCPCS,NON-INHALATION DRUG FOR DME,,30,,,$10.18,$0.00,1,0,0,20161001,
J7999,HCPCS,"COMPOUNDED DRUG, NOC",,30,,,$2.95,$0.00,1,0,0,20161001,
J8498,HCPCS,ANTIEMETIC RECTAL/SUPP NOS,,30,,,$1.45,$0.00,1,0,0,20161001,
J8499,HCPCS,ORAL PRESCRIP DRUG NON CHEMO,,30,,,$1.45,$0.00,1,0,0,20161001,
J8501,HCPCS,ORAL APREPITANT,,30,,,$47.37,$0.00,1,0,0,20161001,
J8510,HCPCS,ORAL BUSULFAN,,30,,,$59.10,$0.00,1,0,0,20161001,
J8520,HCPCS,"CAPECITABINE, ORAL, 150 MG",,30,,,$38.84,$0.00,1,0,0,20161001,
J8521,HCPCS,"CAPECITABINE, ORAL, 500 MG",,30,,,$113.86,$0.00,1,0,0,20161001,
J8530,HCPCS,CYCLOPHOSPHAMIDE ORAL 25 MG,,30,,,$13.58,$0.00,1,0,0,20161001,
J8540,HCPCS,ORAL DEXAMETHASONE,,30,,,$2.80,$0.00,1,0,0,20161001,
J8560,HCPCS,ETOPOSIDE ORAL 50 MG,,30,,,$321.19,$0.00,1,0,0,20161001,
J8562,HCPCS,ORAL FLUDARABINE PHOSPHATE,,30,,,$271.13,$0.00,1,0,0,20161001,
J8565,HCPCS,GEFITINIB ORAL,,30,,,$144.96,$0.00,1,0,0,20161001,
J8597,HCPCS,ANTIEMETIC DRUG ORAL NOS,,30,,,$139.92,$0.00,1,0,0,20161001,
J8610,HCPCS,METHOTREXATE ORAL 2.5 MG,,30,,,$8.44,$0.00,1,0,0,20161001,
J8650,HCPCS,NABILONE ORAL,,30,,,$221.51,$0.00,1,0,0,20161001,
J8655,HCPCS,NETUPITANT PALONOSETRON ORAL,,30,,,"$2,651.06",$0.00,1,0,0,20161001,
J8700,HCPCS,TEMOZOLOMIDE,,30,,,$14.85,$0.00,1,0,0,20161001,
J8705,HCPCS,TOPOTECAN ORAL,,30,,,$545.57,$0.00,1,0,0,20161001,
J8999,HCPCS,ORAL PRESCRIPTION DRUG CHEMO,,30,,,$50.99,$0.00,1,0,0,20161001,
J9000,HCPCS,DOXORUBICIN HCL INJECTION,,30,,,$16.89,$0.00,1,0,0,20161001,
J9015,HCPCS,ALDESLEUKIN INJECTION,,30,,,"$14,158.85",$0.00,1,0,0,20161001,
J9017,HCPCS,ARSENIC TRIOXIDE INJECTION,,30,,,$300.80,$0.00,1,0,0,20161001,
J9019,HCPCS,ERWINAZE INJECTION,,30,,,"$2,035.03",$0.00,1,0,0,20161001,
J9020,HCPCS,"ASPARAGINASE, NOS",,30,,,$245.08,$0.00,1,0,0,20161001,
J9025,HCPCS,AZACITIDINE INJECTION,,30,,,$22.49,$0.00,1,0,0,20161001,
J9027,HCPCS,CLOFARABINE INJECTION,,30,,,$750.23,$0.00,1,0,0,20161001,
J9031,HCPCS,BCG LIVE INTRAVESICAL VAC,,30,,,$681.19,$0.00,1,0,0,20161001,
J9032,HCPCS,"INJECTION, BELINOSTAT, 10MG",,30,,,$176.64,$0.00,1,0,0,20161001,
J9033,HCPCS,BENDAMUSTINE INJECTION,,30,,,$130.09,$0.00,1,0,0,20161001,
J9035,HCPCS,BEVACIZUMAB INJECTION,,30,,,$366.96,$0.00,1,0,0,20161001,
J9039,HCPCS,"INJECTION, BLINATUMOMAB",,30,,,$535.96,$0.00,1,0,0,20161001,
J9040,HCPCS,BLEOMYCIN SULFATE INJECTION,,30,,,$102.83,$0.00,1,0,0,20161001,
J9041,HCPCS,BORTEZOMIB INJECTION,,30,,,$253.59,$0.00,1,0,0,20161001,
J9042,HCPCS,BRENTUXIMAB VEDOTIN INJ,,30,,,$743.92,$0.00,1,0,0,20161001,
J9043,HCPCS,CABAZITAXEL INJECTION,,30,,,$813.02,$0.00,1,0,0,20161001,
J9045,HCPCS,CARBOPLATIN INJECTION,,30,,,$16.89,$0.00,1,0,0,20161001,
J9047,HCPCS,"INJECTION, CARFILZOMIB, 1 MG",,30,,,$170.14,$0.00,1,0,0,20161001,
J9050,HCPCS,CARMUSTINE INJECTION,,30,,,"$15,371.94",$0.00,1,0,0,20161001,
J9055,HCPCS,CETUXIMAB INJECTION,,30,,,$297.56,$0.00,1,0,0,20161001,
J9060,HCPCS,CISPLATIN 10 MG INJECTION,,30,,,$10.13,$0.00,1,0,0,20161001,
J9065,HCPCS,INJ CLADRIBINE PER 1 MG,,30,,,$128.25,$0.00,1,0,0,20161001,
J9070,HCPCS,CYCLOPHOSPHAMIDE 100 MG INJ,,30,,,$208.72,$0.00,1,0,0,20161001,
J9098,HCPCS,CYTARABINE LIPOSOME INJ,,30,,,"$3,131.03",$0.00,1,0,0,20161001,
J9100,HCPCS,CYTARABINE HCL 100 MG INJ,,30,,,$5.07,$0.00,1,0,0,20161001,
J9120,HCPCS,DACTINOMYCIN INJECTION,,30,,,"$6,501.72",$0.00,1,0,0,20161001,
J9130,HCPCS,DACARBAZINE 100 MG INJ,,30,,,$20.26,$0.00,1,0,0,20161001,
J9150,HCPCS,DAUNORUBICIN INJECTION,,30,,,$146.74,$0.00,1,0,0,20161001,
J9151,HCPCS,DAUNORUBICIN CITRATE INJ,,30,,,"$1,335.52",$0.00,1,0,0,20161001,
J9155,HCPCS,DEGARELIX INJECTION,,30,,,$19.44,$0.00,1,0,0,20161001,
J9160,HCPCS,DENILEUKIN DIFTITOX INJ,,30,,,"$3,372.39",$0.00,1,0,0,20161001,
J9165,HCPCS,DIETHYLSTILBESTROL INJECTION,,30,,,$62.19,$0.00,1,0,0,20161001,
J9171,HCPCS,DOCETAXEL INJECTION,,30,,,$22.69,$0.00,1,0,0,20161001,
J9175,HCPCS,ELLIOTTS B SOLUTION PER ML,,30,,,$16.10,$0.00,1,0,0,20161001,
J9178,HCPCS,"INJ, EPIRUBICIN HCL, 2 MG",,30,,,$7.89,$0.00,1,0,0,20161001,
J9179,HCPCS,ERIBULIN MESYLATE INJECTION,,30,,,$560.93,$0.00,1,0,0,20161001,
J9181,HCPCS,ETOPOSIDE INJECTION,,30,,,$3.38,$0.00,1,0,0,20161001,
J9185,HCPCS,FLUDARABINE PHOSPHATE INJ,,30,,,$328.47,$0.00,1,0,0,20161001,
J9190,HCPCS,FLUOROURACIL INJECTION,,30,,,$10.13,$0.00,1,0,0,20161001,
J9200,HCPCS,FLOXURIDINE INJECTION,,30,,,$377.91,$0.00,1,0,0,20161001,
J9201,HCPCS,GEMCITABINE HCL INJECTION,,30,,,$33.77,$0.00,1,0,0,20161001,
J9202,HCPCS,GOSERELIN ACETATE IMPLANT,,30,,,"$1,507.73",$0.00,1,0,0,20161001,
J9206,HCPCS,IRINOTECAN INJECTION,,30,,,$20.26,$0.00,1,0,0,20161001,
J9207,HCPCS,IXABEPILONE INJECTION,,30,,,$396.54,$0.00,1,0,0,20161001,
J9208,HCPCS,IFOSFAMIDE INJECTION,,30,,,$181.20,$0.00,1,0,0,20161001,
J9209,HCPCS,MESNA INJECTION,,30,,,$13.51,$0.00,1,0,0,20161001,
J9211,HCPCS,IDARUBICIN HCL INJECTION,,30,,,$224.27,$0.00,1,0,0,20161001,
J9212,HCPCS,INTERFERON ALFACON-1 INJ,,30,,,$23.02,$0.00,1,0,0,20161001,
J9213,HCPCS,INTERFERON ALFA-2A INJ,,30,,,"$4,095.47",$0.00,1,0,0,20161001,
J9214,HCPCS,INTERFERON ALFA-2B INJ,,30,,,$126.13,$0.00,1,0,0,20161001,
J9215,HCPCS,INTERFERON ALFA-N3 INJ,,30,,,$85.66,$0.00,1,0,0,20161001,
J9216,HCPCS,INTERFERON GAMMA 1-B INJ,,30,,,"$10,935.08",$0.00,1,0,0,20161001,
J9217,HCPCS,LEUPROLIDE ACETATE SUSPNSION,,30,,,"$1,274.52",$0.00,1,0,0,20161001,
J9218,HCPCS,LEUPROLIDE ACETATE INJECITON,,30,,,$33.77,$0.00,1,0,0,20161001,
J9219,HCPCS,LEUPROLIDE ACETATE IMPLANT,,30,,,"$6,913.10",$0.00,1,0,0,20161001,
J9225,HCPCS,VANTAS IMPLANT,,30,,,"$15,398.14",$0.00,1,0,0,20161001,
J9226,HCPCS,SUPPRELIN LA IMPLANT,,30,,,"$42,347.28",$0.00,1,0,0,20161001,
J9228,HCPCS,IPILIMUMAB INJECTION,,30,,,$757.38,$0.00,1,0,0,20161001,
J9230,HCPCS,MECHLORETHAMINE HCL INJ,,30,,,"$1,351.01",$0.00,1,0,0,20161001,
J9245,HCPCS,INJ MELPHALAN HYDROCHL 50 MG,,30,,,"$7,219.09",$0.00,1,0,0,20161001,
J9250,HCPCS,METHOTREXATE SODIUM INJ,,30,,,$1.69,$0.00,1,0,0,20161001,
J9260,HCPCS,METHOTREXATE SODIUM INJ,,30,,,$11.82,$0.00,1,0,0,20161001,
J9261,HCPCS,NELARABINE INJECTION,,30,,,$796.88,$0.00,1,0,0,20161001,
J9262,HCPCS,"INJ, OMACETAXINE MEP, 0.01MG",,30,,,$13.85,$0.00,1,0,0,20161001,
J9263,HCPCS,OXALIPLATIN,,30,,,$3.38,$0.00,1,0,0,20161001,
J9264,HCPCS,PACLITAXEL PROTEIN BOUND,,30,,,$54.07,$0.00,1,0,0,20161001,
J9266,HCPCS,PEGASPARGASE INJECTION,,30,,,"$23,045.33",$0.00,1,0,0,20161001,
J9267,HCPCS,PACLITAXEL INJECTION,,30,,,$1.69,$0.00,1,0,0,20161001,
J9268,HCPCS,PENTOSTATIN INJECTION,,30,,,"$8,318.61",$0.00,1,0,0,20161001,
J9271,HCPCS,INJ PEMBROLIZUMAB,,30,,,$255.08,$0.00,1,0,0,20161001,
J9280,HCPCS,MITOMYCIN INJECTION,,30,,,$367.83,$0.00,1,0,0,20161001,
J9293,HCPCS,MITOXANTRONE HYDROCHL / 5 MG,,30,,,$178.47,$0.00,1,0,0,20161001,
J9299,HCPCS,"INJECTION, NIVOLUMAB",,30,,,$141.69,$0.00,1,0,0,20161001,
J9300,HCPCS,GEMTUZUMAB OZOGAMICIN INJ,,30,,,"$4,528.76",$0.00,1,0,0,20161001,
J9301,HCPCS,OBINUTUZUMAB INJ,,30,,,$302.81,$0.00,1,0,0,20161001,
J9302,HCPCS,OFATUMUMAB INJECTION,,30,,,$269.91,$0.00,1,0,0,20161001,
J9303,HCPCS,PANITUMUMAB INJECTION,,30,,,$543.34,$0.00,1,0,0,20161001,
J9305,HCPCS,PEMETREXED INJECTION,,30,,,$339.84,$0.00,1,0,0,20161001,
J9306,HCPCS,"INJECTION, PERTUZUMAB, 1 MG",,30,,,$57.09,$0.00,1,0,0,20161001,
J9307,HCPCS,PRALATREXATE INJECTION,,30,,,"$1,144.04",$0.00,1,0,0,20161001,
J9308,HCPCS,"INJECTION, RAMUCIRUMAB",,30,,,$301.31,$0.00,1,0,0,20161001,
J9310,HCPCS,RITUXIMAB INJECTION,,30,,,"$3,191.20",$0.00,1,0,0,20161001,
J9315,HCPCS,ROMIDEPSIN INJECTION,,30,,,"$1,556.44",$0.00,1,0,0,20161001,
J9320,HCPCS,STREPTOZOCIN INJECTION,,30,,,"$1,881.93",$0.00,1,0,0,20161001,
J9328,HCPCS,TEMOZOLOMIDE INJECTION,,30,,,$34.80,$0.00,1,0,0,20161001,
J9330,HCPCS,TEMSIROLIMUS INJECTION,,30,,,$335.60,$0.00,1,0,0,20161001,
J9340,HCPCS,THIOTEPA INJECTION,,30,,,"$3,522.99",$0.00,1,0,0,20161001,
J9351,HCPCS,TOPOTECAN INJECTION,,30,,,$6.75,$0.00,1,0,0,20161001,
J9354,HCPCS,"INJ, ADO-TRASTUZUMAB EMT 1MG",,30,,,$163.22,$0.00,1,0,0,20161001,
J9355,HCPCS,TRASTUZUMAB INJECTION,,30,,,$384.45,$0.00,1,0,0,20161001,
J9357,HCPCS,VALRUBICIN INJECTION,,30,,,"$6,144.65",$0.00,1,0,0,20161001,
J9360,HCPCS,VINBLASTINE SULFATE INJ,,30,,,$11.82,$0.00,1,0,0,20161001,
J9370,HCPCS,VINCRISTINE SULFATE 1 MG INJ,,30,,,$23.64,$0.00,1,0,0,20161001,
J9371,HCPCS,"INJ, VINCRISTINE SUL LIP 1MG",,30,,,"$12,263.19",$0.00,1,0,0,20161001,
J9390,HCPCS,VINORELBINE TARTRATE INJ,,30,,,$48.97,$0.00,1,0,0,20161001,
J9395,HCPCS,"INJECTION, FULVESTRANT",,30,,,$515.85,$0.00,1,0,0,20161001,
J9400,HCPCS,"INJ, ZIV-AFLIBERCEPT, 1MG",,30,,,$45.52,$0.00,1,0,0,20161001,
J9600,HCPCS,PORFIMER SODIUM INJECTION,,30,,,"$40,004.40",$0.00,1,0,0,20161001,
J9999,HCPCS,CHEMOTHERAPY DRUG,,30,,,$106.33,$0.00,1,0,0,20161001,
P3001,HCPCS,SCREENING PAP SMEAR BY PHYS,,30,,,$201.55,$0.00,1,0,1,20161001,
P7001,HCPCS,CULTURE BACTERIAL URINE,,30,,,$119.47,$0.00,1,0,1,20161001,
P9010,HCPCS,WHOLE BLOOD FOR TRANSFUSION,,30,,,"$1,259.16",$0.00,1,0,1,20161001,
P9011,HCPCS,BLOOD SPLIT UNIT,,30,,,$582.36,$0.00,1,0,1,20161001,
P9012,HCPCS,CRYOPRECIPITATE EACH UNIT,,30,,,$284.68,$0.00,1,0,1,20161001,
P9016,HCPCS,RBC LEUKOCYTES REDUCED,,30,,,$842.12,$0.00,1,0,1,20161001,
P9017,HCPCS,PLASMA 1 DONOR FRZ W/IN 8 HR,,30,,,$412.26,$0.00,1,0,1,20161001,
P9019,HCPCS,"PLATELETS, EACH UNIT",,30,,,$670.60,$0.00,1,0,1,20161001,
P9020,HCPCS,PLAELET RICH PLASMA UNIT,,30,,,$682.70,$0.00,1,0,1,20161001,
P9021,HCPCS,RED BLOOD CELLS UNIT,,30,,,$828.32,$0.00,1,0,1,20161001,
P9022,HCPCS,WASHED RED BLOOD CELLS UNIT,,30,,,"$1,746.87",$0.00,1,0,1,20161001,
P9023,HCPCS,"FROZEN PLASMA, POOLED, SD",,30,,,$426.69,$0.00,1,0,1,20161001,
P9031,HCPCS,PLATELETS LEUKOCYTES REDUCED,,30,,,$660.88,$0.00,1,0,1,20161001,
P9032,HCPCS,"PLATELETS, IRRADIATED",,30,,,$903.89,$0.00,1,0,1,20161001,
P9033,HCPCS,PLATELETS LEUKOREDUCED IRRAD,,30,,,$920.88,$0.00,1,0,1,20161001,
P9034,HCPCS,"PLATELETS, PHERESIS",,30,,,"$2,415.54",$0.00,1,0,1,20161001,
P9035,HCPCS,PLATELET PHERES LEUKOREDUCED,,30,,,"$2,774.27",$0.00,1,0,1,20161001,
P9036,HCPCS,PLATELET PHERESIS IRRADIATED,,30,,,"$3,000.51",$0.00,1,0,1,20161001,
P9037,HCPCS,PLATE PHERES LEUKOREDU IRRAD,,30,,,"$3,646.74",$0.00,1,0,1,20161001,
P9038,HCPCS,RBC IRRADIATED,,30,,,"$1,169.39",$0.00,1,0,1,20161001,
P9039,HCPCS,RBC DEGLYCEROLIZED,,30,,,"$2,160.83",$0.00,1,0,1,20161001,
P9040,HCPCS,RBC LEUKOREDUCED IRRADIATED,,30,,,"$1,180.10",$0.00,1,0,1,20161001,
P9041,HCPCS,"ALBUMIN (HUMAN),5%, 50ML",,30,,,$65.65,$0.00,1,0,1,20161001,
P9043,HCPCS,"PLASMA PROTEIN FRACT,5%,50ML",,30,,,$160.68,$0.00,1,0,1,20161001,
P9044,HCPCS,CRYOPRECIPITATEREDUCEDPLASMA,,30,,,$264.40,$0.00,1,0,1,20161001,
P9045,HCPCS,"ALBUMIN (HUMAN), 5%, 250 ML",,30,,,$328.19,$0.00,1,0,1,20161001,
P9046,HCPCS,"ALBUMIN (HUMAN), 25%, 20 ML",,30,,,$135.33,$0.00,1,0,1,20161001,
P9047,HCPCS,"ALBUMIN (HUMAN), 25%, 50ML",,30,,,$321.57,$0.00,1,0,1,20161001,
P9048,HCPCS,"PLASMAPROTEIN FRACT,5%,250ML",,30,,,$228.06,$0.00,1,0,1,20161001,
P9050,HCPCS,"GRANULOCYTES, PHERESIS UNIT",,30,,,"$8,627.41",$0.00,1,0,1,20161001,
P9051,HCPCS,"BLOOD, L/R, CMV-NEG",,30,,,"$1,085.78",$0.00,1,0,1,20161001,
P9052,HCPCS,"PLATELETS, HLA-M, L/R, UNIT",,30,,,"$4,005.42",$0.00,1,0,1,20161001,
P9053,HCPCS,"PLT, PHER, L/R CMV-NEG, IRR",,30,,,"$3,357.66",$0.00,1,0,1,20161001,
P9054,HCPCS,"BLOOD, L/R, FROZ/DEGLY/WASH",,30,,,"$1,825.39",$0.00,1,0,1,20161001,
P9055,HCPCS,"PLT, APH/PHER, L/R, CMV-NEG",,30,,,"$2,627.63",$0.00,1,0,1,20161001,
P9056,HCPCS,"BLOOD, L/R, IRRADIATED",,30,,,$662.70,$0.00,1,0,1,20161001,
P9057,HCPCS,"RBC, FRZ/DEG/WSH, L/R, IRRAD",,30,,,"$1,155.36",$0.00,1,0,1,20161001,
P9058,HCPCS,"RBC, L/R, CMV-NEG, IRRAD",,30,,,"$1,416.03",$0.00,1,0,1,20161001,
P9059,HCPCS,"PLASMA, FRZ BETWEEN 8-24HOUR",,30,,,$415.21,$0.00,1,0,1,20161001,
P9060,HCPCS,FR FRZ PLASMA DONOR RETESTED,,30,,,$243.83,$0.00,1,0,1,20161001,
P9070,HCPCS,PATHOGEN REDUCED PLASMA POOL,,30,,,$415.21,$0.00,1,0,1,20161001,
P9071,HCPCS,PATHOGEN REDUCED PLASMA SING,,30,,,$412.26,$0.00,1,0,1,20161001,
P9072,HCPCS,PATHOGEN REDUCED PLATELETS,,30,,,"$3,646.74",$0.00,1,0,1,20161001,
P9615,HCPCS,URINE SPECIMEN COLLECT MULT,,30,,,$17.22,$0.00,1,0,1,20161001,
PHOSP,PHOSP,PARTIAL HOSPITALIZATION PER DIEM,,30,,,$515.38,$0.00,1,0,0,20161001,
Q0035,HCPCS,CARDIOKYMOGRAPHY,,30,,,$156.54,$0.00,1,0,1,20161001,
Q0081,HCPCS,INFUSION THER OTHER THAN CHE,,30,,,$458.24,$0.00,1,0,1,20161001,
Q0083,HCPCS,CHEMO BY OTHER THAN INFUSION,,30,,,$183.01,$0.00,1,0,1,20161001,
Q0084,HCPCS,CHEMOTHERAPY BY INFUSION,,30,,,$458.87,$0.00,1,0,1,20161001,
Q0085,HCPCS,CHEMO BY BOTH INFUSION AND O,,30,,,$436.83,$0.00,1,0,1,20161001,
Q0091,HCPCS,OBTAINING SCREEN PAP SMEAR,,30,,,$81.90,$0.00,1,0,1,20161001,
Q0092,HCPCS,SET UP PORT XRAY EQUIPMENT,,30,,,$130.91,$0.00,1,0,1,20161001,
Q0138,HCPCS,"FERUMOXYTOL, NON-ESRD",,30,,,$4.41,$0.00,1,0,1,20161001,
Q0139,HCPCS,"FERUMOXYTOL, ESRD USE",,30,,,$5.14,$0.00,1,0,1,20161001,
Q0144,HCPCS,"AZITHROMYCIN DIHYDRATE, ORAL",,30,,,$40.32,$0.00,1,0,0,20161001,
Q0162,HCPCS,ONDANSETRON ORAL,,30,,,$1.69,$0.00,1,0,1,20161001,
Q0163,HCPCS,DIPHENHYDRAMINE HCL 50MG,,30,,,$1.69,$0.00,1,0,1,20161001,
Q0164,HCPCS,PROCHLORPERAZINE MALEATE 5MG,,30,,,$1.69,$0.00,1,0,1,20161001,
Q0166,HCPCS,GRANISETRON HCL 1 MG ORAL,,30,,,$6.75,$0.00,1,0,1,20161001,
Q0167,HCPCS,DRONABINOL 2.5MG ORAL,,30,,,$32.08,$0.00,1,0,1,20161001,
Q0169,HCPCS,PROMETHAZINE HCL 12.5MG ORAL,,30,,,$1.69,$0.00,1,0,1,20161001,
Q0175,HCPCS,PERPHENAZINE 4MG ORAL,,30,,,$3.38,$0.00,1,0,1,20161001,
Q0177,HCPCS,HYDROXYZINE PAMOATE 25MG,,30,,,$10.13,$0.00,1,0,1,20161001,
Q0180,HCPCS,DOLASETRON MESYLATE ORAL,,30,,,$312.52,$0.00,1,0,1,20161001,
Q0181,HCPCS,UNSPECIFIED ORAL ANTI-EMETIC,,30,,,$50.47,$0.00,1,0,0,20161001,
Q0512,HCPCS,PX SUP FEE ANTI-CAN SUB PRES,,30,,,$23.26,$0.00,1,0,1,20161001,
Q0515,HCPCS,SERMORELIN ACETATE INJECTION,,30,,,$7.89,$0.00,1,0,0,20161001,
Q2009,HCPCS,FOSPHENYTOIN INJ PE,,30,,,$13.51,$0.00,1,0,1,20161001,
Q2017,HCPCS,"TENIPOSIDE, 50 MG",,30,,,"$5,137.97",$0.00,1,0,1,20161001,
Q2026,HCPCS,RADIESSE INJECTION,,30,,,$706.82,$0.00,1,0,1,20161001,
Q2034,HCPCS,AGRIFLU VACCINE,,30,,,$43.61,$0.00,1,0,1,20161001,
Q2035,HCPCS,"AFLURIA VACC, 3 YRS & >, IM",,30,,,$72.69,$0.00,1,0,1,20161001,
Q2036,HCPCS,"FLULAVAL VACC, 3 YRS & >, IM",,30,,,$85.44,$0.00,1,0,1,20161001,
Q2037,HCPCS,"FLUVIRIN VACC, 3 YRS & >, IM",,30,,,$83.89,$0.00,1,0,1,20161001,
Q2038,HCPCS,"FLUZONE VACC, 3 YRS & >, IM",,30,,,$61.49,$0.00,1,0,1,20161001,
Q2039,HCPCS,"NOS FLU VACC, 3 YRS & >, IM",,30,,,$83.70,$0.00,1,0,1,20161001,
Q2043,HCPCS,SIPULEUCEL-T AUTO CD54+,,30,,,"$71,760.16",$0.00,1,0,1,20161001,
Q2049,HCPCS,IMPORTED LIPODOX INJ,,30,,,"$3,193.91",$0.00,1,0,1,20161001,
Q2050,HCPCS,DOXORUBICIN INJ 10MG,,30,,,"$2,728.57",$0.00,1,0,1,20161001,
Q3001,HCPCS,BRACHYTHERAPY RADIOELEMENTS,,30,,,$141.50,$0.00,1,0,1,20161001,
Q3027,HCPCS,INJ BETA INTERFERON IM 1 MCG,,30,,,$215.06,$0.00,1,0,1,20161001,
Q3028,HCPCS,INJ BETA INTERFERON SQ 1 MCG,,30,,,$16.58,$0.00,1,0,1,20161001,
Q4074,HCPCS,ILOPROST NON-COMP UNIT DOSE,,30,,,$253.06,$0.00,1,0,1,20161001,
Q4081,HCPCS,"EPOETIN ALFA, 100 UNITS ESRD",,30,,,$6.74,$0.00,1,0,1,20161001,
Q4100,HCPCS,"SKIN SUBSTITUTE, NOS",,30,,,"$8,016.48",$0.00,1,0,1,20161001,
Q4101,HCPCS,APLIGRAF,,30,,,$84.42,$0.00,1,0,1,20161001,
Q4102,HCPCS,OASIS WOUND MATRIX,,30,,,$28.21,$0.00,1,0,1,20161001,
Q4103,HCPCS,OASIS BURN MATRIX,,30,,,$28.21,$0.00,1,0,1,20161001,
Q4104,HCPCS,INTEGRA BMWD,,30,,,$67.99,$0.00,1,0,1,20161001,
Q4105,HCPCS,INTEGRA DRT,,30,,,$48.97,$0.00,1,0,1,20161001,
Q4106,HCPCS,DERMAGRAFT,,30,,,$92.21,$0.00,1,0,1,20161001,
Q4107,HCPCS,GRAFTJACKET,,30,,,$238.36,$0.00,1,0,1,20161001,
Q4108,HCPCS,INTEGRA MATRIX,,30,,,$79.23,$0.00,1,0,1,20161001,
Q4110,HCPCS,PRIMATRIX,,30,,,$96.53,$0.00,1,0,1,20161001,
Q4111,HCPCS,GAMMAGRAFT,,30,,,$23.89,$0.00,1,0,1,20161001,
Q4112,HCPCS,CYMETRA INJECTABLE,,30,,,$797.02,$0.00,1,0,1,20161001,
Q4113,HCPCS,GRAFTJACKET XPRESS,,30,,,$797.02,$0.00,1,0,1,20161001,
Q4114,HCPCS,INTEGRA FLOWABLE WOUND MATRI,,30,,,"$3,258.24",$0.00,1,0,1,20161001,
Q4115,HCPCS,ALLOSKIN,,30,,,$30.81,$0.00,1,0,1,20161001,
Q4116,HCPCS,ALLODERM,,30,,,$85.29,$0.00,1,0,1,20161001,
Q4118,HCPCS,MATRISTEM MICROMATRIX,,30,,,$7.27,$0.00,1,0,1,20161001,
Q4119,HCPCS,MATRISTEM WOUND MATRIX,,30,,,$14.54,$0.00,1,0,1,20161001,
Q4121,HCPCS,THERASKIN,,30,,,$211.39,$0.00,1,0,1,20161001,
Q4122,HCPCS,DERMACELL,,30,,,"$1,891.07",$0.00,1,0,1,20161001,
Q4123,HCPCS,ALLOSKIN,,30,,,$40.32,$0.00,1,0,1,20161001,
Q4124,HCPCS,OASIS TRI-LAYER WOUND MATRIX,,30,,,"$3,858.38",$0.00,1,0,1,20161001,
Q4125,HCPCS,ARTHROFLEX,,30,,,"$2,516.40",$0.00,1,0,1,20161001,
Q4126,HCPCS,MEMODERM/DERMA/TRANZ/INTEGUP,,30,,,$390.44,$0.00,1,0,1,20161001,
Q4127,HCPCS,TALYMED,,30,,,$2.93,$0.00,1,0,1,20161001,
Q4128,HCPCS,FLEXHD/ALLOPATCHHD/MATRIXHD,,30,,,$307.19,$0.00,1,0,1,20161001,
Q4129,HCPCS,UNITE BIOMATRIX,,30,,,$247.93,$0.00,1,0,1,20161001,
Q4130,HCPCS,STRATTICE TM,,30,,,"$18,957.22",$0.00,1,0,1,20161001,
Q4131,HCPCS,EPIFIX,,30,,,$529.80,$0.00,1,0,1,20161001,
Q4132,HCPCS,GRAFIX CORE,,30,,,"$3,725.23",$0.00,1,0,1,20161001,
Q4133,HCPCS,GRAFIX PRIME,,30,,,"$3,692.87",$0.00,1,0,1,20161001,
Q4134,HCPCS,HMATRIX,,30,,,"$4,058.23",$0.00,1,0,1,20161001,
Q4137,HCPCS,"AMNIOEXCEL OR BIODEXCEL, 1CM",,30,,,"$1,276.61",$0.00,1,0,1,20161001,
Q4141,HCPCS,"ALLOSKIN AC, 1 CM",,30,,,$27.70,$0.00,1,0,1,20161001,
Q4145,HCPCS,"EPIFIX, INJ, 1MG",,30,,,$60.23,$0.00,1,0,1,20161001,
Q4148,HCPCS,"NEOX 1K, 1CM",,30,,,$231.09,$0.00,1,0,1,20161001,
Q5001,HCPCS,HOSPICE OR HOME HLTH IN HOME,,30,,,$225.69,$0.00,1,0,1,20161001,
Q5002,HCPCS,HOSPICE/HOME HLTH IN ASST LV,,30,,,$344.50,$0.00,1,0,1,20161001,
Q5003,HCPCS,HOSPICE IN LT/NON-SKILLED NF,,30,,,$315.79,$0.00,1,0,1,20161001,
Q5004,HCPCS,HOSPICE IN SNF,,30,,,$350.24,$0.00,1,0,1,20161001,
Q5005,HCPCS,"HOSPICE, INPATIENT HOSPITAL",,30,,,$922.11,$0.00,1,0,1,20161001,
Q5006,HCPCS,HOSPICE IN HOSPICE FACILITY,,30,,,$895.70,$0.00,1,0,1,20161001,
Q5007,HCPCS,HOSPICE IN LTCH,,30,,,$855.50,$0.00,1,0,1,20161001,
Q5009,HCPCS,"HOSPICE/HOME HLTH, PLACE NOS",,30,,,$207.85,$0.00,1,0,1,20161001,
Q5010,HCPCS,HOSPICE HOME CARE IN HOSPICE,,30,,,$610.94,$0.00,1,0,1,20161001,
Q5101,HCPCS,INJ FILGRASTIM GCSF BIOSIMIL,,30,,,$6.31,$0.00,1,0,1,20161001,
Q9950,HCPCS,INJ SULF HEXA LIPID MICROSPH,,30,,,$187.83,$0.00,1,0,1,20161001,
Q9951,HCPCS,"LOCM >= 400 MG/ML IODINE,1ML",,30,,,$5.66,$0.00,1,0,1,20161001,
Q9953,HCPCS,"INJ FE-BASED MR CONTRAST,1ML",,30,,,$42.45,$0.00,1,0,1,20161001,
Q9954,HCPCS,"ORAL MR CONTRAST, 100 ML",,30,,,$14.19,$0.00,1,0,1,20161001,
Q9955,HCPCS,"INJ PERFLEXANE LIP MICROS,ML",,30,,,$4.39,$0.00,1,0,1,20161001,
Q9956,HCPCS,"INJ OCTAFLUOROPROPANE MIC,ML",,30,,,$106.12,$0.00,1,0,1,20161001,
Q9957,HCPCS,"INJ PERFLUTREN LIP MICROS,ML",,30,,,$218.07,$0.00,1,0,1,20161001,
Q9958,HCPCS,"HOCM <=149 MG/ML IODINE, 1ML",,30,,,$0.26,$0.00,1,0,1,20161001,
Q9959,HCPCS,"HOCM 150-199MG/ML IODINE,1ML",,30,,,$0.55,$0.00,1,0,1,20161001,
Q9960,HCPCS,"HOCM 200-249MG/ML IODINE,1ML",,30,,,$1.10,$0.00,1,0,1,20161001,
Q9961,HCPCS,"HOCM 250-299MG/ML IODINE,1ML",,30,,,$1.65,$0.00,1,0,1,20161001,
Q9962,HCPCS,"HOCM 300-349MG/ML IODINE,1ML",,30,,,$1.70,$0.00,1,0,1,20161001,
Q9963,HCPCS,"HOCM 350-399MG/ML IODINE,1ML",,30,,,$2.16,$0.00,1,0,1,20161001,
Q9964,HCPCS,"HOCM>= 400MG/ML IODINE, 1ML",,30,,,$2.60,$0.00,1,0,1,20161001,
Q9965,HCPCS,"LOCM 100-199MG/ML IODINE,1ML",,30,,,$3.30,$0.00,1,0,1,20161001,
Q9966,HCPCS,"LOCM 200-299MG/ML IODINE,1ML",,30,,,$3.73,$0.00,1,0,1,20161001,
Q9967,HCPCS,"LOCM 300-399MG/ML IODINE,1ML",,30,,,$3.99,$0.00,1,0,1,20161001,
Q9968,HCPCS,VISUALIZATION ADJUNCT,,30,,,$58.43,$0.00,1,0,1,20161001,
Q9969,HCPCS,NON-HEU TC-99M ADD-ON/DOSE,,30,,,$65.00,$0.00,1,0,1,20161001,
R0070,HCPCS,TRANSPORT PORTABLE X-RAY,,30,,,$227.30,$0.00,1,0,1,20161001,
R0075,HCPCS,TRANSPORT PORT X-RAY MULTIPL,,30,,,$57.42,$0.00,1,0,1,20161001,
S0017,HCPCS,"INJECTION, AMINOCAPROIC ACID",,30,,,$29.06,$0.00,1,0,0,20161001,
S0020,HCPCS,"INJECTION, BUPIVICAINE HYDRO",,30,,,$17.30,$0.00,1,0,1,20161001,
S0023,HCPCS,"INJECTION, CIMETIDINE HYDROC",,30,,,$12.36,$0.00,1,0,0,20161001,
S0028,HCPCS,"INJECTION, FAMOTIDINE, 20 MG",,30,,,$23.89,$0.00,1,0,0,20161001,
S0030,HCPCS,"INJECTION, METRONIDAZOLE",,30,,,$45.68,$0.00,1,0,0,20161001,
S0032,HCPCS,"INJECTION, NAFCILLIN SODIUM",,30,,,$106.76,$0.00,1,0,0,20161001,
S0034,HCPCS,"INJECTION, OFLOXACIN, 400 MG",,30,,,$33.03,$0.00,1,0,0,20161001,
S0039,HCPCS,"INJECTION, SULFAMETHOXAZOLE",,30,,,$23.99,$0.00,1,0,0,20161001,
S0040,HCPCS,"INJECTION, TICARCILLIN DISOD",,30,,,$65.68,$0.00,1,0,0,20161001,
S0073,HCPCS,"INJECTION, AZTREONAM, 500 MG",,30,,,$81.12,$0.00,1,0,0,20161001,
S0074,HCPCS,"INJECTION, CEFOTETAN DISODIU",,30,,,$57.34,$0.00,1,0,0,20161001,
S0077,HCPCS,"INJECTION, CLINDAMYCIN PHOSP",,30,,,$20.40,$0.00,1,0,0,20161001,
S0078,HCPCS,"INJECTION, FOSPHENYTOIN SODI",,30,,,$795.63,$0.00,1,0,0,20161001,
S0080,HCPCS,"INJECTION, PENTAMIDINE ISETH",,30,,,$309.29,$0.00,1,0,0,20161001,
S0091,HCPCS,GRANISETRON 1MG,,30,,,$356.70,$0.00,1,0,1,20161001,
S0092,HCPCS,HYDROMORPHONE 250 MG,,30,,,$466.58,$0.00,1,0,0,20161001,
S0093,HCPCS,MORPHINE 500 MG,,30,,,$553.74,$0.00,1,0,0,20161001,
S0106,HCPCS,BUPROPION HCL SR 60 TABLETS,,30,,,$493.57,$0.00,1,0,0,20161001,
S0108,HCPCS,MERCAPTOPURINE 50 MG,,30,,,$17.03,$0.00,1,0,0,20161001,
S0109,HCPCS,METHADONE ORAL 5MG,,30,,,$1.26,$0.00,1,0,0,20161001,
S0119,HCPCS,ONDANSETRON 4 MG,,30,,,$46.45,$0.00,1,0,0,20161001,
S0132,HCPCS,INJ GANIRELIX ACETAT 250 MCG,,30,,,$476.78,$0.00,1,0,0,20161001,
S0136,HCPCS,"CLOZAPINE, 25 MG",,30,,,$5.85,$0.00,1,0,0,20161001,
S0137,HCPCS,"DIDANOSINE, 25 MG",,30,,,$16.53,$0.00,1,0,0,20161001,
S0138,HCPCS,"FINASTERIDE, 5 MG",,30,,,$12.72,$0.00,1,0,0,20161001,
S0145,HCPCS,PEG INTERFERON ALFA-2A/180,,30,,,$55.33,$0.00,1,0,1,20161001,
S0157,HCPCS,"BECAPLERMIN GEL 1%, 0.5 GM",,30,,,$79.38,$0.00,1,0,0,20161001,
S0164,HCPCS,INJECTION PANTROPRAZOLE,,30,,,$58.53,$0.00,1,0,0,20161001,
S0166,HCPCS,INJ OLANZAPINE 2.5MG,,30,,,$26.58,$0.00,1,0,0,20161001,
S0169,HCPCS,CALCITROL,,30,,,$6.82,$0.00,1,0,0,20161001,
S0170,HCPCS,ANASTROZOLE 1 MG,,30,,,$36.50,$0.00,1,0,0,20161001,
S0171,HCPCS,BUMETANIDE 0.5 MG,,30,,,$5.36,$0.00,1,0,0,20161001,
S0174,HCPCS,DOLASETRON 50 MG,,30,,,$233.78,$0.00,1,0,0,20161001,
S0179,HCPCS,MEGESTROL 20 MG,,30,,,$2.53,$0.00,1,0,0,20161001,
S0183,HCPCS,PROCHLORPERAZINE 5 MG,,30,,,$2.97,$0.00,1,0,0,20161001,
S0187,HCPCS,TAMOXIFEN 10 MG,,30,,,$9.39,$0.00,1,0,0,20161001,
S0189,HCPCS,TESTOSTERONE PELLET 75 MG,,30,,,$130.63,$0.00,1,0,1,20161001,
S0191,HCPCS,"MISOPROSTOL, ORAL, 200 MCG",,30,,,$10.43,$0.00,1,0,0,20161001,
S0199,HCPCS,MED ABORTION INC ALL EX DRUG,,30,,,"$1,983.98",$0.00,1,0,1,20161001,
S0201,HCPCS,PARTIAL HOSPITALIZATION SERV,,30,,,"$1,487.09",$0.00,1,0,1,20161001,
S0208,HCPCS,PARAMED INTRCEPT NONVOL,,30,,,"$1,667.65",$0.00,1,0,1,20161001,
S0220,HCPCS,MEDICAL CONFERENCE BY PHYSIC,,30,,,$199.81,$0.00,1,0,1,20161001,
S0221,HCPCS,"MEDICAL CONFERENCE, 60 MIN",,30,,,$400.77,$0.00,1,0,1,20161001,
S0255,HCPCS,HOSPICE REFER VISIT NONMD,,30,,,$156.93,$0.00,1,0,1,20161001,
S0257,HCPCS,END OF LIFE COUNSELING,,30,,,$219.73,$0.00,1,0,1,20161001,
S0260,HCPCS,H&P FOR SURGERY,,30,,,$107.73,$0.00,1,0,1,20161001,
S0265,HCPCS,GENETIC COUNSEL 15 MINS,,30,,,$107.73,$0.00,1,0,1,20161001,
S0302,HCPCS,COMPLETED EPSDT,,30,,,$93.49,$0.00,1,0,1,20161001,
S0315,HCPCS,DISEASE MANAGEMENT PROGRAM,,30,,,$107.73,$0.00,1,0,1,20161001,
S0316,HCPCS,FOLLOW-UP/REASSESSMENT,,30,,,$241.15,$0.00,1,0,1,20161001,
S0320,HCPCS,RN TELEPHONE CALLS TO DMP,,30,,,$101.05,$0.00,1,0,1,20161001,
S0390,HCPCS,ROUT FOOT CARE PER VISIT,,30,,,$28.71,$0.00,1,0,1,20161001,
S0400,HCPCS,GLOBAL ESWL KIDNEY,,30,,,"$25,649.06",$0.00,1,0,1,20161001,
S0512,HCPCS,DAILY CONT LENS,,30,,,$102.49,$0.00,1,0,1,20161001,
S0592,HCPCS,COMP CONT LENS EVAL,,30,,,"$1,408.11",$0.00,1,0,1,20161001,
S0601,HCPCS,SCREENING PROCTOSCOPY,,30,,,$371.80,$0.00,1,0,1,20161001,
S0610,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,30,,,$249.10,$0.00,1,0,1,20161001,
S0612,HCPCS,ANNUAL GYNECOLOGICAL EXAMINA,,30,,,$238.45,$0.00,1,0,1,20161001,
S0613,HCPCS,ANN BREAST EXAM,,30,,,$107.73,$0.00,1,0,1,20161001,
S0618,HCPCS,AUDIOMETRY FOR HEARING AID,,30,,,$85.58,$0.00,1,0,1,20161001,
S0620,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,30,,,$60.96,$0.00,1,0,1,20161001,
S0621,HCPCS,ROUTINE OPHTHALMOLOGICAL EXA,,30,,,$310.77,$0.00,1,0,1,20161001,
S0622,HCPCS,PHYS EXAM FOR COLLEGE,,30,,,$107.73,$0.00,1,0,1,20161001,
S0630,HCPCS,REMOVAL OF SUTURES,,30,,,$98.47,$0.00,1,0,1,20161001,
S0810,HCPCS,PHOTOREFRACTIVE KERATECTOMY,,30,,,"$3,613.63",$0.00,1,0,1,20161001,
S0812,HCPCS,PHOTOTHERAP KERATECT,,30,,,"$3,613.63",$0.00,1,0,1,20161001,
S1015,HCPCS,IV TUBING EXTENSION SET,,30,,,$39.59,$0.00,1,0,1,20161001,
S1016,HCPCS,NON-PVC INTRAVENOUS ADMINIST,,30,,,$55.57,$0.00,1,0,1,20161001,
S1040,HCPCS,CRANIAL REMOLDING ORTHOSIS,,30,,,$426.86,$0.00,1,0,1,20161001,
S1090,HCPCS,MOMETASONE SINUS IMPLANT,,30,,,"$4,604.80",$0.00,1,0,1,20161001,
S2070,HCPCS,CYSTO LASER TX URETERAL CALC,,30,,,"$5,190.46",$0.00,1,0,1,20161001,
S2080,HCPCS,LAUP,,30,,,"$12,845.76",$0.00,1,0,1,20161001,
S2083,HCPCS,ADJUSTMENT GASTRIC BAND,,30,,,"$1,590.72",$0.00,1,0,1,20161001,
S2095,HCPCS,TRANSCATH EMBOLIZ MICROSPHER,,30,,,"$13,162.30",$0.00,1,0,1,20161001,
S2117,HCPCS,"ARTHROEREISIS, SUBTALAR",,30,,,"$7,179.92",$0.00,1,0,1,20161001,
S2118,HCPCS,TOTAL HIP RESURFACING,,30,,,$166.13,$0.00,1,0,1,20161001,
S2120,HCPCS,LOW DENSITY LIPOPROTEIN(LDL),,30,,,"$22,143.81",$0.00,1,0,1,20161001,
S2140,HCPCS,CORD BLOOD HARVESTING,,30,,,"$1,517.63",$0.00,1,0,1,20161001,
S2142,HCPCS,CORD BLOOD-DERIVED STEM-CELL,,30,,,"$3,623.44",$0.00,1,0,1,20161001,
S2150,HCPCS,BMT HARV/TRANSPL 28D PKG,,30,,,"$1,273.11",$0.00,1,0,1,20161001,
S2202,HCPCS,ECHOSCLEROTHERAPY,,30,,,$160.10,$0.00,1,0,1,20161001,
S2225,HCPCS,MYRINGOTOMY LASER-ASSIST,,30,,,"$8,965.81",$0.00,1,0,1,20161001,
S2230,HCPCS,IMPLANT SEMI-IMP HEAR,,30,,,"$5,929.85",$0.00,1,0,1,20161001,
S2235,HCPCS,IMPLANT AUDITORY BRAIN IMP,,30,,,"$55,096.51",$0.00,1,0,1,20161001,
S2300,HCPCS,"ARTHROSCOPY, SHOULDER, SURGI",,30,,,"$16,106.21",$0.00,1,0,1,20161001,
S2325,HCPCS,HIP CORE DECOMPRESSION,,30,,,"$2,733.92",$0.00,1,0,1,20161001,
S2340,HCPCS,CHEMODENERVATION OF ABDUCTOR,,30,,,"$8,176.06",$0.00,1,0,1,20161001,
S2341,HCPCS,CHEMODENERV ADDUCT VOCAL,,30,,,"$8,176.06",$0.00,1,0,1,20161001,
S2342,HCPCS,NASAL ENDOSCOP PO DEBRID,,30,,,"$12,008.70",$0.00,1,0,1,20161001,
S2348,HCPCS,DECOMPRESS DISC RF LUMBAR,,30,,,"$9,746.63",$0.00,1,0,1,20161001,
S2900,HCPCS,ROBOTIC SURGICAL SYSTEM,,30,,,"$8,246.15",$0.00,1,0,1,20161001,
S3005,HCPCS,EVAL SELF-ASSESS DEPRESSION,,30,,,$107.73,$0.00,1,0,1,20161001,
S3600,HCPCS,STAT LAB,,30,,,$69.88,$0.00,1,0,1,20161001,
S3620,HCPCS,NEWBORN METABOLIC SCREENING,,30,,,$213.30,$0.00,1,0,1,20161001,
S3630,HCPCS,EOSINOPHIL BLOOD COUNT,,30,,,$57.05,$0.00,1,0,1,20161001,
S3708,HCPCS,GASTROINTESTINAL FAT ABSORPT,,30,,,$474.87,$0.00,1,0,1,20161001,
S3870,HCPCS,CGH TEST DEVELOPMENTAL DELAY,,30,,,"$2,433.31",$0.00,1,0,1,20161001,
S3900,HCPCS,SURFACE EMG,,30,,,"$1,434.62",$0.00,1,0,1,20161001,
S4005,HCPCS,INTERIM LABOR FACILITY GLOBA,,30,,,$501.82,$0.00,1,0,1,20161001,
S4011,HCPCS,IVF PACKAGE,,30,,,"$1,722.49",$0.00,1,0,1,20161001,
S4015,HCPCS,COMPLETE IVF NOS CASE RATE,,30,,,"$17,466.08",$0.00,1,0,1,20161001,
S4021,HCPCS,IVF CANC P ASPIR CASE RATE,,30,,,"$1,263.99",$0.00,1,0,1,20161001,
S4981,HCPCS,INSERT LEVONORGESTREL IUS,,30,,,"$1,583.12",$0.00,1,0,1,20161001,
S4989,HCPCS,CONTRACEPT IUD,,30,,,$750.24,$0.00,1,0,1,20161001,
S4990,HCPCS,NICOTINE PATCH LEGEND,,30,,,$31.69,$0.00,1,0,1,20161001,
S4991,HCPCS,NICOTINE PATCH NONLEGEND,,30,,,$28.49,$0.00,1,0,1,20161001,
S4993,HCPCS,CONTRACEPTIVE PILLS FOR BC,,30,,,$34.38,$0.00,1,0,1,20161001,
S4995,HCPCS,SMOKING CESSATION GUM,,30,,,$67.50,$0.00,1,0,1,20161001,
S5000,HCPCS,"PRESCRIPTION DRUG, GENERIC",,30,,,$23.60,$0.00,1,0,1,20161001,
S5001,HCPCS,"PRESCRIPTION DRUG,BRAND NAME",,30,,,$100.84,$0.00,1,0,1,20161001,
S5010,HCPCS,5% DEXTROSE AND 0.45% SALINE,,30,,,$24.16,$0.00,1,0,1,20161001,
S5012,HCPCS,5% DEXTROSE WITH POTASSIUM,,30,,,$84.01,$0.00,1,0,1,20161001,
S5013,HCPCS,5%DEXTROSE/0.45%SALINE1000ML,,30,,,$23.43,$0.00,1,0,1,20161001,
S5014,HCPCS,D5W/0.45NS W KCL AND MGS04,,30,,,$14.12,$0.00,1,0,1,20161001,
S5105,HCPCS,CENTERBASED DAY CARE PERDIEM,,30,,,$363.60,$0.00,1,0,1,20161001,
S5130,HCPCS,HOMAKER SERVICE NOS PER 15M,,30,,,$6.10,$0.00,1,0,1,20161001,
S5131,HCPCS,HOMEMAKER SERVICE NOS /DIEM,,30,,,$25.26,$0.00,1,0,1,20161001,
S5140,HCPCS,ADULT FOSTER CARE PER DIEM,,30,,,$76.33,$0.00,1,0,1,20161001,
S5161,HCPCS,EMER RSPNS SYS SERV PERMONTH,,30,,,$52.03,$0.00,1,0,1,20161001,
S5190,HCPCS,WELLNESS ASSESSMENT BY NONPH,,30,,,$347.27,$0.00,1,0,1,20161001,
S5199,HCPCS,PERSONAL CARE ITEM NOS EACH,,30,,,$48.29,$0.00,1,0,1,20161001,
S5497,HCPCS,HIT CATH CARE NOC,,30,,,$48.29,$0.00,1,0,1,20161001,
S5498,HCPCS,HIT SIMPLE CATH CARE,,30,,,$40.91,$0.00,1,0,1,20161001,
S5501,HCPCS,HIT COMPLEX CATH CARE,,30,,,$44.10,$0.00,1,0,1,20161001,
S5502,HCPCS,HIT INTERIM CATH CARE,,30,,,$77.69,$0.00,1,0,1,20161001,
S5517,HCPCS,HIT DECLOTTING KIT,,30,,,$89.82,$0.00,1,0,1,20161001,
S5520,HCPCS,HIT PICC INSERT KIT,,30,,,$108.74,$0.00,1,0,1,20161001,
S5523,HCPCS,HIP MIDLINE CATH INSERT KIT,,30,,,$160.77,$0.00,1,0,1,20161001,
S5550,HCPCS,INSULIN RAPID 5 U,,30,,,$0.15,$0.00,1,0,1,20161001,
S5551,HCPCS,INSULIN MOST RAPID 5 U,,30,,,$0.15,$0.00,1,0,1,20161001,
S5553,HCPCS,INSULIN LONG ACTING 5 U,,30,,,$0.15,$0.00,1,0,1,20161001,
S8030,HCPCS,TANTALUM RING APPLICATION,,30,,,"$10,266.59",$0.00,1,0,1,20161001,
S8037,HCPCS,MRCP,,30,,,"$6,881.12",$0.00,1,0,1,20161001,
S8040,HCPCS,TOPOGRAPHIC BRAIN MAPPING,,30,,,"$1,489.01",$0.00,1,0,1,20161001,
S8055,HCPCS,US GUIDANCE FETAL REDUCT,,30,,,"$1,217.90",$0.00,1,0,1,20161001,
S8080,HCPCS,SCINTIMAMMOGRAPHY,,30,,,"$1,035.92",$0.00,1,0,1,20161001,
S8092,HCPCS,ELECTRON BEAM COMPUTED TOMOG,,30,,,$263.47,$0.00,1,0,1,20161001,
S8096,HCPCS,PORTABLE PEAK FLOW METER,,30,,,$58.87,$0.00,1,0,1,20161001,
S8100,HCPCS,SPACER WITHOUT MASK,,30,,,$69.27,$0.00,1,0,1,20161001,
S8101,HCPCS,SPACER WITH MASK,,30,,,$197.91,$0.00,1,0,1,20161001,
S8120,HCPCS,O2 CONTENTS GAS CUBIC FT,,30,,,$28.71,$0.00,1,0,1,20161001,
S8210,HCPCS,MUCUS TRAP,,30,,,$1.38,$0.00,1,0,1,20161001,
S8423,HCPCS,CUSTOM GRAD SLEEVE HEAVY,,30,,,$225.04,$0.00,1,0,1,20161001,
S8424,HCPCS,READY GRADIENT SLEEVE,,30,,,$69.75,$0.00,1,0,1,20161001,
S8426,HCPCS,CUSTOM GRAD GLOVE HEAVY,,30,,,$138.15,$0.00,1,0,1,20161001,
S8427,HCPCS,READY GRADIENT GLOVE,,30,,,$29.52,$0.00,1,0,1,20161001,
S8431,HCPCS,COMPRESSION BANDAGE,,30,,,$17.43,$0.00,1,0,1,20161001,
S8450,HCPCS,SPLINT DIGIT,,30,,,$33.02,$0.00,1,0,1,20161001,
S8451,HCPCS,SPLINT WRIST OR ANKLE,,30,,,$44.70,$0.00,1,0,1,20161001,
S8490,HCPCS,100 INSULIN SYRINGES,,30,,,$1.38,$0.00,1,0,1,20161001,
S8948,HCPCS,LOW-LEVEL LASER TRMT 15 MIN,,30,,,$404.63,$0.00,1,0,1,20161001,
S8950,HCPCS,"COMPLEX LYMPHEDEMA THERAPY,",,30,,,$134.35,$0.00,1,0,1,20161001,
S8990,HCPCS,PT OR MANIP FOR MAINT,,30,,,$75.13,$0.00,1,0,1,20161001,
S9024,HCPCS,PARANASAL SINUS ULTRASOUND,,30,,,$791.59,$0.00,1,0,1,20161001,
S9034,HCPCS,ESWL FOR GALLSTONES,,30,,,"$4,958.32",$0.00,1,0,1,20161001,
S9061,HCPCS,MEDICAL SUPPLIES AND EQUIPME,,30,,,$73.58,$0.00,1,0,1,20161001,
S9083,HCPCS,URGENT CARE CENTER GLOBAL,,30,,,$473.43,$0.00,1,0,1,20161001,
S9088,HCPCS,SERVICES PROVIDED IN URGENT,,30,,,$640.59,$0.00,1,0,1,20161001,
S9097,HCPCS,HOME VISIT WOUND CARE,,30,,,$194.16,$0.00,1,0,1,20161001,
S9098,HCPCS,HOME PHOTOTHERAPY VISIT,,30,,,$287.08,$0.00,1,0,1,20161001,
S9110,HCPCS,TELEMONITORING/HOME PER MNTH,,30,,,$109.77,$0.00,1,0,1,20161001,
S9117,HCPCS,BACK SCHOOL VISIT,,30,,,$107.73,$0.00,1,0,1,20161001,
S9122,HCPCS,HOME HEALTH AIDE OR CERTIFIE,,30,,,$103.35,$0.00,1,0,1,20161001,
S9123,HCPCS,NURSING CARE IN HOME RN,,30,,,$287.08,$0.00,1,0,1,20161001,
S9124,HCPCS,"NURSING CARE, IN THE HOME; B",,30,,,$459.33,$0.00,1,0,1,20161001,
S9125,HCPCS,"RESPITE CARE, IN THE HOME, P",,30,,,$182.29,$0.00,1,0,1,20161001,
S9126,HCPCS,"HOSPICE CARE, IN THE HOME, P",,30,,,$240.67,$0.00,1,0,1,20161001,
S9127,HCPCS,"SOCIAL WORK VISIT, IN THE HO",,30,,,$304.31,$0.00,1,0,1,20161001,
S9128,HCPCS,"SPEECH THERAPY, IN THE HOME,",,30,,,$200.96,$0.00,1,0,1,20161001,
S9129,HCPCS,"OCCUPATIONAL THERAPY, IN THE",,30,,,$229.67,$0.00,1,0,1,20161001,
S9131,HCPCS,PT IN THE HOME PER DIEM,,30,,,$231.96,$0.00,1,0,1,20161001,
S9140,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,30,,,$99.90,$0.00,1,0,1,20161001,
S9145,HCPCS,INSULIN PUMP INITIATION,,30,,,$388.43,$0.00,1,0,1,20161001,
S9152,HCPCS,"SPEECH THERAPY, RE-EVAL",,30,,,$241.15,$0.00,1,0,1,20161001,
S9208,HCPCS,HOME MGMT PRETERM LABOR,,30,,,$275.02,$0.00,1,0,1,20161001,
S9211,HCPCS,HOME MGMT GEST HYPERTENSION,,30,,,$116.56,$0.00,1,0,1,20161001,
S9213,HCPCS,HM PREECLAMP PER DIEM,,30,,,$271.93,$0.00,1,0,1,20161001,
S9214,HCPCS,HM GEST DM PER DIEM,,30,,,$251.80,$0.00,1,0,1,20161001,
S9326,HCPCS,HIT CONT PAIN PER DIEM,,30,,,$199.44,$0.00,1,0,1,20161001,
S9327,HCPCS,HIT INT PAIN PER DIEM,,30,,,$197.89,$0.00,1,0,1,20161001,
S9329,HCPCS,HIT CHEMO PER DIEM,,30,,,$214.46,$0.00,1,0,1,20161001,
S9330,HCPCS,HIT CONT CHEM DIEM,,30,,,$210.92,$0.00,1,0,1,20161001,
S9331,HCPCS,HIT INTERMIT CHEMO DIEM,,30,,,$234.87,$0.00,1,0,1,20161001,
S9335,HCPCS,HT HEMODIALYSIS DIEM,,30,,,$644.03,$0.00,1,0,1,20161001,
S9336,HCPCS,HIT CONT ANTICOAG DIEM,,30,,,$201.72,$0.00,1,0,1,20161001,
S9338,HCPCS,HIT IMMUNOTHERAPY DIEM,,30,,,$249.93,$0.00,1,0,1,20161001,
S9340,HCPCS,HIT ENTERAL PER DIEM,,30,,,$83.36,$0.00,1,0,1,20161001,
S9341,HCPCS,HIT ENTERAL GRAV DIEM,,30,,,$57.22,$0.00,1,0,1,20161001,
S9342,HCPCS,HIT ENTERAL PUMP DIEM,,30,,,$61.46,$0.00,1,0,1,20161001,
S9343,HCPCS,HIT ENTERAL BOLUS NURS,,30,,,$38.13,$0.00,1,0,1,20161001,
S9345,HCPCS,HIT ANTI-HEMOPHIL DIEM,,30,,,$127.22,$0.00,1,0,1,20161001,
S9346,HCPCS,HIT ALPHA-1-PROTEINAS DIEM,,30,,,$89.03,$0.00,1,0,1,20161001,
S9348,HCPCS,HIT SYMPATHOMIM DIEM,,30,,,$220.20,$0.00,1,0,1,20161001,
S9349,HCPCS,HIT TOCOLYSIS DIEM,,30,,,$317.61,$0.00,1,0,1,20161001,
S9351,HCPCS,HIT CONT ANTIEMETIC DIEM,,30,,,$404.05,$0.00,1,0,1,20161001,
S9353,HCPCS,HIT CONT INSULIN DIEM,,30,,,$552.48,$0.00,1,0,1,20161001,
S9355,HCPCS,HIT CHELATION DIEM,,30,,,$164.99,$0.00,1,0,1,20161001,
S9357,HCPCS,HIT ENZYME REPLACE DIEM,,30,,,$179.28,$0.00,1,0,1,20161001,
S9359,HCPCS,HIT ANTI-TNF PER DIEM,,30,,,$328.10,$0.00,1,0,1,20161001,
S9364,HCPCS,HIT TPN TOTAL DIEM,,30,,,$375.55,$0.00,1,0,1,20161001,
S9365,HCPCS,HIT TPN 1 LITER DIEM,,30,,,$432.82,$0.00,1,0,1,20161001,
S9366,HCPCS,HIT TPN 2 LITER DIEM,,30,,,$528.18,$0.00,1,0,1,20161001,
S9367,HCPCS,HIT TPN 3 LITER DIEM,,30,,,$588.10,$0.00,1,0,1,20161001,
S9368,HCPCS,HIT TPN OVER 3L DIEM,,30,,,$753.43,$0.00,1,0,1,20161001,
S9370,HCPCS,HT INJ ANTIEMETIC DIEM,,30,,,$152.62,$0.00,1,0,1,20161001,
S9373,HCPCS,HIT HYDRA TOTAL DIEM,,30,,,$115.88,$0.00,1,0,1,20161001,
S9374,HCPCS,HIT HYDRA 1 LITER DIEM,,30,,,$167.49,$0.00,1,0,1,20161001,
S9375,HCPCS,HIT HYDRA 2 LITER DIEM,,30,,,$214.57,$0.00,1,0,1,20161001,
S9376,HCPCS,HIT HYDRA 3 LITER DIEM,,30,,,$233.86,$0.00,1,0,1,20161001,
S9377,HCPCS,HIT HYDRA OVER 3L DIEM,,30,,,$253.15,$0.00,1,0,1,20161001,
S9379,HCPCS,HIT NOC PER DIEM,,30,,,$48.29,$0.00,1,0,1,20161001,
S9401,HCPCS,ANTICOAG CLINIC PER SESSION,,30,,,$160.77,$0.00,1,0,1,20161001,
S9430,HCPCS,PHARMACY COMP/DISP SERV,,30,,,$172.25,$0.00,1,0,1,20161001,
S9436,HCPCS,LAMAZE CLASS,,30,,,$72.46,$0.00,1,0,1,20161001,
S9441,HCPCS,ASTHMA EDUCATION,,30,,,$168.80,$0.00,1,0,1,20161001,
S9442,HCPCS,BIRTHING CLASS,,30,,,$148.13,$0.00,1,0,1,20161001,
S9443,HCPCS,LACTATION CLASS,,30,,,$234.26,$0.00,1,0,1,20161001,
S9444,HCPCS,PARENTING CLASS,,30,,,$81.27,$0.00,1,0,1,20161001,
S9445,HCPCS,PT EDUCATION NOC INDIVID,,30,,,$428.33,$0.00,1,0,1,20161001,
S9446,HCPCS,PT EDUCATION NOC GROUP,,30,,,$203.18,$0.00,1,0,1,20161001,
S9449,HCPCS,WEIGHT MGMT CLASS,,30,,,$101.58,$0.00,1,0,1,20161001,
S9451,HCPCS,EXERCISE CLASS,,30,,,$114.74,$0.00,1,0,1,20161001,
S9452,HCPCS,NUTRITION CLASS,,30,,,$167.32,$0.00,1,0,1,20161001,
S9453,HCPCS,SMOKING CESSATION CLASS,,30,,,$218.07,$0.00,1,0,1,20161001,
S9455,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,30,,,$141.24,$0.00,1,0,1,20161001,
S9460,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,30,,,$227.90,$0.00,1,0,1,20161001,
S9465,HCPCS,"DIABETIC MANAGEMENT PROGRAM,",,30,,,$161.91,$0.00,1,0,1,20161001,
S9470,HCPCS,"NUTRITIONAL COUNSELING, DIET",,30,,,$125.85,$0.00,1,0,1,20161001,
S9472,HCPCS,CARDIAC REHABILITATION PROGR,,30,,,$367.18,$0.00,1,0,0,20161001,
S9473,HCPCS,PULMONARY REHABILITATION PRO,,30,,,$273.95,$0.00,1,0,0,20161001,
S9474,HCPCS,ENTEROSTOMAL THERAPY BY A RE,,30,,,$258.98,$0.00,1,0,1,20161001,
S9475,HCPCS,AMBULATORY SETTING SUBSTANCE,,30,,,$493.78,$0.00,1,0,1,20161001,
S9476,HCPCS,VESTIBULAR REHAB PER DIEM,,30,,,$152.73,$0.00,1,0,0,20161001,
S9480,HCPCS,INTENSIVE OUTPATIENT PSYCHIA,,30,,,$602.87,$0.00,1,0,1,20161001,
S9484,HCPCS,CRISIS INTERVENTION PER HOUR,,30,,,$189.47,$0.00,1,0,1,20161001,
S9485,HCPCS,CRISIS INTERVENTION MENTAL H,,30,,,$534.84,$0.00,1,0,1,20161001,
S9490,HCPCS,HIT CORTICOSTEROID/DIEM,,30,,,$259.63,$0.00,1,0,1,20161001,
S9494,HCPCS,HIT ANTIBIOTIC TOTAL DIEM,,30,,,$207.20,$0.00,1,0,1,20161001,
S9497,HCPCS,HIT ANTIBIOTIC Q3H DIEM,,30,,,$258.37,$0.00,1,0,1,20161001,
S9500,HCPCS,HIT ANTIBIOTIC Q24H DIEM,,30,,,$296.57,$0.00,1,0,1,20161001,
S9501,HCPCS,HIT ANTIBIOTIC Q12H DIEM,,30,,,$289.85,$0.00,1,0,1,20161001,
S9502,HCPCS,HIT ANTIBIOTIC Q8H DIEM,,30,,,$361.75,$0.00,1,0,1,20161001,
S9503,HCPCS,HIT ANTIBIOTIC Q6H DIEM,,30,,,$333.54,$0.00,1,0,1,20161001,
S9504,HCPCS,HIT ANTIBIOTIC Q4H DIEM,,30,,,$307.53,$0.00,1,0,1,20161001,
S9529,HCPCS,VENIPUNCTURE HOME/SNF,,30,,,$103.33,$0.00,1,0,1,20161001,
S9537,HCPCS,HT HEM HORM INJ DIEM,,30,,,$86.03,$0.00,1,0,1,20161001,
S9542,HCPCS,HT INJ NOC PER DIEM,,30,,,$48.29,$0.00,1,0,1,20161001,
S9560,HCPCS,HT INJ HORMONE DIEM,,30,,,$95.67,$0.00,1,0,1,20161001,
S9562,HCPCS,HT INJ PALIVIZUMAB DIEM,,30,,,$95.67,$0.00,1,0,1,20161001,
S9590,HCPCS,HT IRRIGATION DIEM,,30,,,$137.30,$0.00,1,0,1,20161001,
V5008,HCPCS,HEARING SCREENING,,30,,,$237.60,$0.00,1,0,1,20161001,
V5010,HCPCS,ASSESSMENT FOR HEARING AID,,30,,,$354.41,$0.00,1,0,1,20161001,