[Federal Register: September 8, 1998 (Volume 63, Number 173)]
[Proposed Rules]
[Page 47701-47750]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08se98-37]

[[pp. 47701-47750]] Medicare Program; Prospective Payment System for Hospital
Outpatient Services

[[Continued from page 47700]]

[[Page 47700]]


82585...  A                   Assay cryofibrinogen...  .........  .........  .........  ...........  ...........
82595...  A                   Assay cryoglobulin.....  .........  .........  .........  ...........  ...........
82600...  A                   Assay cyanide..........  .........  .........  .........  ...........  ...........
82607...  A                   Vitamin B-12...........  .........  .........  .........  ...........  ...........
82608...  A                   B-12 binding capacity..  .........  .........  .........  ...........  ...........
82615...  A                   Test for urine cystines  .........  .........  .........  ...........  ...........
82626...  A                   Dehydroepiandrosterone.  .........  .........  .........  ...........  ...........
82627...  A                   Dehydroepiandrosterone.  .........  .........  .........  ...........  ...........
82633...  A                   Desoxycorticoster  one.  .........  .........  .........  ...........  ...........
82634...  A                   Deoxycortisol..........  .........  .........  .........  ...........  ...........
82638...  A                   Assay dibucaine number.  .........  .........  .........  ...........  ...........
82646...  A                   Assay of                 .........  .........  .........  ...........  ...........
                               dihydrocodeinone.
82649...  A                   Assay of dihydromorphin  .........  .........  .........  ...........  ...........
                               one.
82651...  A                   Dihydrotestosterone      .........  .........  .........  ...........  ...........
                               assay.
82652...  A                   Assay, dihydroxyvitamin  .........  .........  .........  ...........  ...........
                               D.
82654...  A                   Assay of dimethadione..  .........  .........  .........  ...........  ...........
82664...  A                   Electrophoretic test...  .........  .........  .........  ...........  ...........
82666...  A                   Epiandrosterone assay..  .........  .........  .........  ...........  ...........
82668...  A                   Erythropoietin.........  .........  .........  .........  ...........  ...........
82670...  A                   Estradiol..............  .........  .........  .........  ...........  ...........
82671...  A                   Estrogens assay........  .........  .........  .........  ...........  ...........
82672...  A                   Estrogen assay.........  .........  .........  .........  ...........  ...........
82677...  A                   Estriol................  .........  .........  .........  ...........  ...........
82679...  A                   Estrone................  .........  .........  .........  ...........  ...........
82690...  A                   Ethchlorvynol..........  .........  .........  .........  ...........  ...........
82693...  A                   Ethylene glycol........  .........  .........  .........  ...........  ...........
82696...  A                   Etiocholanolone........  .........  .........  .........  ...........  ...........
82705...  A                   Fats/lipids, feces,      .........  .........  .........  ...........  ...........
                               qualitative.
82710...  A                   Fats/lipids, feces,      .........  .........  .........  ...........  ...........
                               quantitative.
82715...  A                   Fecal fat assay........  .........  .........  .........  ...........  ...........
82725...  A                   Assay blood fatty acids  .........  .........  .........  ...........  ...........
82728...  A                   Assay ferritin.........  .........  .........  .........  ...........  ...........
82735...  A                   Assay fluoride.........  .........  .........  .........  ...........  ...........
82742...  A                   Assay of flurazepam....  .........  .........  .........  ...........  ...........
82746...  A                   Blood folic acid serum.  .........  .........  .........  ...........  ...........
82747...  A                   Folic acid, RBC........  .........  .........  .........  ...........  ...........
82757...  A                   Assay semen fructose...  .........  .........  .........  ...........  ...........
82759...  A                   RBC galactokinase assay  .........  .........  .........  ...........  ...........
82760...  A                   Assay galactose........  .........  .........  .........  ...........  ...........
82775...  A                   Assay galactose          .........  .........  .........  ...........  ...........
                               transferase.
82776...  A                   Galactose transferase    .........  .........  .........  ...........  ...........
                               test.
82784...  A                   Assay gammaglobulin IgM  .........  .........  .........  ...........  ...........
82785...  A                   Assay, gammaglobulin     .........  .........  .........  ...........  ...........
                               IgE.
82787...  A                   IgG1, 2, 3 and 4.......  .........  .........  .........  ...........  ...........
82800...  A                   Blood pH...............  .........  .........  .........  ...........  ...........
82803...  A                   Blood gases: pH, pO2 &   .........  .........  .........  ...........  ...........
                               pCO2.
82805...  A                   Blood gases W/02         .........  .........  .........  ...........  ...........
                               saturation.
82810...  A                   Blood gases, O2 sat      .........  .........  .........  ...........  ...........
                               only.
82820...  A                   Hemoglobin-oxygen        .........  .........  .........  ...........  ...........
                               affinity.
82926...  A                   Assay gastric acid.....  .........  .........  .........  ...........  ...........
82928...  A                   Assay gastric acid.....  .........  .........  .........  ...........  ...........
82938...  A                   Gastrin test...........  .........  .........  .........  ...........  ...........
82941...  A                   Assay of gastrin.......  .........  .........  .........  ...........  ...........
82943...  A                   Assay of glucagon......  .........  .........  .........  ...........  ...........
82946...  A                   Glucagon tolerance test  .........  .........  .........  ...........  ...........
82947...  A                   Assay quantitative,      .........  .........  .........  ...........  ...........
                               glucose.
82948...  A                   Reagent strip/blood      .........  .........  .........  ...........  ...........
                               glucose.
82950...  A                   Glucose test...........  .........  .........  .........  ...........  ...........
82951...  A                   Glucose tolerance test   .........  .........  .........  ...........  ...........
                               (GTT).
82952...  A                   GTT-added samples......  .........  .........  .........  ...........  ...........
82953...  A                   Glucose-tolbutamide      .........  .........  .........  ...........  ...........
                               test.
82955...  A                   Assay G6PD enzyme......  .........  .........  .........  ...........  ...........
82960...  A                   Test for G6PD enzyme...  .........  .........  .........  ...........  ...........
82962...  A                   Glucose blood test.....  .........  .........  .........  ...........  ...........
82963...  A                   Glucosidase assay......  .........  .........  .........  ...........  ...........
82965...  A                   Assay GDH enzyme.......  .........  .........  .........  ...........  ...........
82975...  A                   Assay glutamine........  .........  .........  .........  ...........  ...........
82977...  A                   Assay of GGT...........  .........  .........  .........  ...........  ...........
82978...  A                   Glutathione assay......  .........  .........  .........  ...........  ...........
82979...  A                   Assay RBC glutathione    .........  .........  .........  ...........  ...........
                               enzyme.
82980...  A                   Assay of glutethimide..  .........  .........  .........  ...........  ...........
82985...  A                   Glycated protein.......  .........  .........  .........  ...........  ...........
83001...  A                   Gonadotropin (FSH).....  .........  .........  .........  ...........  ...........
83002...  A                   Gonadotropin (LH)......  .........  .........  .........  ...........  ...........
83003...  A                   Assay growth hormone     .........  .........  .........  ...........  ...........
                               (HGH).

[[Page 47701]]


83008...  A                   Assay guanosine........  .........  .........  .........  ...........  ...........
83010...  A                   Quant assay haptoglobin  .........  .........  .........  ...........  ...........
83012...  A                   Assay haptoglobins.....  .........  .........  .........  ...........  ...........
83015...  A                   Heavy metal screen.....  .........  .........  .........  ...........  ...........
83018...  A                   Quantitative screen,     .........  .........  .........  ...........  ...........
                               metals.
83019...  A                   Breath isotope test....  .........  .........  .........  ...........  ...........
83020...  A                   Assay hemoglobin.......  .........  .........  .........  ...........  ...........
83026...  A                   Hemoglobin, copper       .........  .........  .........  ...........  ...........
                               sulfate.
83030...  A                   Fetal hemoglobin assay.  .........  .........  .........  ...........  ...........
83033...  A                   Fetal fecal hemoglobin   .........  .........  .........  ...........  ...........
                               assay.
83036...  A                   Glycated hemoglobin      .........  .........  .........  ...........  ...........
                               test.
83045...  A                   Blood methemoglobin      .........  .........  .........  ...........  ...........
                               test.
83050...  A                   Blood methemoglobin      .........  .........  .........  ...........  ...........
                               assay.
83051...  A                   Assay plasma hemoglobin  .........  .........  .........  ...........  ...........
83055...  A                   Blood sulfhemoglobin     .........  .........  .........  ...........  ...........
                               test.
83060...  A                   Blood sulfhemoglobin     .........  .........  .........  ...........  ...........
                               assay.
83065...  A                   Hemoglobin heat assay..  .........  .........  .........  ...........  ...........
83068...  A                   Hemoglobin stability     .........  .........  .........  ...........  ...........
                               screen.
83069...  A                   Assay urine hemoglobin.  .........  .........  .........  ...........  ...........
83070...  A                   Qualt assay hemosiderin  .........  .........  .........  ...........  ...........
83071...  A                   Quant assay of           .........  .........  .........  ...........  ...........
                               hemosiderin.
83088...  A                   Assay histamine........  .........  .........  .........  ...........  ...........
83150...  A                   Assay for HVA..........  .........  .........  .........  ...........  ...........
83491...  A                   Assay of                 .........  .........  .........  ...........  ...........
                               corticosteroids.
83497...  A                   Assay 5-HIAA...........  .........  .........  .........  ...........  ...........
83498...  A                   Assay of progesterone..  .........  .........  .........  ...........  ...........
83499...  A                   Assay of progesterone..  .........  .........  .........  ...........  ...........
83500...  A                   Assay free               .........  .........  .........  ...........  ...........
                               hydroxyproline.
83505...  A                   Assay total              .........  .........  .........  ...........  ...........
                               hydroxyproline.
83516...  A                   Immunoassay, non         .........  .........  .........  ...........  ...........
                               antibody.
83518...  A                   Immunoassay, dipstick..  .........  .........  .........  ...........  ...........
83519...  A                   Immunoassay nonantibody  .........  .........  .........  ...........  ...........
83520...  A                   Immunoassay, RIA.......  .........  .........  .........  ...........  ...........
83525...  A                   Assay of insulin.......  .........  .........  .........  ...........  ...........
83527...  A                   Assay of insulin.......  .........  .........  .........  ...........  ...........
83528...  A                   Assay intrinsic factor.  .........  .........  .........  ...........  ...........
83540...  A                   Assay iron.............  .........  .........  .........  ...........  ...........
83550...  A                   Iron binding test......  .........  .........  .........  ...........  ...........
83570...  A                   Assay IDH enzyme.......  .........  .........  .........  ...........  ...........
83582...  A                   Assay ketogenic          .........  .........  .........  ...........  ...........
                               steroids.
83586...  A                   Assay 17-(17-            .........  .........  .........  ...........  ...........
                               KS)ketosteroids.
83593...  A                   Fractionation            .........  .........  .........  ...........  ...........
                               ketosteroids.
83605...  A                   Lactic acid assay......  .........  .........  .........  ...........  ...........
83615...  A                   Lactate (LD) (LDH)       .........  .........  .........  ...........  ...........
                               enzyme.
83625...  A                   Assay LDH enzymes......  .........  .........  .........  ...........  ...........
83632...  A                   Placental lactogen.....  .........  .........  .........  ...........  ...........
83633...  A                   Test urine for lactose.  .........  .........  .........  ...........  ...........
83634...  A                   Assay urine for lactose  .........  .........  .........  ...........  ...........
83655...  A                   Assay for lead.........  .........  .........  .........  ...........  ...........
83661...  A                   Assay L/S ratio........  .........  .........  .........  ...........  ...........
83662...  A                   L/S ratio, foam          .........  .........  .........  ...........  ...........
                               stability.
83670...  A                   Assay LAP enzyme.......  .........  .........  .........  ...........  ...........
83690...  A                   Assay lipase...........  .........  .........  .........  ...........  ...........
83715...  A                   Assay blood              .........  .........  .........  ...........  ...........
                               lipoproteins.
83717...  A                   Assay blood              .........  .........  .........  ...........  ...........
                               lipoproteins.
83718...  A                   Blood lipoprotein assay  .........  .........  .........  ...........  ...........
83719...  A                   Blood lipoprotein assay  .........  .........  .........  ...........  ...........
83721...  A                   Blood lipoprotein assay  .........  .........  .........  ...........  ...........
83727...  A                   LRH hormone assay......  .........  .........  .........  ...........  ...........
83735...  A                   Assay magnesium........  .........  .........  .........  ...........  ...........
83775...  A                   Assay of md enzyme.....  .........  .........  .........  ...........  ...........
83785...  A                   Assay of manganese.....  .........  .........  .........  ...........  ...........
83805...  A                   Assay of meprobamate...  .........  .........  .........  ...........  ...........
83825...  A                   Assay mercury..........  .........  .........  .........  ...........  ...........
83835...  A                   Assay metanephrines....  .........  .........  .........  ...........  ...........
83840...  A                   Assay methadone........  .........  .........  .........  ...........  ...........
83857...  A                   Assay methemalbumin....  .........  .........  .........  ...........  ...........
83858...  A                   Assay methsuximide.....  .........  .........  .........  ...........  ...........
83864...  A                   Mucopolysaccharides....  .........  .........  .........  ...........  ...........
83866...  A                   Mucopolysaccharides      .........  .........  .........  ...........  ...........
                               screen.
83872...  A                   Assay synovial fluid     .........  .........  .........  ...........  ...........
                               mucin.
83873...  A                   Assay, CSF protein.....  .........  .........  .........  ...........  ...........
83874...  A                   Myoglobin..............  .........  .........  .........  ...........  ...........
83883...  A                   Nephelometry, not        .........  .........  .........  ...........  ...........
                               specified.
83885...  A                   Assay for nickel.......  .........  .........  .........  ...........  ...........

[[Page 47702]]


83887...  A                   Assay nicotine.........  .........  .........  .........  ...........  ...........
83890...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83892...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83894...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83896...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83898...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83902...  A                   Molecular diagnostics..  .........  .........  .........  ...........  ...........
83912...  A                   Genetic examination....  .........  .........  .........  ...........  ...........
83915...  A                   Assay nucleotidase.....  .........  .........  .........  ...........  ...........
83916...  A                   Oligoclonal bands......  .........  .........  .........  ...........  ...........
83918...  A                   Assay organic acids....  .........  .........  .........  ...........  ...........
83925...  A                   Opiates................  .........  .........  .........  ...........  ...........
83930...  A                   Assay blood osmolality.  .........  .........  .........  ...........  ...........
83935...  A                   Assay urine osmolality.  .........  .........  .........  ...........  ...........
83937...  A                   Assay for osteocalcin..  .........  .........  .........  ...........  ...........
83945...  A                   Assay oxalate..........  .........  .........  .........  ...........  ...........
83970...  A                   Assay of parathormone..  .........  .........  .........  ...........  ...........
83986...  A                   Assay body fluid         .........  .........  .........  ...........  ...........
                               acidity.
83992...  A                   Assay for phencyclidine  .........  .........  .........  ...........  ...........
84022...  A                   Assay of phenothiazine.  .........  .........  .........  ...........  ...........
84030...  A                   Assay blood PKU........  .........  .........  .........  ...........  ...........
84035...  A                   Assay phenylketones....  .........  .........  .........  ...........  ...........
84060...  A                   Assay acid phosphatase.  .........  .........  .........  ...........  ...........
84061...  A                   Phosphatase, forensic    .........  .........  .........  ...........  ...........
                               exam.
84066...  A                   Assay prostate           .........  .........  .........  ...........  ...........
                               phosphatase.
84075...  A                   Assay alkaline           .........  .........  .........  ...........  ...........
                               phosphatase.
84078...  A                   Assay alkaline           .........  .........  .........  ...........  ...........
                               phosphatase.
84080...  A                   Assay alkaline           .........  .........  .........  ...........  ...........
                               phosphatases.
84081...  A                   Amniotic fluid enzyme    .........  .........  .........  ...........  ...........
                               test.
84085...  A                   Assay RBC PG6D enzyme..  .........  .........  .........  ...........  ...........
84087...  A                   Assay phosphohexose      .........  .........  .........  ...........  ...........
                               enzymes.
84100...  A                   Assay phosphorus.......  .........  .........  .........  ...........  ...........
84105...  A                   Assay urine phosphorus.  .........  .........  .........  ...........  ...........
84106...  A                   Test for                 .........  .........  .........  ...........  ...........
                               porphobilinogen.
84110...  A                   Assay porphobilinogen..  .........  .........  .........  ...........  ...........
84119...  A                   Test urine for           .........  .........  .........  ...........  ...........
                               porphyrins.
84120...  A                   Assay urine porphyrins.  .........  .........  .........  ...........  ...........
84126...  A                   Assay feces porphyrins.  .........  .........  .........  ...........  ...........
84127...  A                   Porphyrins, feces......  .........  .........  .........  ...........  ...........
84132...  A                   Assay serum potassium..  .........  .........  .........  ...........  ...........
84133...  A                   Assay urine potassium..  .........  .........  .........  ...........  ...........
84134...  A                   Prealbumin.............  .........  .........  .........  ...........  ...........
84135...  A                   Assay pregnanediol.....  .........  .........  .........  ...........  ...........
84138...  A                   Assay pregnanetriol....  .........  .........  .........  ...........  ...........
84140...  A                   Assay for pregnenolone.  .........  .........  .........  ...........  ...........
84143...  A                   Assay/17-                .........  .........  .........  ...........  ...........
                               hydroxypregnenolone.
84144...  A                   Assay progesterone.....  .........  .........  .........  ...........  ...........
84146...  A                   Assay for prolactin....  .........  .........  .........  ...........  ...........
84150...  A                   Assay of prostaglandin.  .........  .........  .........  ...........  ...........
84153...  A                   Prostate specific        .........  .........  .........  ...........  ...........
                               antigen.
84155...  A                   Assay protein..........  .........  .........  .........  ...........  ...........
84160...  A                   Assay serum protein....  .........  .........  .........  ...........  ...........
84165...  A                   Assay serum proteins...  .........  .........  .........  ...........  ...........
84181...  A                   Western blot test......  .........  .........  .........  ...........  ...........
84182...  A                   Protein, western blot    .........  .........  .........  ...........  ...........
                               test.
84202...  A                   Assay RBC                .........  .........  .........  ...........  ...........
                               protoporphyrin.
84203...  A                   Test RBC protoporphyrin  .........  .........  .........  ...........  ...........
84206...  A                   Assay of proinsulin....  .........  .........  .........  ...........  ...........
84207...  A                   Assay vitamin B-6......  .........  .........  .........  ...........  ...........
84210...  A                   Assay pyruvate.........  .........  .........  .........  ...........  ...........
84220...  A                   Assay pyruvate kinase..  .........  .........  .........  ...........  ...........
84228...  A                   Assay quinine..........  .........  .........  .........  ...........  ...........
84233...  A                   Assay estrogen.........  .........  .........  .........  ...........  ...........
84234...  A                   Assay progesterone.....  .........  .........  .........  ...........  ...........
84235...  A                   Assay endocrine hormone  .........  .........  .........  ...........  ...........
84238...  A                   Assay non-endocrine      .........  .........  .........  ...........  ...........
                               receptor.
84244...  A                   Assay of renin.........  .........  .........  .........  ...........  ...........
84252...  A                   Assay vitamin B-2......  .........  .........  .........  ...........  ...........
84255...  A                   Assay selenium.........  .........  .........  .........  ...........  ...........
84260...  A                   Assay serotonin........  .........  .........  .........  ...........  ...........
84270...  A                   Sex hormone globulin     .........  .........  .........  ...........  ...........
                               (SHBG).
84275...  A                   Assay sialic acid......  .........  .........  .........  ...........  ...........
84285...  A                   Assay silica...........  .........  .........  .........  ...........  ...........
84295...  A                   Assay serum sodium.....  .........  .........  .........  ...........  ...........
84300...  A                   Assay urine sodium.....  .........  .........  .........  ...........  ...........

[[Page 47703]]


84305...  A                   Somatomedin............  .........  .........  .........  ...........  ...........
84307...  A                   Somatostatin...........  .........  .........  .........  ...........  ...........
84311...  A                   Spectrophotometry......  .........  .........  .........  ...........  ...........
84315...  A                   Body fluid specific      .........  .........  .........  ...........  ...........
                               gravity.
84375...  A                   Chromatogram assay,      .........  .........  .........  ...........  ...........
                               sugars.
84392...  A                   Assay urine sulfate....  .........  .........  .........  ...........  ...........
84402...  A                   Testosterone...........  .........  .........  .........  ...........  ...........
84403...  A                   Assay total              .........  .........  .........  ...........  ...........
                               testosterone.
84425...  A                   Assay vitamin B-1......  .........  .........  .........  ...........  ...........
84430...  A                   Assay thiocyanate......  .........  .........  .........  ...........  ...........
84432...  A                   Thyroglobulin..........  .........  .........  .........  ...........  ...........
84436...  A                   Assay, total thyroxine.  .........  .........  .........  ...........  ...........
84437...  A                   Assay neonatal           .........  .........  .........  ...........  ...........
                               thyroxine.
84439...  A                   Assay, free thyroxine..  .........  .........  .........  ...........  ...........
84442...  A                   Thyroid activity (TBG)   .........  .........  .........  ...........  ...........
                               assay.
84443...  A                   Assay thyroid stim       .........  .........  .........  ...........  ...........
                               hormone.
84445...  A                   Thyroid immunoglobulins  .........  .........  .........  ...........  ...........
                               TSI.
84446...  A                   Assay vitamin E........  .........  .........  .........  ...........  ...........
84449...  A                   Assay for transcortin..  .........  .........  .........  ...........  ...........
84450...  A                   Transferase (AST)        .........  .........  .........  ...........  ...........
                               (SGOT).
84460...  A                   Alanine amino (ALT)      .........  .........  .........  ...........  ...........
                               (SGPT).
84466...  A                   Transferrin............  .........  .........  .........  ...........  ...........
84478...  A                   Assay triglycerides....  .........  .........  .........  ...........  ...........
84479...  A                   Assay thyroid (t-3 or t- .........  .........  .........  ...........  ...........
                               4).
84480...  A                   Assay triiodothyronine   .........  .........  .........  ...........  ...........
                               (t-3).
84481...  A                   Free assay (FT-3)......  .........  .........  .........  ...........  ...........
84482...  A                   T3 reverse.............  .........  .........  .........  ...........  ...........
84484...  A                   Troponin, quant........  .........  .........  .........  ...........  ...........
84485...  A                   Assay duodenal fluid     .........  .........  .........  ...........  ...........
                               trypsin.
84488...  A                   Test feces for trypsin.  .........  .........  .........  ...........  ...........
84490...  A                   Assay feces for trypsin  .........  .........  .........  ...........  ...........
84510...  A                   Assay tyrosine.........  .........  .........  .........  ...........  ...........
84512...  A                   Troponin, qual.........  .........  .........  .........  ...........  ...........
84520...  A                   Assay urea nitrogen....  .........  .........  .........  ...........  ...........
84525...  A                   Urea nitrogen semi-      .........  .........  .........  ...........  ...........
                               quant.
84540...  A                   Assay urine urea-N.....  .........  .........  .........  ...........  ...........
84545...  A                   Urea-N clearance test..  .........  .........  .........  ...........  ...........
84550...  A                   Assay blood uric acid..  .........  .........  .........  ...........  ...........
84560...  A                   Assay urine uric acid..  .........  .........  .........  ...........  ...........
84577...  A                   Assay feces              .........  .........  .........  ...........  ...........
                               urobilinogen.
84578...  A                   Test urine urobilinogen  .........  .........  .........  ...........  ...........
84580...  A                   Assay urine              .........  .........  .........  ...........  ...........
                               urobilinogen.
84583...  A                   Assay urine              .........  .........  .........  ...........  ...........
                               urobilinogen.
84585...  A                   Assay urine VMA........  .........  .........  .........  ...........  ...........
84586...  A                   VIP assay..............  .........  .........  .........  ...........  ...........
84588...  A                   Assay vasopressin......  .........  .........  .........  ...........  ...........
84590...  A                   Assay vitamin-A........  .........  .........  .........  ...........  ...........
84597...  A                   Assay vitamin-K........  .........  .........  .........  ...........  ...........
84600...  A                   Assay for volatiles....  .........  .........  .........  ...........  ...........
84620...  A                   Xylose tolerance test..  .........  .........  .........  ...........  ...........
84630...  A                   Assay zinc.............  .........  .........  .........  ...........  ...........
84681...  A                   Assay C-peptide........  .........  .........  .........  ...........  ...........
84702...  A                   Chorionic gonadotropin   .........  .........  .........  ...........  ...........
                               test.
84703...  A                   Chorionic gonadotropin   .........  .........  .........  ...........  ...........
                               assay.
84830...  A                   Ovulation tests........  .........  .........  .........  ...........  ...........
84999...  A                   Clinical chemistry test  .........  .........  .........  ...........  ...........
85002...  A                   Bleeding time test.....  .........  .........  .........  ...........  ...........
85007...  A                   Differential WBC count.  .........  .........  .........  ...........  ...........
85008...  A                   Nondifferential WBC      .........  .........  .........  ...........  ...........
                               count.
85009...  A                   Differential WBC count.  .........  .........  .........  ...........  ...........
85013...  A                   Hematocrit.............  .........  .........  .........  ...........  ...........
85014...  A                   Hematocrit.............  .........  .........  .........  ...........  ...........
85018...  A                   Hemoglobin.............  .........  .........  .........  ...........  ...........
85021...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85022...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85023...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85024...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85025...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85027...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85029...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85030...  A                   Automated hemogram.....  .........  .........  .........  ...........  ...........
85031...  A                   Manual hemogram,         .........  .........  .........  ...........  ...........
                               complete cbc.
85041...  A                   Red blood cell (RBC)     .........  .........  .........  ...........  ...........
                               count.
85044...  A                   Reticulocyte count.....  .........  .........  .........  ...........  ...........
85045...  A                   Reticulocyte count.....  .........  .........  .........  ...........  ...........

[[Page 47704]]


85048...  A                   White blood cell (WBC)   .........  .........  .........  ...........  ...........
                               count.
85060...  X                   Blood smear                    882       0.39     $20.57       $11.75        $4.11
                               interpretation.
85095...  T                   Bone marrow aspiration.        121       0.67     $35.26       $21.02        $7.05
85097...  X                   Bone marrow                    882       0.39     $20.57       $11.75        $4.11
                               interpretation.
85102...  T                   Bone marrow biopsy.....        121       0.67     $35.26       $21.02        $7.05
85130...  A                   Chromogenic substrate    .........  .........  .........  ...........  ...........
                               assay.
85170...  A                   Blood clot retraction..  .........  .........  .........  ...........  ...........
85175...  A                   Blood clot lysis time..  .........  .........  .........  ...........  ...........
85210...  A                   Blood clot factor II     .........  .........  .........  ...........  ...........
                               test.
85220...  A                   Blood clot factor V      .........  .........  .........  ...........  ...........
                               test.
85230...  A                   Blood clot factor VII    .........  .........  .........  ...........  ...........
                               test.
85240...  A                   Blood clot factor VIII   .........  .........  .........  ...........  ...........
                               test.
85244...  A                   Blood clot factor VIII   .........  .........  .........  ...........  ...........
                               test.
85245...  A                   Blood clot factor VIII   .........  .........  .........  ...........  ...........
                               test.
85246...  A                   Blood clot factor VIII   .........  .........  .........  ...........  ...........
                               test.
85247...  A                   Blood clot factor VIII   .........  .........  .........  ...........  ...........
                               test.
85250...  A                   Blood clot factor IX     .........  .........  .........  ...........  ...........
                               test.
85260...  A                   Blood clot factor X      .........  .........  .........  ...........  ...........
                               test.
85270...  A                   Blood clot factor XI     .........  .........  .........  ...........  ...........
                               test.
85280...  A                   Blood clot factor XII    .........  .........  .........  ...........  ...........
                               test.
85290...  A                   Blood clot factor XIII   .........  .........  .........  ...........  ...........
                               test.
85291...  A                   Blood clot factor XIII   .........  .........  .........  ...........  ...........
                               test.
85292...  A                   Blood clot factor assay  .........  .........  .........  ...........  ...........
85293...  A                   Blood clot factor assay  .........  .........  .........  ...........  ...........
85300...  A                   Antithrombin III test..  .........  .........  .........  ...........  ...........
85301...  A                   Antithrombin III test..  .........  .........  .........  ...........  ...........
85302...  A                   Blood clot inhibitor     .........  .........  .........  ...........  ...........
                               antigen.
85303...  A                   Blood clot inhibitor     .........  .........  .........  ...........  ...........
                               test.
85305...  A                   Blood clot inhibitor     .........  .........  .........  ...........  ...........
                               assay.
85306...  A                   Blood clot inhibitor     .........  .........  .........  ...........  ...........
                               test.
85335...  A                   Factor inhibitor test..  .........  .........  .........  ...........  ...........
85337...  A                   Thrombomodulin.........  .........  .........  .........  ...........  ...........
85345...  A                   Coagulation time.......  .........  .........  .........  ...........  ...........
85347...  A                   Coagulation time.......  .........  .........  .........  ...........  ...........
85348...  A                   Coagulation time.......  .........  .........  .........  ...........  ...........
85360...  A                   Euglobulin lysis.......  .........  .........  .........  ...........  ...........
85362...  A                   Fibrin degradation       .........  .........  .........  ...........  ...........
                               products.
85366...  A                   Fibrinogen test........  .........  .........  .........  ...........  ...........
85370...  A                   Fibrinogen test........  .........  .........  .........  ...........  ...........
85378...  A                   Fibrin degradation.....  .........  .........  .........  ...........  ...........
85379...  A                   Fibrin degradation.....  .........  .........  .........  ...........  ...........
85384...  A                   Fibrinogen.............  .........  .........  .........  ...........  ...........
85385...  A                   Fibrinogen.............  .........  .........  .........  ...........  ...........
85390...  A                   Fibrinolysins screen...  .........  .........  .........  ...........  ...........
85400...  A                   Fibrinolytic plasmin...  .........  .........  .........  ...........  ...........
85410...  A                   Fibrinolytic             .........  .........  .........  ...........  ...........
                               antiplasmin.
85415...  A                   Fibrinolytic             .........  .........  .........  ...........  ...........
                               plasminogen.
85420...  A                   Fibrinolytic             .........  .........  .........  ...........  ...........
                               plasminogen.
85421...  A                   Fibrinolytic             .........  .........  .........  ...........  ...........
                               plasminogen.
85441...  A                   Heinz bodies; direct...  .........  .........  .........  ...........  ...........
85445...  A                   Heinz bodies; induced..  .........  .........  .........  ...........  ...........
85460...  A                   Hemoglobin, fetal......  .........  .........  .........  ...........  ...........
85461...  A                   Hemoglobin, fetal......  .........  .........  .........  ...........  ...........
85475...  A                   Hemolysin..............  .........  .........  .........  ...........  ...........
85520...  A                   Heparin assay..........  .........  .........  .........  ...........  ...........
85525...  A                   Heparin................  .........  .........  .........  ...........  ...........
85530...  A                   Heparin-protamine        .........  .........  .........  ...........  ...........
                               tolerance.
85535...  A                   Iron stain, blood cells  .........  .........  .........  ...........  ...........
85540...  A                   Wbc alkaline             .........  .........  .........  ...........  ...........
                               phosphatase.
85547...  A                   RBC mechanical           .........  .........  .........  ...........  ...........
                               fragility.
85549...  A                   Muramidase.............  .........  .........  .........  ...........  ...........
85555...  A                   RBC osmotic fragility..  .........  .........  .........  ...........  ...........
85557...  A                   RBC osmotic fragility..  .........  .........  .........  ...........  ...........
85576...  A                   Blood platelet           .........  .........  .........  ...........  ...........
                               aggregation.
85585...  A                   Blood platelet           .........  .........  .........  ...........  ...........
                               estimation.
85590...  A                   Platelet manual count..  .........  .........  .........  ...........  ...........
85595...  A                   Platelet count,          .........  .........  .........  ...........  ...........
                               automated.
85597...  A                   Platelet neutralization  .........  .........  .........  ...........  ...........
85610...  A                   Prothrombin time.......  .........  .........  .........  ...........  ...........
85611...  A                   Prothrombin test.......  .........  .........  .........  ...........  ...........
85612...  A                   Viper venom prothrombin  .........  .........  .........  ...........  ...........
                               time.
85613...  A                   Russell viper venom,     .........  .........  .........  ...........  ...........
                               diluted.
85635...  A                   Reptilase test.........  .........  .........  .........  ...........  ...........
85651...  A                   Rbc sed rate, nonauto..  .........  .........  .........  ...........  ...........
85652...  A                   Rbc sed rate, auto.....  .........  .........  .........  ...........  ...........

[[Page 47705]]


85660...  A                   RBC sickle cell test...  .........  .........  .........  ...........  ...........
85670...  A                   Thrombin time, plasma..  .........  .........  .........  ...........  ...........
85675...  A                   Thrombin time, titer...  .........  .........  .........  ...........  ...........
85705...  A                   Thromboplastin           .........  .........  .........  ...........  ...........
                               inhibition.
85730...  A                   Thromboplastin time,     .........  .........  .........  ...........  ...........
                               partial.
85732...  A                   Thromboplastin time,     .........  .........  .........  ...........  ...........
                               partial.
85810...  A                   Blood viscosity          .........  .........  .........  ...........  ...........
                               examination.
85999...  A                   Hematology procedure...  .........  .........  .........  ...........  ...........
86000...  A                   Agglutinins; febrile...  .........  .........  .........  ...........  ...........
86003...  A                   Allergen specific IgE..  .........  .........  .........  ...........  ...........
86005...  A                   Allergen specific IgE..  .........  .........  .........  ...........  ...........
86021...  A                   WBC antibody             .........  .........  .........  ...........  ...........
                               identification.
86022...  A                   Platelet antibodies....  .........  .........  .........  ...........  ...........
86023...  A                   Immunoglobulin assay...  .........  .........  .........  ...........  ...........
86038...  A                   Antinuclear antibodies.  .........  .........  .........  ...........  ...........
86039...  A                   Antinuclear antibodies   .........  .........  .........  ...........  ...........
                               (ANA).
86060...  A                   Antistreptolysin O       .........  .........  .........  ...........  ...........
                               titer.
86063...  A                   Antistreptolysin O       .........  .........  .........  ...........  ...........
                               screen.
86077...  X                   Physician blood bank           882       0.39     $20.57       $11.75        $4.11
                               service.
86078...  X                   Physician blood bank           882       0.39     $20.57       $11.75        $4.11
                               service.
86079...  X                   Physician blood bank           882       0.39     $20.57       $11.75        $4.11
                               service.
86140...  A                   C-reactive protein.....  .........  .........  .........  ...........  ...........
86147...  A                   Cardiolipin antibody...  .........  .........  .........  ...........  ...........
86148...  A                   Phospholipid antibody..  .........  .........  .........  ...........  ...........
86155...  A                   Chemotaxis assay.......  .........  .........  .........  ...........  ...........
86156...  A                   Cold agglutinin screen.  .........  .........  .........  ...........  ...........
86157...  A                   Cold agglutinin, titer.  .........  .........  .........  ...........  ...........
86160...  A                   Complement, antigen....  .........  .........  .........  ...........  ...........
86161...  A                   Complement/function      .........  .........  .........  ...........  ...........
                               activity.
86162...  A                   Complement, total        .........  .........  .........  ...........  ...........
                               (CH50).
86171...  A                   Complement fixation,     .........  .........  .........  ...........  ...........
                               each.
86185...  A                   Counterimmunoelectropho  .........  .........  .........  ...........  ...........
                               resis.
86215...  A                   Deoxyribonuclease,       .........  .........  .........  ...........  ...........
                               antibody.
86225...  A                   DNA antibody...........  .........  .........  .........  ...........  ...........
86226...  A                   DNA antibody, single     .........  .........  .........  ...........  ...........
                               strand.
86235...  A                   Nuclear antigen          .........  .........  .........  ...........  ...........
                               antibody.
86243...  A                   Fc receptor............  .........  .........  .........  ...........  ...........
86255...  A                   Fluorescent antibody;    .........  .........  .........  ...........  ...........
                               screen.
86256...  A                   Fluorescent antibody;    .........  .........  .........  ...........  ...........
                               titer.
86277...  A                   Growth hormone antibody  .........  .........  .........  ...........  ...........
86280...  A                   Hemagglutination         .........  .........  .........  ...........  ...........
                               inhibition.
86308...  A                   Heterophile antibodies.  .........  .........  .........  ...........  ...........
86309...  A                   Heterophile antibodies.  .........  .........  .........  ...........  ...........
86310...  A                   Heterophile antibodies.  .........  .........  .........  ...........  ...........
86316...  A                   Immunoassay, tumor       .........  .........  .........  ...........  ...........
                               antigen.
86317...  A                   Immunoassay, infectious  .........  .........  .........  ...........  ...........
                               agent.
86318...  A                   Immunoassay, infectious  .........  .........  .........  ...........  ...........
                               agent.
86320...  A                   Serum                    .........  .........  .........  ...........  ...........
                               immunoelectrophoresis.
86325...  A                   Other                    .........  .........  .........  ...........  ...........
                               immunoelectrophoresis.
86327...  A                   Immunoelectrophoresis    .........  .........  .........  ...........  ...........
                               assay.
86329...  A                   Immunodiffusion........  .........  .........  .........  ...........  ...........
86331...  A                   Immunodiffusion          .........  .........  .........  ...........  ...........
                               ouchterlony.
86332...  A                   Immune complex assay...  .........  .........  .........  ...........  ...........
86334...  A                   Immunofixation           .........  .........  .........  ...........  ...........
                               procedure.
86337...  A                   Insulin antibodies.....  .........  .........  .........  ...........  ...........
86340...  A                   Intrinsic factor         .........  .........  .........  ...........  ...........
                               antibody.
86341...  A                   Islet cell antibody....  .........  .........  .........  ...........  ...........
86343...  A                   Leukocyte histamine      .........  .........  .........  ...........  ...........
                               release.
86344...  A                   Leukocyte phagocytosis.  .........  .........  .........  ...........  ...........
86353...  A                   Lymphocyte               .........  .........  .........  ...........  ...........
                               transformation.
86359...  A                   T cells, total count...  .........  .........  .........  ...........  ...........
86360...  A                   T cell absolute count/   .........  .........  .........  ...........  ...........
                               ratio.
86361...  A                   T cell absolute count..  .........  .........  .........  ...........  ...........
86376...  A                   Microsomal antibody....  .........  .........  .........  ...........  ...........
86378...  A                   Migration inhibitory     .........  .........  .........  ...........  ...........
                               factor.
86382...  A                   Neutralization test,     .........  .........  .........  ...........  ...........
                               viral.
86384...  A                   Nitroblue tetrazolium    .........  .........  .........  ...........  ...........
                               dye.
86403...  A                   Particle agglutination   .........  .........  .........  ...........  ...........
                               test.
86406...  A                   Particle agglutination   .........  .........  .........  ...........  ...........
                               test.
86430...  A                   Rheumatoid factor test.  .........  .........  .........  ...........  ...........
86431...  A                   Rheumatoid factor,       .........  .........  .........  ...........  ...........
                               quant.
86485...  X                   Skin test, candida.....        861       0.13      $6.86        $3.62        $1.37
86490...  X                   Coccidioidomycosis skin        861       0.13      $6.86        $3.62        $1.37
                               test.
86510...  X                   Histoplasmosis skin            861       0.13      $6.86        $3.62        $1.37
                               test.
86580...  X                   TB intradermal test....        861       0.13      $6.86        $3.62        $1.37

[[Page 47706]]


86585...  X                   TB tine test...........        861       0.13      $6.86        $3.62        $1.37
86586...  X                   Skin test, unlisted....        861       0.13      $6.86        $3.62        $1.37
86588...  A                   Streptocollus, direct    .........  .........  .........  ...........  ...........
                               screen.
86590...  A                   Streptokinase, antibody  .........  .........  .........  ...........  ...........
86592...  A                   Blood serology,          .........  .........  .........  ...........  ...........
                               qualitative.
86593...  A                   Blood serology,          .........  .........  .........  ...........  ...........
                               quantitative.
86602...  A                   Antinomyces antibody...  .........  .........  .........  ...........  ...........
86603...  A                   Adenovirus, antibody...  .........  .........  .........  ...........  ...........
86606...  A                   Aspergillus antibody...  .........  .........  .........  ...........  ...........
86609...  A                   Bacterium, antibody....  .........  .........  .........  ...........  ...........
86612...  A                   Blastomyces, antibody..  .........  .........  .........  ...........  ...........
86615...  A                   Bordetella antibody....  .........  .........  .........  ...........  ...........
86617...  A                   Lyme disease antibody..  .........  .........  .........  ...........  ...........
86618...  A                   Lyme disease antibody..  .........  .........  .........  ...........  ...........
86619...  A                   Borrelia antibody......  .........  .........  .........  ...........  ...........
86622...  A                   Brucella, antibody.....  .........  .........  .........  ...........  ...........
86625...  A                   Campylobacter, antibody  .........  .........  .........  ...........  ...........
86628...  A                   Candida, antibody......  .........  .........  .........  ...........  ...........
86631...  A                   Chlamydia, antibody....  .........  .........  .........  ...........  ...........
86632...  A                   Chlamydia, IgM,          .........  .........  .........  ...........  ...........
                               antibody.
86635...  A                   Coccidioides, antibody.  .........  .........  .........  ...........  ...........
86638...  A                   Q fever antibody.......  .........  .........  .........  ...........  ...........
86641...  A                   Cryptococcus antibody..  .........  .........  .........  ...........  ...........
86644...  A                   CMV antibody...........  .........  .........  .........  ...........  ...........
86645...  A                   CMV antibody, IgM......  .........  .........  .........  ...........  ...........
86648...  A                   Diphtheria antibody....  .........  .........  .........  ...........  ...........
86651...  A                   Encephalitis antibody..  .........  .........  .........  ...........  ...........
86652...  A                   Encephalitis antibody..  .........  .........  .........  ...........  ...........
86653...  A                   Encephalitis, antibody.  .........  .........  .........  ...........  ...........
86654...  A                   Encephalitis, antibody.  .........  .........  .........  ...........  ...........
86658...  A                   Enterovirus, antibody..  .........  .........  .........  ...........  ...........
86663...  A                   Epstein-barr antibody..  .........  .........  .........  ...........  ...........
86664...  A                   Epstein-barr antibody..  .........  .........  .........  ...........  ...........
86665...  A                   Epstein-barr, antibody.  .........  .........  .........  ...........  ...........
86668...  A                   Francisella tularensis.  .........  .........  .........  ...........  ...........
86671...  A                   Fungus, antibody.......  .........  .........  .........  ...........  ...........
86674...  A                   Giardia lamblia........  .........  .........  .........  ...........  ...........
86677...  A                   Helicobacter pylori....  .........  .........  .........  ...........  ...........
86682...  A                   Helminth, antibody.....  .........  .........  .........  ...........  ...........
86684...  A                   Hemophilus influenza...  .........  .........  .........  ...........  ...........
86687...  A                   HTLV I.................  .........  .........  .........  ...........  ...........
86688...  A                   HTLV-II................  .........  .........  .........  ...........  ...........
86689...  A                   HTLV/HIV confirmatory    .........  .........  .........  ...........  ...........
                               test.
86692...  A                   Hepatitis, delta agent.  .........  .........  .........  ...........  ...........
86694...  A                   Herpes simplex test....  .........  .........  .........  ...........  ...........
86695...  A                   Herpes simplex test....  .........  .........  .........  ...........  ...........
86698...  A                   Histoplasma............  .........  .........  .........  ...........  ...........
86701...  A                   HIV-1..................  .........  .........  .........  ...........  ...........
86702...  A                   HIV-2..................  .........  .........  .........  ...........  ...........
86703...  A                   HIV-1/HIV-2, single      .........  .........  .........  ...........  ...........
                               assay.
86704...  A                   Hep b core ab test, igg  .........  .........  .........  ...........  ...........
                               & m.
86705...  A                   Hep b core ab test, igm  .........  .........  .........  ...........  ...........
86706...  A                   Hepatitis b surface ab   .........  .........  .........  ...........  ...........
                               test.
86707...  A                   Hepatitis be ab test...  .........  .........  .........  ...........  ...........
86708...  A                   Hep a ab test, igg & m.  .........  .........  .........  ...........  ...........
86709...  A                   Hep a ab test, igm.....  .........  .........  .........  ...........  ...........
86710...  A                   Influenza virus........  .........  .........  .........  ...........  ...........
86713...  A                   Legionella.............  .........  .........  .........  ...........  ...........
86717...  A                   Leishmania.............  .........  .........  .........  ...........  ...........
86720...  A                   Leptospira.............  .........  .........  .........  ...........  ...........
86723...  A                   Listeria monocytogenes.  .........  .........  .........  ...........  ...........
86727...  A                   Lymph choriomeningitis.  .........  .........  .........  ...........  ...........
86729...  A                   Lympho venereum........  .........  .........  .........  ...........  ...........
86732...  A                   Mucormycosis...........  .........  .........  .........  ...........  ...........
86735...  A                   Mumps..................  .........  .........  .........  ...........  ...........
86738...  A                   Mycoplasma.............  .........  .........  .........  ...........  ...........
86741...  A                   Neisseria meningitidis.  .........  .........  .........  ...........  ...........
86744...  A                   Nocardia...............  .........  .........  .........  ...........  ...........
86747...  A                   Parvovirus.............  .........  .........  .........  ...........  ...........
86750...  A                   Malaria................  .........  .........  .........  ...........  ...........
86753...  A                   Protozoa, not elsewhere  .........  .........  .........  ...........  ...........
86756...  A                   Respiratory virus......  .........  .........  .........  ...........  ...........
86759...  A                   Rotavirus..............  .........  .........  .........  ...........  ...........
86762...  A                   Rubella................  .........  .........  .........  ...........  ...........
86765...  A                   Rubeola................  .........  .........  .........  ...........  ...........

[[Page 47707]]


86768...  A                   Salmonella.............  .........  .........  .........  ...........  ...........
86771...  A                   Shigella...............  .........  .........  .........  ...........  ...........
86774...  A                   Tetanus................  .........  .........  .........  ...........  ...........
86777...  A                   Toxoplasma.............  .........  .........  .........  ...........  ...........
86778...  A                   Toxoplasma, IgM........  .........  .........  .........  ...........  ...........
86781...  A                   Treponema pallidum       .........  .........  .........  ...........  ...........
                               confirm.
86784...  A                   Trichinella............  .........  .........  .........  ...........  ...........
86787...  A                   Varicella-zoster.......  .........  .........  .........  ...........  ...........
86790...  A                   Virus, not specified...  .........  .........  .........  ...........  ...........
86793...  A                   Yersinia...............  .........  .........  .........  ...........  ...........
86800...  A                   Thyroglobulin antibody.  .........  .........  .........  ...........  ...........
86803...  A                   Hepatitis c ab test....  .........  .........  .........  ...........  ...........
86804...  A                   Hep c ab test, confirm.  .........  .........  .........  ...........  ...........
86805...  A                   Lymphocytotoxicity       .........  .........  .........  ...........  ...........
                               assay.
86806...  A                   Lymphocytotoxicity       .........  .........  .........  ...........  ...........
                               assay.
86807...  A                   Cytotoxic antibody       .........  .........  .........  ...........  ...........
                               screening.
86808...  A                   Cytotoxic antibody       .........  .........  .........  ...........  ...........
                               screening.
86812...  A                   HLA typing, A, B, or C.  .........  .........  .........  ...........  ...........
86813...  A                   HLA typing, A, B, or C.  .........  .........  .........  ...........  ...........
86816...  A                   HLA typing, DR/DQ......  .........  .........  .........  ...........  ...........
86817...  A                   HLA typing, DR/DQ......  .........  .........  .........  ...........  ...........
86821...  A                   Lymphocyte culture,      .........  .........  .........  ...........  ...........
                               mixed.
86822...  A                   Lymphocyte culture,      .........  .........  .........  ...........  ...........
                               primed.
86849...  A                   Immunology procedure...  .........  .........  .........  ...........  ...........
86850...  A                   RBC antibody screen....  .........  .........  .........  ...........  ...........
86860...  A                   RBC antibody elution...  .........  .........  .........  ...........  ...........
86870...  A                   RBC antibody             .........  .........  .........  ...........  ...........
                               identification.
86880...  A                   Coombs test............  .........  .........  .........  ...........  ...........
86885...  A                   Coombs test............  .........  .........  .........  ...........  ...........
86886...  A                   Coombs test............  .........  .........  .........  ...........  ...........
86890...  A                   Autologous blood         .........  .........  .........  ...........  ...........
                               process.
86891...  A                   Autologous blood, op     .........  .........  .........  ...........  ...........
                               salvage.
86900...  A                   Blood typing, ABO......  .........  .........  .........  ...........  ...........
86901...  A                   Blood typing, Rh (D)...  .........  .........  .........  ...........  ...........
86903...  A                   Blood typing, antigen    .........  .........  .........  ...........  ...........
                               screen.
86904...  A                   Blood typing, patient    .........  .........  .........  ...........  ...........
                               serum.
86905...  A                   Blood typing, RBC        .........  .........  .........  ...........  ...........
                               antigens.
86906...  A                   Blood typing, Rh         .........  .........  .........  ...........  ...........
                               phenotype.
86910...  E                   Blood typing, paternity  .........  .........  .........  ...........  ...........
                               test.
86911...  E                   Blood typing, antigen    .........  .........  .........  ...........  ...........
                               system.
86915...  A                   Bone marrow............  .........  .........  .........  ...........  ...........
86920...  A                   Compatibility test.....  .........  .........  .........  ...........  ...........
86921...  A                   Compatibility test.....  .........  .........  .........  ...........  ...........
86922...  A                   Compatibility test.....  .........  .........  .........  ...........  ...........
86927...  A                   Plasma, fresh frozen...  .........  .........  .........  ...........  ...........
86930...  A                   Frozen blood prep......  .........  .........  .........  ...........  ...........
86931...  A                   Frozen blood thaw......  .........  .........  .........  ...........  ...........
86932...  A                   Frozen blood, freeze/    .........  .........  .........  ...........  ...........
                               thaw.
86940...  A                   Hemolysins/agglutinins   .........  .........  .........  ...........  ...........
                               auto.
86941...  A                   Hemolysins/agglutinins.  .........  .........  .........  ...........  ...........
86945...  A                   Blood product/           .........  .........  .........  ...........  ...........
                               irradiation.
86950...  A                   Leukacyte transfusion..  .........  .........  .........  ...........  ...........
86965...  A                   Pooling blood platelets  .........  .........  .........  ...........  ...........
86970...  A                   RBC pretreatment.......  .........  .........  .........  ...........  ...........
86971...  A                   RBC pretreatment.......  .........  .........  .........  ...........  ...........
86972...  A                   RBC pretreatment.......  .........  .........  .........  ...........  ...........
86975...  A                   RBC pretreatment, serum  .........  .........  .........  ...........  ...........
86976...  A                   RBC pretreatment, serum  .........  .........  .........  ...........  ...........
86977...  A                   RBC pretreatment, serum  .........  .........  .........  ...........  ...........
86978...  A                   RBC pretreatment, serum  .........  .........  .........  ...........  ...........
86985...  A                   Split blood or products  .........  .........  .........  ...........  ...........
86999...  A                   Transfusion procedure..  .........  .........  .........  ...........  ...........
87001...  A                   Small animal             .........  .........  .........  ...........  ...........
                               inoculation.
87003...  A                   Small animal             .........  .........  .........  ...........  ...........
                               inoculation.
87015...  A                   Specimen concentration.  .........  .........  .........  ...........  ...........
87040...  A                   Blood culture for        .........  .........  .........  ...........  ...........
                               bacteria.
87045...  A                   Stool culture for        .........  .........  .........  ...........  ...........
                               bacteria.
87060...  A                   Nose/throat              .........  .........  .........  ...........  ...........
                               culture,bacteria.
87070...  A                   Culture specimen,        .........  .........  .........  ...........  ...........
                               bacteria.
87072...  A                   Culture of specimen by   .........  .........  .........  ...........  ...........
                               kit.
87075...  A                   Culture specimen,        .........  .........  .........  ...........  ...........
                               bacteria.
87076...  A                   Bacteria identification  .........  .........  .........  ...........  ...........
87081...  A                   Bacteria culture screen  .........  .........  .........  ...........  ...........
87082...  A                   Culture of specimen by   .........  .........  .........  ...........  ...........
                               kit.
87083...  A                   Culture of specimen by   .........  .........  .........  ...........  ...........
                               kit.

[[Page 47708]]


87084...  A                   Culture of specimen by   .........  .........  .........  ...........  ...........
                               kit.
87085...  A                   Culture of specimen by   .........  .........  .........  ...........  ...........
                               kit.
87086...  A                   Urine culture, colony    .........  .........  .........  ...........  ...........
                               count.
87087...  A                   Urine bacteria culture.  .........  .........  .........  ...........  ...........
87088...  A                   Urine bacteria culture.  .........  .........  .........  ...........  ...........
87101...  A                   Skin fungus culture....  .........  .........  .........  ...........  ...........
87102...  A                   Fungus isolation         .........  .........  .........  ...........  ...........
                               culture.
87103...  A                   Blood fungus culture...  .........  .........  .........  ...........  ...........
87106...  A                   Fungus identification..  .........  .........  .........  ...........  ...........
87109...  A                   Mycoplasma culture.....  .........  .........  .........  ...........  ...........
87110...  A                   Culture, chlamydia.....  .........  .........  .........  ...........  ...........
87116...  A                   Mycobacteria culture...  .........  .........  .........  ...........  ...........
87117...  A                   Mycobacteria culture...  .........  .........  .........  ...........  ...........
87118...  A                   Mycobacteria             .........  .........  .........  ...........  ...........
                               identification.
87140...  A                   Culture typing,          .........  .........  .........  ...........  ...........
                               fluorescent.
87143...  A                   Culture typing, GLC      .........  .........  .........  ...........  ...........
                               method.
87145...  A                   Culture typing, phage    .........  .........  .........  ...........  ...........
                               method.
87147...  A                   Culture typing,          .........  .........  .........  ...........  ...........
                               serologic.
87151...  A                   Culture typing,          .........  .........  .........  ...........  ...........
                               serologic.
87155...  A                   Culture typing,          .........  .........  .........  ...........  ...........
                               precipitin.
87158...  A                   Culture typing, added    .........  .........  .........  ...........  ...........
                               method.
87163...  A                   Special microbiology     .........  .........  .........  ...........  ...........
                               culture.
87164...  A                   Dark field examination.  .........  .........  .........  ...........  ...........
87166...  A                   Dark field examination.  .........  .........  .........  ...........  ...........
87174...  A                   Endotoxin, bacterial...  .........  .........  .........  ...........  ...........
87175...  A                   Assay, endotoxin,        .........  .........  .........  ...........  ...........
                               bacterial.
87176...  A                   Endotoxin, bacterial...  .........  .........  .........  ...........  ...........
87177...  A                   Ova and parasites        .........  .........  .........  ...........  ...........
                               smears.
87181...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               each.
87184...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               each.
87186...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               MIC.
87187...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               MBC.
87188...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               each.
87190...  A                   TB antibiotic            .........  .........  .........  ...........  ...........
                               sensitivity.
87192...  A                   Antibiotic sensitivity,  .........  .........  .........  ...........  ...........
                               each.
87197...  A                   Bactericidal level,      .........  .........  .........  ...........  ...........
                               serum.
87205...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87206...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87207...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87208...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87210...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87211...  A                   Smear, stain &           .........  .........  .........  ...........  ...........
                               interpret.
87220...  A                   Tissue exam for fungi..  .........  .........  .........  ...........  ...........
87230...  A                   Assay, toxin or          .........  .........  .........  ...........  ...........
                               antitoxin.
87250...  A                   Virus inoculation for    .........  .........  .........  ...........  ...........
                               test.
87252...  A                   Virus inoculation for    .........  .........  .........  ...........  ...........
                               test.
87253...  A                   Virus inoculation for    .........  .........  .........  ...........  ...........
                               test.
87260...  A                   Adenovirus ag, dfa.....  .........  .........  .........  ...........  ...........
87265...  A                   Pertussis ag, dfa......  .........  .........  .........  ...........  ...........
87270...  A                   Chylmd trach ag, dfa...  .........  .........  .........  ...........  ...........
87272...  A                   Cryptosporidum ag, dfa.  .........  .........  .........  ...........  ...........
87274...  A                   Herpes simplex ag, dfa.  .........  .........  .........  ...........  ...........
87276...  A                   Influenza ag, dfa......  .........  .........  .........  ...........  ...........
87278...  A                   Legion pneumo ag, dfa..  .........  .........  .........  ...........  ...........
87280...  A                   Resp syncytial ag, dfa.  .........  .........  .........  ...........  ...........
87285...  A                   Trepon pallidum ag, dfa  .........  .........  .........  ...........  ...........
87290...  A                   Varicella ag, dfa......  .........  .........  .........  ...........  ...........
87299...  A                   Ag detection nos, dfa..  .........  .........  .........  ...........  ...........
87301...  A                   Adenovirus ag, eia.....  .........  .........  .........  ...........  ...........
87320...  A                   Chylmd trach ag, eia...  .........  .........  .........  ...........  ...........
87324...  A                   Clostridium ag, eia....  .........  .........  .........  ...........  ...........
87328...  A                   Cryptospor ag, eia.....  .........  .........  .........  ...........  ...........
87332...  A                   Cytomegalovirus ag, eia  .........  .........  .........  ...........  ...........
87335...  A                   E coli 0157 ag, eia....  .........  .........  .........  ...........  ...........
87340...  A                   Hepatitis b surface ag,  .........  .........  .........  ...........  ...........
                               eia.
87350...  A                   Hepatitis b ag, eia....  .........  .........  .........  ...........  ...........
87380...  A                   Hepatitis delta ag, eia  .........  .........  .........  ...........  ...........
87385...  A                   Histoplasma capsul ag,   .........  .........  .........  ...........  ...........
                               eia.
87390...  A                   Hiv-1 ag, eia..........  .........  .........  .........  ...........  ...........
87391...  A                   Hiv-2 ag, eia..........  .........  .........  .........  ...........  ...........
87420...  A                   Resp syncytial ag, eia.  .........  .........  .........  ...........  ...........
87425...  A                   Rotavirus ag, eia......  .........  .........  .........  ...........  ...........
87430...  A                   Strep a ag, eia........  .........  .........  .........  ...........  ...........
87449...  A                   Ag detect nos, eia,      .........  .........  .........  ...........  ...........
                               mult.
87450...  A                   Ag detect nos, eia,      .........  .........  .........  ...........  ...........
                               single.

[[Page 47709]]


87470...  A                   Bartonella, dna, dir     .........  .........  .........  ...........  ...........
                               probe.
87471...  A                   Bartonella, dna, amp     .........  .........  .........  ...........  ...........
                               probe.
87472...  A                   Bartonella, dna, quant.  .........  .........  .........  ...........  ...........
87475...  A                   Lyme dis, dna, dir       .........  .........  .........  ...........  ...........
                               probe.
87476...  A                   Lyme dis, dna, amp       .........  .........  .........  ...........  ...........
                               probe.
87477...  A                   Lyme dis, dna, quant...  .........  .........  .........  ...........  ...........
87480...  A                   Candida, dna, dir probe  .........  .........  .........  ...........  ...........
87481...  A                   Candida, dna, amp probe  .........  .........  .........  ...........  ...........
87482...  A                   Candida, dna, quant....  .........  .........  .........  ...........  ...........
87485...  A                   Chylmd pneum, dna, dir   .........  .........  .........  ...........  ...........
                               probe.
87486...  A                   Chylmd pneum, dna, amp   .........  .........  .........  ...........  ...........
                               probe.
87487...  A                   Chylmd pneum, dna,       .........  .........  .........  ...........  ...........
                               quant.
87490...  A                   Chylmd trach, dna, dir   .........  .........  .........  ...........  ...........
                               probe.
87491...  A                   Chylmd trach, dna, amp   .........  .........  .........  ...........  ...........
                               probe.
87492...  A                   Chylmd trach, dna,       .........  .........  .........  ...........  ...........
                               quant.
87495...  A                   Cytomeg, dna, dir probe  .........  .........  .........  ...........  ...........
87496...  A                   Cytomeg, dna, amp probe  .........  .........  .........  ...........  ...........
87497...  A                   Cytomeg, dna, quant....  .........  .........  .........  ...........  ...........
87510...  A                   Gardner vag, dna, dir    .........  .........  .........  ...........  ...........
                               probe.
87511...  A                   Gardner vag, dna, amp    .........  .........  .........  ...........  ...........
                               probe.
87512...  A                   Gardner vag, dna, quant  .........  .........  .........  ...........  ...........
87515...  A                   Hepatitis b, dna, dir    .........  .........  .........  ...........  ...........
                               probe.
87516...  A                   Hepatitis b, dna, amp    .........  .........  .........  ...........  ...........
                               probe.
87517...  A                   Hepatitis b, dna, quant  .........  .........  .........  ...........  ...........
87520...  A                   Hepatitis c, rna, dir    .........  .........  .........  ...........  ...........
                               probe.
87521...  A                   Hepatitis c, rna, amp    .........  .........  .........  ...........  ...........
                               probe.
87522...  A                   Hepatitis c, rna, quant  .........  .........  .........  ...........  ...........
87525...  A                   Hepatitis g, dna, dir    .........  .........  .........  ...........  ...........
                               probe.
87526...  A                   Hepatitis g, dna, amp    .........  .........  .........  ...........  ...........
                               probe.
87527...  A                   Hepatitis g, dna, quant  .........  .........  .........  ...........  ...........
87528...  A                   Hsv, dna, dir probe....  .........  .........  .........  ...........  ...........
87529...  A                   Hsv, dna, amp probe....  .........  .........  .........  ...........  ...........
87530...  A                   Hsv, dna, quant........  .........  .........  .........  ...........  ...........
87531...  A                   Hhv-6, dna, dir probe..  .........  .........  .........  ...........  ...........
87532...  A                   Hhv-6, dna, amp probe..  .........  .........  .........  ...........  ...........
87533...  A                   Hhv-6, dna, quant......  .........  .........  .........  ...........  ...........
87534...  A                   Hiv-1, dna, dir probe..  .........  .........  .........  ...........  ...........
87535...  A                   Hiv-1, dna, amp probe..  .........  .........  .........  ...........  ...........
87536...  A                   Hiv-1, dna, quant......  .........  .........  .........  ...........  ...........
87537...  A                   Hiv-2, dna, dir probe..  .........  .........  .........  ...........  ...........
87538...  A                   Hiv-2, dna, amp probe..  .........  .........  .........  ...........  ...........
87539...  A                   Hiv-2, dna, quant......  .........  .........  .........  ...........  ...........
87540...  A                   Legion pneumo, dna, dir  .........  .........  .........  ...........  ...........
                               prob.
87541...  A                   Legion pneumo, dna, amp  .........  .........  .........  ...........  ...........
                               prob.
87542...  A                   Legion pneumo, dna,      .........  .........  .........  ...........  ...........
                               quant.
87550...  A                   Mycobacteria, dna, dir   .........  .........  .........  ...........  ...........
                               probe.
87551...  A                   Mycobacteria, dna, amp   .........  .........  .........  ...........  ...........
                               probe.
87552...  A                   Mycobacteria, dna,       .........  .........  .........  ...........  ...........
                               quant.
87555...  A                   M.tuberculo, dna, dir    .........  .........  .........  ...........  ...........
                               probe.
87556...  A                   M.tuberculo, dna, amp    .........  .........  .........  ...........  ...........
                               probe.
87557...  A                   M.tuberculo, dna, quant  .........  .........  .........  ...........  ...........
87560...  A                   M.avium-intra, dna, dir  .........  .........  .........  ...........  ...........
                               prob.
87561...  A                   M.avium-intra, dna, amp  .........  .........  .........  ...........  ...........
                               prob.
87562...  A                   M.avium-intra, dna,      .........  .........  .........  ...........  ...........
                               quant.
87580...  A                   M.pneumon, dna, dir      .........  .........  .........  ...........  ...........
                               probe.
87581...  A                   M.pneumon, dna, amp      .........  .........  .........  ...........  ...........
                               probe.
87582...  A                   M.pneumon, dna, quant..  .........  .........  .........  ...........  ...........
87590...  A                   N.gonorrhoeae, dna, dir  .........  .........  .........  ...........  ...........
                               prob.
87591...  A                   N.gonorrhoeae, dna, amp  .........  .........  .........  ...........  ...........
                               prob.
87592...  A                   N.gonorrhoeae, dna,      .........  .........  .........  ...........  ...........
                               quant.
87620...  A                   Hpv, dna, dir probe....  .........  .........  .........  ...........  ...........
87621...  A                   Hpv, dna, amp probe....  .........  .........  .........  ...........  ...........
87622...  A                   Hpv, dna, quant........  .........  .........  .........  ...........  ...........
87650...  A                   Strep a, dna, dir probe  .........  .........  .........  ...........  ...........
87651...  A                   Strep a, dna, amp probe  .........  .........  .........  ...........  ...........
87652...  A                   Strep a, dna, quant....  .........  .........  .........  ...........  ...........
87797...  A                   Detect agent nos, dna,   .........  .........  .........  ...........  ...........
                               dir.
87798...  A                   Detect agent nos, dna,   .........  .........  .........  ...........  ...........
                               amp.
87799...  A                   Detect agent nos, dna,   .........  .........  .........  ...........  ...........
                               quant.
87810...  A                   Chylmd trach assay w/    .........  .........  .........  ...........  ...........
                               optic.
87850...  A                   N. gonorrhoeae assay w/  .........  .........  .........  ...........  ...........
                               optic.
87880...  A                   Strep a assay w/optic..  .........  .........  .........  ...........  ...........
87899...  A                   Agent nos assay w/optic  .........  .........  .........  ...........  ...........
87999...  A                   Microbiology procedure.  .........  .........  .........  ...........  ...........
88000...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.

[[Page 47710]]


88005...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.
88007...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.
88012...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.
88014...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.
88016...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               gross.
88020...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               complete.
88025...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               complete.
88027...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               complete.
88028...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               complete.
88029...  E                   Autopsy (necropsy),      .........  .........  .........  ...........  ...........
                               complete.
88036...  E                   Limited autopsy........  .........  .........  .........  ...........  ...........
88037...  E                   Limited autopsy........  .........  .........  .........  ...........  ...........
88040...  E                   Forensic autopsy         .........  .........  .........  ...........  ...........
                               (necropsy).
88045...  E                   Coroner's autopsy        .........  .........  .........  ...........  ...........
                               (necropsy).
88099...  E                   Necropsy (autopsy)       .........  .........  .........  ...........  ...........
                               procedure.
88104...  X                   Cytopathology, fluids..        882       0.39     $20.57       $11.75        $4.11
88106...  X                   Cytopathology, fluids..        882       0.39     $20.57       $11.75        $4.11
88107...  X                   Cytopathology, fluids..        882       0.39     $20.57       $11.75        $4.11
88108...  X                   Cytopath, concentrate          882       0.39     $20.57       $11.75        $4.11
                               tech.
88125...  X                   Forensic cytopathology.        881       0.20     $10.77        $6.78        $2.15
88130...  A                   Sex chromatin            .........  .........  .........  ...........  ...........
                               identification.
88140...  A                   Sex chromatin            .........  .........  .........  ...........  ...........
                               identification.
88141...  N                   Cytopath cerv/vag        .........  .........  .........  ...........  ...........
                               interpret.
88142...  A                   Cytopath cerv/vag thin   .........  .........  .........  ...........  ...........
                               layer.
88150...  A                   Cytopath cerv/vag......  .........  .........  .........  ...........  ...........
88152...  A                   Cytopath cerv/vag auto.  .........  .........  .........  ...........  ...........
88155...  A                   Cytopath cerv/vag index  .........  .........  .........  ...........  ...........
88156...  A                   Cytopath cerv/vag tbs..  .........  .........  .........  ...........  ...........
88158...  A                   Cytopath cerv/vag tbs    .........  .........  .........  ...........  ...........
                               auto.
88160...  X                   Cytopath smear, other          882       0.39     $20.57       $11.75        $4.11
                               source.
88161...  X                   Cytopath smear, other          882       0.39     $20.57       $11.75        $4.11
                               source.
88162...  X                   Cytopath smear, other          882       0.39     $20.57       $11.75        $4.11
                               source.
88170...  T                   Fine needle aspiration.        121       0.67     $35.26       $21.02        $7.05
88171...  T                   Fine needle aspiration.        121       0.67     $35.26       $21.02        $7.05
88172...  X                   Evaluation of smear....        882       0.39     $20.57       $11.75        $4.11
88173...  X                   Interpretation of smear        882       0.39     $20.57       $11.75        $4.11
88180...  X                   Cell marker study......        882       0.39     $20.57       $11.75        $4.11
88182...  X                   Cell marker study......        882       0.39     $20.57       $11.75        $4.11
88199...  X                   Cytopathology procedure        881       0.20     $10.77        $6.78        $2.15
88230...  A                   Tissue culture,          .........  .........  .........  ...........  ...........
                               lymphocyte.
88233...  A                   Tissue culture, skin/    .........  .........  .........  ...........  ...........
                               biopsy.
88235...  A                   Tissue culture,          .........  .........  .........  ...........  ...........
                               placenta.
88237...  A                   Tissue culture, bone     .........  .........  .........  ...........  ...........
                               marrow.
88239...  A                   Tissue culture, other..  .........  .........  .........  ...........  ...........
88245...  A                   Chromosome analysis....  .........  .........  .........  ...........  ...........
88248...  A                   Chromosome analysis....  .........  .........  .........  ...........  ...........
88250...  A                   Chromosome analysis....  .........  .........  .........  ...........  ...........
88260...  A                   Chromosome analysis: 5   .........  .........  .........  ...........  ...........
                               cells.
88261...  A                   Chromosome analysis: 5   .........  .........  .........  ...........  ...........
                               cells.
88262...  A                   Chromosome count:15-20   .........  .........  .........  ...........  ...........
                               cells.
88263...  A                   Chromosome analysis:45   .........  .........  .........  ...........  ...........
                               cells.
88267...  A                   Chromosome               .........  .........  .........  ...........  ...........
                               analysis:placenta.
88269...  A                   Chromosome               .........  .........  .........  ...........  ...........
                               analysis:amniotic.
88280...  A                   Chromosome karyotype     .........  .........  .........  ...........  ...........
                               study.
88283...  A                   Chromosome banding       .........  .........  .........  ...........  ...........
                               study.
88285...  A                   Chromosome count:        .........  .........  .........  ...........  ...........
                               additional.
88289...  A                   Chromosome study:        .........  .........  .........  ...........  ...........
                               additional.
88299...  A                   Cytogenetic study......  .........  .........  .........  ...........  ...........
88300...  X                   Surg path, gross.......        881       0.20     $10.77        $6.78        $2.15
88302...  X                   Tissue exam by                 882       0.39     $20.57       $11.75        $4.11
                               pathologist.
88304...  X                   Tissue exam by                 882       0.39     $20.57       $11.75        $4.11
                               pathologist.
88305...  X                   Tissue exam by                 882       0.39     $20.57       $11.75        $4.11
                               pathologist.
88307...  X                   Tissue exam by                 883       0.65     $34.28       $20.34        $6.86
                               pathologist.
88309...  X                   Tissue exam by                 883       0.65     $34.28       $20.34        $6.86
                               pathologist.
88311...  X                   Decalcify tissue.......        881       0.20     $10.77        $6.78        $2.15
88312...  X                   Special stains.........        882       0.39     $20.57       $11.75        $4.11
88313...  X                   Special stains.........        881       0.20     $10.77        $6.78        $2.15
88314...  X                   Histochemical stain....        882       0.39     $20.57       $11.75        $4.11
88318...  X                   Chemical histochemistry        882       0.39     $20.57       $11.75        $4.11
88319...  X                   Enzyme histochemistry..        882       0.39     $20.57       $11.75        $4.11
88321...  X                   Microslide consultation        882       0.39     $20.57       $11.75        $4.11
88323...  X                   Microslide consultation        882       0.39     $20.57       $11.75        $4.11
88325...  X                   Comprehensive review of        882       0.39     $20.57       $11.75        $4.11
                               data.
88329...  X                   Pathology consult in           882       0.39     $20.57       $11.75        $4.11
                               surgery.
88331...  X                   Pathology consult in           882       0.39     $20.57       $11.75        $4.11
                               surgery.

[[Page 47711]]


88332...  X                   Pathology consult in           882       0.39     $20.57       $11.75        $4.11
                               surgery.
88342...  X                   Immunocytochemistry....        882       0.39     $20.57       $11.75        $4.11
88346...  X                   Immunofluorescent study        882       0.39     $20.57       $11.75        $4.11
88347...  X                   Immunofluorescent study        882       0.39     $20.57       $11.75        $4.11
88348...  X                   Electron microscopy....        883       0.65     $34.28       $20.34        $6.86
88349...  X                   Scanning electron              883       0.65     $34.28       $20.34        $6.86
                               microscopy.
88355...  X                   Analysis, skeletal             883       0.65     $34.28       $20.34        $6.86
                               muscle.
88356...  X                   Analysis, nerve........        883       0.65     $34.28       $20.34        $6.86
88358...  X                   Analysis, tumor........        883       0.65     $34.28       $20.34        $6.86
88362...  X                   Nerve teasing                  883       0.65     $34.28       $20.34        $6.86
                               preparations.
88365...  X                   Tissue hybridization...        883       0.65     $34.28       $20.34        $6.86
88371...  A                   Protein, western blot    .........  .........  .........  ...........  ...........
                               tissue.
88372...  A                   Protein analysis w/      .........  .........  .........  ...........  ...........
                               probe.
88399...  X                   Surgical pathology             881       0.20     $10.77        $6.78        $2.15
                               procedure.
89050...  A                   Body fluid cell count..  .........  .........  .........  ...........  ...........
89051...  A                   Body fluid cell count..  .........  .........  .........  ...........  ...........
89060...  A                   Exam,synovial fluid      .........  .........  .........  ...........  ...........
                               crystals.
89100...  X                   Sample intestinal              928       3.11    $164.55       $83.85       $32.91
                               contents.
89105...  X                   Sample intestinal              928       3.11    $164.55       $83.85       $32.91
                               contents.
89125...  A                   Specimen fat stain.....  .........  .........  .........  ...........  ...........
89130...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89132...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89135...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89136...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89140...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89141...  X                   Sample stomach contents        928       3.11    $164.55       $83.85       $32.91
89160...  A                   Exam feces for meat      .........  .........  .........  ...........  ...........
                               fibers.
89190...  A                   Nasal smear for          .........  .........  .........  ...........  ...........
                               eosinophils.
89250...  A                   Fertilization of oocyte  .........  .........  .........  ...........  ...........
89251...  A                   Culture oocyte w/        .........  .........  .........  ...........  ...........
                               embryos.
89252...  A                   Assist oocyte            .........  .........  .........  ...........  ...........
                               fertilization.
89253...  A                   Embryo hatching........  .........  .........  .........  ...........  ...........
89254...  A                   Oocyte identification..  .........  .........  .........  ...........  ...........
89255...  A                   Prepare embryo for       .........  .........  .........  ...........  ...........
                               transfer.
89256...  A                   Prepare cryopreserved    .........  .........  .........  ...........  ...........
                               embryo.
89257...  A                   Sperm identification...  .........  .........  .........  ...........  ...........
89258...  A                   Cryopreservation,        .........  .........  .........  ...........  ...........
                               embryo.
89259...  A                   Cryopreservation, sperm  .........  .........  .........  ...........  ...........
89260...  A                   Sperm isolation, simple  .........  .........  .........  ...........  ...........
89261...  A                   Sperm isolation,         .........  .........  .........  ...........  ...........
                               complex.
89300...  A                   Semen analysis.........  .........  .........  .........  ...........  ...........
89310...  A                   Semen analysis.........  .........  .........  .........  ...........  ...........
89320...  A                   Semen analysis.........  .........  .........  .........  ...........  ...........
89325...  A                   Sperm antibody test....  .........  .........  .........  ...........  ...........
89329...  A                   Sperm evaluation test..  .........  .........  .........  ...........  ...........
89330...  A                   Evaluation, cervical     .........  .........  .........  ...........  ...........
                               mucus.
89350...  X                   Sputum specimen                881       0.20     $10.77        $6.78        $2.15
                               collection.
89355...  A                   Exam feces for starch..  .........  .........  .........  ...........  ...........
89360...  X                   Collect sweat for test.        881       0.20     $10.77        $6.78        $2.15
89365...  A                   Water load test........  .........  .........  .........  ...........  ...........
89399...  X                   Pathology lab procedure        881       0.20     $10.77        $6.78        $2.15
90700...  X                   DTaP immunization......        901       0.07      $3.92        $2.49         0.78
90701...  X                   DTP immunization.......        901       0.07      $3.92        $2.49         0.78
90702...  X                   DT immunization........        901       0.07      $3.92        $2.49         0.78
90703...  X                   Tetanus immunization...        901       0.07      $3.92        $2.49         0.78
90704...  X                   Mumps immunization.....        901       0.07      $3.92        $2.49         0.78
90705...  X                   Measles immunization...        901       0.07      $3.92        $2.49         0.78
90706...  X                   Rubella immunization...        901       0.07      $3.92        $2.49         0.78
90707...  X                   MMR virus immunization.        902       1.78     $94.03       $41.58       $18.81
90708...  X                   Measles-rubella                901       0.07      $3.92        $2.49         0.78
                               immunization.
90709...  X                   Rubella & mumps                901       0.07      $3.92        $2.49         0.78
                               immunization.
90710...  X                   Combined vaccine.......        901       0.07      $3.92        $2.49         0.78
90711...  X                   Combined vaccine.......        901       0.07      $3.92        $2.49         0.78
90712...  X                   Oral poliovirus                902       1.78     $94.03       $41.58       $18.81
                               immunization.
90713...  X                   Poliomyelitis                  902       1.78     $94.03       $41.58       $18.81
                               immunization.
90714...  X                   Typhoid immunization...        901       0.07      $3.92        $2.49         0.78
90716...  X                   Chicken pox vaccine....        902       1.78     $94.03       $41.58       $18.81
90717...  X                   Yellow fever                   902       1.78     $94.03       $41.58       $18.81
                               immunization.
90718...  X                   Td immunization........        901       0.07      $3.92        $2.49         0.78
90719...  X                   Diphtheria immunization        901       0.07      $3.92        $2.49         0.78
90720...  X                   DTP/HIB vaccine........        902       1.78     $94.03       $41.58       $18.81
90721...  X                   Dtap/hib vaccine.......        903       1.17     $61.71       $25.76       $12.34
90724...  X                   Influenza immunization.        901       0.07      $3.92        $2.49         0.78
90725...  X                   Cholera immunization...        901       0.07      $3.92        $2.49         0.78
90726...  X                   Rabies immunization....        903       1.17     $61.71       $25.76       $12.34

[[Page 47712]]


90727...  X                   Plague immunization....        903       1.17     $61.71       $25.76       $12.34
90728...  X                   BCG immunization.......        903       1.17     $61.71       $25.76       $12.34
90730...  X                   Hepatitis A vaccine....        901       0.07      $3.92        $2.49         0.78
90732...  X                   Pneumococcal                   901       0.07      $3.92        $2.49         0.78
                               immunization.
90733...  X                   Meningococcal                  902       1.78     $94.03       $41.58       $18.81
                               immunization.
90735...  X                   Encephalitis virus             903       1.17     $61.71       $25.76       $12.34
                               vaccine.
90737...  X                   Influenza B                    902       1.78     $94.03       $41.58       $18.81
                               immunization.
90741...  X                   Passive immunization,          902       1.78     $94.03       $41.58       $18.81
                               ISG.
90742...  X                   Special passive                903       1.17     $61.71       $25.76       $12.34
                               immunization.
90744...  X                   Hepatitis B vaccine,           902       1.78     $94.03       $41.58       $18.81
                               under 11.
90745...  X                   Hepatitis B vaccine, 11-       902       1.78     $94.03       $41.58       $18.81
                               19.
90746...  X                   Hepatitis B vaccine,           902       1.78     $94.03       $41.58       $18.81
                               over 20.
90747...  X                   Hepatitis B vaccine,           902       1.78     $94.03       $41.58       $18.81
                               ill pat.
90748...  X                   Hepatitis b/hib vaccine        901       0.07      $3.92        $2.49         0.78
90749...  X                   Immunization procedure.        901       0.07      $3.92        $2.49         0.78
90780...  X                   IV infusion therapy, 1         906       1.46     $77.38       $42.49       $15.48
                               hour.
90781...  X                   IV infusion, additional        906       1.46     $77.38       $42.49       $15.48
                               hour.
90782...  X                   Injection (SC)/(IM)....        907       0.85     $45.05       $11.98        $9.01
90783...  X                   Injection (IA).........        907       0.85     $45.05       $11.98        $9.01
90784...  X                   Injection (IV).........        907       0.85     $45.05       $11.98        $9.01
90788...  X                   Injection of antibiotic        907       0.85     $45.05       $11.98        $9.01
90799...  X                   Therapeutic/diag               907       0.85     $45.05       $11.98        $9.01
                               injection.
90801...  S                   Psy dx interview.......        092       1.57     $83.25       $21.92       $16.65
90802...  S                   Intac psy dx interview.        092       1.57     $83.25       $21.92       $16.65
90804...  S                   Psytx, office (20-30)..        091       1.19     $62.69       $15.37       $12.54
90805...  S                   Psytx, office (20-30) w/       091       1.19     $62.69       $15.37       $12.54
                               e&m.
90806...  S                   Psytx, office (45-50)..        092       1.57     $83.25       $21.92       $16.65
90807...  S                   Psytx, office (45-50) w/       092       1.57     $83.25       $21.92       $16.65
                               e&m.
90808...  S                   Psytx, office (75-80)..        092       1.57     $83.25       $21.92       $16.65
90809...  S                   Psytx, office (75-80) w/       092       1.57     $83.25       $21.92       $16.65
                               e&m.
90810...  S                   Intac psytx, office (20-       091       1.19     $62.69       $15.37       $12.54
                               30).
90811...  S                   Intac psytx, off 20-30         091       1.19     $62.69       $15.37       $12.54
                               w/e&m.
90812...  S                   Intac psytx, office (45-       092       1.57     $83.25       $21.92       $16.65
                               50).
90813...  S                   Intac psytx, off 45-50         092       1.57     $83.25       $21.92       $16.65
                               w/e&m.
90814...  S                   Intac psytx, office (75-       092       1.57     $83.25       $21.92       $16.65
                               80).
90815...  S                   Intac psytx, off 75-80         092       1.57     $83.25       $21.92       $16.65
                               w/e&m.
90816...  S                   Psytx, hosp (20-30)....        091       1.19     $62.69       $15.37       $12.54
90817...  S                   Psytx, hosp (20-30) w/         091       1.19     $62.69       $15.37       $12.54
                               e&m.
90818...  S                   Psytx, hosp (45-50)....        092       1.57     $83.25       $21.92       $16.65
90819...  S                   Psytx, hosp (45-50) w/         092       1.57     $83.25       $21.92       $16.65
                               e&m.
90821...  S                   Psytx, hosp (75-80)....        092       1.57     $83.25       $21.92       $16.65
90822...  S                   Psytx, hosp (75-80) w/         092       1.57     $83.25       $21.92       $16.65
                               e&m.
90823...  S                   Intac psytx, hosp (20-         091       1.19     $62.69       $15.37       $12.54
                               30).
90824...  S                   Intac psytx, hsp 20-30         091       1.19     $62.69       $15.37       $12.54
                               w/e&m.
90826...  S                   Intac psytx, hosp (45-         092       1.57     $83.25       $21.92       $16.65
                               50).
90827...  S                   Intac psytx, hsp 45-50         092       1.57     $83.25       $21.92       $16.65
                               w/e&m.
90828...  S                   Intac psytx, hosp (75-         092       1.57     $83.25       $21.92       $16.65
                               80).
90829...  S                   Intac psytx, hsp 75-80         092       1.57     $83.25       $21.92       $16.65
                               w/e&m.
90845...  S                   Psychoanalysis.........        092       1.57     $83.25       $21.92       $16.65
90846...  S                   Family psytx w/o               093       1.54     $81.29       $20.11       $16.26
                               patient.
90847...  S                   Family psytx w/patient.        093       1.54     $81.29       $20.11       $16.26
90849...  S                   Multiple family group          094       1.24     $65.62       $20.11       $13.12
                               psytx.
90853...  S                   Group psychotherapy....        094       1.24     $65.62       $20.11       $13.12
90857...  S                   Intac group psytx......        094       1.24     $65.62       $20.11       $13.12
90862...  X                   Medication management..        090       0.85     $45.05       $12.43        $9.01
90865...  S                   Narcosynthesis.........        092       1.57     $83.25       $21.92       $16.65
90870...  S                   Electroconvulsive              919       3.17    $167.49       $80.00       $33.50
                               therapy.
90871...  S                   Electroconvulsive              919       3.17    $167.49       $80.00       $33.50
                               therapy.
90875...  E                   Psychophysiological      .........  .........  .........  ...........  ...........
                               therapy.
90876...  E                   Psychophysiological      .........  .........  .........  ...........  ...........
                               therapy.
90880...  S                   Hypnotherapy...........        092       1.57     $83.25       $21.92       $16.65
90882...  E                   Environmental            .........  .........  .........  ...........  ...........
                               manipulation.
90885...  N                   Psy evaluation of        .........  .........  .........  ...........  ...........
                               records.
90887...  N                   Consultation with        .........  .........  .........  ...........  ...........
                               family.
90889...  N                   Preparation of report..  .........  .........  .........  ...........  ...........
90899...  S                   Psychiatric service/           091       1.19     $62.69       $15.37       $12.54
                               therapy.
90901...  S                   Biofeedback, any method        920       1.17     $61.71       $29.61       $12.34
90911...  S                   Biofeedback peri/uro/          920       1.17     $61.71       $29.61       $12.34
                               rectal.
90918...  A                   ESRD related services,   .........  .........  .........  ...........  ...........
                               month.
90919...  A                   ESRD related services,   .........  .........  .........  ...........  ...........
                               month.
90920...  A                   ESRD related services,   .........  .........  .........  ...........  ...........
                               month.
90921...  A                   ESRD related services,   .........  .........  .........  ...........  ...........
                               month.
90922...  A                   ESRD related services,   .........  .........  .........  ...........  ...........
                               day.
90923...  A                   Esrd related services,   .........  .........  .........  ...........  ...........
                               day.
90924...  A                   Esrd related services,   .........  .........  .........  ...........  ...........
                               day.

[[Page 47713]]


90925...  A                   Esrd related services,   .........  .........  .........  ...........  ...........
                               day.
90935...  S                   Hemodialysis, one              926       4.28    $226.25       $69.83       $45.25
                               evaluation.
90937...  S                   Hemodialysis, repeated         926       4.28    $226.25       $69.83       $45.25
                               eval.
90945...  S                   Dialysis, one                  926       4.28    $226.25       $69.83       $45.25
                               evaluation.
90947...  S                   Dialysis, repeated eval        926       4.28    $226.25       $69.83       $45.25
90989...  E                   Dialysis training/       .........  .........  .........  ...........  ...........
                               complete.
90993...  N                   Dialysis training/       .........  .........  .........  ...........  ...........
                               incomplete.
90997...  S                   Hemoperfusion..........        926       4.28    $226.25       $69.83       $45.25
90999...  S                   Dialysis procedure.....        926       4.28    $226.25       $69.83       $45.25
91000...  X                   Esophageal intubation..        928       3.11    $164.55       $83.85       $32.91
91010...  X                   Esophagus motility             928       3.11    $164.55       $83.85       $32.91
                               study.
91011...  X                   Esophagus motility             928       3.11    $164.55       $83.85       $32.91
                               study.
91012...  X                   Esophagus motility             928       3.11    $164.55       $83.85       $32.91
                               study.
91020...  X                   Gastric motility.......        928       3.11    $164.55       $83.85       $32.91
91030...  X                   Acid perfusion of              928       3.11    $164.55       $83.85       $32.91
                               esophagus.
91032...  X                   Esophagus, acid reflux         928       3.11    $164.55       $83.85       $32.91
                               test.
91033...  X                   Prolonged acid reflux          928       3.11    $164.55       $83.85       $32.91
                               test.
91052...  X                   Gastric analysis test..        928       3.11    $164.55       $83.85       $32.91
91055...  X                   Gastric intubation for         928       3.11    $164.55       $83.85       $32.91
                               smear.
91060...  X                   Gastric saline load            928       3.11    $164.55       $83.85       $32.91
                               test.
91065...  X                   Breath hydrogen test...        928       3.11    $164.55       $83.85       $32.91
91100...  X                   Pass intestine bleeding        928       3.11    $164.55       $83.85       $32.91
                               tube.
91105...  X                   Gastric intubation             928       3.11    $164.55       $83.85       $32.91
                               treatment.
91122...  N                   Anal pressure record...  .........  .........  .........  ...........  ...........
91299...  X                   Gastroenterology               928       3.11    $164.55       $83.85       $32.91
                               procedure.
92002...  V                   Eye exam, new patient..        913  .........  .........  ...........  ...........
92004...  V                   Eye exam, new patient..        915  .........  .........  ...........  ...........
92012...  V                   Eye exam established pt        913  .........  .........  ...........  ...........
92014...  V                   Eye exam & treatment...        915  .........  .........  ...........  ...........
92015...  E                   Refraction.............  .........  .........  .........  ...........  ...........
92018...  T                   New eye exam &                 676       6.30    $333.01      $140.35        $66.6
                               treatment.
92019...  T                   Eye exam & treatment...        676       6.30    $333.01      $140.35        $66.6
92020...  N                   Special eye evaluation.  .........  .........  .........  ...........  ...........
92060...  X                   Special eye evaluation.        930       1.02     $53.87       $22.83       $10.77
92065...  X                   Orthoptic/pleoptic             930       1.02     $53.87       $22.83       $10.77
                               training.
92070...  N                   Fitting of contact lens  .........  .........  .........  ...........  ...........
92081...  X                   Visual field                   930       1.02     $53.87       $22.83       $10.77
                               examination(s).
92082...  X                   Visual field                   930       1.02     $53.87       $22.83       $10.77
                               examination(s).
92083...  X                   Visual field                   930       1.02     $53.87       $22.83       $10.77
                               examination(s).
92100...  N                   Serial tonometry         .........  .........  .........  ...........  ...........
                               exam(s).
92120...  X                   Tonography & eye               931       0.74     $39.18       $21.47        $7.84
                               evaluation.
92130...  X                   Water provocation              931       0.74     $39.18       $21.47        $7.84
                               tonography.
92140...  X                   Glaucoma provocative           930       1.02     $53.87       $22.83       $10.77
                               tests.
92225...  N                   Special eye exam,        .........  .........  .........  ...........  ...........
                               initial.
92226...  N                   Special eye exam,        .........  .........  .........  ...........  ...........
                               subsequent.
92230...  X                   Eye exam with photos...        931       0.74     $39.18       $21.47        $7.84
92235...  X                   Eye exam with photos...        932       2.52    $133.21       $65.09       $26.64
92240...  X                   Icg angiography........        931       0.74     $39.18       $21.47        $7.84
92250...  X                   Eye exam with photos...        931       0.74     $39.18       $21.47        $7.84
92260...  N                   Ophthalmoscopy/          .........  .........  .........  ...........  ...........
                               dynamometry.
92265...  X                   Eye muscle evaluation..        932       2.52    $133.21       $65.09       $26.64
92270...  X                   Electro-oculography....        932       2.52    $133.21       $65.09       $26.64
92275...  X                   Electroretinography....        981       1.46     $77.38       $41.81       $15.48
92283...  X                   Color vision                   930       1.02     $53.87       $22.83       $10.77
                               examination.
92284...  X                   Dark adaptation eye            930       1.02     $53.87       $22.83       $10.77
                               exam.
92285...  X                   Eye photography........        930       1.02     $53.87       $22.83       $10.77
92286...  X                   Internal eye                   932       2.52    $133.21       $65.09       $26.64
                               photography.
92287...  X                   Internal eye                   932       2.52    $133.21       $65.09       $26.64
                               photography.
92310...  E                   Contact lens fitting...  .........  .........  .........  ...........  ...........
92311...  X                   Contact lens fitting...        936       0.52     $27.42        $9.49        $5.48
92312...  X                   Contact lens fitting...        936       0.52     $27.42        $9.49        $5.48
92313...  X                   Contact lens fitting...        936       0.52     $27.42        $9.49        $5.48
92314...  E                   Prescription of contact  .........  .........  .........  ...........  ...........
                               lens.
92315...  X                   Prescription of contact        936       0.52     $27.42        $9.49        $5.48
                               lens.
92316...  X                   Prescription of contact        936       0.52     $27.42        $9.49        $5.48
                               lens.
92317...  X                   Prescription of contact        936       0.52     $27.42        $9.49        $5.48
                               lens.
92325...  X                   Modification of contact        936       0.52     $27.42        $9.49        $5.48
                               lens.
92326...  X                   Replacement of contact         936       0.52     $27.42        $9.49        $5.48
                               lens.
92330...  X                   Fitting of artificial          936       0.52     $27.42        $9.49        $5.48
                               eye.
92335...  N                   Fitting of artificial    .........  .........  .........  ...........  ...........
                               eye.
92340...  E                   Fitting of spectacles..  .........  .........  .........  ...........  ...........
92341...  E                   Fitting of spectacles..  .........  .........  .........  ...........  ...........
92342...  E                   Fitting of spectacles..  .........  .........  .........  ...........  ...........
92352...  X                   Special spectacles             936       0.52     $27.42        $9.49        $5.48
                               fitting.
92353...  X                   Special spectacles             936       0.52     $27.42        $9.49        $5.48
                               fitting.

[[Page 47714]]


92354...  X                   Special spectacles             936       0.52     $27.42        $9.49        $5.48
                               fitting.
92355...  X                   Special spectacles             936       0.52     $27.42        $9.49        $5.48
                               fitting.
92358...  X                   Eye prosthesis service.        936       0.52     $27.42        $9.49        $5.48
92370...  E                   Repair & adjust          .........  .........  .........  ...........  ...........
                               spectacles.
92371...  X                   Repair & adjust                936       0.52     $27.42        $9.49        $5.48
                               spectacles.
92390...  E                   Supply of spectacles...  .........  .........  .........  ...........  ...........
92391...  E                   Supply of contact        .........  .........  .........  ...........  ...........
                               lenses.
92392...  E                   Supply of low vision     .........  .........  .........  ...........  ...........
                               aids.
92393...  E                   Supply of artificial     .........  .........  .........  ...........  ...........
                               eye.
92395...  E                   Supply of spectacles...  .........  .........  .........  ...........  ...........
92396...  E                   Supply of contact        .........  .........  .........  ...........  ...........
                               lenses.
92499...  X                   Eye service or                 931       0.74     $39.18       $21.47        $7.84
                               procedure.
92502...  T                   Ear and throat                 311       1.43     $75.42       $20.57       $15.08
                               examination.
92504...  N                   Ear microscopy           .........  .........  .........  ...........  ...........
                               examination.
92506...  A                   Speech & hearing         .........  .........  .........  ...........  ...........
                               evaluation.
92507...  A                   Speech/hearing therapy.  .........  .........  .........  ...........  ...........
92508...  A                   Speech/hearing therapy.  .........  .........  .........  ...........  ...........
92510...  A                   Rehab for ear implant..  .........  .........  .........  ...........  ...........
92511...  T                   Nasopharyngos-.........        331       0.69     $36.24       $14.01        $7.25
                              copy...................
92512...  X                   Nasal function studies.        940       3.04    $160.63       $51.98       $32.13
92516...  X                   Facial nerve function          940       3.04    $160.63       $51.98       $32.13
                               test.
92520...  X                   Laryngeal function             940       3.04    $160.63       $51.98       $32.13
                               studies.
92525...  A                   Oral function            .........  .........  .........  ...........  ...........
                               evaluation.
92526...  A                   Oral function therapy..  .........  .........  .........  ...........  ...........
92531...  N                   Spontaneous nystagmus    .........  .........  .........  ...........  ...........
                               study.
92532...  N                   Positional nystagmus     .........  .........  .........  ...........  ...........
                               study.
92533...  N                   Caloric vestibular test  .........  .........  .........  ...........  ...........
92534...  N                   Optokinetic nystagmus..  .........  .........  .........  ...........  ...........
92541...  X                   Spontaneous nystagmus          940       3.04    $160.63       $51.98       $32.13
                               test.
92542...  X                   Positional nystagmus           940       3.04    $160.63       $51.98       $32.13
                               test.
92543...  X                   Caloric vestibular test        940       3.04    $160.63       $51.98       $32.13
92544...  X                   Optokinetic nystagmus          940       3.04    $160.63       $51.98       $32.13
                               test.
92545...  X                   Oscillating tracking           940       3.04    $160.63       $51.98       $32.13
                               test.
92546...  X                   Sinusoidal rotational          940       3.04    $160.63       $51.98       $32.13
                               test.
92547...  X                   Supplemental electrical        940       3.04    $160.63       $51.98       $32.13
                               test.
92548...  X                   Posturography..........        940       3.04    $160.63       $51.98       $32.13
92551...  E                   Pure tone hearing test,  .........  .........  .........  ...........  ...........
                               air.
92552...  X                   Pure tone audiometry,          941       0.74     $39.18       $13.56        $7.84
                               air.
92553...  X                   Audiometry, air & bone.        941       0.74     $39.18       $13.56        $7.84
92555...  X                   Speech threshold               941       0.74     $39.18       $13.56        $7.84
                               audiometry.
92556...  X                   Speech audiometry,             941       0.74     $39.18       $13.56        $7.84
                               complete.
92557...  X                   Comprehensive hearing          942       1.48     $78.36       $22.15       $15.67
                               test.
92559...  E                   Group audiometric        .........  .........  .........  ...........  ...........
                               testing.
92560...  E                   Bekesy audiometry,       .........  .........  .........  ...........  ...........
                               screen.
92561...  X                   Bekesy audiometry,             942       1.48     $78.36       $22.15       $15.67
                               diagnosis.
92562...  X                   Loudness balance test..        942       1.48     $78.36       $22.15       $15.67
92563...  X                   Tone decay hearing test        942       1.48     $78.36       $22.15       $15.67
92564...  X                   Sisi hearing test......        942       1.48     $78.36       $22.15       $15.67
92565...  X                   Stenger test, pure tone        942       1.48     $78.36       $22.15       $15.67
92567...  X                   Tympanometry...........        941       0.74     $39.18       $13.56        $7.84
92568...  X                   Acoustic reflex testing        942       1.48     $78.36       $22.15       $15.67
92569...  X                   Acoustic reflex decay          942       1.48     $78.36       $22.15       $15.67
                               test.
92571...  X                   Filtered speech hearing        942       1.48     $78.36       $22.15       $15.67
                               test.
92572...  X                   Staggered spondaic word        942       1.48     $78.36       $22.15       $15.67
                               test.
92573...  X                   Lombard test...........        942       1.48     $78.36       $22.15       $15.67
92575...  X                   Sensorineural acuity           942       1.48     $78.36       $22.15       $15.67
                               test.
92576...  X                   Synthetic sentence test        942       1.48     $78.36       $22.15       $15.67
92577...  X                   Stenger test, speech...        942       1.48     $78.36       $22.15       $15.67
92579...  X                   Visual audiometry (vra)        942       1.48     $78.36       $22.15       $15.67
92582...  X                   Conditioning play              942       1.48     $78.36       $22.15       $15.67
                               audiometry.
92583...  X                   Select picture                 942       1.48     $78.36       $22.15       $15.67
                               audiometry.
92584...  X                   Electrocochleography...        940       3.04    $160.63       $51.98       $32.13
92585...  X                   Auditory evoked                982       1.39     $73.46       $38.87       $14.69
                               potential.
92587...  X                   Evoked auditory test...        940       3.04    $160.63       $51.98       $32.13
92588...  X                   Evoked auditory test...        940       3.04    $160.63       $51.98       $32.13
92589...  X                   Auditory function              942       1.48     $78.36       $22.15       $15.67
                               test(s).
92590...  E                   Hearing aid exam, one    .........  .........  .........  ...........  ...........
                               ear.
92591...  E                   Hearing aid exam, both   .........  .........  .........  ...........  ...........
                               ears.
92592...  E                   Hearing aid check, one   .........  .........  .........  ...........  ...........
                               ear.
92593...  E                   Hearing aid check, both  .........  .........  .........  ...........  ...........
                               ears.
92594...  E                   Electro hearing aid      .........  .........  .........  ...........  ...........
                               test, one.
92595...  E                   Electro hearing aid      .........  .........  .........  ...........  ...........
                               test, both.
92596...  X                   Ear protector                  942       1.48     $78.36       $22.15       $15.67
                               evaluation.
92597...  A                   Oral speech device eval  .........  .........  .........  ...........  ...........

[[Page 47715]]


92598...  A                   Modify oral speech       .........  .........  .........  ...........  ...........
                               device.
92599...  X                   ENT procedure/service..        941       0.74     $39.18       $13.56        $7.84
92950...  S                   Heart/lung                     947       4.07    $215.48      $109.61       $43.10
                               resuscitation(CPR.
92953...  S                   Temporary external             947       4.07    $215.48      $109.61       $43.10
                               pacing.
92960...  S                   Heart electroconversion        947       4.07    $215.48      $109.61       $43.10
92970...  C                   Cardioassist, internal.  .........  .........  .........  ...........  ...........
92971...  C                   Cardioassist, external.  .........  .........  .........  ...........  ...........
92975...  C                   Dissolve clot, heart     .........  .........  .........  ...........  ...........
                               vessel.
92977...  C                   Dissolve clot, heart     .........  .........  .........  ...........  ...........
                               vessel.
92978...  C                   Intravas us, heart (add- .........  .........  .........  ...........  ...........
                               on).
92979...  C                   Intravas us, heart (add- .........  .........  .........  ...........  ...........
                               on).
92980...  C                   Insert intracoronary     .........  .........  .........  ...........  ...........
                               stent.
92981...  C                   Insert intracoronary     .........  .........  .........  ...........  ...........
                               stent.
92982...  C                   Coronary artery          .........  .........  .........  ...........  ...........
                               dilation.
92984...  C                   Coronary artery          .........  .........  .........  ...........  ...........
                               dilation.
92986...  C                   Revision of aortic       .........  .........  .........  ...........  ...........
                               valve.
92987...  C                   Revision of mitral       .........  .........  .........  ...........  ...........
                               valve.
92990...  C                   Revision of pulmonary    .........  .........  .........  ...........  ...........
                               valve.
92992...  C                   Revision of heart        .........  .........  .........  ...........  ...........
                               chamber.
92993...  C                   Revision of heart        .........  .........  .........  ...........  ...........
                               chamber.
92995...  C                   Coronary atherectomy...  .........  .........  .........  ...........  ...........
92996...  C                   Coronary atherectomy...  .........  .........  .........  ...........  ...........
92997...  C                   Pul art balloon repair,  .........  .........  .........  ...........  ...........
                               perc.
92998...  C                   Pul art balloon repair,  .........  .........  .........  ...........  ...........
                               perc.
93000...  N                   Electrocardiogram,       .........  .........  .........  ...........  ...........
                               complete.
93005...  X                   Electrocardiogram,             950       0.35     $18.61       $15.82        $3.72
                               tracing.
93010...  N                   Electrocardiogram        .........  .........  .........  ...........  ...........
                               report.
93012...  X                   Transmission of ecg....        956       1.11     $58.77       $55.82       $11.75
93014...  N                   Report on transmitted    .........  .........  .........  ...........  ...........
                               ecg.
93015...  N                   Cardiovascular stress    .........  .........  .........  ...........  ...........
                               test.
93016...  N                   Cardiovascular stress    .........  .........  .........  ...........  ...........
                               test.
93017...  X                   Cardiovascular stress          949       1.46     $77.38       $62.83       $15.48
                               test.
93018...  N                   Cardiovascular stress    .........  .........  .........  ...........  ...........
                               test.
93024...  X                   Cardiac drug stress            949       1.46     $77.38       $62.83       $15.48
                               test.
93040...  N                   Rhythm ECG with report.  .........  .........  .........  ...........  ...........
93041...  X                   Rhythm ECG, tracing....        950       0.35     $18.61       $15.82        $3.72
93042...  N                   Rhythm ECG, report.....  .........  .........  .........  ...........  ...........
93224...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93225...  X                   ECG monitor/record, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93226...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93227...  N                   ECG monitor/review, 24   .........  .........  .........  ...........  ...........
                               hrs.
93230...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93231...  X                   Ecg monitor/record, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93232...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93233...  N                   ECG monitor/review, 24   .........  .........  .........  ...........  ...........
                               hrs.
93235...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93236...  X                   ECG monitor/report, 24         956       1.11     $58.77       $55.82       $11.75
                               hrs.
93237...  N                   ECG monitor/review, 24   .........  .........  .........  ...........  ...........
                               hrs.
93268...  X                   ECG record/review......        956       1.11     $58.77       $55.82       $11.75
93270...  X                   ECG recording..........        956       1.11     $58.77       $55.82       $11.75
93271...  X                   Ecg/monitoring and             956       1.11     $58.77       $55.82       $11.75
                               anaylysis.
93272...  N                   Ecg/review,interpret     .........  .........  .........  ...........  ...........
                               only.
93278...  X                   ECG/signal-averaged....        956       1.11     $58.77       $55.82       $11.75
93303...  X                   Echo transthoracic.....        957       2.83    $149.86      $117.07       $29.97
93304...  X                   Echo transthoracic.....        957       2.83    $149.86      $117.07       $29.97
93307...  X                   Echo exam of heart.....        957       2.83    $149.86      $117.07       $29.97
93308...  X                   Echo exam of heart.....        957       2.83    $149.86      $117.07       $29.97
93312...  X                   Echo transesophageal...        957       2.83    $149.86      $117.07       $29.97
93313...  X                   Echo transesophageal...        957       2.83    $149.86      $117.07       $29.97
93314...  N                   Echo transesophageal...  .........  .........  .........  ...........  ...........
93315...  X                   Echo transesophageal...        957       2.83    $149.86      $117.07       $29.97
93316...  X                   Echo transesophageal...        957       2.83    $149.86      $117.07       $29.97
93317...  N                   Echo transesophageal...  .........  .........  .........  ...........  ...........
93320...  X                   Doppler echo exam,             957       2.83    $149.86      $117.07       $29.97
                               heart.
93321...  X                   Doppler echo exam,             957       2.83    $149.86      $117.07       $29.97
                               heart.
93325...  X                   Doppler color flow.....        957       2.83    $149.86      $117.07       $29.97
93350...  X                   Echo transthoracic.....        957       2.83    $149.86      $117.07       $29.97
93501...  T                   Right heart                    958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.
93503...  T                   Insert/place heart             958      26.11  $1,381.03      $659.47      $276.21
                               catheter.
93505...  T                   Biopsy of heart lining.        958      26.11  $1,381.03      $659.47      $276.21
93508...  T                   Cath placement,                343       9.52    $503.44      $224.87      $100.69
                               angiography.
93510...  T                   Left heart                     958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.
93511...  T                   Left heart                     958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.
93514...  T                   Left heart                     958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.
93524...  T                   Left heart                     958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.

[[Page 47716]]


93526...  T                   Rt & Lt heart catheters        958      26.11  $1,381.03      $659.47      $276.21
93527...  T                   Rt & Lt heart catheters        958      26.11  $1,381.03      $659.47      $276.21
93528...  T                   Rt & Lt heart catheters        958      26.11  $1,381.03      $659.47      $276.21
93529...  T                   Rt, Lt heart                   958      26.11  $1,381.03      $659.47      $276.21
                               catheterization.
93530...  T                   Rt heart cath,                 958      26.11  $1,381.03      $659.47      $276.21
                               congenital.
93531...  T                   R & l heart cath,              958      26.11  $1,381.03      $659.47      $276.21
                               congenital.
93532...  T                   R & l heart cath,              958      26.11  $1,381.03      $659.47      $276.21
                               congenital.
93533...  T                   R & l heart cath,              958      26.11  $1,381.03      $659.47      $276.21
                               congenital.
93536...  T                   Insert circulation assi        958      26.11  $1,381.03      $659.47      $276.21
93539...  N                   Injection, cardiac cath  .........  .........  .........  ...........  ...........
93540...  N                   Injection, cardiac cath  .........  .........  .........  ...........  ...........
93541...  N                   Injection for lung       .........  .........  .........  ...........  ...........
                               angiogram.
93542...  N                   Injection for heart x-   .........  .........  .........  ...........  ...........
                               rays.
93543...  N                   Injection for heart x-   .........  .........  .........  ...........  ...........
                               rays.
93544...  N                   Injection for            .........  .........  .........  ...........  ...........
                               aortography.
93545...  N                   Injection for coronary   .........  .........  .........  ...........  ...........
                               xrays.
93555...  N                   Imaging, cardiac cath..  .........  .........  .........  ...........  ...........
93556...  N                   Imaging, cardiac cath..  .........  .........  .........  ...........  ...........
93561...  N                   Cardiac output           .........  .........  .........  ...........  ...........
                               measurement.
93562...  N                   Cardiac output           .........  .........  .........  ...........  ...........
                               measurement.
93600...  S                   Bundle of His recording        960       4.24    $224.29      $144.41       $44.86
93602...  S                   Intra-atrial recording.        960       4.24    $224.29      $144.41       $44.86
93603...  S                   Right ventricular              960       4.24    $224.29      $144.41       $44.86
                               recording.
93607...  S                   Right ventricular              960       4.24    $224.29      $144.41       $44.86
                               recording.
93609...  S                   Mapping of tachycardia.        960       4.24    $224.29      $144.41       $44.86
93610...  S                   Intra-atrial pacing....        960       4.24    $224.29      $144.41       $44.86
93612...  S                   Intraventricular pacing        960       4.24    $224.29      $144.41       $44.86
93615...  S                   Esophageal recording...        960       4.24    $224.29      $144.41       $44.86
93616...  S                   Esophageal recording...        960       4.24    $224.29      $144.41       $44.86
93618...  S                   Heart rhythm pacing....        960       4.24    $224.29      $144.41       $44.86
93619...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93620...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93621...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93622...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93623...  S                   Stimulation, pacing            960       4.24    $224.29      $144.41       $44.86
                               heart.
93624...  S                   Electrophysiologic             960       4.24    $224.29      $144.41       $44.86
                               study.
93631...  S                   Heart pacing, mapping..        960       4.24    $224.29      $144.41       $44.86
93640...  S                   Evaluation heart device        960       4.24    $224.29      $144.41       $44.86
93641...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93642...  S                   Electrophysiology              960       4.24    $224.29      $144.41       $44.86
                               evaluation.
93650...  S                   Ablate heart dysrhythm         960       4.24    $224.29      $144.41       $44.86
                               focus.
93651...  S                   Ablate heart dysrhythm         960       4.24    $224.29      $144.41       $44.86
                               focus.
93652...  S                   Ablate heart dysrhythm         960       4.24    $224.29      $144.41       $44.86
                               focus.
93660...  S                   Tilt table evaluation..        960       4.24    $224.29      $144.41       $44.86
93720...  X                   Total body                     967       1.70     $90.11       $57.40       $18.02
                               plethysmography.
93721...  X                   Plethysmography tracing        967       1.70     $90.11       $57.40       $18.02
93722...  N                   Plethysmography report.  .........  .........  .........  ...........  ...........
93724...  S                   Analyze pacemaker              960       4.24    $224.29      $144.41       $44.86
                               system.
93731...  X                   Analyze pacemaker              966       0.39     $20.57       $12.43        $4.11
                               system.
93732...  X                   Analyze pacemaker              966       0.39     $20.57       $12.43        $4.11
                               system.
93733...  X                   Telephone analysis,            966       0.39     $20.57       $12.43        $4.11
                               pacemaker.
93734...  X                   Analyze pacemaker              966       0.39     $20.57       $12.43        $4.11
                               system.
93735...  X                   Analyze pacemaker              966       0.39     $20.57       $12.43        $4.11
                               system.
93736...  X                   Telephone analysis,            966       0.39     $20.57       $12.43        $4.11
                               pacemaker.
93737...  X                   Analyze cardio/                966       0.39     $20.57       $12.43        $4.11
                               defibrillator.
93738...  X                   Analyze cardio/                966       0.39     $20.57       $12.43        $4.11
                               defibrillator.
93740...  X                   Temperature gradient           967       1.70     $90.11       $57.40       $18.02
                               studies.
93760...  E                   Cephalic thermogram....  .........  .........  .........  ...........  ...........
93762...  E                   Peripheral thermogram..  .........  .........  .........  ...........  ...........
93770...  N                   Measure venous pressure  .........  .........  .........  ...........  ...........
93784...  E                   Ambulatory BP            .........  .........  .........  ...........  ...........
                               monitoring.
93786...  E                   Ambulatory BP recording  .........  .........  .........  ...........  ...........
93788...  E                   Ambulatory BP analysis.  .........  .........  .........  ...........  ...........
93790...  E                   Review/report BP         .........  .........  .........  ...........  ...........
                               recording.
93797...  X                   Cardiac rehab..........        948       0.81     $43.10       $16.95        $8.62
93798...  X                   Cardiac rehab/monitor..        948       0.81     $43.10       $16.95        $8.62
93799...  X                   Cardiovascular                 967       1.70     $90.11       $57.40       $18.02
                               procedure.
93875...  X                   Extracranial study.....        968       2.37    $125.37       $79.55       $25.07
93880...  X                   Extracranial study.....        968       2.37    $125.37       $79.55       $25.07
93882...  X                   Extracranial study.....        968       2.37    $125.37       $79.55       $25.07
93886...  X                   Intracranial study.....        968       2.37    $125.37       $79.55       $25.07
93888...  X                   Intracranial study.....        968       2.37    $125.37       $79.55       $25.07
93922...  X                   Extremity study........        967       1.70     $90.11       $57.40       $18.02
93923...  X                   Extremity study........        967       1.70     $90.11       $57.40       $18.02
93924...  X                   Extremity study........        967       1.70     $90.11       $57.40       $18.02

[[Page 47717]]


93925...  X                   Lower extremity study..        968       2.37    $125.37       $79.55       $25.07
93926...  X                   Lower extremity study..        968       2.37    $125.37       $79.55       $25.07
93930...  X                   Upper extremity study..        968       2.37    $125.37       $79.55       $25.07
93931...  X                   Upper extremity study..        968       2.37    $125.37       $79.55       $25.07
93965...  X                   Extremity study........        967       1.70     $90.11       $57.40       $18.02
93970...  X                   Extremity study........        968       2.37    $125.37       $79.55       $25.07
93971...  X                   Extremity study........        968       2.37    $125.37       $79.55       $25.07
93975...  X                   Vascular study.........        968       2.37    $125.37       $79.55       $25.07
93976...  X                   Vascular study.........        968       2.37    $125.37       $79.55       $25.07
93978...  X                   Vascular study.........        968       2.37    $125.37       $79.55       $25.07
93979...  X                   Vascular study.........        968       2.37    $125.37       $79.55       $25.07
93980...  X                   Penile vascular study..        968       2.37    $125.37       $79.55       $25.07
93981...  X                   Penile vascular study..        968       2.37    $125.37       $79.55       $25.07
93990...  X                   Doppler flow testing...        968       2.37    $125.37       $79.55       $25.07
94010...  X                   Breathing capacity test        971       0.78     $41.14       $21.47        $8.23
94060...  X                   Evaluation of wheezing.        971       0.78     $41.14       $21.47        $8.23
94070...  S                   Evaluation of wheezing.        973       1.89     $99.90       $55.82       $19.98
94150...  N                   Vital capacity test....  .........  .........  .........  ...........  ...........
94200...  X                   Lung function test (MBC/       971       0.78     $41.14       $21.47        $8.23
                               MVV).
94240...  X                   Residual lung capacity.        972       1.02     $53.87       $29.38       $10.77
94250...  X                   Expired gas collection.        971       0.78     $41.14       $21.47        $8.23
94260...  X                   Thoracic gas volume....        971       0.78     $41.14       $21.47        $8.23
94350...  X                   Lung nitrogen washout          972       1.02     $53.87       $29.38       $10.77
                               curve.
94360...  X                   Measure airflow                971       0.78     $41.14       $21.47        $8.23
                               resistance.
94370...  X                   Breath airway closing          972       1.02     $53.87       $29.38       $10.77
                               volume.
94375...  X                   Respiratory flow volume        971       0.78     $41.14       $21.47        $8.23
                               loop.
94400...  X                   CO2 breathing response         971       0.78     $41.14       $21.47        $8.23
                               curve.
94450...  X                   Hypoxia response curve.        971       0.78     $41.14       $21.47        $8.23
94620...  S                   Pulmonary stress               973       1.89     $99.90       $55.82       $19.98
                               testing.
94640...  S                   Airway inhalation              976       0.44     $23.30       $14.92        $4.66
                               treatment.
94642...  S                   Aerosol inhalation             976       0.44     $23.30       $14.92        $4.66
                               treatment.
94650...  S                   Pressure breathing             976       0.44     $23.30       $14.92        $4.66
                               (IPPB).
94651...  S                   Pressure breathing             976       0.44     $23.30       $14.92        $4.66
                               (IPPB).
94652...  C                   Pressure breathing       .........  .........  .........  ...........  ...........
                               (IPPB).
94656...  C                   Initial ventilator mgmt  .........  .........  .........  ...........  ...........
94657...  S                   Cont. ventilator.......        976       0.44     $23.30       $14.92        $4.66
94660...  S                   Pos airway pressure,           976       0.44     $23.30       $14.92        $4.66
                               CPAP.
94662...  S                   Neg pressure                   976       0.44     $23.30       $14.92        $4.66
                               ventilation,cnp.
94664...  S                   Aerosol or vapor               976       0.44     $23.30       $14.92        $4.66
                               inhalations.
94665...  S                   Aerosol or vapor               976       0.44     $23.30       $14.92        $4.66
                               inhalations.
94667...  S                   Chest wall manipulation        976       0.44     $23.30       $14.92        $4.66
94668...  S                   Chest wall manipulation        976       0.44     $23.30       $14.92        $4.66
94680...  X                   Exhaled air analysis:          972       1.02     $53.87       $29.38       $10.77
                               O2.
94681...  X                   Exhaled air analysis:          972       1.02     $53.87       $29.38       $10.77
                               O2,CO2.
94690...  X                   Exhaled air analysis...        972       1.02     $53.87       $29.38       $10.77
94720...  X                   Monoxide diffusing             972       1.02     $53.87       $29.38       $10.77
                               capacity.
94725...  X                   Membrane diffusion             972       1.02     $53.87       $29.38       $10.77
                               capacity.
94750...  S                   Pulmonary compliance           973       1.89     $99.90       $55.82       $19.98
                               study.
94760...  N                   Measure blood oxygen     .........  .........  .........  ...........  ...........
                               level.
94761...  N                   Measure blood oxygen     .........  .........  .........  ...........  ...........
                               level.
94762...  X                   Measure blood oxygen           971       0.78     $41.14       $21.47        $8.23
                               level.
94770...  X                   Exhaled carbon dioxide         971       0.78     $41.14       $21.47        $8.23
                               test.
94772...  S                   Breath recording,              973       1.89     $99.90       $55.82       $19.98
                               infant.
94799...  X                   Pulmonary service/             971       0.78     $41.14       $21.47        $8.23
                               procedure.
95004...  X                   Allergy skin tests.....        977       0.63     $33.30       $12.66        $6.66
95010...  X                   Sensitivity skin tests.        977       0.63     $33.30       $12.66        $6.66
95015...  X                   Sensitivity skin tests.        977       0.63     $33.30       $12.66        $6.66
95024...  X                   Allergy skin tests.....        977       0.63     $33.30       $12.66        $6.66
95027...  X                   Skin end point                 977       0.63     $33.30       $12.66        $6.66
                               titration.
95028...  X                   Allergy skin tests.....        977       0.63     $33.30       $12.66        $6.66
95044...  X                   Allergy patch tests....        977       0.63     $33.30       $12.66        $6.66
95052...  X                   Photo patch test.......        977       0.63     $33.30       $12.66        $6.66
95056...  X                   Photosensitivity tests.        977       0.63     $33.30       $12.66        $6.66
95060...  X                   Eye allergy tests......        977       0.63     $33.30       $12.66        $6.66
95065...  X                   Nose allergy test......        977       0.63     $33.30       $12.66        $6.66
95070...  S                   Bronchial allergy tests        973       1.89     $99.90       $55.82       $19.98
95071...  S                   Bronchial allergy tests        973       1.89     $99.90       $55.82       $19.98
95075...  X                   Ingestion challenge            928       3.11    $164.55       $83.85       $32.91
                               test.
95078...  X                   Provocative testing....        977       0.63     $33.30       $12.66        $6.66
95115...  X                   Immunotherapy, one             978       0.31     $16.65        $3.39        $3.33
                               injection.
95117...  X                   Immunotherapy                  978       0.31     $16.65        $3.39        $3.33
                               injections.
95120...  E                   Immunotherapy, one       .........  .........  .........  ...........  ...........
                               injection.
95125...  E                   Immunotherapy, many      .........  .........  .........  ...........  ...........
                               antigens.
95130...  E                   Immunotherapy, insect    .........  .........  .........  ...........  ...........
                               venom.
95131...  E                   Immunotherapy, insect    .........  .........  .........  ...........  ...........
                               venoms.

[[Page 47718]]


95132...  E                   Immunotherapy, insect    .........  .........  .........  ...........  ...........
                               venoms.
95133...  E                   Immunotherapy, insect    .........  .........  .........  ...........  ...........
                               venoms.
95134...  E                   Immunotherapy, insect    .........  .........  .........  ...........  ...........
                               venoms.
95144...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95145...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95146...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95147...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95148...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95149...  X                   Antigen therapy                901       0.07      $3.92        $2.49         $.78
                               services.
95165...  X                   Antigen therapy                978       0.31     $16.65        $3.39        $3.33
                               services.
95170...  X                   Antigen therapy                901       0.07      $3.92        $2.49         $.78
                               services.
95180...  X                   Rapid desensitization..        977       0.63     $33.30       $12.66        $6.66
95199...  X                   Allergy immunology             977       0.63     $33.30       $12.66        $6.66
                               services.
95805...  S                   Multiple sleep latency         979      10.17    $537.72      $288.83      $107.54
                               test.
95806...  S                   Sleep study, unattended        979      10.17    $537.72      $288.83      $107.54
95807...  S                   Sleep study, attended..        979      10.17    $537.72      $288.83      $107.54
95808...  S                   Polysomnography, 1-3...        979      10.17    $537.72      $288.83      $107.54
95810...  S                   Polysomnography, 4 or          979      10.17    $537.72      $288.83      $107.54
                               more.
95811...  S                   Polysomnography w/cpap.        979      10.17    $537.72      $288.83      $107.54
95812...  S                   Electroencephalogram           979      10.17    $537.72      $288.83      $107.54
                               (EEG).
95813...  S                   Electroencephalogram           979      10.17    $537.72      $288.83      $107.54
                               (EEG).
95816...  X                   Electroencephalogram           980       2.15    $113.62       $57.86       $22.72
                               (EEG).
95819...  X                   Electroencephalogram           980       2.15    $113.62       $57.86       $22.72
                               (EEG).
95822...  X                   Sleep                          980       2.15    $113.62       $57.86       $22.72
                               electroencephalogram.
95824...  X                   Electroencephalography.        980       2.15    $113.62       $57.86       $22.72
95827...  S                   Night                          979      10.17    $537.72      $288.83      $107.54
                               electroencephalogram.
95829...  X                   Surgery                        980       2.15    $113.62       $57.86       $22.72
                               electrocorticogram.
95830...  N                   Insert electrodes for    .........  .........  .........  ...........  ...........
                               EEG.
95831...  N                   Limb muscle testing,     .........  .........  .........  ...........  ...........
                               manual.
95832...  N                   Hand muscle testing,     .........  .........  .........  ...........  ...........
                               manual.
95833...  N                   Body muscle testing,     .........  .........  .........  ...........  ...........
                               manual.
95834...  N                   Body muscle testing,     .........  .........  .........  ...........  ...........
                               manual.
95851...  N                   Range of motion          .........  .........  .........  ...........  ...........
                               measurements.
95852...  N                   Range of motion          .........  .........  .........  ...........  ...........
                               measurements.
95857...  X                   Tensilon test..........        981       1.46     $77.38       $41.81       $15.48
95858...  X                   Tensilon test & myogram        982       1.39     $73.46       $38.87       $14.69
95860...  X                   Muscle test, one limb..        982       1.39     $73.46       $38.87       $14.69
95861...  X                   Muscle test, two limbs.        982       1.39     $73.46       $38.87       $14.69
95863...  X                   Muscle test, 3 limbs...        982       1.39     $73.46       $38.87       $14.69
95864...  X                   Muscle test, 4 limbs...        982       1.39     $73.46       $38.87       $14.69
95867...  X                   Muscle test, head or           981       1.46     $77.38       $41.81       $15.48
                               neck.
95868...  X                   Muscle test, head or           982       1.39     $73.46       $38.87       $14.69
                               neck.
95869...  X                   Muscle test, thor              981       1.46     $77.38       $41.81       $15.48
                               paraspinal.
95870...  X                   Muscle test, non-              981       1.46     $77.38       $41.81       $15.48
                               paraspinal.
95872...  X                   Muscle test, one fiber.        982       1.39     $73.46       $38.87       $14.69
95875...  X                   Limb exercise test.....        982       1.39     $73.46       $38.87       $14.69
95900...  X                   Motor nerve conduction         981       1.46     $77.38       $41.81       $15.48
                               test.
95903...  X                   Motor nerve conduction         982       1.39     $73.46       $38.87       $14.69
                               test.
95904...  X                   Sense nerve conduction         982       1.39     $73.46       $38.87       $14.69
                               test.
95920...  C                   Intraoperative nerve     .........  .........  .........  ...........  ...........
                               testing.
95921...  X                   Autonomic nervous func         981       1.46     $77.38       $41.81       $15.48
                               test.
95922...  X                   Autonomic nervous func         981       1.46     $77.38       $41.81       $15.48
                               test.
95923...  X                   Autonomic nervous func         981       1.46     $77.38       $41.81       $15.48
                               test.
95925...  X                   Somatosensory testing..        982       1.39     $73.46       $38.87       $14.69
95926...  X                   Somatosensory testing..        981       1.46     $77.38       $41.81       $15.48
95927...  X                   Somatosensory testing..        981       1.46     $77.38       $41.81       $15.48
95930...  X                   Visual evoked potential        981       1.46     $77.38       $41.81       $15.48
                               test.
95933...  X                   Blink reflex test......        981       1.46     $77.38       $41.81       $15.48
95934...  X                   `h' reflex test........        981       1.46     $77.38       $41.81       $15.48
95936...  X                   `h' reflex test........        981       1.46     $77.38       $41.81       $15.48
95937...  X                   Neuromuscular junction         981       1.46     $77.38       $41.81       $15.48
                               test.
95950...  X                   Ambulatory eeg                 981       1.46     $77.38       $41.81       $15.48
                               monitoring.
95951...  S                   EEG monitoring/                979      10.17    $537.72      $288.83      $107.54
                               videorecord.
95953...  S                   EEG monitoring/computer        979      10.17    $537.72      $288.83      $107.54
95954...  S                   EEG monitoring/giving          979      10.17    $537.72      $288.83      $107.54
                               drugs.
95955...  X                   EEG during surgery.....        980       2.15    $113.62       $57.86       $22.72
95956...  N                   EEG monitoring/cable/    .........  .........  .........  ...........  ...........
                               radio.
95957...  N                   EEG digital analysis...  .........  .........  .........  ...........  ...........
95958...  S                   EEG monitoring/function        979      10.17    $537.72      $288.83      $107.54
                               test.
95961...  C                   Electrode stimulation,   .........  .........  .........  ...........  ...........
                               brain.
95962...  C                   Electrode stimulation,   .........  .........  .........  ...........  ...........
                               brain.
95999...  N                   Neurological procedure.  .........  .........  .........  ...........  ...........
96100...  X                   Psychological testing..        089       2.54    $134.19       $37.29       $26.84
96105...  X                   Assessment of aphasia..        089       2.54    $134.19       $37.29       $26.84
96110...  X                   Developmental test, lim        089       2.54    $134.19       $37.29       $26.84

[[Page 47719]]


96111...  X                   Developmental test,            089       2.54    $134.19       $37.29       $26.84
                               extend.
96115...  X                   Neurobehavior status           089       2.54    $134.19       $37.29       $26.84
                               exam.
96117...  X                   Neuropsych test battery        089       2.54    $134.19       $37.29       $26.84
96400...  S                   Chemotherapy, (SC)/(IM)        987       0.65     $34.28       $13.33        $6.86
96405...  S                   Intralesional chemo            987       0.65     $34.28       $13.33        $6.86
                               admin.
96406...  S                   Intralesional chemo            987       0.65     $34.28       $13.33        $6.86
                               admin.
96408...  S                   Chemotherapy, push             988       4.15    $219.40       $97.63       $43.88
                               technique.
96410...  S                   Chemotherapy, infusion         988       4.15    $219.40       $97.63       $43.88
                               method.
96412...  S                   Chemotherapy, infusion         988       4.15    $219.40       $97.63       $43.88
                               method.
96414...  S                   Chemotherapy, infusion         989       1.72     $91.09       $40.68       $18.22
                               method.
96420...  S                   Chemotherapy, push             988       4.15    $219.40       $97.63       $43.88
                               technique.
96422...  S                   Chemotherapy, infusion         988       4.15    $219.40       $97.63       $43.88
                               method.
96423...  S                   Chemotherapy, infusion         988       4.15    $219.40       $97.63       $43.88
                               method.
96425...  S                   Chemotherapy, infusion         989       1.72     $91.09       $40.68       $18.22
                               method.
96440...  S                   Chemotherapy,                  989       1.72     $91.09       $40.68       $18.22
                               intracavitary.
96445...  S                   Chemotherapy,                  989       1.72     $91.09       $40.68       $18.22
                               intracavitary.
96450...  S                   Chemotherapy, into CNS.        989       1.72     $91.09       $40.68       $18.22
96520...  E                   Pump refilling,          .........  .........  .........  ...........  ...........
                               maintenance.
96530...  E                   Pump refilling,          .........  .........  .........  ...........  ...........
                               maintenance.
96542...  S                   Chemotherapy injection.        989       1.72     $91.09       $40.68       $18.22
96545...  N                   Provide chemotherapy     .........  .........  .........  ...........  ...........
                               agent.
96549...  S                   Chemotherapy,                  987       0.65     $34.28       $13.33        $6.86
                               unspecified.
96900...  S                   Ultraviolet light              990       0.43     $22.53        $8.14        $4.51
                               therapy.
96902...  N                   Trichogram.............  .........  .........  .........  ...........  ...........
96910...  S                   Photochemotherapy with         990       0.43     $22.53        $8.14        $4.51
                               UV-B.
96912...  S                   Photochemotherapy with         990       0.43     $22.53        $8.14        $4.51
                               UV-A.
96913...  S                   Photochemotherapy, UV-A        990       0.43     $22.53        $8.14        $4.51
                               or B.
96999...  S                   Dermatological                 990       0.43     $22.53        $8.14        $4.51
                               procedure.
97001...  A                   Pt evaluation..........  .........  .........  .........  ...........  ...........
97002...  A                   Pt re-evaluation.......  .........  .........  .........  ...........  ...........
97003...  A                   Ot evaluation..........  .........  .........  .........  ...........  ...........
97004...  A                   Ot re-evaluation.......  .........  .........  .........  ...........  ...........
97010...  A                   Hot or cold packs        .........  .........  .........  ...........  ...........
                               therapy.
97012...  A                   Mechanical traction      .........  .........  .........  ...........  ...........
                               therapy.
97014...  A                   Electric stimulation     .........  .........  .........  ...........  ...........
                               therapy.
97016...  A                   Vasopneumatic device     .........  .........  .........  ...........  ...........
                               therapy.
97018...  A                   Paraffin bath therapy..  .........  .........  .........  ...........  ...........
97020...  A                   Microwave therapy......  .........  .........  .........  ...........  ...........
97022...  A                   Whirlpool therapy......  .........  .........  .........  ...........  ...........
97024...  A                   Diathermy treatment....  .........  .........  .........  ...........  ...........
97026...  A                   Infrared therapy.......  .........  .........  .........  ...........  ...........
97028...  A                   Ultraviolet therapy....  .........  .........  .........  ...........  ...........
97032...  A                   Electrical stimulation.  .........  .........  .........  ...........  ...........
97033...  A                   Electric current         .........  .........  .........  ...........  ...........
                               therapy.
97034...  A                   Contrast bath therapy..  .........  .........  .........  ...........  ...........
97035...  A                   Ultrasound therapy.....  .........  .........  .........  ...........  ...........
97036...  A                   Hydrotherapy...........  .........  .........  .........  ...........  ...........
97039...  A                   Physical therapy         .........  .........  .........  ...........  ...........
                               treatment.
97110...  A                   Therapeutic exercises..  .........  .........  .........  ...........  ...........
97112...  A                   Neuromuscular            .........  .........  .........  ...........  ...........
                               reeducation.
97113...  A                   Aquatic therapy/         .........  .........  .........  ...........  ...........
                               exercises.
97116...  A                   Gait training therapy..  .........  .........  .........  ...........  ...........
97122...  A                   Manual traction therapy  .........  .........  .........  ...........  ...........
97124...  A                   Massage therapy........  .........  .........  .........  ...........  ...........
97139...  A                   Physical medicine        .........  .........  .........  ...........  ...........
                               procedure.
97150...  A                   Group therapeutic        .........  .........  .........  ...........  ...........
                               procedures.
97250...  S                   Myofascial release.....        997       0.69     $36.24        $7.25        $7.25
97260...  S                   Regional manipulation..        997       0.69     $36.24        $7.25        $7.25
97261...  S                   Supplemental                   997       0.69     $36.24        $7.25        $7.25
                               manipulations.
97265...  A                   Joint mobilization.....  .........  .........  .........  ...........  ...........
97504...  A                   Orthotic training......  .........  .........  .........  ...........  ...........
97520...  A                   Prosthetic training....  .........  .........  .........  ...........  ...........
97530...  A                   Therapeutic activities.  .........  .........  .........  ...........  ...........
97535...  A                   Self care mngment        .........  .........  .........  ...........  ...........
                               training.
97537...  A                   Community/work           .........  .........  .........  ...........  ...........
                               reintegration.
97542...  A                   Wheelchair mngement      .........  .........  .........  ...........  ...........
                               training.
97545...  A                   Work hardening.........  .........  .........  .........  ...........  ...........
97546...  A                   Work hardening.........  .........  .........  .........  ...........  ...........
97703...  A                   Prosthetic checkout....  .........  .........  .........  ...........  ...........
97750...  A                   Physical performance     .........  .........  .........  ...........  ...........
                               test.
97770...  A                   Cognitive skills         .........  .........  .........  ...........  ...........
                               development.
97780...  E                   Acupuncture w/o stim...  .........  .........  .........  ...........  ...........
97781...  E                   Acupuncture w/stim.....  .........  .........  .........  ...........  ...........
97799...  A                   Physical medicine        .........  .........  .........  ...........  ...........
                               procedure.
98925...  S                   Osteopathic                    997       0.69     $36.24        $7.25        $7.25
                               manipulation.

[[Page 47720]]


98926...  S                   Osteopathic                    997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98927...  S                   Osteopathic                    997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98928...  S                   Osteopathic                    997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98929...  S                   Osteopathic                    997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98940...  S                   Chiropractic                   997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98941...  S                   Chiropractic                   997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98942...  S                   Chiropractic                   997       0.69     $36.24        $7.25        $7.25
                               manipulation.
98943...  E                   Chiropractic             .........  .........  .........  ...........  ...........
                               manipulation.
99000...  E                   Specimen handling......  .........  .........  .........  ...........  ...........
99001...  N                   Specimen handling......  .........  .........  .........  ...........  ...........
99002...  E                   Device handling........  .........  .........  .........  ...........  ...........
99024...  N                   Post-op follow-up visit  .........  .........  .........  ...........  ...........
99025...  N                   Initial surgical         .........  .........  .........  ...........  ...........
                               evaluation.
99050...  E                   Medical services after   .........  .........  .........  ...........  ...........
                               hrs.
99052...  E                   Medical services at      .........  .........  .........  ...........  ...........
                               night.
99054...  E                   Medical services,        .........  .........  .........  ...........  ...........
                               unusual hrs.
99056...  E                   Non-office medical       .........  .........  .........  ...........  ...........
                               services.
99058...  N                   Office emergency care..  .........  .........  .........  ...........  ...........
99070...  E                   Special supplies.......  .........  .........  .........  ...........  ...........
99071...  E                   Patient education        .........  .........  .........  ...........  ...........
                               materials.
99075...  E                   Medical testimony......  .........  .........  .........  ...........  ...........
99078...  S                   Group health education.        921  .........  .........  ...........  ...........
99080...  E                   Special reports or       .........  .........  .........  ...........  ...........
                               forms.
99082...  E                   Unusual physician        .........  .........  .........  ...........  ...........
                               travel.
99090...  E                   Computer data analysis.  .........  .........  .........  ...........  ...........
99100...  N                   Special anesthesia       .........  .........  .........  ...........  ...........
                               service.
99116...  N                   Anesthesia with          .........  .........  .........  ...........  ...........
                               hypothermia.
99135...  N                   Special anesthesia       .........  .........  .........  ...........  ...........
                               procedure.
99140...  N                   Emergency anesthesia...  .........  .........  .........  ...........  ...........
99141...  N                   Sedation, iv/im or       .........  .........  .........  ...........  ...........
                               inhalant.
99142...  N                   Sedation, oral/rectal/   .........  .........  .........  ...........  ...........
                               nasal.
99175...  N                   Induction of vomiting..  .........  .........  .........  ...........  ...........
99183...  S                   Hyperbaric oxygen              969       2.65    $140.06      $141.70       $28.01
                               therapy.
99185...  N                   Regional hypothermia...  .........  .........  .........  ...........  ...........
99186...  N                   Total body hypothermia.  .........  .........  .........  ...........  ...........
99190...  C                   Special pump services..  .........  .........  .........  ...........  ...........
99191...  C                   Special pump services..  .........  .........  .........  ...........  ...........
99192...  C                   Special pump services..  .........  .........  .........  ...........  ...........
99195...  X                   Phlebotomy.............        999       0.43     $22.53       $10.85        $4.51
99199...  N                   Special service or       .........  .........  .........  ...........  ...........
                               report.
99201...  V                   Office/outpatient              911  .........  .........  ...........  ...........
                               visit, new.
99202...  V                   Office/outpatient              911  .........  .........  ...........  ...........
                               visit, new.
99203...  V                   Office/outpatient              913  .........  .........  ...........  ...........
                               visit, new.
99204...  V                   Office/outpatient              915  .........  .........  ...........  ...........
                               visit, new.
99205...  V                   Office/outpatient              915  .........  .........  ...........  ...........
                               visit, new.
99211...  V                   Office/outpatient              911  .........  .........  ...........  ...........
                               visit, est.
99212...  V                   Office/outpatient              911  .........  .........  ...........  ...........
                               visit, est.
99213...  V                   Office/outpatient              913  .........  .........  ...........  ...........
                               visit, est.
99214...  V                   Office/outpatient              915  .........  .........  ...........  ...........
                               visit, est.
99215...  V                   Office/outpatient              915  .........  .........  ...........  ...........
                               visit, est.
99217...  N                   Observation care         .........  .........  .........  ...........  ...........
                               discharge.
99218...  N                   Observation care.......  .........  .........  .........  ...........  ...........
99219...  N                   Observation care.......  .........  .........  .........  ...........  ...........
99220...  N                   Observation care.......  .........  .........  .........  ...........  ...........
99221...  E                   Initial hospital care..  .........  .........  .........  ...........  ...........
99222...  E                   Initial hospital care..  .........  .........  .........  ...........  ...........
99223...  E                   Initial hospital care..  .........  .........  .........  ...........  ...........
99231...  E                   Subsequent hospital      .........  .........  .........  ...........  ...........
                               care.
99232...  E                   Subsequent hospital      .........  .........  .........  ...........  ...........
                               care.
99233...  E                   Subsequent hospital      .........  .........  .........  ...........  ...........
                               care.
99234...  C                   Observ/hosp same date..  .........  .........  .........  ...........  ...........
99235...  C                   Observ/hosp same date..  .........  .........  .........  ...........  ...........
99236...  C                   Observ/hosp same date..  .........  .........  .........  ...........  ...........
99238...  E                   Hospital discharge day.  .........  .........  .........  ...........  ...........
99239...  E                   Hospital discharge day.  .........  .........  .........  ...........  ...........
99241...  V                   Office consultation....        911  .........  .........  ...........  ...........
99242...  V                   Office consultation....        911  .........  .........  ...........  ...........
99243...  V                   Office consultation....        913  .........  .........  ...........  ...........
99244...  V                   Office consultation....        915  .........  .........  ...........  ...........
99245...  V                   Office consultation....        915  .........  .........  ...........  ...........
99251...  C                   Initial inpatient        .........  .........  .........  ...........  ...........
                               consult.
99252...  C                   Initial inpatient        .........  .........  .........  ...........  ...........
                               consult.
99253...  C                   Initial inpatient        .........  .........  .........  ...........  ...........
                               consult.
99254...  C                   Initial inpatient        .........  .........  .........  ...........  ...........
                               consult.
99255...  C                   Initial inpatient        .........  .........  .........  ...........  ...........
                               consult.

[[Page 47721]]


99261...  C                   Follow-up inpatient      .........  .........  .........  ...........  ...........
                               consult.
99262...  C                   Follow-up inpatient      .........  .........  .........  ...........  ...........
                               consult.
99263...  C                   Follow-up inpatient      .........  .........  .........  ...........  ...........
                               consult.
99271...  V                   Confirmatory                   911  .........  .........  ...........  ...........
                               consultation.
99272...  V                   Confirmatory                   911  .........  .........  ...........  ...........
                               consultation.
99273...  V                   Confirmatory                   913  .........  .........  ...........  ...........
                               consultation.
99274...  V                   Confirmatory                   915  .........  .........  ...........  ...........
                               consultation.
99275...  V                   Confirmatory                   915  .........  .........  ...........  ...........
                               consultation.
99281...  V                   Emergency dept visit...        951  .........  .........  ...........  ...........
99282...  V                   Emergency dept visit...        951  .........  .........  ...........  ...........
99283...  V                   Emergency dept visit...        953  .........  .........  ...........  ...........
99284...  V                   Emergency dept visit...        955  .........  .........  ...........  ...........
99285...  V                   Emergency dept visit...        955  .........  .........  ...........  ...........
99288...  E                   Direct advanced life     .........  .........  .........  ...........  ...........
                               support.
99291...  S                   Critical care, first           900       7.44    $393.74      $144.87       $78.75
                               hour.
99292...  N                   Critical care, addl 30   .........  .........  .........  ...........  ...........
                               min.
99295...  C                   Neonatal critical care.  .........  .........  .........  ...........  ...........
99296...  C                   Neonatal critical care.  .........  .........  .........  ...........  ...........
99297...  C                   Neonatal critical care.  .........  .........  .........  ...........  ...........
99301...  E                   Nursing facility care..  .........  .........  .........  ...........  ...........
99302...  E                   Nursing facility care..  .........  .........  .........  ...........  ...........
99303...  E                   Nursing facility care..  .........  .........  .........  ...........  ...........
99311...  E                   Nursing facility care,   .........  .........  .........  ...........  ...........
                               subseq.
99312...  E                   Nursing facility care,   .........  .........  .........  ...........  ...........
                               subseq.
99313...  E                   Nursing facility care,   .........  .........  .........  ...........  ...........
                               subseq.
99315...  E                   Nursing fac discharge    .........  .........  .........  ...........  ...........
                               day.
99316...  E                   Nursing fac discharge    .........  .........  .........  ...........  ...........
                               day.
99321...  N                   Rest home visit, new     .........  .........  .........  ...........  ...........
                               patient.
99322...  N                   Rest home visit, new     .........  .........  .........  ...........  ...........
                               patient.
99323...  N                   Rest home visit, new     .........  .........  .........  ...........  ...........
                               patient.
99331...  N                   Rest home visit, estab   .........  .........  .........  ...........  ...........
                               pat.
99332...  N                   Rest home visit, estab   .........  .........  .........  ...........  ...........
                               pat.
99333...  N                   Rest home visit, estab   .........  .........  .........  ...........  ...........
                               pat.
99341...  N                   Home visit, new patient  .........  .........  .........  ...........  ...........
99342...  N                   Home visit, new patient  .........  .........  .........  ...........  ...........
99343...  N                   Home visit, new patient  .........  .........  .........  ...........  ...........
99344...  N                   Home visit, new patient  .........  .........  .........  ...........  ...........
99345...  N                   Home visit, new patient  .........  .........  .........  ...........  ...........
99347...  N                   Home visit, estab        .........  .........  .........  ...........  ...........
                               patient.
99348...  N                   Home visit, estab        .........  .........  .........  ...........  ...........
                               patient.
99349...  N                   Home visit, estab        .........  .........  .........  ...........  ...........
                               patient.
99350...  N                   Home visit, estab        .........  .........  .........  ...........  ...........
                               patient.
99354...  N                   Prolonged service,       .........  .........  .........  ...........  ...........
                               office.
99355...  N                   Prolonged service,       .........  .........  .........  ...........  ...........
                               office.
99356...  C                   Prolonged service,       .........  .........  .........  ...........  ...........
                               inpatient.
99357...  C                   Prolonged service,       .........  .........  .........  ...........  ...........
                               inpatient.
99358...  N                   Prolonged serv, w/o      .........  .........  .........  ...........  ...........
                               contact.
99359...  N                   Prolonged serv, w/o      .........  .........  .........  ...........  ...........
                               contact.
99360...  E                   Physician standby        .........  .........  .........  ...........  ...........
                               services.
99361...  E                   Physician/team           .........  .........  .........  ...........  ...........
                               conference.
99362...  E                   Physician/team           .........  .........  .........  ...........  ...........
                               conference.
99371...  E                   Physician phone          .........  .........  .........  ...........  ...........
                               consultation.
99372...  E                   Physician phone          .........  .........  .........  ...........  ...........
                               consultation.
99373...  E                   Physician phone          .........  .........  .........  ...........  ...........
                               consultation.
99374...  E                   Home health care         .........  .........  .........  ...........  ...........
                               supervision.
99375...  E                   Home health care         .........  .........  .........  ...........  ...........
                               supervision.
99377...  E                   Hospice care             .........  .........  .........  ...........  ...........
                               supervision.
99378...  E                   Hospice care             .........  .........  .........  ...........  ...........
                               supervision.
99379...  E                   Nursing fac care         .........  .........  .........  ...........  ...........
                               supervision.
99380...  E                   Nursing fac care         .........  .........  .........  ...........  ...........
                               supervision.
99381...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               infant.
99382...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               age 1-4.
99383...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               age 5-11.
99384...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               12-17.
99385...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               18-39.
99386...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               40-64.
99387...  E                   Preventive visit, new,   .........  .........  .........  ...........  ...........
                               65 & over.
99391...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               infant.
99392...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               age 1-4.
99393...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               age 5-11.
99394...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               12-17.
99395...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               18-39.
99396...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               40-64.
99397...  E                   Preventive visit, est,   .........  .........  .........  ...........  ...........
                               65 & over.
99401...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               indiv.

[[Page 47722]]


99402...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               indiv.
99403...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               indiv.
99404...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               indiv.
99411...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               group.
99412...  E                   Preventive counseling,   .........  .........  .........  ...........  ...........
                               group.
99420...  E                   Health risk assessment   .........  .........  .........  ...........  ...........
                               test.
99429...  E                   Unlisted preventive      .........  .........  .........  ...........  ...........
                               service.
99431...  N                   Initial care, normal     .........  .........  .........  ...........  ...........
                               newborn.
99432...  N                   Newborn care not in      .........  .........  .........  ...........  ...........
                               hospital.
99433...  C                   Normal newborn care,     .........  .........  .........  ...........  ...........
                               hospital.
99435...  E                   Hospital NB discharge    .........  .........  .........  ...........  ...........
                               day.
99436...  N                   Attendance, birth......  .........  .........  .........  ...........  ...........
99440...  S                   Newborn resuscitation..        947       4.07    $215.48      $109.61       $43.10
99450...  E                   Life/disability          .........  .........  .........  ...........  ...........
                               evaluation.
99455...  N                   Disability examination.  .........  .........  .........  ...........  ...........
99456...  N                   Disability examination.  .........  .........  .........  ...........  ...........
99499...  N                   Unlisted E/M service...  .........  .........  .........  ...........  ...........
A0021...  E                   Outside state ambulance  .........  .........  .........  ...........  ...........
                               serv.
A0030...  A                   Air ambulance service..  .........  .........  .........  ...........  ...........
A0040...  A                   Helicopter ambulance     .........  .........  .........  ...........  ...........
                               service.
A0050...  A                   Water amb service        .........  .........  .........  ...........  ...........
                               emergency.
A0080...  E                   Noninterest escort in    .........  .........  .........  ...........  ...........
                               non er.
A0090...  E                   Interest escort in non   .........  .........  .........  ...........  ...........
                               er.
A0100...  E                   Nonemergency transport   .........  .........  .........  ...........  ...........
                               taxi.
A0110...  E                   Nonemergency transport   .........  .........  .........  ...........  ...........
                               bus.
A0120...  E                   Noner transport mini-    .........  .........  .........  ...........  ...........
                               bus.
A0130...  E                   Noner transport wheelch  .........  .........  .........  ...........  ...........
                               van.
A0140...  E                   Nonemergency transport   .........  .........  .........  ...........  ...........
                               air.
A0160...  E                   Noner transport case     .........  .........  .........  ...........  ...........
                               worker.
A0170...  E                   Noner transport parking  .........  .........  .........  ...........  ...........
                               fees.
A0180...  E                   Noner transport lodgng   .........  .........  .........  ...........  ...........
                               recip.
A0190...  E                   Noner transport meals    .........  .........  .........  ...........  ...........
                               recip.
A0200...  E                   Noner transport lodgng   .........  .........  .........  ...........  ...........
                               escrt.
A0210...  E                   Noner transport meals    .........  .........  .........  ...........  ...........
                               escort.
A0225...  A                   Neonatal emergency       .........  .........  .........  ...........  ...........
                               transport.
A0300...  A                   Ambulance basic non-     .........  .........  .........  ...........  ...........
                               emer all.
A0302...  A                   Ambulance basic          .........  .........  .........  ...........  ...........
                               emergeny all.
A0304...  A                   Amb adv non-er no serv   .........  .........  .........  ...........  ...........
                               all.
A0306...  A                   Amb adv non-er spec      .........  .........  .........  ...........  ...........
                               serv all.
A0308...  A                   Amb adv er no spec serv  .........  .........  .........  ...........  ...........
                               all.
A0310...  A                   Amb adv er spec serv     .........  .........  .........  ...........  ...........
                               all.
A0320...  A                   Amb basic non-er +       .........  .........  .........  ...........  ...........
                               supplies.
A0322...  A                   Amb basic emerg +        .........  .........  .........  ...........  ...........
                               supplies.
A0324...  A                   Adv non-er serv sep      .........  .........  .........  ...........  ...........
                               mileage.
A0326...  A                   Adv non-er no serv sep   .........  .........  .........  ...........  ...........
                               mile.
A0328...  A                   Adv er no serv sep       .........  .........  .........  ...........  ...........
                               mileage.
A0330...  A                   Adv er spec serv sep     .........  .........  .........  ...........  ...........
                               mile.
A0340...  A                   Amb basic non-er +       .........  .........  .........  ...........  ...........
                               mileage.
A0342...  A                   Ambul basic emer +       .........  .........  .........  ...........  ...........
                               mileage.
A0344...  A                   Amb adv non-er no serv   .........  .........  .........  ...........  ...........
                               +mile.
A0346...  A                   Amb adv non-er serv +    .........  .........  .........  ...........  ...........
                               mile.
A0348...  A                   Adv emer no spec serv +  .........  .........  .........  ...........  ...........
                               mile.
A0350...  A                   Adv emer spec serv +     .........  .........  .........  ...........  ...........
                               mileage.
A0360...  A                   Basic non-er sep mile &  .........  .........  .........  ...........  ...........
                               supp.
A0362...  A                   Basic emer sep mile &    .........  .........  .........  ...........  ...........
                               supply.
A0364...  A                   Adv non-er no serv sep   .........  .........  .........  ...........  ...........
                               mi & su.
A0366...  A                   Adv non-er serv sep mil  .........  .........  .........  ...........  ...........
                               & supp.
A0368...  A                   Adv er no serv sep mile  .........  .........  .........  ...........  ...........
                               & supp.
A0370...  A                   Adv er spec serv sep mi  .........  .........  .........  ...........  ...........
                               & supp.
A0380...  A                   Basic life support       .........  .........  .........  ...........  ...........
                               mileage.
A0382...  A                   Basic support routine    .........  .........  .........  ...........  ...........
                               suppls.
A0384...  A                   Bls defibrillation       .........  .........  .........  ...........  ...........
                               supplies.
A0390...  A                   Advanced life support    .........  .........  .........  ...........  ...........
                               mileage.
A0392...  A                   Als defibrillation       .........  .........  .........  ...........  ...........
                               supplies.
A0394...  A                   Als IV drug therapy      .........  .........  .........  ...........  ...........
                               supplies.
A0396...  A                   Als esophageal intub     .........  .........  .........  ...........  ...........
                               suppls.
A0398...  A                   Als routine disposble    .........  .........  .........  ...........  ...........
                               suppls.
A0420...  A                   Ambulance waiting 1/2    .........  .........  .........  ...........  ...........
                               hr.
A0422...  A                   Ambulance 02 life        .........  .........  .........  ...........  ...........
                               sustaining.
A0424...  A                   Extra ambulance          .........  .........  .........  ...........  ...........
                               attendant.
A0888...  E                   Noncovered ambulance     .........  .........  .........  ...........  ...........
                               mileage.
A0999...  A                   Unlisted ambulance       .........  .........  .........  ...........  ...........
                               service.
A4206...  A                   1 CC sterile syringe &   .........  .........  .........  ...........  ...........
                               needle.
A4207...  A                   2 CC sterile syringe &   .........  .........  .........  ...........  ...........
                               needle.
A4208...  A                   3 CC sterile syringe &   .........  .........  .........  ...........  ...........
                               needle.

[[Page 47723]]


A4209...  A                   5+ CC sterile syringe &  .........  .........  .........  ...........  ...........
                               needle.
A4210...  E                   Nonneedle injection      .........  .........  .........  ...........  ...........
                               device.
A4211...  A                   Supp for self-adm        .........  .........  .........  ...........  ...........
                               injections.
A4212...  A                   Non coring needle or     .........  .........  .........  ...........  ...........
                               stylet.
A4213...  A                   20+ CC syringe only....  .........  .........  .........  ...........  ...........
A4214...  A                   30 CC sterile water/     .........  .........  .........  ...........  ...........
                               saline.
A4215...  A                   Sterile needle.........  .........  .........  .........  ...........  ...........
A4220...  A                   Infusion pump refill     .........  .........  .........  ...........  ...........
                               kit.
A4221...  A                   Maint drug infus cath    .........  .........  .........  ...........  ...........
                               per wk.
A4222...  A                   Drug infusion pump       .........  .........  .........  ...........  ...........
                               supplies.
A4230...  E                   Infus insulin pump non   .........  .........  .........  ...........  ...........
                               needl.
A4231...  E                   Infusion insulin pump    .........  .........  .........  ...........  ...........
                               needle.
A4232...  E                   Syringe w/needle         .........  .........  .........  ...........  ...........
                               insulin 3cc.
A4244...  A                   Alcohol or peroxide per  .........  .........  .........  ...........  ...........
                               pint.
A4245...  A                   Alcohol wipes per box..  .........  .........  .........  ...........  ...........
A4246...  A                   Betadine/phisohex        .........  .........  .........  ...........  ...........
                               solution.
A4247...  A                   Betadine/iodine swabs/   .........  .........  .........  ...........  ...........
                               wipes.
A4250...  E                   Urine reagent strips/    .........  .........  .........  ...........  ...........
                               tablets.
A4253...  A                   Blood glucose/reagent    .........  .........  .........  ...........  ...........
                               strips.
A4254...  A                   Battery for glucose      .........  .........  .........  ...........  ...........
                               monitor.
A4255...  A                   Glucose monitor          .........  .........  .........  ...........  ...........
                               platforms.
A4256...  A                   Calibrator solution/     .........  .........  .........  ...........  ...........
                               chips.
A4258...  A                   Lancet device each.....  .........  .........  .........  ...........  ...........
A4259...  A                   Lancets per box........  .........  .........  .........  ...........  ...........
A4260...  E                   Levonorgestrel implant.  .........  .........  .........  ...........  ...........
A4262...  N                   Temporary tear duct      .........  .........  .........  ...........  ...........
                               plug.
A4263...  A                   Permanent tear duct      .........  .........  .........  ...........  ...........
                               plug.
A4265...  A                   Paraffin...............  .........  .........  .........  ...........  ...........
A4270...  A                   Disposable endoscope     .........  .........  .........  ...........  ...........
                               sheath.
A4300...  A                   Cath impl vasc access    .........  .........  .........  ...........  ...........
                               portal.
A4301...  A                   Implantable access syst  .........  .........  .........  ...........  ...........
                               perc.
A4305...  A                   Drug delivery system     .........  .........  .........  ...........  ...........
                               >=50 ML.
A4306...  A                   Drug delivery system     .........  .........  .........  ...........  ...........
                               <=5 ML.
A4310...  A                   Insert tray w/o bag/     .........  .........  .........  ...........  ...........
                               cath.
A4311...  A                   Catheter w/o bag 2-way   .........  .........  .........  ...........  ...........
                               latex.
A4312...  A                   Cath w/o bag 2-way       .........  .........  .........  ...........  ...........
                               silicone.
A4313...  A                   Catheter w/bag 3-way...  .........  .........  .........  ...........  ...........
A4314...  A                   Cath w/drainage 2-way    .........  .........  .........  ...........  ...........
                               latex.
A4315...  A                   Cath w/drainage 2-way    .........  .........  .........  ...........  ...........
                               silcne.
A4316...  A                   Cath w/drainage 3-way..  .........  .........  .........  ...........  ...........
A4320...  A                   Irrigation tray........  .........  .........  .........  ...........  ...........
A4321...  A                   Cath therapeutic irrig   .........  .........  .........  ...........  ...........
                               agent.
A4322...  A                   Irrigation syringe.....  .........  .........  .........  ...........  ...........
A4323...  A                   Saline irrigation        .........  .........  .........  ...........  ...........
                               solution.
A4326...  A                   Male external catheter.  .........  .........  .........  ...........  ...........
A4327...  A                   Fem urinary collect dev  .........  .........  .........  ...........  ...........
                               cup.
A4328...  A                   Fem urinary collect      .........  .........  .........  ...........  ...........
                               pouch.
A4329...  A                   External catheter start  .........  .........  .........  ...........  ...........
                               set.
A4330...  A                   Stool collection pouch.  .........  .........  .........  ...........  ...........
A4335...  A                   Incontinence supply....  .........  .........  .........  ...........  ...........
A4338...  A                   Indwelling catheter      .........  .........  .........  ...........  ...........
                               latex.
A4340...  A                   Indwelling catheter      .........  .........  .........  ...........  ...........
                               special.
A4344...  A                   Cath indw foley 2 way    .........  .........  .........  ...........  ...........
                               silicn.
A4346...  A                   Cath indw foley 3 way..  .........  .........  .........  ...........  ...........
A4347...  A                   Male external catheter.  .........  .........  .........  ...........  ...........
A4351...  A                   Straight tip urine       .........  .........  .........  ...........  ...........
                               catheter.
A4352...  A                   Coude tip urinary        .........  .........  .........  ...........  ...........
                               catheter.
A4353...  A                   Intermittent urinary     .........  .........  .........  ...........  ...........
                               cath.
A4354...  A                   Cath insertion tray w/   .........  .........  .........  ...........  ...........
                               bag.
A4355...  A                   Bladder irrigation       .........  .........  .........  ...........  ...........
                               tubing.
A4356...  A                   Ext ureth clmp or compr  .........  .........  .........  ...........  ...........
                               dvc.
A4357...  A                   Bedside drainage bag...  .........  .........  .........  ...........  ...........
A4358...  A                   Urinary leg bag........  .........  .........  .........  ...........  ...........
A4359...  A                   Urinary suspensory w/o   .........  .........  .........  ...........  ...........
                               leg b.
A4361...  A                   Ostomy face plate......  .........  .........  .........  ...........  ...........
A4362...  A                   Solid skin barrier.....  .........  .........  .........  ...........  ...........
A4363...  A                   Liquid skin barrier....  .........  .........  .........  ...........  ...........
A4364...  A                   Ostomy/cath adhesive...  .........  .........  .........  ...........  ...........
A4365...  A                   Ostomy adhesive remover  .........  .........  .........  ...........  ...........
                               wipe.
A4367...  A                   Ostomy belt............  .........  .........  .........  ...........  ...........
A4368...  A                   Ostomy filter..........  .........  .........  .........  ...........  ...........
A4397...  A                   Irrigation supply        .........  .........  .........  ...........  ...........
                               sleeve.
A4398...  A                   Ostomy irrigation bag..  .........  .........  .........  ...........  ...........
A4399...  A                   Ostomy irrig cone/cath   .........  .........  .........  ...........  ...........
                               w brs.
A4400...  A                   Ostomy irrigation set..  .........  .........  .........  ...........  ...........

[[Page 47724]]


A4402...  A                   Lubricant per ounce....  .........  .........  .........  ...........  ...........
A4404...  A                   Ostomy ring each.......  .........  .........  .........  ...........  ...........
A4421...  A                   Ostomy supply misc.....  .........  .........  .........  ...........  ...........
A4454...  A                   Tape all types all       .........  .........  .........  ...........  ...........
                               sizes.
A4455...  A                   Adhesive remover per     .........  .........  .........  ...........  ...........
                               ounce.
A4460...  A                   Elastic compression      .........  .........  .........  ...........  ...........
                               bandage.
A4462...  A                   Abdmnl drssng holder/    .........  .........  .........  ...........  ...........
                               binder.
A4465...  A                   Non-elastic extremity    .........  .........  .........  ...........  ...........
                               binder.
A4470...  A                   Gravlee jet washer.....  .........  .........  .........  ...........  ...........
A4480...  A                   Vabra aspirator........  .........  .........  .........  ...........  ...........
A4481...  A                   Tracheostoma filter....  .........  .........  .........  ...........  ...........
A4490...  E                   Above knee surgical      .........  .........  .........  ...........  ...........
                               stocking.
A4495...  E                   Thigh length surg        .........  .........  .........  ...........  ...........
                               stocking.
A4500...  E                   Below knee surgical      .........  .........  .........  ...........  ...........
                               stocking.
A4510...  E                   Full length surg         .........  .........  .........  ...........  ...........
                               stocking.
A4550...  E                   Surgical trays.........  .........  .........  .........  ...........  ...........
A4554...  E                   Disposable underpads...  .........  .........  .........  ...........  ...........
A4556...  A                   Electrodes.............  .........  .........  .........  ...........  ...........
A4557...  A                   Lead wires.............  .........  .........  .........  ...........  ...........
A4558...  A                   Conductive paste or gel  .........  .........  .........  ...........  ...........
A4560...  A                   Pessary................  .........  .........  .........  ...........  ...........
A4565...  A                   Slings.................  .........  .........  .........  ...........  ...........
A4570...  A                   Splint.................  .........  .........  .........  ...........  ...........
A4572...  A                   Rib belt...............  .........  .........  .........  ...........  ...........
A4575...  E                   Hyperbaric o2 chamber    .........  .........  .........  ...........  ...........
                               disps.
A4580...  A                   Cast supplies (plaster)  .........  .........  .........  ...........  ...........
A4590...  A                   Special casting          .........  .........  .........  ...........  ...........
                               material.
A4595...  A                   TENS suppl 2 lead per    .........  .........  .........  ...........  ...........
                               month.
A4611...  A                   Heavy duty battery.....  .........  .........  .........  ...........  ...........
A4612...  A                   Battery cables.........  .........  .........  .........  ...........  ...........
A4613...  A                   Battery charger........  .........  .........  .........  ...........  ...........
A4615...  A                   Cannula nasal..........  .........  .........  .........  ...........  ...........
A4616...  A                   Tubing (oxygen) per      .........  .........  .........  ...........  ...........
                               foot.
A4617...  A                   Mouth piece............  .........  .........  .........  ...........  ...........
A4618...  A                   Breathing circuits.....  .........  .........  .........  ...........  ...........
A4619...  A                   Face tent..............  .........  .........  .........  ...........  ...........
A4620...  A                   Variable concentration   .........  .........  .........  ...........  ...........
                               mask.
A4621...  A                   Tracheotomy mask or      .........  .........  .........  ...........  ...........
                               collar.
A4622...  A                   Tracheostomy or          .........  .........  .........  ...........  ...........
                               larngectomy.
A4623...  A                   Tracheostomy inner       .........  .........  .........  ...........  ...........
                               cannula.
A4624...  A                   Tracheal suction tube..  .........  .........  .........  ...........  ...........
A4625...  A                   Trach care kit for new   .........  .........  .........  ...........  ...........
                               trach.
A4626...  A                   Tracheostomy cleaning    .........  .........  .........  ...........  ...........
                               brush.
A4627...  E                   Spacer bag/reservoir...  .........  .........  .........  ...........  ...........
A4628...  A                   Oropharyngeal suction    .........  .........  .........  ...........  ...........
                               cath.
A4629...  A                   Tracheostomy care kit..  .........  .........  .........  ...........  ...........
A4630...  A                   Repl bat t.e.n.s. own    .........  .........  .........  ...........  ...........
                               by pt.
A4631...  A                   Wheelchair battery.....  .........  .........  .........  ...........  ...........
A4635...  A                   Underarm crutch pad....  .........  .........  .........  ...........  ...........
A4636...  A                   Handgrip for cane etc..  .........  .........  .........  ...........  ...........
A4637...  A                   Repl tip cane/crutch/    .........  .........  .........  ...........  ...........
                               walker.
A4640...  A                   Alternating pressure     .........  .........  .........  ...........  ...........
                               pad.
A4641...  N                   Diagnostic imaging       .........  .........  .........  ...........  ...........
                               agent.
A4642...  N                   Satumomab pendetide per  .........  .........  .........  ...........  ...........
                               dose.
A4643...  N                   High dose contrast MRI.  .........  .........  .........  ...........  ...........
A4644...  N                   Contrast 100-199 MGs     .........  .........  .........  ...........  ...........
                               iodine.
A4645...  N                   Contrast 200-299 MGs     .........  .........  .........  ...........  ...........
                               iodine.
A4646...  N                   Contrast 300-399 MGs     .........  .........  .........  ...........  ...........
                               iodine.
A4647...  N                   Supp-paramagnetic contr  .........  .........  .........  ...........  ...........
                               mat.
A4649...  A                   Surgical supplies......  .........  .........  .........  ...........  ...........
A4650...  A                   Supp esrd centrifuge...  .........  .........  .........  ...........  ...........
A4655...  A                   Esrd syringe/needle....  .........  .........  .........  ...........  ...........
A4660...  A                   Esrd blood pressure      .........  .........  .........  ...........  ...........
                               device.
A4663...  A                   Esrd blood pressure      .........  .........  .........  ...........  ...........
                               cuff.
A4670...  E                   Auto blood pressure      .........  .........  .........  ...........  ...........
                               monitor.
A4680...  A                   Activated carbon         .........  .........  .........  ...........  ...........
                               filters.
A4690...  A                   Dialyzers..............  .........  .........  .........  ...........  ...........
A4700...  A                   Standard dialysate       .........  .........  .........  ...........  ...........
                               solution.
A4705...  A                   Bicarb dialysate         .........  .........  .........  ...........  ...........
                               solution.
A4712...  A                   Sterile water..........  .........  .........  .........  ...........  ...........
A4714...  A                   Treated water for        .........  .........  .........  ...........  ...........
                               dialysis.
A4730...  A                   Fistula cannulation set  .........  .........  .........  ...........  ...........
                               dial.
A4735...  A                   Local/topical            .........  .........  .........  ...........  ...........
                               anesthetics.
A4740...  A                   Esrd shunt accessory...  .........  .........  .........  ...........  ...........
A4750...  A                   Arterial or venous       .........  .........  .........  ...........  ...........
                               tubing.

[[Page 47725]]


A4755...  A                   Arterial and venous      .........  .........  .........  ...........  ...........
                               tubing.
A4760...  A                   Standard testing         .........  .........  .........  ...........  ...........
                               solution.
A4765...  A                   Dialysate concentrate..  .........  .........  .........  ...........  ...........
A4770...  A                   Blood testing supplies.  .........  .........  .........  ...........  ...........
A4771...  A                   Blood clotting time      .........  .........  .........  ...........  ...........
                               tube.
A4772...  A                   Dextrostick/glucose      .........  .........  .........  ...........  ...........
                               strips.
A4773...  A                   Hemostix...............  .........  .........  .........  ...........  ...........
A4774...  A                   Ammonia test paper.....  .........  .........  .........  ...........  ...........
A4780...  A                   Esrd sterilizing agent.  .........  .........  .........  ...........  ...........
A4790...  A                   Esrd cleansing agents..  .........  .........  .........  ...........  ...........
A4800...  A                   Heparin/antidote         .........  .........  .........  ...........  ...........
                               dialysis.
A4820...  A                   Supplies hemodialysis    .........  .........  .........  ...........  ...........
                               kit.
A4850...  A                   Rubber tipped hemostats  .........  .........  .........  ...........  ...........
A4860...  A                   Disposable catheter      .........  .........  .........  ...........  ...........
                               caps.
A4870...  A                   Plumbing/electrical      .........  .........  .........  ...........  ...........
                               work.
A4880...  A                   Water storage tanks....  .........  .........  .........  ...........  ...........
A4890...  A                   Contracts/repair/        .........  .........  .........  ...........  ...........
                               maintenance.
A4900...  A                   Capd supply kit........  .........  .........  .........  ...........  ...........
A4901...  A                   Capd supply kit........  .........  .........  .........  ...........  ...........
A4905...  A                   Ipd supply kit.........  .........  .........  .........  ...........  ...........
A4910...  A                   Esrd nonmedical          .........  .........  .........  ...........  ...........
                               supplies.
A4912...  A                   Gomco drain bottle.....  .........  .........  .........  ...........  ...........
A4913...  A                   Esrd supply............  .........  .........  .........  ...........  ...........
A4914...  A                   Preparation kit........  .........  .........  .........  ...........  ...........
A4918...  A                   Venous pressure clamp..  .........  .........  .........  ...........  ...........
A4919...  A                   Supp dialysis dialyzer   .........  .........  .........  ...........  ...........
                               holde.
A4920...  A                   Harvard pressure clamp.  .........  .........  .........  ...........  ...........
A4921...  A                   Measuring cylinder.....  .........  .........  .........  ...........  ...........
A4927...  A                   Gloves.................  .........  .........  .........  ...........  ...........
A5051...  A                   Pouch clsd w barr        .........  .........  .........  ...........  ...........
                               attached.
A5052...  A                   Clsd ostomy pouch w/o    .........  .........  .........  ...........  ...........
                               barr.
A5053...  A                   Clsd ostomy pouch        .........  .........  .........  ...........  ...........
                               faceplate.
A5054...  A                   Clsd ostomy pouch w/     .........  .........  .........  ...........  ...........
                               flange.
A5055...  A                   Stoma cap..............  .........  .........  .........  ...........  ...........
A5061...  A                   Pouch drainable w        .........  .........  .........  ...........  ...........
                               barrier at.
A5062...  A                   Drnble ostomy pouch w/o  .........  .........  .........  ...........  ...........
                               barr.
A5063...  A                   Drain ostomy pouch w/    .........  .........  .........  ...........  ...........
                               flange.
A5064...  E                   Drain ostomy pouch w/    .........  .........  .........  ...........  ...........
                               fceplte.
A5065...  E                   Drain ostomy pouch on    .........  .........  .........  ...........  ...........
                               fcplte.
A5071...  A                   Urinary pouch w/barrier  .........  .........  .........  ...........  ...........
A5072...  A                   Urinary pouch w/o        .........  .........  .........  ...........  ...........
                               barrier.
A5073...  A                   Urinary pouch on barr w/ .........  .........  .........  ...........  ...........
                               flng.
A5074...  E                   Urinary pouch w/         .........  .........  .........  ...........  ...........
                               faceplate.
A5075...  E                   Urinary pouch on         .........  .........  .........  ...........  ...........
                               faceplate.
A5081...  A                   Continent stoma plug...  .........  .........  .........  ...........  ...........
A5082...  A                   Continent stoma          .........  .........  .........  ...........  ...........
                               catheter.
A5093...  A                   Ostomy accessory convex  .........  .........  .........  ...........  ...........
                               inse.
A5102...  A                   Bedside drain btl w/wo   .........  .........  .........  ...........  ...........
                               tube.
A5105...  A                   Urinary suspensory.....  .........  .........  .........  ...........  ...........
A5112...  A                   Urinary leg bag........  .........  .........  .........  ...........  ...........
A5113...  A                   Latex leg strap........  .........  .........  .........  ...........  ...........
A5114...  A                   Foam/fabric leg strap..  .........  .........  .........  ...........  ...........
A5119...  A                   Skin barrier wipes box   .........  .........  .........  ...........  ...........
                               pr 50.
A5121...  A                   Solid skin barrier 6x6.  .........  .........  .........  ...........  ...........
A5122...  A                   Solid skin barrier 8x8.  .........  .........  .........  ...........  ...........
A5123...  A                   Skin barrier with        .........  .........  .........  ...........  ...........
                               flange.
A5126...  A                   Adhesive disc/foam pad.  .........  .........  .........  ...........  ...........
A5131...  A                   Appliance cleaner......  .........  .........  .........  ...........  ...........
A5149...  A                   Incontinence/ostomy      .........  .........  .........  ...........  ...........
                               supply.
A5500...  A                   Diab shoe for density    .........  .........  .........  ...........  ...........
                               insert.
A5501...  A                   Diabetic custom molded   .........  .........  .........  ...........  ...........
                               shoe.
A5502...  A                   Diabetic shoe density    .........  .........  .........  ...........  ...........
                               insert.
A5503...  A                   Diabetic shoe w/roller/  .........  .........  .........  ...........  ...........
                               rockr.
A5504...  A                   Diabetic shoe with       .........  .........  .........  ...........  ...........
                               wedge.
A5505...  A                   Diab shoe w/metatarsal   .........  .........  .........  ...........  ...........
                               bar.
A5506...  A                   Diabetic shoe w/off set  .........  .........  .........  ...........  ...........
                               heel.
A5507...  A                   Modification diabetic    .........  .........  .........  ...........  ...........
                               shoe.
A6020...  A                   Collagen dressing cover  .........  .........  .........  ...........  ...........
                               ea.
A6025...  E                   Silicone gel sheet,      .........  .........  .........  ...........  ...........
                               each.
A6154...  A                   Wound pouch each.......  .........  .........  .........  ...........  ...........
A6196...  A                   Alginate dressing <=16   .........  .........  .........  ...........  ...........
                               sq in.
A6197...  A                   Alginate drsg >16 <=48   .........  .........  .........  ...........  ...........
                               sq in.
A6198...  A                   Alginate dressing > 48   .........  .........  .........  ...........  ...........
                               sq in.
A6199...  A                   Alginate drsg wound      .........  .........  .........  ...........  ...........
                               filler.
A6203...  A                   Composite drsg <= 16 sq  .........  .........  .........  ...........  ...........
                               in.

[[Page 47726]]


A6204...  A                   Composite drsg >16<=48   .........  .........  .........  ...........  ...........
                               sq in.
A6205...  A                   Composite drsg > 48 sq   .........  .........  .........  ...........  ...........
                               in.
A6206...  A                   Contact layer <= 16 sq   .........  .........  .........  ...........  ...........
                               in.
A6207...  A                   Contact layer >16<= 48   .........  .........  .........  ...........  ...........
                               sq in.
A6208...  A                   Contact layer > 48 sq    .........  .........  .........  ...........  ...........
                               in.
A6209...  A                   Foam drsg <=16 sq in w/  .........  .........  .........  ...........  ...........
                               o bdr.
A6210...  A                   Foam drg >16<=48 sq in   .........  .........  .........  ...........  ...........
                               w/o b.
A6211...  A                   Foam drg > 48 sq in w/o  .........  .........  .........  ...........  ...........
                               brdr.
A6212...  A                   Foam drg <=16 sq in w/   .........  .........  .........  ...........  ...........
                               border.
A6213...  A                   Foam drg >16<=48 sq in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6214...  A                   Foam drg > 48 sq in w/   .........  .........  .........  ...........  ...........
                               border.
A6215...  A                   Foam dressing wound      .........  .........  .........  ...........  ...........
                               filler.
A6216...  A                   Non-sterile gauze<=16    .........  .........  .........  ...........  ...........
                               sq in.
A6217...  A                   Non-sterile              .........  .........  .........  ...........  ...........
                               gauze>16<=48 sq.
A6218...  A                   Non-sterile gauze > 48   .........  .........  .........  ...........  ...........
                               sq in.
A6219...  A                   Gauze <= 16 sq in w/     .........  .........  .........  ...........  ...........
                               border.
A6220...  A                   Gauze >16 <=48 sq in w/  .........  .........  .........  ...........  ...........
                               bordr.
A6221...  A                   Gauze > 48 sq in w/      .........  .........  .........  ...........  ...........
                               border.
A6222...  A                   Gauze <=16 in no w/sal   .........  .........  .........  ...........  ...........
                               w/o b.
A6223...  A                   Gauze >16<=48 no w/sal   .........  .........  .........  ...........  ...........
                               w/o b.
A6224...  A                   Gauze > 48 in no w/sal   .........  .........  .........  ...........  ...........
                               w/o b.
A6228...  A                   Gauze <= 16 sq in water/ .........  .........  .........  ...........  ...........
                               sal.
A6229...  A                   Gauze >16<=48 sq in      .........  .........  .........  ...........  ...........
                               watr/sal.
A6230...  A                   Gauze > 48 sq in water/  .........  .........  .........  ...........  ...........
                               salne.
A6234...  A                   Hydrocolld drg <=16 w/o  .........  .........  .........  ...........  ...........
                               bdr.
A6235...  A                   Hydrocolld drg >16<=48   .........  .........  .........  ...........  ...........
                               w/o b.
A6236...  A                   Hydrocolld drg > 48 in   .........  .........  .........  ...........  ...........
                               w/o b.
A6237...  A                   Hydrocolld drg <=16 in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6238...  A                   Hydrocolld drg >16<=48   .........  .........  .........  ...........  ...........
                               w/bdr.
A6239...  A                   Hydrocolld drg > 48 in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6240...  A                   Hydrocolld drg filler    .........  .........  .........  ...........  ...........
                               paste.
A6241...  A                   Hydrocolloid drg filler  .........  .........  .........  ...........  ...........
                               dry.
A6242...  A                   Hydrogel drg <=16 in w/  .........  .........  .........  ...........  ...........
                               o bdr.
A6243...  A                   Hydrogel drg >16<=48 w/  .........  .........  .........  ...........  ...........
                               o bdr.
A6244...  A                   Hydrogel drg >48 in w/o  .........  .........  .........  ...........  ...........
                               bdr.
A6245...  A                   Hydrogel drg <= 16 in w/ .........  .........  .........  ...........  ...........
                               bdr.
A6246...  A                   Hydrogel drg >16<=48 in  .........  .........  .........  ...........  ...........
                               w/b.
A6247...  A                   Hydrogel drg > 48 sq in  .........  .........  .........  ...........  ...........
                               w/b.
A6248...  A                   Hydrogel drsg gel        .........  .........  .........  ...........  ...........
                               filler.
A6250...  A                   Skin seal protect        .........  .........  .........  ...........  ...........
                               moisturizr.
A6251...  A                   Absorpt drg <=16 sq in   .........  .........  .........  ...........  ...........
                               w/o b.
A6252...  A                   Absorpt drg >16 <=48 w/  .........  .........  .........  ...........  ...........
                               o bdr.
A6253...  A                   Absorpt drg > 48 sq in   .........  .........  .........  ...........  ...........
                               w/o b.
A6254...  A                   Absorpt drg <=16 sq in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6255...  A                   Absorpt drg >16<=48 in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6256...  A                   Absorpt drg > 48 sq in   .........  .........  .........  ...........  ...........
                               w/bdr.
A6257...  A                   Transparent film <= 16   .........  .........  .........  ...........  ...........
                               sq in.
A6258...  A                   Transparent film         .........  .........  .........  ...........  ...........
                               >16<=48 in.
A6259...  A                   Transparent film > 48    .........  .........  .........  ...........  ...........
                               sq in.
A6260...  A                   Wound cleanser any type/ .........  .........  .........  ...........  ...........
                               size.
A6261...  A                   Wound filler gel/paste/  .........  .........  .........  ...........  ...........
                               oz.
A6262...  A                   Wound filler dry form/   .........  .........  .........  ...........  ...........
                               gram.
A6263...  A                   Non-sterile elastic      .........  .........  .........  ...........  ...........
                               gauze/yd.
A6264...  A                   Non-sterile no elastic   .........  .........  .........  ...........  ...........
                               gauze.
A6265...  A                   Tape per 18 sq inches..  .........  .........  .........  ...........  ...........
A6266...  A                   Impreg gauze no h20/sal/ .........  .........  .........  ...........  ...........
                               yard.
A6402...  A                   Sterile gauze <= 16 sq   .........  .........  .........  ...........  ...........
                               in.
A6403...  A                   Sterile gauze>16 <= 48   .........  .........  .........  ...........  ...........
                               sq in.
A6404...  A                   Sterile gauze > 48 sq    .........  .........  .........  ...........  ...........
                               in.
A6405...  A                   Sterile elastic gauze/   .........  .........  .........  ...........  ...........
                               yd.
A6406...  A                   Sterile non-elastic      .........  .........  .........  ...........  ...........
                               gauze/yd.
A9150...  E                   Misc/exper non-          .........  .........  .........  ...........  ...........
                               prescript dru.
A9160...  E                   Podiatrist non-covered   .........  .........  .........  ...........  ...........
                               servi.
A9170...  E                   Chiropractor non-        .........  .........  .........  ...........  ...........
                               covered ser.
A9190...  E                   Misc/expe personal       .........  .........  .........  ...........  ...........
                               comfort i.
A9270...  E                   Non-covered item or      .........  .........  .........  ...........  ...........
                               service.
A9300...  E                   Exercise equipment.....  .........  .........  .........  ...........  ...........
A9500...  N                   Technetium TC 99m        .........  .........  .........  ...........  ...........
                               sestamibi.
A9502...  N                   Technetium TC99M         .........  .........  .........  ...........  ...........
                               tetrofosmin.
A9503...  N                   Technetium TC 99m        .........  .........  .........  ...........  ...........
                               medronate.
A9505...  N                   Thallous chloride TL     .........  .........  .........  ...........  ...........
                               201/mci.
A9600...  N                   Strontium-89 chloride..  .........  .........  .........  ...........  ...........
B4034...  A                   Enter feed supkit syr    .........  .........  .........  ...........  ...........
                               by day.
B4035...  A                   Enteral feed supp pump   .........  .........  .........  ...........  ...........
                               per d.
B4036...  A                   Enteral feed sup kit     .........  .........  .........  ...........  ...........
                               grav by.

[[Page 47727]]


B4081...  A                   Enteral ng tubing w/     .........  .........  .........  ...........  ...........
                               stylet.
B4082...  A                   Enteral ng tubing w/o    .........  .........  .........  ...........  ...........
                               stylet.
B4083...  A                   Enteral stomach tube     .........  .........  .........  ...........  ...........
                               levine.
B4084...  A                   Gastrostomy/jejunostomy  .........  .........  .........  ...........  ...........
                               tubi.
B4085...  A                   Gastrostomy tube w/ring  .........  .........  .........  ...........  ...........
                               each.
B4150...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category i.
B4151...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category i-.
B4152...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category ii.
B4153...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category ii.
B4154...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category IV.
B4155...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category v.
B4156...  A                   Enteral formulae         .........  .........  .........  ...........  ...........
                               category vi.
B4164...  A                   Parenteral 50% dextrose  .........  .........  .........  ...........  ...........
                               solu.
B4168...  A                   Parenteral sol amino     .........  .........  .........  ...........  ...........
                               acid 3..
B4172...  A                   Parenteral sol amino     .........  .........  .........  ...........  ...........
                               acid 5..
B4176...  A                   Parenteral sol amino     .........  .........  .........  ...........  ...........
                               acid 7-.
B4178...  A                   Parenteral sol amino     .........  .........  .........  ...........  ...........
                               acid >.
B4180...  A                   Parenteral sol carb >    .........  .........  .........  ...........  ...........
                               50%.
B4184...  A                   Parenteral sol lipids    .........  .........  .........  ...........  ...........
                               10%.
B4186...  A                   Parenteral sol lipids    .........  .........  .........  ...........  ...........
                               20%.
B4189...  A                   Parenteral sol amino     .........  .........  .........  ...........  ...........
                               acid &.
B4193...  A                   Parenteral sol 52-73 gm  .........  .........  .........  ...........  ...........
                               prot.
B4197...  A                   Parenteral sol 74-100    .........  .........  .........  ...........  ...........
                               gm pro.
B4199...  A                   Parenteral sol > 100gm   .........  .........  .........  ...........  ...........
                               prote.
B4216...  A                   Parenteral nutrition     .........  .........  .........  ...........  ...........
                               additiv.
B4220...  A                   Parenteral supply kit    .........  .........  .........  ...........  ...........
                               premix.
B4222...  A                   Parenteral supply kit    .........  .........  .........  ...........  ...........
                               homemi.
B4224...  A                   Parenteral               .........  .........  .........  ...........  ...........
                               administration ki.
B5000...  A                   Parenteral sol renal-    .........  .........  .........  ...........  ...........
                               amirosy.
B5100...  A                   Parenteral sol hepatic-  .........  .........  .........  ...........  ...........
                               fream.
B5200...  A                   Parenteral sol stres-    .........  .........  .........  ...........  ...........
                               brnch c.
B9000...  A                   Enter infusion pump w/o  .........  .........  .........  ...........  ...........
                               alrm.
B9002...  A                   Enteral infusion pump w/ .........  .........  .........  ...........  ...........
                                ala.
B9004...  A                   Parenteral infus pump    .........  .........  .........  ...........  ...........
                               portab.
B9006...  A                   Parenteral infus pump    .........  .........  .........  ...........  ...........
                               statio.
B9998...  A                   Enteral supp not         .........  .........  .........  ...........  ...........
                               otherwise c.
B9999...  A                   Parenteral supp not      .........  .........  .........  ...........  ...........
                               othrws c.
D0120...  E                   Periodic oral            .........  .........  .........  ...........  ...........
                               evaluation.
D0140...  E                   Limit oral eval problm   .........  .........  .........  ...........  ...........
                               focus.
D0150...  S                   Comprehensve oral              031       1.33     $70.52       $14.10       $14.10
                               evaluation.
D0160...  E                   Extensv oral eval prob   .........  .........  .........  ...........  ...........
                               focus.
D0210...  E                   Intraor complete film    .........  .........  .........  ...........  ...........
                               series.
D0220...  E                   Intraoral periapical     .........  .........  .........  ...........  ...........
                               first f.
D0230...  E                   Intraoral periapical ea  .........  .........  .........  ...........  ...........
                               add.
D0240...  S                   Intraoral occlusal film        031       1.33     $70.52       $14.10       $14.10
D0250...  S                   Extraoral first film...        031       1.33     $70.52       $14.10       $14.10
D0260...  S                   Extraoral ea additional        031       1.33     $70.52       $14.10       $14.10
                               film.
D0270...  S                   Dental bitewing single         031       1.33     $70.52       $14.10       $14.10
                               film.
D0272...  S                   Dental bitewings two           031       1.33     $70.52       $14.10       $14.10
                               films.
D0274...  S                   Dental bitewings four          031       1.33     $70.52       $14.10       $14.10
                               films.
D0290...  E                   Dental film skull/       .........  .........  .........  ...........  ...........
                               facial bon.
D0310...  E                   Dental saliography.....  .........  .........  .........  ...........  ...........
D0320...  E                   Dental tmj arthrogram    .........  .........  .........  ...........  ...........
                               incl i.
D0321...  E                   Dental other tmj films.  .........  .........  .........  ...........  ...........
D0322...  E                   Dental tomographic       .........  .........  .........  ...........  ...........
                               survey.
D0330...  E                   Dental panoramic film..  .........  .........  .........  ...........  ...........
D0340...  E                   Dental cephalometric     .........  .........  .........  ...........  ...........
                               film.
D0415...  E                   Bacteriologic study....  .........  .........  .........  ...........  ...........
D0425...  E                   Caries susceptibility    .........  .........  .........  ...........  ...........
                               test.
D0460...  S                   Pulp vitality test.....        031       1.33     $70.52       $14.10       $14.10
D0470...  E                   Diagnostic casts.......  .........  .........  .........  ...........  ...........
D0471...  S                   Diagnostic photographs.        031       1.33     $70.52       $14.10       $14.10
D0501...  S                   Histopathologic                031       1.33     $70.52       $14.10       $14.10
                               examinations.
D0502...  S                   Other oral pathology           031       1.33     $70.52       $14.10       $14.10
                               procedu.
D0999...  S                   Unspecified diagnostic         031       1.33     $70.52       $14.10       $14.10
                               proce.
D1110...  E                   Dental prophylaxis       .........  .........  .........  ...........  ...........
                               adult.
D1120...  E                   Dental prophylaxis       .........  .........  .........  ...........  ...........
                               child.
D1201...  E                   Topical fluor w prophy   .........  .........  .........  ...........  ...........
                               child.
D1203...  E                   Topical fluor w/o        .........  .........  .........  ...........  ...........
                               prophy chi.
D1204...  E                   Topical fluor w/o        .........  .........  .........  ...........  ...........
                               prophy adu.
D1205...  E                   Topical fluoride w/      .........  .........  .........  ...........  ...........
                               prophy a.
D1310...  E                   Nutri counsel-control    .........  .........  .........  ...........  ...........
                               caries.
D1320...  E                   Tobacco counseling.....  .........  .........  .........  ...........  ...........
D1330...  E                   Oral hygiene             .........  .........  .........  ...........  ...........
                               instruction.
D1351...  E                   Dental sealant per       .........  .........  .........  ...........  ...........
                               tooth.

[[Page 47728]]


D1510...  S                   Space maintainer fxd           031       1.33     $70.52       $14.10       $14.10
                               unilat.
D1515...  S                   Fixed bilat space              031       1.33     $70.52       $14.10       $14.10
                               maintainer.
D1520...  S                   Remove unilat space            031       1.33     $70.52       $14.10       $14.10
                               maintain.
D1525...  S                   Remove bilat space             031       1.33     $70.52       $14.10       $14.10
                               maintain.
D1550...  S                   Recement space                 031       1.33     $70.52       $14.10       $14.10
                               maintainer.
D2110...  E                   Amalgam one surface      .........  .........  .........  ...........  ...........
                               primary.
D2120...  E                   Amalgam two surfaces     .........  .........  .........  ...........  ...........
                               primary.
D2130...  E                   Amalgam three surfaces   .........  .........  .........  ...........  ...........
                               prima.
D2131...  E                   Amalgam four/more surf   .........  .........  .........  ...........  ...........
                               prima.
D2140...  E                   Amalgam one surface      .........  .........  .........  ...........  ...........
                               permanen.
D2150...  E                   Amalgam two surfaces     .........  .........  .........  ...........  ...........
                               permane.
D2160...  E                   Amalgam three surfaces   .........  .........  .........  ...........  ...........
                               perma.
D2161...  E                   Amalgam 4 or > surfaces  .........  .........  .........  ...........  ...........
                               perm.
D2210...  E                   Silcate cement per       .........  .........  .........  ...........  ...........
                               restorat.
D2330...  E                   Resin one surface-       .........  .........  .........  ...........  ...........
                               anterior.
D2331...  E                   Resin two surfaces-      .........  .........  .........  ...........  ...........
                               anterior.
D2332...  E                   Resin three surfaces-    .........  .........  .........  ...........  ...........
                               anterio.
D2335...  E                   Resin 4/> surf or w      .........  .........  .........  ...........  ...........
                               incis an.
D2336...  E                   Composite resin crown..  .........  .........  .........  ...........  ...........
D2380...  E                   Resin one surf poster    .........  .........  .........  ...........  ...........
                               primar.
D2381...  E                   Resin two surf poster    .........  .........  .........  ...........  ...........
                               primar.
D2382...  E                   Resin three/more surf    .........  .........  .........  ...........  ...........
                               post p.
D2385...  E                   Resin one surf poster    .........  .........  .........  ...........  ...........
                               perman.
D2386...  E                   Resin two surf poster    .........  .........  .........  ...........  ...........
                               perman.
D2387...  E                   Resin three/more surf    .........  .........  .........  ...........  ...........
                               post p.
D2410...  E                   Dental gold foil one     .........  .........  .........  ...........  ...........
                               surface.
D2420...  E                   Dental gold foil two     .........  .........  .........  ...........  ...........
                               surface.
D2430...  E                   Dental gold foil three   .........  .........  .........  ...........  ...........
                               surfa.
D2510...  E                   Dental inlay metalic 1   .........  .........  .........  ...........  ...........
                               surf.
D2520...  E                   Dental inlay metallic 2  .........  .........  .........  ...........  ...........
                               surf.
D2530...  E                   Dental inlay metl 3/     .........  .........  .........  ...........  ...........
                               more sur.
D2543...  E                   Dental onlay metallic 3  .........  .........  .........  ...........  ...........
                               surf.
D2544...  E                   Dental onlay metl 4/     .........  .........  .........  ...........  ...........
                               more sur.
D2610...  E                   Inlay porcelain/ceramic  .........  .........  .........  ...........  ...........
                               1 su.
D2620...  E                   Inlay porcelain/ceramic  .........  .........  .........  ...........  ...........
                               2 su.
D2630...  E                   Dental onlay porc 3/     .........  .........  .........  ...........  ...........
                               more sur.
D2642...  E                   Dental onlay porcelin 2  .........  .........  .........  ...........  ...........
                               surf.
D2643...  E                   Dental onlay porcelin 3  .........  .........  .........  ...........  ...........
                               surf.
D2644...  E                   Dental onlay porc 4/     .........  .........  .........  ...........  ...........
                               more sur.
D2650...  E                   Inlay composite/resin    .........  .........  .........  ...........  ...........
                               one su.
D2651...  E                   Inlay composite/resin    .........  .........  .........  ...........  ...........
                               two su.
D2652...  E                   Dental inlay resin 3/    .........  .........  .........  ...........  ...........
                               mre sur.
D2662...  E                   Dental onlay resin 2     .........  .........  .........  ...........  ...........
                               surface.
D2663...  E                   Dental onlay resin 3     .........  .........  .........  ...........  ...........
                               surface.
D2664...  E                   Dental onlay resin 4/    .........  .........  .........  ...........  ...........
                               mre sur.
D2710...  E                   Crown resin laboratory.  .........  .........  .........  ...........  ...........
D2720...  E                   Crown resin w/ high      .........  .........  .........  ...........  ...........
                               noble me.
D2721...  E                   Crown resin w/ base      .........  .........  .........  ...........  ...........
                               metal.
D2722...  E                   Crown resin w/ noble     .........  .........  .........  ...........  ...........
                               metal.
D2740...  E                   Crown porcelain/ceramic  .........  .........  .........  ...........  ...........
                               subs.
D2750...  E                   Crown porcelain w/ h     .........  .........  .........  ...........  ...........
                               noble m.
D2751...  E                   Crown porcelain fused    .........  .........  .........  ...........  ...........
                               base m.
D2752...  E                   Crown porcelain w/       .........  .........  .........  ...........  ...........
                               noble met.
D2790...  E                   Crown full cast high     .........  .........  .........  ...........  ...........
                               noble m.
D2791...  E                   Crown full cast base     .........  .........  .........  ...........  ...........
                               metal.
D2792...  E                   Crown full cast noble    .........  .........  .........  ...........  ...........
                               metal.
D2810...  E                   Crown 3/4 cast metallic  .........  .........  .........  ...........  ...........
D2910...  E                   Dental recement inlay..  .........  .........  .........  ...........  ...........
D2920...  E                   Dental recement crown..  .........  .........  .........  ...........  ...........
D2930...  E                   Prefab stnlss steel      .........  .........  .........  ...........  ...........
                               crwn pri.
D2931...  E                   Prefab stnlss steel      .........  .........  .........  ...........  ...........
                               crown pe.
D2932...  E                   Prefabricated resin      .........  .........  .........  ...........  ...........
                               crown.
D2933...  E                   Prefab stainless steel   .........  .........  .........  ...........  ...........
                               crown.
D2940...  E                   Dental sedative filling  .........  .........  .........  ...........  ...........
D2950...  E                   Core build-up incl any   .........  .........  .........  ...........  ...........
                               pins.
D2951...  E                   Tooth pin retention....  .........  .........  .........  ...........  ...........
D2952...  E                   Post and core cast +     .........  .........  .........  ...........  ...........
                               crown.
D2954...  E                   Prefab post/core +       .........  .........  .........  ...........  ...........
                               crown.
D2955...  E                   Post removal...........  .........  .........  .........  ...........  ...........
D2960...  E                   Laminate labial veneer.  .........  .........  .........  ...........  ...........
D2961...  E                   Lab labial veneer resin  .........  .........  .........  ...........  ...........
D2962...  E                   Lab labial veneer        .........  .........  .........  ...........  ...........
                               porcelain.
D2970...  S                   Temporary-fractured            031       1.33     $70.52       $14.10       $14.10
                               tooth.
D2980...  E                   Crown repair...........  .........  .........  .........  ...........  ...........
D2999...  S                   Dental unspec                  031       1.33     $70.52       $14.10       $14.10
                               restorative pr.

[[Page 47729]]


D3110...  E                   Pulp cap direct........  .........  .........  .........  ...........  ...........
D3120...  E                   Pulp cap indirect......  .........  .........  .........  ...........  ...........
D3220...  E                   Therapeutic pulpotomy..  .........  .........  .........  ...........  ...........
D3230...  E                   Pulpal therapy anterior  .........  .........  .........  ...........  ...........
                               prim.
D3240...  E                   Pulpal therapy           .........  .........  .........  ...........  ...........
                               posterior pri.
D3310...  E                   Anterior...............  .........  .........  .........  ...........  ...........
D3320...  E                   Root canal therapy 2     .........  .........  .........  ...........  ...........
                               canals.
D3330...  E                   Root canal therapy 3     .........  .........  .........  ...........  ...........
                               canals.
D3346...  E                   Retreat root canal       .........  .........  .........  ...........  ...........
                               anterior.
D3347...  E                   Retreat root canal       .........  .........  .........  ...........  ...........
                               bicuspid.
D3348...  E                   Retreat root canal       .........  .........  .........  ...........  ...........
                               molar.
D3351...  E                   Apexification/recalc     .........  .........  .........  ...........  ...........
                               initial.
D3352...  E                   Apexification/recalc     .........  .........  .........  ...........  ...........
                               interim.
D3353...  E                   Apexification/recalc     .........  .........  .........  ...........  ...........
                               final.
D3410...  E                   Apicoect/perirad surg    .........  .........  .........  ...........  ...........
                               anter.
D3421...  E                   Root surgery bicuspid..  .........  .........  .........  ...........  ...........
D3425...  E                   Root surgery molar.....  .........  .........  .........  ...........  ...........
D3426...  E                   Root surgery ea add      .........  .........  .........  ...........  ...........
                               root.
D3430...  E                   Retrograde filling.....  .........  .........  .........  ...........  ...........
D3450...  E                   Root amputation........  .........  .........  .........  ...........  ...........
D3460...  S                   Endodontic endosseous          031       1.33     $70.52       $14.10       $14.10
                               implan.
D3470...  E                   Intentional              .........  .........  .........  ...........  ...........
                               replantation.
D3910...  E                   Isolation-tooth w rubb   .........  .........  .........  ...........  ...........
                               dam.
D3920...  E                   Tooth splitting........  .........  .........  .........  ...........  ...........
D3950...  E                   Canal prep/fitting of    .........  .........  .........  ...........  ...........
                               dowel.
D3960...  E                   Bleaching of discolored  .........  .........  .........  ...........  ...........
                               toot.
D3999...  S                   Endodontic procedure...        031       1.33     $70.52       $14.10       $14.10
D4210...  E                   Gingivectomy/plasty per  .........  .........  .........  ...........  ...........
                               quad.
D4211...  E                   Gingivectomy/plasty per  .........  .........  .........  ...........  ...........
                               toot.
D4220...  E                   Gingival curettage per   .........  .........  .........  ...........  ...........
                               quadr.
D4240...  E                   Gingival flap proc w/    .........  .........  .........  ...........  ...........
                               planin.
D4249...  E                   Crown lengthen hard      .........  .........  .........  ...........  ...........
                               tissue.
D4250...  S                   Mucogingival surg per          031       1.33     $70.52       $14.10       $14.10
                               quadra.
D4260...  S                   Osseous surgery per            031       1.33     $70.52       $14.10       $14.10
                               quadrant.
D4263...  S                   Bone replce graft first        031       1.33     $70.52       $14.10       $14.10
                               site.
D4264...  S                   Bone replce graft each         031       1.33     $70.52       $14.10       $14.10
                               add.
D4266...  E                   Guided tiss regen        .........  .........  .........  ...........  ...........
                               resorble.
D4267...  E                   Guided tiss regen        .........  .........  .........  ...........  ...........
                               nonresorb.
D4270...  S                   Pedicle soft tissue            031       1.33     $70.52       $14.10       $14.10
                               graft pr.
D4271...  S                   Free soft tissue graft         031       1.33     $70.52       $14.10       $14.10
                               proc.
D4273...  S                   Subepithelial tissue           031       1.33     $70.52       $14.10       $14.10
                               graft.
D4274...  E                   Distal/proximal wedge    .........  .........  .........  ...........  ...........
                               proc.
D4320...  E                   Provision splnt          .........  .........  .........  ...........  ...........
                               intracoronal.
D4321...  E                   Provisional splint       .........  .........  .........  ...........  ...........
                               extracoro.
D4341...  E                   Periodontal scaling &    .........  .........  .........  ...........  ...........
                               root.
D4355...  S                   Full mouth debridement.        031       1.33     $70.52       $14.10       $14.10
D4381...  S                   Localized chemo                031       1.33     $70.52       $14.10       $14.10
                               delivery.
D4910...  E                   Periodontal maint        .........  .........  .........  ...........  ...........
                               procedures.
D4920...  E                   Unscheduled dressing     .........  .........  .........  ...........  ...........
                               change.
D4999...  E                   Unspecified periodontal  .........  .........  .........  ...........  ...........
                               proc.
D5110...  E                   Dentures complete        .........  .........  .........  ...........  ...........
                               maxillary.
D5120...  E                   Dentures complete        .........  .........  .........  ...........  ...........
                               mandible.
D5130...  E                   Dentures immediat        .........  .........  .........  ...........  ...........
                               maxillary.
D5140...  E                   Dentures immediat        .........  .........  .........  ...........  ...........
                               mandible.
D5211...  E                   Dentures maxill part     .........  .........  .........  ...........  ...........
                               resin.
D5212...  E                   Dentures mand part       .........  .........  .........  ...........  ...........
                               resin.
D5213...  E                   Dentures maxill part     .........  .........  .........  ...........  ...........
                               metal.
D5214...  E                   Dentures mandibl part    .........  .........  .........  ...........  ...........
                               metal.
D5281...  E                   Removable partial        .........  .........  .........  ...........  ...........
                               denture.
D5410...  E                   Dentures adjust cmplt    .........  .........  .........  ...........  ...........
                               maxil.
D5411...  E                   Dentures adjust cmplt    .........  .........  .........  ...........  ...........
                               mand.
D5421...  E                   Dentures adjust part     .........  .........  .........  ...........  ...........
                               maxill.
D5422...  E                   Dentures adjust part     .........  .........  .........  ...........  ...........
                               mandbl.
D5510...  E                   Dentur repr broken       .........  .........  .........  ...........  ...........
                               compl bas.
D5520...  E                   Replace denture teeth    .........  .........  .........  ...........  ...........
                               complt.
D5610...  E                   Dentures repair resin    .........  .........  .........  ...........  ...........
                               base.
D5620...  E                   Rep part denture cast    .........  .........  .........  ...........  ...........
                               frame.
D5630...  E                   Rep partial denture      .........  .........  .........  ...........  ...........
                               clasp.
D5640...  E                   Replace part denture     .........  .........  .........  ...........  ...........
                               teeth.
D5650...  E                   Add tooth to partial     .........  .........  .........  ...........  ...........
                               denture.
D5660...  E                   Add clasp to partial     .........  .........  .........  ...........  ...........
                               denture.
D5710...  E                   Dentures rebase cmplt    .........  .........  .........  ...........  ...........
                               maxil.
D5711...  E                   Dentures rebase cmplt    .........  .........  .........  ...........  ...........
                               mand.
D5720...  E                   Dentures rebase part     .........  .........  .........  ...........  ...........
                               maxill.
D5721...  E                   Dentures rebase part     .........  .........  .........  ...........  ...........
                               mandbl.

[[Page 47730]]


D5730...  E                   Denture reln cmplt       .........  .........  .........  ...........  ...........
                               maxil ch.
D5731...  E                   Denture reln cmplt mand  .........  .........  .........  ...........  ...........
                               chr.
D5740...  E                   Denture reln part maxil  .........  .........  .........  ...........  ...........
                               chr.
D5741...  E                   Denture reln part mand   .........  .........  .........  ...........  ...........
                               chr.
D5750...  E                   Denture reln cmplt max   .........  .........  .........  ...........  ...........
                               lab.
D5751...  E                   Denture reln cmplt mand  .........  .........  .........  ...........  ...........
                               lab.
D5760...  E                   Denture reln part maxil  .........  .........  .........  ...........  ...........
                               lab.
D5761...  E                   Denture reln part mand   .........  .........  .........  ...........  ...........
                               lab.
D5810...  E                   Denture interm cmplt     .........  .........  .........  ...........  ...........
                               maxill.
D5811...  E                   Denture interm cmplt     .........  .........  .........  ...........  ...........
                               mandbl.
D5820...  E                   Denture interm part      .........  .........  .........  ...........  ...........
                               maxill.
D5821...  E                   Denture interm part      .........  .........  .........  ...........  ...........
                               mandbl.
D5850...  E                   Denture tiss conditn     .........  .........  .........  ...........  ...........
                               maxill.
D5851...  E                   Denture tiss condtin     .........  .........  .........  ...........  ...........
                               mandbl.
D5860...  E                   Overdenture complete...  .........  .........  .........  ...........  ...........
D5861...  E                   Overdenture partial....  .........  .........  .........  ...........  ...........
D5862...  E                   Precision attachment...  .........  .........  .........  ...........  ...........
D5899...  E                   Removable prosthodontic  .........  .........  .........  ...........  ...........
                               proc.
D5911...  S                   Facial moulage                 031       1.33     $70.52       $14.10       $14.10
                               sectional.
D5912...  S                   Facial moulage complete        031       1.33     $70.52       $14.10       $14.10
D5913...  E                   Nasal prosthesis.......  .........  .........  .........  ...........  ...........
D5914...  E                   Auricular prosthesis...  .........  .........  .........  ...........  ...........
D5915...  E                   Orbital prosthesis.....  .........  .........  .........  ...........  ...........
D5916...  E                   Ocular prosthesis......  .........  .........  .........  ...........  ...........
D5919...  E                   Facial prosthesis......  .........  .........  .........  ...........  ...........
D5922...  E                   Nasal septal prosthesis  .........  .........  .........  ...........  ...........
D5923...  E                   Ocular prosthesis        .........  .........  .........  ...........  ...........
                               interim.
D5924...  E                   Cranial prosthesis.....  .........  .........  .........  ...........  ...........
D5925...  E                   Facial augmentation      .........  .........  .........  ...........  ...........
                               implant.
D5926...  E                   Replacement nasal        .........  .........  .........  ...........  ...........
                               prosthesis.
D5927...  E                   Auricular replacement..  .........  .........  .........  ...........  ...........
D5928...  E                   Orbital replacement....  .........  .........  .........  ...........  ...........
D5929...  E                   Facial replacement.....  .........  .........  .........  ...........  ...........
D5931...  E                   Surgical obturator.....  .........  .........  .........  ...........  ...........
D5932...  E                   Postsurgical obturator.  .........  .........  .........  ...........  ...........
D5933...  E                   Refitting of obturator.  .........  .........  .........  ...........  ...........
D5934...  E                   Mandibular flange        .........  .........  .........  ...........  ...........
                               prosthesis.
D5935...  E                   Mandibular denture       .........  .........  .........  ...........  ...........
                               prosth.
D5936...  E                   Temp obturator           .........  .........  .........  ...........  ...........
                               prosthesis.
D5937...  E                   Trismus appliance......  .........  .........  .........  ...........  ...........
D5951...  E                   Feeding aid............  .........  .........  .........  ...........  ...........
D5952...  E                   Pediatric speech aid...  .........  .........  .........  ...........  ...........
D5953...  E                   Adult speech aid.......  .........  .........  .........  ...........  ...........
D5954...  E                   Superimposed prosthesis  .........  .........  .........  ...........  ...........
D5955...  E                   Palatal lift prosthesis  .........  .........  .........  ...........  ...........
D5958...  E                   Intraoral con def inter  .........  .........  .........  ...........  ...........
                               plt.
D5959...  E                   Intraoral con def mod    .........  .........  .........  ...........  ...........
                               palat.
D5960...  E                   Modify speech aid        .........  .........  .........  ...........  ...........
                               prosthesis.
D5982...  E                   Surgical stent.........  .........  .........  .........  ...........  ...........
D5983...  S                   Radiation applicator...        031       1.33     $70.52       $14.10       $14.10
D5984...  S                   Radiation shield.......        031       1.33     $70.52       $14.10       $14.10
D5985...  S                   Radiation cone locator.        031       1.33     $70.52       $14.10       $14.10
D5986...  E                   Fluoride applicator....  .........  .........  .........  ...........  ...........
D5987...  S                   Commissure splint......        031       1.33     $70.52       $14.10       $14.10
D5988...  E                   Surgical splint........  .........  .........  .........  ...........  ...........
D5999...  E                   Maxillofacial            .........  .........  .........  ...........  ...........
                               prosthesis.
D6010...  E                   Odontics endosteal       .........  .........  .........  ...........  ...........
                               implant.
D6020...  E                   Odontics abutment        .........  .........  .........  ...........  ...........
                               placement.
D6040...  E                   Odontics eposteal        .........  .........  .........  ...........  ...........
                               implant.
D6050...  E                   Odontics transosteal     .........  .........  .........  ...........  ...........
                               implnt.
D6055...  E                   Implant connecting bar.  .........  .........  .........  ...........  ...........
D6080...  E                   Implant maintenance....  .........  .........  .........  ...........  ...........
D6090...  E                   Repair implant.........  .........  .........  .........  ...........  ...........
D6095...  E                   Odontics repr abutment.  .........  .........  .........  ...........  ...........
D6100...  E                   Removal of implant.....  .........  .........  .........  ...........  ...........
D6199...  E                   Implant procedure......  .........  .........  .........  ...........  ...........
D6210...  E                   Prosthodont high noble   .........  .........  .........  ...........  ...........
                               metal.
D6211...  E                   Bridge base metal cast.  .........  .........  .........  ...........  ...........
D6212...  E                   Bridge noble metal cast  .........  .........  .........  ...........  ...........
D6240...  E                   Bridge porcelain high    .........  .........  .........  ...........  ...........
                               noble.
D6241...  E                   Bridge porcelain base    .........  .........  .........  ...........  ...........
                               metal.
D6242...  E                   Bridge porcelain nobel   .........  .........  .........  ...........  ...........
                               metal.
D6250...  E                   Bridge resin w/high      .........  .........  .........  ...........  ...........
                               noble.
D6251...  E                   Bridge resin base metal  .........  .........  .........  ...........  ...........
D6252...  E                   Bridge resin w/noble     .........  .........  .........  ...........  ...........
                               metal.

[[Page 47731]]


D6520...  E                   Dental retainer two      .........  .........  .........  ...........  ...........
                               surfaces.
D6530...  E                   Retainer metallic 3+     .........  .........  .........  ...........  ...........
                               surface.
D6543...  E                   Dental retainr onlay 3   .........  .........  .........  ...........  ...........
                               surf.
D6544...  E                   Dental retainr onlay 4/  .........  .........  .........  ...........  ...........
                               more.
D6545...  E                   Dental retainr cast      .........  .........  .........  ...........  ...........
                               metl.
D6720...  E                   Retain crown resin w hi  .........  .........  .........  ...........  ...........
                               nble.
D6721...  E                   Crown resin w/base       .........  .........  .........  ...........  ...........
                               metal.
D6722...  E                   Crown resin w/noble      .........  .........  .........  ...........  ...........
                               metal.
D6750...  E                   Crown porcelain high     .........  .........  .........  ...........  ...........
                               noble.
D6751...  E                   Crown porcelain base     .........  .........  .........  ...........  ...........
                               metal.
D6752...  E                   Crown porcelain noble    .........  .........  .........  ...........  ...........
                               metal.
D6780...  E                   Crown 3/4 high noble     .........  .........  .........  ...........  ...........
                               metal.
D6790...  E                   Crown full high noble    .........  .........  .........  ...........  ...........
                               metal.
D6791...  E                   Crown full base metal    .........  .........  .........  ...........  ...........
                               cast.
D6792...  E                   Crown full noble metal   .........  .........  .........  ...........  ...........
                               cast.
D6920...  S                   Dental connector bar...        031       1.33     $70.52       $14.10       $14.10
D6930...  E                   Dental recement bridge.  .........  .........  .........  ...........  ...........
D6940...  E                   Stress breaker.........  .........  .........  .........  ...........  ...........
D6950...  E                   Precision attachment...  .........  .........  .........  ...........  ...........
D6970...  E                   Post & core plus         .........  .........  .........  ...........  ...........
                               retainer.
D6971...  E                   Cast post bridge         .........  .........  .........  ...........  ...........
                               retainer.
D6972...  E                   Prefab post & core plus  .........  .........  .........  ...........  ...........
                               reta.
D6973...  E                   Core build up for        .........  .........  .........  ...........  ...........
                               retainer.
D6975...  E                   Coping metal...........  .........  .........  .........  ...........  ...........
D6980...  E                   Bridge repair..........  .........  .........  .........  ...........  ...........
D6999...  E                   Fixed prosthodontic      .........  .........  .........  ...........  ...........
                               proc.
D7110...  S                   Oral surgery single            031       1.33     $70.52       $14.10       $14.10
                               tooth.
D7120...  S                   Each add tooth                 031       1.33     $70.52       $14.10       $14.10
                               extraction.
D7130...  S                   Tooth root removal.....        031       1.33     $70.52       $14.10       $14.10
D7210...  S                   Rem imp tooth w mucoper        031       1.33     $70.52       $14.10       $14.10
                               flp.
D7220...  S                   Impact tooth remov soft        031       1.33     $70.52       $14.10       $14.10
                               tiss.
D7230...  S                   Impact tooth remov part        031       1.33     $70.52       $14.10       $14.10
                               bony.
D7240...  S                   Impact tooth remov comp        031       1.33     $70.52       $14.10       $14.10
                               bony.
D7241...  S                   Impact tooth rem bony w/       031       1.33     $70.52       $14.10       $14.10
                               comp.
D7250...  S                   Tooth root removal.....        031       1.33     $70.52       $14.10       $14.10
D7260...  S                   Oral antral fistula            031       1.33     $70.52       $14.10       $14.10
                               closure.
D7270...  E                   Tooth reimplantation...  .........  .........  .........  ...........  ...........
D7272...  E                   Tooth transplantation..  .........  .........  .........  ...........  ...........
D7280...  E                   Exposure impact tooth    .........  .........  .........  ...........  ...........
                               orthod.
D7281...  E                   Exposure tooth aid       .........  .........  .........  ...........  ...........
                               eruption.
D7285...  E                   Biopsy of oral tissue    .........  .........  .........  ...........  ...........
                               hard.
D7286...  E                   Biopsy of oral tissue    .........  .........  .........  ...........  ...........
                               soft.
D7290...  E                   Repositioning of teeth.  .........  .........  .........  ...........  ...........
D7291...  S                   Transseptal fiberotomy.        031       1.33     $70.52       $14.10       $14.10
D7310...  E                   Alveoplasty w/           .........  .........  .........  ...........  ...........
                               extraction.
D7320...  E                   Alveoplasty w/o          .........  .........  .........  ...........  ...........
                               extraction.
D7340...  E                   Vestibuloplasty ridge    .........  .........  .........  ...........  ...........
                               extens.
D7350...  E                   Vestibuloplasty exten    .........  .........  .........  ...........  ...........
                               graft.
D7410...  E                   Rad exc lesion up to     .........  .........  .........  ...........  ...........
                               1.25 cm.
D7420...  E                   Lesion > 1.25 cm.......  .........  .........  .........  ...........  ...........
D7430...  E                   Exc benign tumor to      .........  .........  .........  ...........  ...........
                               1.25 cm.
D7431...  E                   Benign tumor exc > 1.25  .........  .........  .........  ...........  ...........
                               cm.
D7440...  E                   Malig tumor exc to 1.25  .........  .........  .........  ...........  ...........
                               cm.
D7441...  E                   Malig tumor > 1.25 cm..  .........  .........  .........  ...........  ...........
D7450...  E                   Rem odontogen cyst to    .........  .........  .........  ...........  ...........
                               1.25cm.
D7451...  E                   Rem odontogen cyst >     .........  .........  .........  ...........  ...........
                               1.25 cm.
D7460...  E                   Rem nonodonto cyst to    .........  .........  .........  ...........  ...........
                               1.25cm.
D7461...  E                   Rem nonodonto cyst >     .........  .........  .........  ...........  ...........
                               1.25 cm.
D7465...  E                   Lesion destruction.....  .........  .........  .........  ...........  ...........
D7470...  E                   Rem exostosis maxilla/   .........  .........  .........  ...........  ...........
                               mandib.
D7480...  E                   Partial ostectomy......  .........  .........  .........  ...........  ...........
D7490...  E                   Mandible resection.....  .........  .........  .........  ...........  ...........
D7510...  E                   I&d absc intraoral soft  .........  .........  .........  ...........  ...........
                               tiss.
D7520...  E                   I&d abscess extraoral..  .........  .........  .........  ...........  ...........
D7530...  E                   Removal fb skin/areolar  .........  .........  .........  ...........  ...........
                               tiss.
D7540...  E                   Removal of fb reaction.  .........  .........  .........  ...........  ...........
D7550...  E                   Removal of sloughed off  .........  .........  .........  ...........  ...........
                               bone.
D7560...  E                   Maxillary sinusotomy...  .........  .........  .........  ...........  ...........
D7610...  E                   Maxilla open reduct      .........  .........  .........  ...........  ...........
                               simple.
D7620...  E                   Clsd reduct simpl        .........  .........  .........  ...........  ...........
                               maxilla fx.
D7630...  E                   Open red simpl mandible  .........  .........  .........  ...........  ...........
                               fx.
D7640...  E                   Clsd red simpl mandible  .........  .........  .........  ...........  ...........
                               fx.
D7650...  E                   Open red simp malar/     .........  .........  .........  ...........  ...........
                               zygom fx.
D7660...  E                   Clsd red simp malar/     .........  .........  .........  ...........  ...........
                               zygom fx.
D7670...  E                   Open red simple          .........  .........  .........  ...........  ...........
                               alveolus fx.

[[Page 47732]]


D7680...  E                   Reduct simple facial     .........  .........  .........  ...........  ...........
                               bone fx.
D7710...  E                   Maxilla open reduct      .........  .........  .........  ...........  ...........
                               compound.
D7720...  E                   Clsd reduct compd        .........  .........  .........  ...........  ...........
                               maxilla fx.
D7730...  E                   Open reduct compd        .........  .........  .........  ...........  ...........
                               mandble fx.
D7740...  E                   Clsd reduct compd        .........  .........  .........  ...........  ...........
                               mandble fx.
D7750...  E                   Open red comp malar/     .........  .........  .........  ...........  ...........
                               zygma fx.
D7760...  E                   Clsd red comp malar/     .........  .........  .........  ...........  ...........
                               zygma fx.
D7770...  E                   Open reduc compd         .........  .........  .........  ...........  ...........
                               alveolus fx.
D7780...  E                   Reduct compnd facial     .........  .........  .........  ...........  ...........
                               bone fx.
D7810...  E                   Tmj open reduct-         .........  .........  .........  ...........  ...........
                               dislocation.
D7820...  E                   Closed tmp manipulation  .........  .........  .........  ...........  ...........
D7830...  E                   Tmj manipulation under   .........  .........  .........  ...........  ...........
                               anest.
D7840...  E                   Removal of tmj condyle.  .........  .........  .........  ...........  ...........
D7850...  E                   Tmj meniscectomy.......  .........  .........  .........  ...........  ...........
D7852...  E                   Tmj repair of joint      .........  .........  .........  ...........  ...........
                               disc.
D7854...  E                   Tmj excisn of joint      .........  .........  .........  ...........  ...........
                               membrane.
D7856...  E                   Tmj cutting of a muscle  .........  .........  .........  ...........  ...........
D7858...  E                   Tmj reconstruction.....  .........  .........  .........  ...........  ...........
D7860...  E                   Tmj cutting into joint.  .........  .........  .........  ...........  ...........
D7865...  E                   Tmj reshaping            .........  .........  .........  ...........  ...........
                               components.
D7870...  E                   Tmj aspiration joint     .........  .........  .........  ...........  ...........
                               fluid.
D7872...  E                   Tmj diagnostic           .........  .........  .........  ...........  ...........
                               arthroscopy.
D7873...  E                   Tmj arthroscopy lysis    .........  .........  .........  ...........  ...........
                               adhesn.
D7874...  E                   Tmj arthroscopy disc     .........  .........  .........  ...........  ...........
                               reposit.
D7875...  E                   Tmj arthroscopy          .........  .........  .........  ...........  ...........
                               synovectomy.
D7876...  E                   Tmj arthroscopy          .........  .........  .........  ...........  ...........
                               discectomy.
D7877...  E                   Tmj arthroscopy          .........  .........  .........  ...........  ...........
                               debridement.
D7880...  E                   Occlusal orthotic        .........  .........  .........  ...........  ...........
                               appliance.
D7899...  E                   Tmj unspecified therapy  .........  .........  .........  ...........  ...........
D7910...  E                   Dent sutur recent wnd    .........  .........  .........  ...........  ...........
                               to 5cm.
D7911...  E                   Dental suture wound to   .........  .........  .........  ...........  ...........
                               5 cm.
D7912...  E                   Suture complicate wnd >  .........  .........  .........  ...........  ...........
                               5 cm.
D7920...  E                   Dental skin graft......  .........  .........  .........  ...........  ...........
D7940...  S                   Reshaping bone                 031       1.33     $70.52       $14.10       $14.10
                               orthognathic.
D7941...  E                   Bone cutting ramus       .........  .........  .........  ...........  ...........
                               closed.
D7942...  E                   Bone cutting ramus open  .........  .........  .........  ...........  ...........
D7943...  E                   Cutting ramus open w/    .........  .........  .........  ...........  ...........
                               graft.
D7944...  E                   Bone cutting segmented.  .........  .........  .........  ...........  ...........
D7945...  E                   Bone cutting body        .........  .........  .........  ...........  ...........
                               mandible.
D7946...  E                   Reconstruction maxilla   .........  .........  .........  ...........  ...........
                               total.
D7947...  E                   Reconstruct maxilla      .........  .........  .........  ...........  ...........
                               segment.
D7948...  E                   Reconstruct midface no   .........  .........  .........  ...........  ...........
                               graft.
D7949...  E                   Reconstruct midface w/   .........  .........  .........  ...........  ...........
                               graft.
D7950...  E                   Mandible graft.........  .........  .........  .........  ...........  ...........
D7955...  E                   Repair maxillofacial     .........  .........  .........  ...........  ...........
                               defects.
D7960...  E                   Frenulectomy/            .........  .........  .........  ...........  ...........
                               frenulotomy.
D7970...  E                   Excision hyperplastic    .........  .........  .........  ...........  ...........
                               tissue.
D7971...  E                   Excision pericoronal     .........  .........  .........  ...........  ...........
                               gingiva.
D7980...  E                   Sialolithotomy.........  .........  .........  .........  ...........  ...........
D7981...  E                   Excision of salivary     .........  .........  .........  ...........  ...........
                               gland.
D7982...  E                   Sialodochoplasty.......  .........  .........  .........  ...........  ...........
D7983...  E                   Closure of salivary      .........  .........  .........  ...........  ...........
                               fistula.
D7990...  E                   Emergency tracheotomy..  .........  .........  .........  ...........  ...........
D7991...  E                   Dental coronoidectomy..  .........  .........  .........  ...........  ...........
D7995...  E                   Synthetic graft facial   .........  .........  .........  ...........  ...........
                               bones.
D7996...  E                   Implant mandible for     .........  .........  .........  ...........  ...........
                               augment.
D7999...  E                   Oral surgery procedure.  .........  .........  .........  ...........  ...........
D8010...  E                   Limited dental tx        .........  .........  .........  ...........  ...........
                               primary.
D8020...  E                   Limited dental tx        .........  .........  .........  ...........  ...........
                               transition.
D8030...  E                   Limited dental tx        .........  .........  .........  ...........  ...........
                               adolescent.
D8040...  E                   Limited dental tx adult  .........  .........  .........  ...........  ...........
D8050...  E                   Intercep dental tx       .........  .........  .........  ...........  ...........
                               primary.
D8060...  E                   Intercep dental tx       .........  .........  .........  ...........  ...........
                               transitn.
D8070...  E                   Compre dental tx         .........  .........  .........  ...........  ...........
                               transition.
D8080...  E                   Compre dental tx         .........  .........  .........  ...........  ...........
                               adolescent.
D8090...  E                   Compre dental tx adult.  .........  .........  .........  ...........  ...........
D8210...  E                   Orthodontic rem          .........  .........  .........  ...........  ...........
                               appliance tx.
D8220...  E                   Fixed appliance therapy  .........  .........  .........  ...........  ...........
                               habt.
D8660...  E                   Preorthodontic tx visit  .........  .........  .........  ...........  ...........
D8670...  E                   Periodic orthodontc tx   .........  .........  .........  ...........  ...........
                               visit.
D8680...  E                   Orthodontic retention..  .........  .........  .........  ...........  ...........
D8690...  E                   Orthodontic treatment..  .........  .........  .........  ...........  ...........
D8999...  E                   Orthodontic procedure..  .........  .........  .........  ...........  ...........
D9110...  N                   Tx dental pain minor     .........  .........  .........  ...........  ...........
                               proc.
D9210...  E                   Dent anesthesia w/o      .........  .........  .........  ...........  ...........
                               surgery.

[[Page 47733]]


D9211...  E                   Regional block           .........  .........  .........  ...........  ...........
                               anesthesia.
D9212...  E                   Trigeminal block         .........  .........  .........  ...........  ...........
                               anesthesia.
D9215...  E                   Local anesthesia.......  .........  .........  .........  ...........  ...........
D9220...  E                   General anesthesia.....  .........  .........  .........  ...........  ...........
D9221...  E                   General anesthesia ea    .........  .........  .........  ...........  ...........
                               ad 15m.
D9230...  N                   Analgesia..............  .........  .........  .........  ...........  ...........
D9240...  E                   Intravenous sedation...  .........  .........  .........  ...........  ...........
D9310...  E                   Dental consultation....  .........  .........  .........  ...........  ...........
D9410...  E                   Dental house call......  .........  .........  .........  ...........  ...........
D9420...  E                   Hospital call..........  .........  .........  .........  ...........  ...........
D9430...  E                   Office visit during      .........  .........  .........  ...........  ...........
                               hours.
D9440...  E                   Office visit after       .........  .........  .........  ...........  ...........
                               hours.
D9610...  E                   Dent therapeutic drug    .........  .........  .........  ...........  ...........
                               inject.
D9630...  S                   Other drugs/medicaments        031       1.33     $70.52       $14.10       $14.10
D9910...  E                   Dent appl desensitizing  .........  .........  .........  ...........  ...........
                               med.
D9920...  E                   Behavior management....  .........  .........  .........  ...........  ...........
D9930...  S                   Treatment of                   031       1.33     $70.52       $14.10       $14.10
                               complications.
D9940...  S                   Dental occlusal guard..        031       1.33     $70.52       $14.10       $14.10
D9941...  E                   Fabrication athletic     .........  .........  .........  ...........  ...........
                               guard.
D9950...  S                   Occlusion analysis.....        031       1.33     $70.52       $14.10       $14.10
D9951...  S                   Limited occlusal               031       1.33     $70.52       $14.10       $14.10
                               adjustment.
D9952...  S                   Complete occlusal              031       1.33     $70.52       $14.10       $14.10
                               adjustment.
D9970...  E                   Enamel microabrasion...  .........  .........  .........  ...........  ...........
D9999...  E                   Adjunctive procedure...  .........  .........  .........  ...........  ...........
E0100...  A                   Cane adjust/fixed with   .........  .........  .........  ...........  ...........
                               tip.
E0105...  A                   Cane adjust/fixed quad/  .........  .........  .........  ...........  ...........
                               3 pro.
E0110...  A                   Crutch forearm pair....  .........  .........  .........  ...........  ...........
E0111...  A                   Crutch forearm each....  .........  .........  .........  ...........  ...........
E0112...  A                   Crutch underarm pair     .........  .........  .........  ...........  ...........
                               wood.
E0113...  A                   Crutch underarm each     .........  .........  .........  ...........  ...........
                               wood.
E0114...  A                   Crutch underarm pair no  .........  .........  .........  ...........  ...........
                               wood.
E0116...  A                   Crutch underarm each no  .........  .........  .........  ...........  ...........
                               wood.
E0130...  A                   Walker rigid adjust/     .........  .........  .........  ...........  ...........
                               fixed ht.
E0135...  A                   Walker folding adjust/   .........  .........  .........  ...........  ...........
                               fixed.
E0141...  A                   Rigid walker wheeled wo  .........  .........  .........  ...........  ...........
                               seat.
E0142...  A                   Walker rigid wheeled     .........  .........  .........  ...........  ...........
                               with se.
E0143...  A                   Walker folding wheeled   .........  .........  .........  ...........  ...........
                               w/o s.
E0145...  A                   Walker whled seat/       .........  .........  .........  ...........  ...........
                               crutch att.
E0146...  A                   Folding walker wheels w  .........  .........  .........  ...........  ...........
                               seat.
E0147...  A                   Walker variable wheel    .........  .........  .........  ...........  ...........
                               resist.
E0153...  A                   Forearm crutch platform  .........  .........  .........  ...........  ...........
                               atta.
E0154...  A                   Walker platform          .........  .........  .........  ...........  ...........
                               attachment.
E0155...  A                   Walker rigd pick-up/     .........  .........  .........  ...........  ...........
                               wheel at.
E0156...  A                   Walker seat attachment.  .........  .........  .........  ...........  ...........
E0157...  A                   Walker crutch            .........  .........  .........  ...........  ...........
                               attachment.
E0158...  A                   Walker leg extensions..  .........  .........  .........  ...........  ...........
E0159...  A                   Brake for wheeled        .........  .........  .........  ...........  ...........
                               walker.
E0160...  A                   Sitz type bath or        .........  .........  .........  ...........  ...........
                               equipment.
E0161...  A                   Sitz bath/equipment w/   .........  .........  .........  ...........  ...........
                               faucet.
E0162...  A                   Sitz bath chair........  .........  .........  .........  ...........  ...........
E0163...  A                   Commode chair stationry  .........  .........  .........  ...........  ...........
                               fxd.
E0164...  A                   Commode chair mobile     .........  .........  .........  ...........  ...........
                               fixed a.
E0165...  A                   Commode chair stationry  .........  .........  .........  ...........  ...........
                               det.
E0166...  A                   Commode chair mobile     .........  .........  .........  ...........  ...........
                               detach.
E0167...  A                   Commode chair pail or    .........  .........  .........  ...........  ...........
                               pan.
E0175...  A                   Commode chair foot rest  .........  .........  .........  ...........  ...........
E0176...  A                   Air pressre pad/cushion  .........  .........  .........  ...........  ...........
                               nonp.
E0177...  A                   Water press pad/cushion  .........  .........  .........  ...........  ...........
                               nonp.
E0178...  A                   Gel pressre pad/cushion  .........  .........  .........  ...........  ...........
                               nonp.
E0179...  A                   Dry pressre pad/cushion  .........  .........  .........  ...........  ...........
                               nonp.
E0180...  A                   Press pad alternating w  .........  .........  .........  ...........  ...........
                               pump.
E0181...  A                   Press pad alternating w/ .........  .........  .........  ...........  ...........
                                pum.
E0182...  A                   Pressure pad             .........  .........  .........  ...........  ...........
                               alternating pum.
E0184...  A                   Dry pressure mattress..  .........  .........  .........  ...........  ...........
E0185...  A                   Gel pressure mattress    .........  .........  .........  ...........  ...........
                               pad.
E0186...  A                   Air pressure mattress..  .........  .........  .........  ...........  ...........
E0187...  A                   Water pressure mattress  .........  .........  .........  ...........  ...........
E0188...  E                   Synthetic sheepskin pad  .........  .........  .........  ...........  ...........
E0189...  E                   Lambswool sheepskin pad  .........  .........  .........  ...........  ...........
E0191...  A                   Protector heel or elbow  .........  .........  .........  ...........  ...........
E0192...  A                   Pad wheelchr low press/  .........  .........  .........  ...........  ...........
                               posit.
E0193...  A                   Powered air flotation    .........  .........  .........  ...........  ...........
                               bed.
E0194...  A                   Air fluidized bed......  .........  .........  .........  ...........  ...........
E0196...  A                   Gel pressure mattress..  .........  .........  .........  ...........  ...........
E0197...  A                   Air pressure pad for     .........  .........  .........  ...........  ...........
                               mattres.

[[Page 47734]]


E0198...  A                   Water pressure pad for   .........  .........  .........  ...........  ...........
                               mattr.
E0199...  A                   Dry pressure pad for     .........  .........  .........  ...........  ...........
                               mattres.
E0200...  A                   Heat lamp without stand  .........  .........  .........  ...........  ...........
E0202...  A                   Phototherapy light w/    .........  .........  .........  ...........  ...........
                               photom.
E0205...  A                   Heat lamp with stand...  .........  .........  .........  ...........  ...........
E0210...  A                   Electric heat pad        .........  .........  .........  ...........  ...........
                               standard.
E0215...  A                   Electric heat pad moist  .........  .........  .........  ...........  ...........
E0217...  A                   Water circ heat pad w    .........  .........  .........  ...........  ...........
                               pump.
E0218...  A                   Water circ cold pad w    .........  .........  .........  ...........  ...........
                               pump.
E0220...  A                   Hot water bottle.......  .........  .........  .........  ...........  ...........
E0225...  A                   Hydrocollator unit.....  .........  .........  .........  ...........  ...........
E0230...  A                   Ice cap or collar......  .........  .........  .........  ...........  ...........
E0235...  A                   Paraffin bath unit       .........  .........  .........  ...........  ...........
                               portable.
E0236...  A                   Pump for water           .........  .........  .........  ...........  ...........
                               circulating p.
E0238...  A                   Heat pad non-electric    .........  .........  .........  ...........  ...........
                               moist.
E0239...  A                   Hydrocollator unit       .........  .........  .........  ...........  ...........
                               portable.
E0241...  E                   Bath tub wall rail.....  .........  .........  .........  ...........  ...........
E0242...  E                   Bath tub rail floor....  .........  .........  .........  ...........  ...........
E0243...  E                   Toilet rail............  .........  .........  .........  ...........  ...........
E0244...  E                   Toilet seat raised.....  .........  .........  .........  ...........  ...........
E0245...  E                   Tub stool or bench.....  .........  .........  .........  ...........  ...........
E0246...  A                   Transfer tub rail        .........  .........  .........  ...........  ...........
                               attachment.
E0249...  A                   Pad water circulating    .........  .........  .........  ...........  ...........
                               heat u.
E0250...  A                   Hosp bed fixed ht w/     .........  .........  .........  ...........  ...........
                               mattres.
E0251...  A                   Hosp bed fixd ht w/o     .........  .........  .........  ...........  ...........
                               mattres.
E0255...  A                   Hospital bed var ht w/   .........  .........  .........  ...........  ...........
                               mattr.
E0256...  A                   Hospital bed var ht w/o  .........  .........  .........  ...........  ...........
                               matt.
E0260...  A                   Hosp bed semi-electr w/  .........  .........  .........  ...........  ...........
                               matt.
E0261...  A                   Hosp bed semi-electr w/  .........  .........  .........  ...........  ...........
                               o mat.
E0265...  A                   Hosp bed total electr w/ .........  .........  .........  ...........  ...........
                                mat.
E0266...  A                   Hosp bed total elec w/o  .........  .........  .........  ...........  ...........
                               matt.
E0270...  A                   Hospital bed             .........  .........  .........  ...........  ...........
                               institutional t.
E0271...  A                   Mattress innerspring...  .........  .........  .........  ...........  ...........
E0272...  A                   Mattress foam rubber...  .........  .........  .........  ...........  ...........
E0273...  A                   Bed board..............  .........  .........  .........  ...........  ...........
E0274...  A                   Over-bed table.........  .........  .........  .........  ...........  ...........
E0275...  A                   Bed pan standard.......  .........  .........  .........  ...........  ...........
E0276...  A                   Bed pan fracture.......  .........  .........  .........  ...........  ...........
E0277...  A                   Powered pres-redu air    .........  .........  .........  ...........  ...........
                               mattrs.
E0280...  A                   Bed cradle.............  .........  .........  .........  ...........  ...........
E0290...  A                   Hosp bed fx ht w/o       .........  .........  .........  ...........  ...........
                               rails w/m.
E0291...  A                   Hosp bed fx ht w/o rail  .........  .........  .........  ...........  ...........
                               w/o.
E0292...  A                   Hosp bed var ht w/o      .........  .........  .........  ...........  ...........
                               rail w/o.
E0293...  A                   Hosp bed var ht w/o      .........  .........  .........  ...........  ...........
                               rail w/.
E0294...  A                   Hosp bed semi-elect w/   .........  .........  .........  ...........  ...........
                               mattr.
E0295...  A                   Hosp bed semi-elect w/o  .........  .........  .........  ...........  ...........
                               matt.
E0296...  A                   Hosp bed total elect w/  .........  .........  .........  ...........  ...........
                               matt.
E0297...  A                   Hosp bed total elect w/  .........  .........  .........  ...........  ...........
                               o mat.
E0305...  A                   Rails bed side half      .........  .........  .........  ...........  ...........
                               length.
E0310...  A                   Rails bed side full      .........  .........  .........  ...........  ...........
                               length.
E0315...  A                   Bed accessory brd/tbl/   .........  .........  .........  ...........  ...........
                               supprt.
E0325...  A                   Urinal male jug-type...  .........  .........  .........  ...........  ...........
E0326...  A                   Urinal female jug-type.  .........  .........  .........  ...........  ...........
E0350...  A                   Control unit bowel       .........  .........  .........  ...........  ...........
                               system.
E0352...  A                   Disposable pack w/bowel  .........  .........  .........  ...........  ...........
                               syst.
E0370...  A                   Air elevator for heel..  .........  .........  .........  ...........  ...........
E0371...  A                   Nonpower mattress        .........  .........  .........  ...........  ...........
                               overlay.
E0372...  A                   Powered air mattress     .........  .........  .........  ...........  ...........
                               overlay.
E0373...  A                   Nonpowered pressure      .........  .........  .........  ...........  ...........
                               mattress.
E0424...  A                   Stationary compressed    .........  .........  .........  ...........  ...........
                               gas 02.
E0425...  A                   Gas system stationary    .........  .........  .........  ...........  ...........
                               compre.
E0430...  A                   Oxygen system gas        .........  .........  .........  ...........  ...........
                               portable.
E0431...  A                   Portable gaseous 02....  .........  .........  .........  ...........  ...........
E0434...  A                   Portable liquid 02.....  .........  .........  .........  ...........  ...........
E0435...  A                   Oxygen system liquid     .........  .........  .........  ...........  ...........
                               portabl.
E0439...  A                   Stationary liquid 02...  .........  .........  .........  ...........  ...........
E0440...  A                   Oxygen system liquid     .........  .........  .........  ...........  ...........
                               station.
E0441...  A                   Oxygen contents gas per/ .........  .........  .........  ...........  ...........
                               unit.
E0442...  A                   Oxygen contents liq per/ .........  .........  .........  ...........  ...........
                               unit.
E0443...  A                   Port 02 contents gas/    .........  .........  .........  ...........  ...........
                               unit.
E0444...  A                   Port 02 contents liq/    .........  .........  .........  ...........  ...........
                               unit.
E0450...  A                   Volume vent stationary/  .........  .........  .........  ...........  ...........
                               porta.
E0452...  A                   Intermit assis device w  .........  .........  .........  ...........  ...........
                               cpap.
E0453...  A                   Ventilator 12 hrs/less   .........  .........  .........  ...........  ...........
                               per d.
E0455...  A                   Oxygen tent excl croup/  .........  .........  .........  ...........  ...........
                               ped t.

[[Page 47735]]


E0457...  A                   Chest shell............  .........  .........  .........  ...........  ...........
E0459...  A                   Chest wrap.............  .........  .........  .........  ...........  ...........
E0460...  A                   Neg press vent portabl/  .........  .........  .........  ...........  ...........
                               statn.
E0462...  A                   Rocking bed w/ or w/o    .........  .........  .........  ...........  ...........
                               side r.
E0480...  A                   Percussor elect/pneum    .........  .........  .........  ...........  ...........
                               home m.
E0500...  A                   Ippb all types.........  .........  .........  .........  ...........  ...........
E0550...  A                   Humidif extens supple w  .........  .........  .........  ...........  ...........
                               ippb.
E0555...  A                   Humidifier for use w/    .........  .........  .........  ...........  ...........
                               regula.
E0560...  A                   Humidifier supplemental  .........  .........  .........  ...........  ...........
                               w/ i.
E0565...  A                   Compressor air power     .........  .........  .........  ...........  ...........
                               source.
E0570...  A                   Nebulizer with           .........  .........  .........  ...........  ...........
                               compression.
E0575...  A                   Nebulizer ultrasonic...  .........  .........  .........  ...........  ...........
E0580...  A                   Nebulizer for use w/     .........  .........  .........  ...........  ...........
                               regulat.
E0585...  A                   Nebulizer w/ compressor  .........  .........  .........  ...........  ...........
                               & he.
E0600...  A                   Suction pump portab hom  .........  .........  .........  ...........  ...........
                               modl.
E0601...  A                   Cont airway pressure     .........  .........  .........  ...........  ...........
                               device.
E0605...  A                   Vaporizer room type....  .........  .........  .........  ...........  ...........
E0606...  A                   Drainage board postural  .........  .........  .........  ...........  ...........
E0607...  A                   Blood glucose monitor    .........  .........  .........  ...........  ...........
                               home.
E0608...  A                   Apnea monitor..........  .........  .........  .........  ...........  ...........
E0609...  A                   Blood gluc mon w/        .........  .........  .........  ...........  ...........
                               special fea.
E0610...  A                   Pacemaker monitr         .........  .........  .........  ...........  ...........
                               audible/vis.
E0615...  A                   Pacemaker monitr         .........  .........  .........  ...........  ...........
                               digital/vis.
E0621...  A                   Patient lift sling or    .........  .........  .........  ...........  ...........
                               seat.
E0625...  A                   Patient lift bathroom    .........  .........  .........  ...........  ...........
                               or toi.
E0627...  A                   Seat lift incorp lift-   .........  .........  .........  ...........  ...........
                               chair.
E0628...  A                   Seat lift for pt furn-   .........  .........  .........  ...........  ...........
                               electr.
E0629...  A                   Seat lift for pt furn-   .........  .........  .........  ...........  ...........
                               non-el.
E0630...  A                   Patient lift hydraulic.  .........  .........  .........  ...........  ...........
E0635...  A                   Patient lift electric..  .........  .........  .........  ...........  ...........
E0650...  A                   Pneuma compresor non-    .........  .........  .........  ...........  ...........
                               segment.
E0651...  A                   Pneum compressor         .........  .........  .........  ...........  ...........
                               segmental.
E0652...  A                   Pneum compres w/cal      .........  .........  .........  ...........  ...........
                               pressure.
E0655...  A                   Pneumatic appliance      .........  .........  .........  ...........  ...........
                               half arm.
E0660...  A                   Pneumatic appliance      .........  .........  .........  ...........  ...........
                               full leg.
E0665...  A                   Pneumatic appliance      .........  .........  .........  ...........  ...........
                               full arm.
E0666...  A                   Pneumatic appliance      .........  .........  .........  ...........  ...........
                               half leg.
E0667...  A                   Seg pneumatic appl full  .........  .........  .........  ...........  ...........
                               leg.
E0668...  A                   Seg pneumatic appl full  .........  .........  .........  ...........  ...........
                               arm.
E0669...  A                   Seg pneumatic appli      .........  .........  .........  ...........  ...........
                               half leg.
E0671...  A                   Pressure pneum appl      .........  .........  .........  ...........  ...........
                               full leg.
E0672...  A                   Pressure pneum appl      .........  .........  .........  ...........  ...........
                               full arm.
E0673...  A                   Pressure pneum appl      .........  .........  .........  ...........  ...........
                               half leg.
E0690...  A                   Ultraviolet cabinet....  .........  .........  .........  ...........  ...........
E0700...  A                   Safety equipment.......  .........  .........  .........  ...........  ...........
E0710...  A                   Restraints any type....  .........  .........  .........  ...........  ...........
E0720...  A                   Tens two lead..........  .........  .........  .........  ...........  ...........
E0730...  A                   Tens four lead.........  .........  .........  .........  ...........  ...........
E0731...  A                   Conductive garment for   .........  .........  .........  ...........  ...........
                               tens/.
E0740...  A                   Incontinence treatment   .........  .........  .........  ...........  ...........
                               systm.
E0744...  A                   Neuromuscular stim for   .........  .........  .........  ...........  ...........
                               scoli.
E0745...  A                   Neuromuscular stim for   .........  .........  .........  ...........  ...........
                               shock.
E0746...  A                   Electromyograph          .........  .........  .........  ...........  ...........
                               biofeedback.
E0747...  A                   Elec osteogen stim not   .........  .........  .........  ...........  ...........
                               spine.
E0748...  A                   Elec osteogen stim       .........  .........  .........  ...........  ...........
                               spinal.
E0749...  A                   Elec osteogen stim       .........  .........  .........  ...........  ...........
                               implanted.
E0751...  A                   Pulse generator or       .........  .........  .........  ...........  ...........
                               receiver.
E0753...  A                   Neurostimul electrodes/  .........  .........  .........  ...........  ...........
                               leads.
E0755...  A                   Electronic salivary      .........  .........  .........  ...........  ...........
                               reflex s.
E0760...  A                   Osteogen ultrasound      .........  .........  .........  ...........  ...........
                               stimltor.
E0776...  A                   Iv pole................  .........  .........  .........  ...........  ...........
E0781...  A                   External ambulatory      .........  .........  .........  ...........  ...........
                               infus pu.
E0782...  A                   Non-programble infusion  .........  .........  .........  ...........  ...........
                               pump.
E0783...  A                   Programmable infusion    .........  .........  .........  ...........  ...........
                               pump.
E0784...  A                   Ext amb infusn pump      .........  .........  .........  ...........  ...........
                               insulin.
E0791...  A                   Parenteral infusion      .........  .........  .........  ...........  ...........
                               pump sta.
E0840...  A                   Tract frame attach       .........  .........  .........  ...........  ...........
                               headboard.
E0850...  A                   Traction stand free      .........  .........  .........  ...........  ...........
                               standing.
E0855...  A                   Cervical traction        .........  .........  .........  ...........  ...........
                               equipment.
E0860...  A                   Tract equip cervical     .........  .........  .........  ...........  ...........
                               tract.
E0870...  A                   Tract frame attach       .........  .........  .........  ...........  ...........
                               footboard.
E0880...  A                   Trac stand free stand    .........  .........  .........  ...........  ...........
                               extrem.
E0890...  A                   Traction frame attach    .........  .........  .........  ...........  ...........
                               pelvic.
E0900...  A                   Trac stand free stand    .........  .........  .........  ...........  ...........
                               pelvic.
E0910...  A                   Trapeze bar attached to  .........  .........  .........  ...........  ...........
                               bed.

[[Page 47736]]


E0920...  A                   Fracture frame attached  .........  .........  .........  ...........  ...........
                               to b.
E0930...  A                   Fracture frame free      .........  .........  .........  ...........  ...........
                               standing.
E0935...  A                   Exercise device passive  .........  .........  .........  ...........  ...........
                               moti.
E0940...  A                   Trapeze bar free         .........  .........  .........  ...........  ...........
                               standing.
E0941...  A                   Gravity assisted         .........  .........  .........  ...........  ...........
                               traction de.
E0942...  A                   Cervical head harness/   .........  .........  .........  ...........  ...........
                               halter.
E0943...  A                   Cervical pillow........  .........  .........  .........  ...........  ...........
E0944...  A                   Pelvic belt/harness/     .........  .........  .........  ...........  ...........
                               boot.
E0945...  A                   Belt/harness extremity.  .........  .........  .........  ...........  ...........
E0946...  A                   Fracture frame dual w    .........  .........  .........  ...........  ...........
                               cross.
E0947...  A                   Fracture frame           .........  .........  .........  ...........  ...........
                               attachmnts pe.
E0948...  A                   Fracture frame           .........  .........  .........  ...........  ...........
                               attachmnts ce.
E0950...  A                   Tray...................  .........  .........  .........  ...........  ...........
E0951...  A                   Loop heel..............  .........  .........  .........  ...........  ...........
E0952...  A                   Loop tie...............  .........  .........  .........  ...........  ...........
E0953...  A                   Pneumatic tire.........  .........  .........  .........  ...........  ...........
E0954...  A                   Wheelchair semi-         .........  .........  .........  ...........  ...........
                               pneumatic ca.
E0958...  A                   Whlchr att-conv 1 arm    .........  .........  .........  ...........  ...........
                               drive.
E0959...  A                   Amputee adapter........  .........  .........  .........  ...........  ...........
E0961...  A                   Wheelchair brake         .........  .........  .........  ...........  ...........
                               extension.
E0962...  A                   Wheelchair 1 inch        .........  .........  .........  ...........  ...........
                               cushion.
E0963...  A                   Wheelchair 2 inch        .........  .........  .........  ...........  ...........
                               cushion.
E0964...  A                   Wheelchair 3 inch        .........  .........  .........  ...........  ...........
                               cushion.
E0965...  A                   Wheelchair 4 inch        .........  .........  .........  ...........  ...........
                               cushion.
E0966...  A                   Wheelchair head rest     .........  .........  .........  ...........  ...........
                               extensi.
E0967...  A                   Wheelchair hand rims...  .........  .........  .........  ...........  ...........
E0968...  A                   Wheelchair commode seat  .........  .........  .........  ...........  ...........
E0969...  A                   Wheelchair narrowing     .........  .........  .........  ...........  ...........
                               device.
E0970...  A                   Wheelchair no. 2         .........  .........  .........  ...........  ...........
                               footplates.
E0971...  A                   Wheelchair anti-tipping  .........  .........  .........  ...........  ...........
                               devi.
E0972...  A                   Transfer board or        .........  .........  .........  ...........  ...........
                               device.
E0973...  A                   Wheelchair adjustabl     .........  .........  .........  ...........  ...........
                               height.
E0974...  A                   Wheelchair grade-aid...  .........  .........  .........  ...........  ...........
E0975...  A                   Wheelchair reinforced    .........  .........  .........  ...........  ...........
                               seat u.
E0976...  A                   Wheelchair reinforced    .........  .........  .........  ...........  ...........
                               back u.
E0977...  A                   Wheelchair wedge         .........  .........  .........  ...........  ...........
                               cushion.
E0978...  A                   Wheelchair belt w/       .........  .........  .........  ...........  ...........
                               airplane b.
E0979...  A                   Wheelchair belt with     .........  .........  .........  ...........  ...........
                               velcro.
E0980...  A                   Wheelchair safety vest.  .........  .........  .........  ...........  ...........
E0990...  A                   Whellchair elevating     .........  .........  .........  ...........  ...........
                               leg res.
E0991...  A                   Wheelchair upholstry     .........  .........  .........  ...........  ...........
                               seat.
E0992...  A                   Wheelchair solid seat    .........  .........  .........  ...........  ...........
                               insert.
E0993...  A                   Wheelchair back          .........  .........  .........  ...........  ...........
                               upholstery.
E0994...  A                   Wheelchair arm rest....  .........  .........  .........  ...........  ...........
E0995...  A                   Wheelchair calf rest...  .........  .........  .........  ...........  ...........
E0996...  A                   Wheelchair tire solid..  .........  .........  .........  ...........  ...........
E0997...  A                   Wheelchair caster w/ a   .........  .........  .........  ...........  ...........
                               fork.
E0998...  A                   Wheelchair caster w/o a  .........  .........  .........  ...........  ...........
                               fork.
E0999...  A                   Wheelchr pneumatic tire  .........  .........  .........  ...........  ...........
                               w/wh.
E1000...  A                   Wheelchair tire          .........  .........  .........  ...........  ...........
                               pneumatic ca.
E1001...  A                   Wheelchair wheel.......  .........  .........  .........  ...........  ...........
E1031...  A                   Rollabout chair with     .........  .........  .........  ...........  ...........
                               casters.
E1050...  A                   Whelchr fxd full length  .........  .........  .........  ...........  ...........
                               arms.
E1060...  A                   Wheelchair detachable    .........  .........  .........  ...........  ...........
                               arms.
E1065...  A                   Wheelchair power         .........  .........  .........  ...........  ...........
                               attachment.
E1066...  A                   Wheelchair battery       .........  .........  .........  ...........  ...........
                               charger.
E1069...  A                   Wheelchair deep cycle    .........  .........  .........  ...........  ...........
                               batter.
E1070...  A                   Wheelchair detachable    .........  .........  .........  ...........  ...........
                               foot r.
E1083...  A                   Hemi-wheelchair fixed    .........  .........  .........  ...........  ...........
                               arms.
E1084...  A                   Hemi-wheelchair          .........  .........  .........  ...........  ...........
                               detachable a.
E1085...  A                   Hemi-wheelchair fixed    .........  .........  .........  ...........  ...........
                               arms.
E1086...  A                   Hemi-wheelchair          .........  .........  .........  ...........  ...........
                               detachable a.
E1087...  A                   Wheelchair lightwt       .........  .........  .........  ...........  ...........
                               fixed arm.
E1088...  A                   Wheelchair lightweight   .........  .........  .........  ...........  ...........
                               det a.
E1089...  A                   Wheelchair lightwt       .........  .........  .........  ...........  ...........
                               fixed arm.
E1090...  A                   Wheelchair lightweight   .........  .........  .........  ...........  ...........
                               det a.
E1091...  A                   Wheelchair youth.......  .........  .........  .........  ...........  ...........
E1092...  A                   Wheelchair wide w/ leg   .........  .........  .........  ...........  ...........
                               rests.
E1093...  A                   Wheelchair wide w/ foot  .........  .........  .........  ...........  ...........
                               rest.
E1100...  A                   Whchr s-recl fxd arm     .........  .........  .........  ...........  ...........
                               leg res.
E1110...  A                   Wheelchair semi-recl     .........  .........  .........  ...........  ...........
                               detach.
E1130...  A                   Whlchr stand fxd arm ft  .........  .........  .........  ...........  ...........
                               rest.
E1140...  A                   Wheelchair standard      .........  .........  .........  ...........  ...........
                               detach a.
E1150...  A                   Wheelchair standard w/   .........  .........  .........  ...........  ...........
                               leg r.
E1160...  A                   Wheelchair fixed arms..  .........  .........  .........  ...........  ...........

[[Page 47737]]


E1170...  A                   Whlchr ampu fxd arm leg  .........  .........  .........  ...........  ...........
                               rest.
E1171...  A                   Wheelchair amputee w/o   .........  .........  .........  ...........  ...........
                               leg r.
E1172...  A                   Wheelchair amputee       .........  .........  .........  ...........  ...........
                               detach ar.
E1180...  A                   Wheelchair amputee w/    .........  .........  .........  ...........  ...........
                               foot r.
E1190...  A                   Wheelchair amputee w/    .........  .........  .........  ...........  ...........
                               leg re.
E1195...  A                   Wheelchair amputee       .........  .........  .........  ...........  ...........
                               heavy dut.
E1200...  A                   Wheelchair amputee       .........  .........  .........  ...........  ...........
                               fixed arm.
E1210...  A                   Whlchr moto ful arm leg  .........  .........  .........  ...........  ...........
                               rest.
E1211...  A                   Wheelchair motorized w/  .........  .........  .........  ...........  ...........
                               det.
E1212...  A                   Wheelchair motorized w   .........  .........  .........  ...........  ...........
                               full.
E1213...  A                   Wheelchair motorized w/  .........  .........  .........  ...........  ...........
                               det.
E1220...  A                   Whlchr special size/     .........  .........  .........  ...........  ...........
                               constrc.
E1221...  A                   Wheelchair spec size w   .........  .........  .........  ...........  ...........
                               foot.
E1222...  A                   Wheelchair spec size w/  .........  .........  .........  ...........  ...........
                               leg.
E1223...  A                   Wheelchair spec size w   .........  .........  .........  ...........  ...........
                               foot.
E1224...  A                   Wheelchair spec size w/  .........  .........  .........  ...........  ...........
                               leg.
E1225...  A                   Wheelchair spec sz semi- .........  .........  .........  ...........  ...........
                               recl.
E1226...  A                   Wheelchair spec sz full- .........  .........  .........  ...........  ...........
                               recl.
E1227...  A                   Wheelchair spec sz spec  .........  .........  .........  ...........  ...........
                               ht a.
E1228...  A                   Wheelchair spec sz spec  .........  .........  .........  ...........  ...........
                               ht b.
E1230...  A                   Power operated vehicle.  .........  .........  .........  ...........  ...........
E1240...  A                   Whchr litwt det arm leg  .........  .........  .........  ...........  ...........
                               rest.
E1250...  A                   Wheelchair lightwt       .........  .........  .........  ...........  ...........
                               fixed arm.
E1260...  A                   Wheelchair lightwt foot  .........  .........  .........  ...........  ...........
                               rest.
E1270...  A                   Wheelchair lightweight   .........  .........  .........  ...........  ...........
                               leg r.
E1280...  A                   Whchr h-duty det arm     .........  .........  .........  ...........  ...........
                               leg res.
E1285...  A                   Wheelchair heavy duty    .........  .........  .........  ...........  ...........
                               fixed.
E1290...  A                   Wheelchair hvy duty      .........  .........  .........  ...........  ...........
                               detach a.
E1295...  A                   Wheelchair heavy duty    .........  .........  .........  ...........  ...........
                               fixed.
E1296...  A                   Wheelchair special seat  .........  .........  .........  ...........  ...........
                               heig.
E1297...  A                   Wheelchair special seat  .........  .........  .........  ...........  ...........
                               dept.
E1298...  A                   Wheelchair spec seat     .........  .........  .........  ...........  ...........
                               depth/w.
E1300...  A                   Whirlpool portable.....  .........  .........  .........  ...........  ...........
E1310...  A                   Whirlpool non-portable.  .........  .........  .........  ...........  ...........
E1340...  A                   Repair for DME, per 15   .........  .........  .........  ...........  ...........
                               min.
E1353...  A                   Oxygen supplies          .........  .........  .........  ...........  ...........
                               regulator.
E1355...  A                   Oxygen supplies stand/   .........  .........  .........  ...........  ...........
                               rack.
E1372...  A                   Oxy suppl heater for     .........  .........  .........  ...........  ...........
                               nebuliz.
E1375...  A                   Oxygen suppl nebulizer   .........  .........  .........  ...........  ...........
                               porta.
E1377...  A                   Oxygen concentrator to   .........  .........  .........  ...........  ...........
                               244 c.
E1378...  A                   Oxygen concentrator to   .........  .........  .........  ...........  ...........
                               488 c.
E1379...  A                   Oxygen concentrator to   .........  .........  .........  ...........  ...........
                               732 c.
E1380...  A                   Oxygen concentrator to   .........  .........  .........  ...........  ...........
                               976 c.
E1381...  A                   Oxygen concentrat to     .........  .........  .........  ...........  ...........
                               1220 cu.
E1382...  A                   Oxygen concentrat to     .........  .........  .........  ...........  ...........
                               1464 cu.
E1383...  A                   Oxygen concentrat to     .........  .........  .........  ...........  ...........
                               1708 cu.
E1384...  A                   Oxygen concentrat to     .........  .........  .........  ...........  ...........
                               1952 cu.
E1385...  A                   Oxygen concentrator >    .........  .........  .........  ...........  ...........
                               1952 c.
E1399...  A                   Durable medical          .........  .........  .........  ...........  ...........
                               equipment mi.
E1400...  A                   Oxygen concentrator < 2  .........  .........  .........  ...........  ...........
                               lite.
E1401...  A                   Oxygen concentrator 2-3  .........  .........  .........  ...........  ...........
                               lite.
E1402...  A                   Oxygen concentrator 3-4  .........  .........  .........  ...........  ...........
                               lite.
E1403...  A                   Oxygen concentrator 4-5  .........  .........  .........  ...........  ...........
                               lite.
E1404...  A                   Oxygen concentrator > 5  .........  .........  .........  ...........  ...........
                               lite.
E1405...  A                   O2/water vapor enrich w/ .........  .........  .........  ...........  ...........
                               heat.
E1406...  A                   O2/water vapor enrich w/ .........  .........  .........  ...........  ...........
                               o he.
E1510...  A                   Kidney dialysate         .........  .........  .........  ...........  ...........
                               delivry sys.
E1520...  A                   Heparin infusion pump    .........  .........  .........  ...........  ...........
                               for di.
E1530...  A                   Air bubble detector for  .........  .........  .........  ...........  ...........
                               dial.
E1540...  A                   Pressure alarm for       .........  .........  .........  ...........  ...........
                               dialysis.
E1550...  A                   Bath conductivity meter  .........  .........  .........  ...........  ...........
E1560...  A                   Blood leak detector for  .........  .........  .........  ...........  ...........
                               dial.
E1570...  A                   Adjustable chair for     .........  .........  .........  ...........  ...........
                               esrd pt.
E1575...  A                   Transducer protector/    .........  .........  .........  ...........  ...........
                               fluid b.
E1580...  A                   Unipuncture control      .........  .........  .........  ...........  ...........
                               system.
E1590...  A                   Hemodialysis machine...  .........  .........  .........  ...........  ...........
E1592...  A                   Auto interm peritoneal   .........  .........  .........  ...........  ...........
                               dialy.
E1594...  A                   Cycler dialysis machine  .........  .........  .........  ...........  ...........
E1600...  A                   Deliv/install equip for  .........  .........  .........  ...........  ...........
                               dial.
E1610...  A                   Reverse osmosis water    .........  .........  .........  ...........  ...........
                               purifi.
E1615...  A                   Deionizer water          .........  .........  .........  ...........  ...........
                               purification.
E1620...  A                   Blood pump for dialysis  .........  .........  .........  ...........  ...........
E1625...  A                   Water softening system.  .........  .........  .........  ...........  ...........
E1630...  A                   Reciprocating            .........  .........  .........  ...........  ...........
                               peritoneal dia.
E1632...  A                   Wearable artificial      .........  .........  .........  ...........  ...........
                               kidney.

[[Page 47738]]


E1635...  A                   Compact travel           .........  .........  .........  ...........  ...........
                               hemodialyzer.
E1636...  A                   Sorbent cartridges for   .........  .........  .........  ...........  ...........
                               dialy.
E1640...  A                   Replacement components   .........  .........  .........  ...........  ...........
                               for d.
E1699...  A                   Dialysis equipment       .........  .........  .........  ...........  ...........
                               unspecifi.
E1700...  A                   Jaw motion rehab system  .........  .........  .........  ...........  ...........
E1701...  A                   Repl cushions for jaw    .........  .........  .........  ...........  ...........
                               motion.
E1702...  A                   Repl measr scales jaw    .........  .........  .........  ...........  ...........
                               motion.
E1800...  A                   Adjust elbow ext/flex    .........  .........  .........  ...........  ...........
                               device.
E1805...  A                   Adjust wrist ext/flex    .........  .........  .........  ...........  ...........
                               device.
E1810...  A                   Adjust knee ext/flex     .........  .........  .........  ...........  ...........
                               device.
E1815...  A                   Adjust ankle ext/flex    .........  .........  .........  ...........  ...........
                               device.
E1820...  A                   Soft interface material  .........  .........  .........  ...........  ...........
E1825...  A                   Adjust finger ext/flex   .........  .........  .........  ...........  ...........
                               devc.
E1830...  A                   Adjust toe ext/flex      .........  .........  .........  ...........  ...........
                               device.
G0001...  N                   Drawing blood for        .........  .........  .........  ...........  ...........
                               specimen.
G0002...  N                   Temporary urinary        .........  .........  .........  ...........  ...........
                               catheter.
G0004...  X                   ECG transm phys review         956       1.11     $58.77       $55.82       $11.75
                               & int.
G0005...  X                   ECG 24 hour recording..        956       1.11     $58.77       $55.82       $11.75
G0006...  X                   ECG transmission &             956       1.11     $58.77       $55.82       $11.75
                               analysis.
G0007...  N                   ECG phy review &         .........  .........  .........  ...........  ...........
                               interpret.
G0008...  X                   Admin influenza virus          901       0.07      $3.92        $2.49        $0.78
                               vac.
G0009...  X                   Admin pneumococcal             901       0.07      $3.92        $2.49        $0.78
                               vaccine.
G0010...  X                   Admin hepatitis b              902       1.78     $94.03       $41.58       $18.81
                               vaccine.
G0015...  X                   Post symptom ECG               956       1.11     $58.77       $55.82       $11.75
                               tracing.
G0016...  N                   Post symptom ECG md      .........  .........  .........  ...........  ...........
                               review.
G0025...  X                   Collagen skin test kit.        881       0.20     $10.77        $6.78        $2.15
G0026...  A                   Fecal leukocyte          .........  .........  .........  ...........  ...........
                               examination.
G0027...  A                   Semen analysis.........  .........  .........  .........  ...........  ...........
G0030...  S                   PET imaging prev PET           760      17.91    $947.13      $419.46      $189.43
                               single.
G0031...  S                   PET imaging prev PET           760      17.91    $947.13      $419.46      $189.43
                               multple.
G0032...  S                   PET follow SPECT 78464         760      17.91    $947.13      $419.46      $189.43
                               singl.
G0033...  S                   PET follow SPECT 78464         760      17.91    $947.13      $419.46      $189.43
                               mult.
G0034...  S                   PET follow SPECT 76865         760      17.91    $947.13      $419.46      $189.43
                               singl.
G0035...  S                   PET follow SPECT 78465         760      17.91    $947.13      $419.46      $189.43
                               mult.
G0036...  S                   PET follow cornry angio        760      17.91    $947.13      $419.46      $189.43
                               sing.
G0037...  S                   PET follow cornry angio        760      17.91    $947.13      $419.46      $189.43
                               mult.
G0038...  S                   PET follow myocard perf        760      17.91    $947.13      $419.46      $189.43
                               sing.
G0039...  S                   PET follow myocard perf        760      17.91    $947.13      $419.46      $189.43
                               mult.
G0040...  S                   PET follow stress echo         760      17.91    $947.13      $419.46      $189.43
                               singl.
G0041...  S                   PET follow stress echo         760      17.91    $947.13      $419.46      $189.43
                               mult.
G0042...  S                   PET follow ventriculogm        760      17.91    $947.13      $419.46      $189.43
                               sing.
G0043...  S                   PET follow ventriculogm        760      17.91    $947.13      $419.46      $189.43
                               mult.
G0044...  S                   PET following rest ECG         760      17.91    $947.13      $419.46      $189.43
                               singl.
G0045...  S                   PET following rest ECG         760      17.91    $947.13      $419.46      $189.43
                               mult.
G0046...  S                   PET follow stress ECG          760      17.91    $947.13      $419.46      $189.43
                               singl.
G0047...  S                   PET follow stress ECG          760      17.91    $947.13      $419.46      $189.43
                               mult.
G0050...  S                   Residual urine by              747       1.65     $87.17       $54.69       $17.43
                               ultrasound.
G0101...  V                   CA screen;pelvic/breast        913  .........  .........  ...........  ...........
                               exam.
G0104...  T                   CA screen;flexi                446       2.59    $137.12       $65.09       $27.42
                               sigmoidscope.
G0105...  T                   Colorectal scrn; hi            426       6.85    $362.40      $187.81       $72.48
                               risk ind.
G0106...  S                   Colon CA screen;barium         736       1.85     $97.95       $54.24       $19.59
                               enema.
G0107...  A                   CA screen; fecal blood   .........  .........  .........  ...........  ...........
                               test.
G0110...  A                   Nett pulm-rehab educ;    .........  .........  .........  ...........  ...........
                               ind.
G0111...  A                   Nett pulm-rehab educ;    .........  .........  .........  ...........  ...........
                               group.
G0112...  A                   Nett;nutrition guid,     .........  .........  .........  ...........  ...........
                               initial.
G0113...  A                   Nett;nutrition           .........  .........  .........  ...........  ...........
                               guid,subseqnt.
G0114...  A                   Nett; psychosocial       .........  .........  .........  ...........  ...........
                               consult.
G0115...  A                   Nett; psychological      .........  .........  .........  ...........  ...........
                               testing.
G0116...  A                   Nett; psychosocial       .........  .........  .........  ...........  ...........
                               counsel.
G0120...  S                   Colon ca scrn; barium          736       1.85     $97.95       $54.24       $19.59
                               enema.
G0121...  E                   Colon ca scrn; barium    .........  .........  .........  ...........  ...........
                               enema.
G0122...  E                   Colon ca scrn; barium    .........  .........  .........  ...........  ...........
                               enema.
J0120...  N                   Tetracyclin injection..  .........  .........  .........  ...........  ...........
J0150...  N                   Injection adenosine 6    .........  .........  .........  ...........  ...........
                               MG.
J0170...  N                   Adrenalin epinephrin     .........  .........  .........  ...........  ...........
                               inject.
J0190...  N                   Inj biperiden lactate/5  .........  .........  .........  ...........  ...........
                               mg.
J0205...  N                   Alglucerase injection..  .........  .........  .........  ...........  ...........
J0207...  N                   Amifostine.............  .........  .........  .........  ...........  ...........
J0210...  N                   Methyldopate hcl         .........  .........  .........  ...........  ...........
                               injection.
J0256...  N                   Alpha 1-proteinase 500   .........  .........  .........  ...........  ...........
                               MG.
J0270...  E                   Alprostadil for          .........  .........  .........  ...........  ...........
                               injection.
J0280...  N                   Aminophyllin 250 MG inj  .........  .........  .........  ...........  ...........
J0290...  N                   Ampicillin 500 MG inj..  .........  .........  .........  ...........  ...........
J0295...  N                   Ampicillin sodium per    .........  .........  .........  ...........  ...........
                               1.5 gm.
J0300...  N                   Amobarbital 125 MG inj.  .........  .........  .........  ...........  ...........

[[Page 47739]]


J0330...  N                   Succinycholine chloride  .........  .........  .........  ...........  ...........
                               inj.
J0340...  N                   Nandrolon                .........  .........  .........  ...........  ...........
                               phenpropionate inj.
J0350...  N                   Injection anistreplase   .........  .........  .........  ...........  ...........
                               30 u.
J0360...  N                   Hydralazine hcl          .........  .........  .........  ...........  ...........
                               injection.
J0380...  N                   Inj metaraminol          .........  .........  .........  ...........  ...........
                               bitartrate.
J0390...  N                   Chloroquine injection..  .........  .........  .........  ...........  ...........
J0400...  N                   Inj trimethaphan         .........  .........  .........  ...........  ...........
                               camsylate.
J0460...  N                   Atropine sulfate         .........  .........  .........  ...........  ...........
                               injection.
J0470...  N                   Dimecaprol injection...  .........  .........  .........  ...........  ...........
J0475...  N                   Baclofen 10 MG           .........  .........  .........  ...........  ...........
                               injection.
J0500...  N                   Dicyclomine injection..  .........  .........  .........  ...........  ...........
J0510...  N                   Benzquinamide injection  .........  .........  .........  ...........  ...........
J0515...  N                   Inj benztropine          .........  .........  .........  ...........  ...........
                               mesylate.
J0520...  N                   Bethanechol chloride     .........  .........  .........  ...........  ...........
                               inject.
J0530...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0540...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0550...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0560...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0570...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0580...  N                   Penicillin g benzathine  .........  .........  .........  ...........  ...........
                               inj.
J0585...  N                   Botulinum toxin a per    .........  .........  .........  ...........  ...........
                               unit.
J0590...  N                   Ethylnorepinephrine hcl  .........  .........  .........  ...........  ...........
                               inj.
J0600...  N                   Edetate calcium          .........  .........  .........  ...........  ...........
                               disodium inj.
J0610...  N                   Calcium gluconate        .........  .........  .........  ...........  ...........
                               injection.
J0620...  N                   Calcium glycer & lact/   .........  .........  .........  ...........  ...........
                               10 ML.
J0630...  N                   Calcitonin salmon        .........  .........  .........  ...........  ...........
                               injection.
J0635...  N                   Calcitriol injection...  .........  .........  .........  ...........  ...........
J0640...  X                   Leucovorin calcium             064       4.17    $220.38      $140.12       $44.08
                               injection.
J0670...  N                   Inj mepivacaine HCL/10   .........  .........  .........  ...........  ...........
                               ml.
J0690...  N                   Cefazolin sodium         .........  .........  .........  ...........  ...........
                               injection.
J0694...  N                   Cefoxitin sodium         .........  .........  .........  ...........  ...........
                               injection.
J0695...  N                   Cefonocid sodium         .........  .........  .........  ...........  ...........
                               injection.
J0696...  N                   Ceftriaxone sodium       .........  .........  .........  ...........  ...........
                               injection.
J0697...  N                   Sterile cefuroxime       .........  .........  .........  ...........  ...........
                               injection.
J0698...  N                   Cefotaxime sodium        .........  .........  .........  ...........  ...........
                               injection.
J0702...  N                   Betamethasone acet&sod   .........  .........  .........  ...........  ...........
                               phosp.
J0704...  N                   Betamethasone sod phosp/ .........  .........  .........  ...........  ...........
                               4 MG.
J0710...  N                   Cephapirin sodium        .........  .........  .........  ...........  ...........
                               injection.
J0713...  N                   Inj ceftazidime per 500  .........  .........  .........  ...........  ...........
                               mg.
J0715...  N                   Ceftizoxime sodium /     .........  .........  .........  ...........  ...........
                               500 MG.
J0720...  N                   Chloramphenicol sodium   .........  .........  .........  ...........  ...........
                               injec.
J0725...  N                   Chorionic gonadotropin/  .........  .........  .........  ...........  ...........
                               1000u.
J0730...  N                   Chlorpheniramin maleate  .........  .........  .........  ...........  ...........
                               inj.
J0735...  N                   Clonidine hydrochloride  .........  .........  .........  ...........  ...........
J0740...  N                   Cidofovir injection....  .........  .........  .........  ...........  ...........
J0743...  N                   Cilastatin sodium        .........  .........  .........  ...........  ...........
                               injection.
J0745...  N                   Inj codeine phosphate /  .........  .........  .........  ...........  ...........
                               30 MG.
J0760...  N                   Colchicine injection...  .........  .........  .........  ...........  ...........
J0770...  N                   Colistimethate sodium    .........  .........  .........  ...........  ...........
                               inj.
J0780...  N                   Prochlorperazine         .........  .........  .........  ...........  ...........
                               injection.
J0800...  N                   Corticotropin injection  .........  .........  .........  ...........  ...........
J0810...  N                   Cortisone injection....  .........  .........  .........  ...........  ...........
J0835...  N                   Inj cosyntropin per      .........  .........  .........  ...........  ...........
                               0.25 MG.
J0850...  N                   Cytomegalovirus imm IV / .........  .........  .........  ...........  ...........
                               vial.
J0895...  N                   Deferoxamine mesylate    .........  .........  .........  ...........  ...........
                               inj.
J0900...  N                   Testosterone enanthate   .........  .........  .........  ...........  ...........
                               inj.
J0945...  N                   Brompheniramine maleate  .........  .........  .........  ...........  ...........
                               inj.
J0970...  N                   Estradiol valerate       .........  .........  .........  ...........  ...........
                               injection.
J1000...  N                   Depo-estradiol           .........  .........  .........  ...........  ...........
                               cypionate inj.
J1020...  N                   Methylprednisolone 20    .........  .........  .........  ...........  ...........
                               MG inj.
J1030...  N                   Methylprednisolone 40    .........  .........  .........  ...........  ...........
                               MG inj.
J1040...  N                   Methylprednisolone 80    .........  .........  .........  ...........  ...........
                               MG inj.
J1050...  N                   Medroxyprogesterone inj  .........  .........  .........  ...........  ...........
J1055...  E                   Medrxyprogester acetate  .........  .........  .........  ...........  ...........
                               inj.
J1060...  N                   Testosterone cypionate   .........  .........  .........  ...........  ...........
                               1 ML.
J1070...  N                   Testosterone cypionat    .........  .........  .........  ...........  ...........
                               100 MG.
J1080...  N                   Testosterone cypionat    .........  .........  .........  ...........  ...........
                               200 MG.
J1090...  N                   Testosterone cypionate   .........  .........  .........  ...........  ...........
                               50 MG.
J1095...  N                   Inj dexamethasone        .........  .........  .........  ...........  ...........
                               acetate.
J1100...  N                   Dexamethosone sodium     .........  .........  .........  ...........  ...........
                               phos.
J1110...  N                   Inj dihydroergotamine    .........  .........  .........  ...........  ...........
                               mesylt.
J1120...  N                   Acetazolamid sodium      .........  .........  .........  ...........  ...........
                               injectio.
J1160...  N                   Digoxin injection......  .........  .........  .........  ...........  ...........
J1165...  N                   Phenytoin sodium         .........  .........  .........  ...........  ...........
                               injection.
J1170...  N                   Hydromorphone injection  .........  .........  .........  ...........  ...........

[[Page 47740]]


J1180...  N                   Dyphylline injection...  .........  .........  .........  ...........  ...........
J1190...  N                   Dexrazoxane HCl          .........  .........  .........  ...........  ...........
                               injection.
J1200...  N                   Diphenhydramine hcl      .........  .........  .........  ...........  ...........
                               injectio.
J1205...  N                   Chlorothiazide sodium    .........  .........  .........  ...........  ...........
                               inj.
J1212...  N                   Dimethyl sulfoxide 50%   .........  .........  .........  ...........  ...........
                               50 ML.
J1230...  N                   Methadone injection....  .........  .........  .........  ...........  ...........
J1240...  N                   Dimenhydrinate           .........  .........  .........  ...........  ...........
                               injection.
J1245...  N                   Dipyridamole injection.  .........  .........  .........  ...........  ...........
J1250...  N                   Inj dobutamine HCL/250   .........  .........  .........  ...........  ...........
                               mg.
J1320...  N                   Amitriptyline injection  .........  .........  .........  ...........  ...........
J1325...  N                   Epoprostenol injection.  .........  .........  .........  ...........  ...........
J1330...  N                   Ergonovine maleate       .........  .........  .........  ...........  ...........
                               injection.
J1362...  N                   Erythromycin glucep /    .........  .........  .........  ...........  ...........
                               250 MG.
J1364...  N                   Erythro lactobionate /   .........  .........  .........  ...........  ...........
                               500 MG.
J1380...  N                   Estradiol valerate 10    .........  .........  .........  ...........  ...........
                               MG inj.
J1390...  N                   Estradiol valerate 20    .........  .........  .........  ...........  ...........
                               MG inj.
J1410...  N                   Inj estrogen conjugate   .........  .........  .........  ...........  ...........
                               25 MG.
J1435...  N                   Injection estrone per 1  .........  .........  .........  ...........  ...........
                               MG.
J1436...  N                   Etidronate disodium inj  .........  .........  .........  ...........  ...........
J1440...  N                   Filgrastim 300 mcg       .........  .........  .........  ...........  ...........
                               injeciton.
J1441...  N                   Filgrastim 480 mcg       .........  .........  .........  ...........  ...........
                               injection.
J1455...  N                   Foscarnet sodium         .........  .........  .........  ...........  ...........
                               injection.
J1460...  N                   Gamma globulin 1 CC inj  .........  .........  .........  ...........  ...........
J1470...  N                   Gamma globulin 2 CC inj  .........  .........  .........  ...........  ...........
J1480...  N                   Gamma globulin 3 CC inj  .........  .........  .........  ...........  ...........
J1490...  N                   Gamma globulin 4 CC inj  .........  .........  .........  ...........  ...........
J1500...  N                   Gamma globulin 5 CC inj  .........  .........  .........  ...........  ...........
J1510...  N                   Gamma globulin 6 CC inj  .........  .........  .........  ...........  ...........
J1520...  N                   Gamma globulin 7 CC inj  .........  .........  .........  ...........  ...........
J1530...  N                   Gamma globulin 8 CC inj  .........  .........  .........  ...........  ...........
J1540...  N                   Gamma globulin 9 CC inj  .........  .........  .........  ...........  ...........
J1550...  N                   Gamma globulin 10 CC     .........  .........  .........  ...........  ...........
                               inj.
J1560...  N                   Gamma globulin > 10 CC   .........  .........  .........  ...........  ...........
                               inj.
J1561...  N                   Immune globulin 500 mg.  .........  .........  .........  ...........  ...........
J1562...  N                   Immune globulin 5 gms..  .........  .........  .........  ...........  ...........
J1565...  N                   RSV-ivig...............  .........  .........  .........  ...........  ...........
J1570...  N                   Ganciclovir sodium       .........  .........  .........  ...........  ...........
                               injection.
J1580...  N                   Garamycin gentamicin     .........  .........  .........  ...........  ...........
                               inj.
J1600...  N                   Gold sodium thiomaleate  .........  .........  .........  ...........  ...........
                               inj.
J1610...  N                   Glucagon hydrochloride/  .........  .........  .........  ...........  ...........
                               1 MG.
J1620...  N                   Gonadorelin hydroch/     .........  .........  .........  ...........  ...........
                               100 mcg.
J1626...  N                   Granisetron HCl          .........  .........  .........  ...........  ...........
                               injection.
J1630...  N                   Haloperidol injection..  .........  .........  .........  ...........  ...........
J1631...  N                   Haloperidol decanoate    .........  .........  .........  ...........  ...........
                               inj.
J1642...  N                   Inj heparin sodium per   .........  .........  .........  ...........  ...........
                               10 u.
J1644...  N                   Inj heparin sodium per   .........  .........  .........  ...........  ...........
                               1000u.
J1645...  N                   Dalteparin sodium......  .........  .........  .........  ...........  ...........
J1650...  N                   Inj enoxaparin sodium    .........  .........  .........  ...........  ...........
                               30 mg.
J1670...  N                   Tetanus immune globulin  .........  .........  .........  ...........  ...........
                               inj.
J1690...  N                   Prednisolone tebutate    .........  .........  .........  ...........  ...........
                               inj.
J1700...  N                   Hydrocortisone acetate   .........  .........  .........  ...........  ...........
                               inj.
J1710...  N                   Hydrocortisone sodium    .........  .........  .........  ...........  ...........
                               ph inj.
J1720...  N                   Hydrocortisone sodium    .........  .........  .........  ...........  ...........
                               succ i.
J1730...  N                   Diazoxide injection....  .........  .........  .........  ...........  ...........
J1739...  N                   Hydroxyprogesterone cap  .........  .........  .........  ...........  ...........
                               125.
J1741...  N                   Hydroxyprogesterone cap  .........  .........  .........  ...........  ...........
                               250.
J1742...  N                   Ibutilide fumarate       .........  .........  .........  ...........  ...........
                               injection.
J1760...  N                   Iron dextran 2 CC inj..  .........  .........  .........  ...........  ...........
J1770...  N                   Iron dextran 5 CC inj..  .........  .........  .........  ...........  ...........
J1780...  N                   Iron dextran 10 CC inj.  .........  .........  .........  ...........  ...........
J1785...  N                   Injection imiglucerase / .........  .........  .........  ...........  ...........
                               unit.
J1790...  N                   Droperidol injection...  .........  .........  .........  ...........  ...........
J1800...  N                   Propranolol injection..  .........  .........  .........  ...........  ...........
J1810...  N                   Droperidol/fentanyl inj  .........  .........  .........  ...........  ...........
J1820...  N                   Insulin injection......  .........  .........  .........  ...........  ...........
J1825...  N                   Interferon beta-1a.....  .........  .........  .........  ...........  ...........
J1830...  N                   Interferon beta-1b /     .........  .........  .........  ...........  ...........
                               .25 MG.
J1840...  N                   Kanamycin sulfate 500    .........  .........  .........  ...........  ...........
                               MG inj.
J1850...  N                   Kanamycin sulfate 75 MG  .........  .........  .........  ...........  ...........
                               inj.
J1885...  N                   Ketorolac tromethamine   .........  .........  .........  ...........  ...........
                               inj.
J1890...  N                   Cephalothin sodium       .........  .........  .........  ...........  ...........
                               injection.
J1910...  N                   Kutapressin injection..  .........  .........  .........  ...........  ...........
J1930...  N                   Propiomazine injection.  .........  .........  .........  ...........  ...........
J1940...  N                   Furosemide injection...  .........  .........  .........  ...........  ...........
J1950...  X                   Leuprolide acetate /           064       4.17    $220.38      $140.12       $44.08
                               3.75 MG.

[[Page 47741]]


J1955...  N                   Inj levocarnitine per 1  .........  .........  .........  ...........  ...........
                               gm.
J1960...  N                   Levorphanol tartrate     .........  .........  .........  ...........  ...........
                               inj.
J1970...  N                   Methotrimeprazine        .........  .........  .........  ...........  ...........
                               injection.
J1980...  N                   Hyoscyamine sulfate inj  .........  .........  .........  ...........  ...........
J1990...  N                   Chlordiazepoxide         .........  .........  .........  ...........  ...........
                               injection.
J2000...  N                   Lidocaine injection....  .........  .........  .........  ...........  ...........
J2010...  N                   Lincomycin injection...  .........  .........  .........  ...........  ...........
J2060...  N                   Lorazepam injection....  .........  .........  .........  ...........  ...........
J2150...  N                   Mannitol injection.....  .........  .........  .........  ...........  ...........
J2175...  N                   Meperidine hydrochl /    .........  .........  .........  ...........  ...........
                               100 MG.
J2180...  N                   Meperidine/promethazine  .........  .........  .........  ...........  ...........
                               inj.
J2210...  N                   Methylergonovin maleate  .........  .........  .........  ...........  ...........
                               inj.
J2240...  N                   Metocurine iodide        .........  .........  .........  ...........  ...........
                               injection.
J2250...  N                   Inj midazolam            .........  .........  .........  ...........  ...........
                               hydrochloride.
J2260...  N                   Inj milrinone lactate /  .........  .........  .........  ...........  ...........
                               5 ML.
J2270...  N                   Morphine sulfate         .........  .........  .........  ...........  ...........
                               injection.
J2275...  N                   Morphine sulfate         .........  .........  .........  ...........  ...........
                               injection.
J2300...  N                   Inj nalbuphine           .........  .........  .........  ...........  ...........
                               hydrochloride.
J2310...  N                   Inj naloxone             .........  .........  .........  ...........  ...........
                               hydrochloride.
J2320...  N                   Nandrolone decanoate 50  .........  .........  .........  ...........  ...........
                               MG.
J2321...  N                   Nandrolone decanoate     .........  .........  .........  ...........  ...........
                               100 MG.
J2322...  N                   Nandrolone decanoate     .........  .........  .........  ...........  ...........
                               200 MG.
J2330...  N                   Thiothixene injection..  .........  .........  .........  ...........  ...........
J2350...  N                   Niacinamide/niacin       .........  .........  .........  ...........  ...........
                               injection.
J2360...  N                   Orphenadrine injection.  .........  .........  .........  ...........  ...........
J2370...  N                   Phenylephrine hcl        .........  .........  .........  ...........  ...........
                               injection.
J2400...  N                   Chloroprocaine hcl       .........  .........  .........  ...........  ...........
                               injection.
J2405...  N                   Ondansetron hcl          .........  .........  .........  ...........  ...........
                               injection.
J2410...  N                   Oxymorphone hcl          .........  .........  .........  ...........  ...........
                               injection.
J2430...  N                   Pamidronate disodium /   .........  .........  .........  ...........  ...........
                               30 MG.
J2440...  N                   Papaverin hcl injection  .........  .........  .........  ...........  ...........
J2460...  N                   Oxytetracycline          .........  .........  .........  ...........  ...........
                               injection.
J2480...  N                   Hydrochlorides of opium  .........  .........  .........  ...........  ...........
                               inj.
J2510...  N                   Penicillin g procaine    .........  .........  .........  ...........  ...........
                               inj.
J2512...  N                   Inj pentagastrin per 2   .........  .........  .........  ...........  ...........
                               ML.
J2515...  N                   Pentobarbital sodium     .........  .........  .........  ...........  ...........
                               inj.
J2540...  N                   Penicillin g potassium   .........  .........  .........  ...........  ...........
                               inj.
J2545...  A                   Pentamidine isethionte/  .........  .........  .........  ...........  ...........
                               300mg.
J2550...  N                   Promethazine hcl         .........  .........  .........  ...........  ...........
                               injection.
J2560...  N                   Phenobarbital sodium     .........  .........  .........  ...........  ...........
                               inj.
J2590...  N                   Oxytocin injection.....  .........  .........  .........  ...........  ...........
J2597...  N                   Inj desmopressin         .........  .........  .........  ...........  ...........
                               acetate.
J2640...  N                   Prednisolone sodium ph   .........  .........  .........  ...........  ...........
                               inj.
J2650...  N                   Prednisolone acetate     .........  .........  .........  ...........  ...........
                               inj.
J2670...  N                   Totazoline hcl           .........  .........  .........  ...........  ...........
                               injection.
J2675...  N                   Inj progesterone per 50  .........  .........  .........  ...........  ...........
                               MG.
J2680...  N                   Fluphenazine decanoate   .........  .........  .........  ...........  ...........
                               25 MG.
J2690...  N                   Procainamide hcl         .........  .........  .........  ...........  ...........
                               injection.
J2700...  N                   Oxacillin sodium         .........  .........  .........  ...........  ...........
                               injeciton.
J2710...  N                   Neostigmine methylslfte  .........  .........  .........  ...........  ...........
                               inj.
J2720...  N                   Inj protamine sulfate/   .........  .........  .........  ...........  ...........
                               10 MG.
J2725...  N                   Inj protirelin per 250   .........  .........  .........  ...........  ...........
                               mcg.
J2730...  N                   Pralidoxime chloride     .........  .........  .........  ...........  ...........
                               inj.
J2760...  N                   Phentolaine mesylate     .........  .........  .........  ...........  ...........
                               inj.
J2765...  N                   Metoclopramide hcl       .........  .........  .........  ...........  ...........
                               injection.
J2790...  N                   Rho d immune globulin    .........  .........  .........  ...........  ...........
                               inj.
J2800...  N                   Methocarbamol injection  .........  .........  .........  ...........  ...........
J2810...  N                   Inj theophylline per 40  .........  .........  .........  ...........  ...........
                               MG.
J2820...  N                   Sargramostim injection.  .........  .........  .........  ...........  ...........
J2860...  N                   Secobarbital sodium inj  .........  .........  .........  ...........  ...........
J2910...  N                   Aurothioglucose          .........  .........  .........  ...........  ...........
                               injeciton.
J2912...  N                   Sodium chloride          .........  .........  .........  ...........  ...........
                               injection.
J2920...  N                   Methylprednisolone       .........  .........  .........  ...........  ...........
                               injection.
J2930...  N                   Methylprednisolone       .........  .........  .........  ...........  ...........
                               injection.
J2950...  N                   Promazine hcl injeciton  .........  .........  .........  ...........  ...........
J2970...  N                   Methicillin sodium       .........  .........  .........  ...........  ...........
                               injection.
J2995...  N                   Inj streptokinase /      .........  .........  .........  ...........  ...........
                               250000 IU.
J2996...  N                   Alteplase recombinant    .........  .........  .........  ...........  ...........
                               inj.
J3000...  N                   Streptomycin injection.  .........  .........  .........  ...........  ...........
J3010...  N                   Fentanyl citrate         .........  .........  .........  ...........  ...........
                               injeciton.
J3030...  N                   Sumatriptan succinate /  .........  .........  .........  ...........  ...........
                               6 MG.
J3070...  N                   Pentazocine hcl          .........  .........  .........  ...........  ...........
                               injeciton.
J3080...  N                   Chlorprothixene          .........  .........  .........  ...........  ...........
                               injection.
J3105...  N                   Terbutaline sulfate inj  .........  .........  .........  ...........  ...........
J3120...  N                   Testosterone enanthate   .........  .........  .........  ...........  ...........
                               inj.

[[Page 47742]]


J3130...  N                   Testosterone enanthate   .........  .........  .........  ...........  ...........
                               inj.
J3140...  N                   Testosterone suspension  .........  .........  .........  ...........  ...........
                               inj.
J3150...  N                   Testosteron propionate   .........  .........  .........  ...........  ...........
                               inj.
J3230...  N                   Chlorpromazine hcl       .........  .........  .........  ...........  ...........
                               injection.
J3240...  N                   Thyrotropin injection..  .........  .........  .........  ...........  ...........
J3250...  N                   Trimethobenzamide hcl    .........  .........  .........  ...........  ...........
                               inj.
J3260...  N                   Tobramycin sulfate       .........  .........  .........  ...........  ...........
                               injection.
J3265...  N                   Injection torsemide 10   .........  .........  .........  ...........  ...........
                               mg/ml.
J3270...  N                   Imipramine hcl           .........  .........  .........  ...........  ...........
                               injection.
J3280...  N                   Thiethylperazine         .........  .........  .........  ...........  ...........
                               maleate inj.
J3301...  N                   Triamcinolone acetonide  .........  .........  .........  ...........  ...........
                               inj.
J3302...  N                   Triamcinolone diacetate  .........  .........  .........  ...........  ...........
                               inj.
J3303...  N                   Triamcinolone            .........  .........  .........  ...........  ...........
                               hexacetonl inj.
J3305...  N                   Inj trimetrexate         .........  .........  .........  ...........  ...........
                               glucoronate.
J3310...  N                   Perphenazine injeciton.  .........  .........  .........  ...........  ...........
J3320...  N                   Spectinomycn di-hcl inj  .........  .........  .........  ...........  ...........
J3350...  N                   Urea injection.........  .........  .........  .........  ...........  ...........
J3360...  N                   Diazepam injection.....  .........  .........  .........  ...........  ...........
J3364...  N                   Urokinase 5000 IU        .........  .........  .........  ...........  ...........
                               injection.
J3365...  N                   Urokinase 250,000 IU     .........  .........  .........  ...........  ...........
                               inj.
J3370...  E                   Vancomycin hcl           .........  .........  .........  ...........  ...........
                               injeciton.
J3390...  N                   Methoxamine injection..  .........  .........  .........  ...........  ...........
J3400...  N                   Triflupromazine hcl inj  .........  .........  .........  ...........  ...........
J3410...  N                   Hydroxyzine hcl          .........  .........  .........  ...........  ...........
                               injeciton.
J3420...  N                   Vitamin b12 injection..  .........  .........  .........  ...........  ...........
J3430...  N                   Vitamin k phytonadione   .........  .........  .........  ...........  ...........
                               inj.
J3450...  N                   Mephentermine sulfate    .........  .........  .........  ...........  ...........
                               inj.
J3470...  N                   Hyaluronidase injection  .........  .........  .........  ...........  ...........
J3475...  N                   Inj magnesium sulfate..  .........  .........  .........  ...........  ...........
J3480...  N                   Inj potassium chloride.  .........  .........  .........  ...........  ...........
J3490...  N                   Drugs unclassified       .........  .........  .........  ...........  ...........
                               injection.
J3520...  E                   Edetate disodium per     .........  .........  .........  ...........  ...........
                               150 mg.
J3530...  N                   Nasal vaccine            .........  .........  .........  ...........  ...........
                               inhalation.
J3535...  E                   Metered dose inhaler     .........  .........  .........  ...........  ...........
                               drug.
J3570...  E                   Laetrile amygdalin vit   .........  .........  .........  ...........  ...........
                               B17.
J7030...  A                   Normal saline solution   .........  .........  .........  ...........  ...........
                               infus.
J7040...  A                   Normal saline solution   .........  .........  .........  ...........  ...........
                               infus.
J7042...  A                   5% dextrose/normal       .........  .........  .........  ...........  ...........
                               saline.
J7050...  A                   Normal saline solution   .........  .........  .........  ...........  ...........
                               infus.
J7051...  A                   Sterile saline/water...  .........  .........  .........  ...........  ...........
J7060...  A                   5% dextrose/water......  .........  .........  .........  ...........  ...........
J7070...  A                   D5w infusion...........  .........  .........  .........  ...........  ...........
J7100...  A                   Dextran 40 infusion....  .........  .........  .........  ...........  ...........
J7110...  A                   Dextran 75 infusion....  .........  .........  .........  ...........  ...........
J7120...  A                   Ringers lactate          .........  .........  .........  ...........  ...........
                               infusion.
J7130...  A                   Hypertonic saline        .........  .........  .........  ...........  ...........
                               solution.
J7190...  N                   Factor viii............  .........  .........  .........  ...........  ...........
J7191...  N                   Factor VIII (porcine)..  .........  .........  .........  ...........  ...........
J7192...  N                   Factor viii recombinant  .........  .........  .........  ...........  ...........
J7194...  N                   Factor ix complex......  .........  .........  .........  ...........  ...........
J7196...  N                   Othr hemophilia clot     .........  .........  .........  ...........  ...........
                               factors.
J7197...  N                   Antithrombin iii         .........  .........  .........  ...........  ...........
                               injection.
J7300...  E                   Intraut copper           .........  .........  .........  ...........  ...........
                               contraceptive.
J7310...  N                   Ganciclovir long act     .........  .........  .........  ...........  ...........
                               implant.
J7500...  N                   Azathiop po tab 50mg     .........  .........  .........  ...........  ...........
                               100s ea.
J7501...  N                   Azathioprine parenteral  .........  .........  .........  ...........  ...........
J7503...  N                   Cyclosporine parenteral  .........  .........  .........  ...........  ...........
J7504...  N                   Lymphocyte immune        .........  .........  .........  ...........  ...........
                               globulin.
J7505...  N                   Monoclonal antibodies..  .........  .........  .........  ...........  ...........
J7506...  N                   Prednisone oral........  .........  .........  .........  ...........  ...........
J7507...  N                   Tacrolimus oral per 1    .........  .........  .........  ...........  ...........
                               MG.
J7508...  N                   Tacrolimus oral per 5    .........  .........  .........  ...........  ...........
                               MG.
J7509...  N                   Methylprednisolone oral  .........  .........  .........  ...........  ...........
J7510...  N                   Prednisolone oral per 5  .........  .........  .........  ...........  ...........
                               mg.
J7599...  N                   Immunosuppressive drug   .........  .........  .........  ...........  ...........
                               noc.
J7610...  A                   Acetylcysteine 10%       .........  .........  .........  ...........  ...........
                               injection.
J7615...  A                   Acetylcysteine 20%       .........  .........  .........  ...........  ...........
                               injection.
J7620...  A                   Albuterol sulfate .083%/ .........  .........  .........  ...........  ...........
                               ml.
J7625...  A                   Albuterol sulfate .5%    .........  .........  .........  ...........  ...........
                               inj.
J7627...  A                   Bitolterolmesylate       .........  .........  .........  ...........  ...........
                               inhal sol.
J7630...  A                   Cromolyn sodium          .........  .........  .........  ...........  ...........
                               injeciton.
J7640...  A                   Epinephrine injection..  .........  .........  .........  ...........  ...........
J7645...  A                   Ipratropium bromide      .........  .........  .........  ...........  ...........
                               .02%/ml.
J7650...  A                   Isoetharine hcl .1% inj  .........  .........  .........  ...........  ...........
J7651...  A                   Isoetharine hcl .125%    .........  .........  .........  ...........  ...........
                               inj.

[[Page 47743]]


J7652...  A                   Isoetharine hcl .167%    .........  .........  .........  ...........  ...........
                               inj.
J7653...  A                   Isoetharine hcl .2%/     .........  .........  .........  ...........  ...........
                               inj.
J7654...  A                   Isoetharine hcl .25%     .........  .........  .........  ...........  ...........
                               inj.
J7655...  A                   Isoetharine hcl 1% inj.  .........  .........  .........  ...........  ...........
J7660...  A                   Isoproterenol hcl .5%    .........  .........  .........  ...........  ...........
                               inj.
J7665...  A                   Isoproterenol hcl 1%     .........  .........  .........  ...........  ...........
                               inj.
J7670...  A                   Metaproterenol sulfate   .........  .........  .........  ...........  ...........
                               .4%.
J7672...  A                   Metaproterenol sulfate   .........  .........  .........  ...........  ...........
                               .6%.
J7675...  A                   Metaproterenol sulfate   .........  .........  .........  ...........  ...........
                               5%.
J7699...  A                   Inhalation solution for  .........  .........  .........  ...........  ...........
                               DME.
J7799...  A                   Non-inhalation drug for  .........  .........  .........  ...........  ...........
                               DME.
J8499...  E                   Oral prescrip drug non   .........  .........  .........  ...........  ...........
                               chemo.
J8530...  N                   Cyclophosphamide oral    .........  .........  .........  ...........  ...........
                               25 MG.
J8560...  N                   Etoposide oral 50 MG...  .........  .........  .........  ...........  ...........
J8600...  N                   Melphalan oral 2 MG....  .........  .........  .........  ...........  ...........
J8610...  X                   Methotrexate oral 2.5          061       1.04     $54.85       $36.61       $10.97
                               MG.
J8999...  X                   Oral prescription drug         061       1.04     $54.85       $36.61       $10.97
                               chemo.
J9000...  X                   Doxorubic hcl 10 MG vl         062       1.69     $89.13       $36.61       $17.83
                               chemo.
J9015...  X                   Aldesleukin/single use         061       1.04     $54.85       $36.61       $10.97
                               vial.
J9020...  X                   Asparaginase injection.        062       1.69     $89.13       $36.61       $17.83
J9031...  X                   Bcg live intravesical          063       2.89    $152.79      $110.97       $30.56
                               vac.
J9040...  X                   Bleomycin sulfate              063       2.89    $152.79      $110.97       $30.56
                               injection.
J9045...  X                   Carboplatin injection..        063       2.89    $152.79      $110.97       $30.56
J9050...  X                   Carmus bischl nitro inj        063       2.89    $152.79      $110.97       $30.56
J9060...  X                   Cisplatin 10 MG                062       1.69     $89.13       $36.61       $17.83
                               injeciton.
J9062...  X                   Cisplatin 50 MG                063       2.89    $152.79      $110.97       $30.56
                               injeciton.
J9065...  X                   Inj cladribine per 1 MG        062       1.69     $89.13       $36.61       $17.83
J9070...  X                   Cyclophosphamide 100 MG        061       1.04     $54.85       $36.61       $10.97
                               inj.
J9080...  X                   Cyclophosphamide 200 MG        061       1.04     $54.85       $36.61       $10.97
                               inj.
J9090...  X                   Cyclophosphamide 500 MG        061       1.04     $54.85       $36.61       $10.97
                               inj.
J9091...  X                   Cyclophosphamide 1.0           062       1.69     $89.13       $36.61       $17.83
                               grm inj.
J9092...  X                   Cyclophosphamide 2.0           062       1.69     $89.13       $36.61       $17.83
                               grm inj.
J9093...  X                   Cyclophosphamide               061       1.04     $54.85       $36.61       $10.97
                               lyophilized.
J9094...  X                   Cyclophosphamide               061       1.04     $54.85       $36.61       $10.97
                               lyophilized.
J9095...  X                   Cyclophosphamide               061       1.04     $54.85       $36.61       $10.97
                               lyophilized.
J9096...  X                   Cyclophosphamide               062       1.69     $89.13       $36.61       $17.83
                               lyophilized.
J9097...  X                   Cyclophosphamide               062       1.69     $89.13       $36.61       $17.83
                               lyophilized.
J9100...  X                   Cytarabine hcl 100 MG          061       1.04     $54.85       $36.61       $10.97
                               inj.
J9110...  X                   Cytarabine hcl 500 MG          061       1.04     $54.85       $36.61       $10.97
                               inj.
J9120...  X                   Dactinomycin                   061       1.04     $54.85       $36.61       $10.97
                               actinomycin d.
J9130...  X                   Dacarbazine 10 MG inj..        061       1.04     $54.85       $36.61       $10.97
J9140...  X                   Dacarbazine 200 MG inj.        061       1.04     $54.85       $36.61       $10.97
J9150...  X                   Daunorubicin...........        062       1.69     $89.13       $36.61       $17.83
J9165...  X                   Diethylstilbestrol             061       1.04     $54.85       $36.61       $10.97
                               injection.
J9170...  X                   Docetaxel..............        061       1.04     $54.85       $36.61       $10.97
J9181...  X                   Etoposide 10 MG inj....        061       1.04     $54.85       $36.61       $10.97
J9182...  X                   Etoposide 100 MG inj...        063       2.89    $152.79      $110.97       $30.56
J9185...  X                   Fludarabine phosphate          063       2.89    $152.79      $110.97       $30.56
                               inj.
J9190...  X                   Fluorouracil injection.        061       1.04     $54.85       $36.61       $10.97
J9200...  X                   Floxuridine injection..        063       2.89    $152.79      $110.97       $30.56
J9201...  X                   Gemcitabine HCl........        061       1.04     $54.85       $36.61       $10.97
J9202...  X                   Goserelin acetate              063       2.89    $152.79      $110.97       $30.56
                               implant.
J9206...  X                   Irinotecan injection...        061       1.04     $54.85       $36.61       $10.97
J9208...  X                   Ifosfomide injection...        063       2.89    $152.79      $110.97       $30.56
J9209...  X                   Mesna injection........        063       2.89    $152.79      $110.97       $30.56
J9211...  X                   Idarubicin hcl                 062       1.69     $89.13       $36.61       $17.83
                               injeciton.
J9213...  X                   Interferon alfa-2a inj.        062       1.69     $89.13       $36.61       $17.83
J9214...  X                   Interferon alfa-2b inj.        061       1.04     $54.85       $36.61       $10.97
J9215...  X                   Interferon alfa-n3 inj.        061       1.04     $54.85       $36.61       $10.97
J9216...  X                   Interferon gamma 1-b           063       2.89    $152.79      $110.97       $30.56
                               inj.
J9217...  X                   Leuprolide acetate             064       4.17    $220.38      $140.12       $44.08
                               suspnsion.
J9218...  X                   Leuprolide acetate             061       1.04     $54.85       $36.61       $10.97
                               injeciton.
J9230...  X                   Mechlorethamine hcl inj        061       1.04     $54.85       $36.61       $10.97
J9245...  X                   Inj melphalan hydrochl         064       4.17    $220.38      $140.12       $44.08
                               50 MG.
J9250...  X                   Methotrexate sodium inj        061       1.04     $54.85       $36.61       $10.97
J9260...  X                   Methotrexate sodium inj        061       1.04     $54.85       $36.61       $10.97
J9265...  X                   Paclitaxel injection...        062       1.69     $89.13       $36.61       $17.83
J9266...  X                   Pegaspargase/singl dose        061       1.04     $54.85       $36.61       $10.97
                               vial.
J9268...  X                   Pentostatin injection..        062       1.69     $89.13       $36.61       $17.83
J9270...  X                   Plicamycin                     063       2.89    $152.79      $110.97       $30.56
                               (mithramycin) inj.
J9280...  X                   Mitomycin 5 MG inj.....        063       2.89    $152.79      $110.97       $30.56
J9290...  X                   Mitomycin 20 MG inj....        064       4.17    $220.38      $140.12       $44.08
J9291...  X                   Mitomycin 40 MG inj....        064       4.17    $220.38      $140.12       $44.08
J9293...  X                   Mitoxantrone hydrochl /        064       4.17    $220.38      $140.12       $44.08
                               5 MG.
J9320...  X                   Streptozocin injection.        063       2.89    $152.79      $110.97       $30.56

[[Page 47744]]


J9340...  X                   Thiotepa injection.....        063       2.89    $152.79      $110.97       $30.56
J9350...  X                   Topotecan..............        061       1.04     $54.85       $36.61       $10.97
J9360...  X                   Vinblastine sulfate inj        061       1.04     $54.85       $36.61       $10.97
J9370...  X                   Vincristine sulfate 1          062       1.69     $89.13       $36.61       $17.83
                               MG inj.
J9375...  X                   Vincristine sulfate 2          063       2.89    $152.79      $110.97       $30.56
                               MG inj.
J9380...  X                   Vincristine sulfate 5          063       2.89    $152.79      $110.97       $30.56
                               MG inj.
J9390...  X                   Vinorelbine tartrate/10        061       1.04     $54.85       $36.61       $10.97
                               mg.
J9600...  X                   Porfimer sodium........        061       1.04     $54.85       $36.61       $10.97
J9999...  X                   Chemotherapy drug......        061       1.04     $54.85       $36.61       $10.97
K0001...  A                   Standard wheelchair....  .........  .........  .........  ...........  ...........
K0002...  A                   Stnd hemi (low seat)     .........  .........  .........  ...........  ...........
                               whlchr.
K0003...  A                   Lightweight wheelchair.  .........  .........  .........  ...........  ...........
K0004...  A                   High strength ltwt       .........  .........  .........  ...........  ...........
                               whlchr.
K0005...  A                   Ultralightweight         .........  .........  .........  ...........  ...........
                               wheelchair.
K0006...  A                   Heavy duty wheelchair..  .........  .........  .........  ...........  ...........
K0007...  A                   Extra heavy duty         .........  .........  .........  ...........  ...........
                               wheelchair.
K0008...  A                   Cstm manual wheelchair/  .........  .........  .........  ...........  ...........
                               base.
K0009...  A                   Other manual wheelchair/ .........  .........  .........  ...........  ...........
                               base.
K0010...  A                   Stnd wt frame power      .........  .........  .........  ...........  ...........
                               whlchr.
K0011...  A                   Stnd wt pwr whlchr w     .........  .........  .........  ...........  ...........
                               control.
K0012...  A                   Ltwt portbl power        .........  .........  .........  ...........  ...........
                               whlchr.
K0013...  A                   Custom power whlchr      .........  .........  .........  ...........  ...........
                               base.
K0014...  A                   Other power whlchr base  .........  .........  .........  ...........  ...........
K0015...  A                   Detach non-adjus hght    .........  .........  .........  ...........  ...........
                               armrst.
K0016...  A                   Detach adjust armrst     .........  .........  .........  ...........  ...........
                               cmplete.
K0017...  A                   Detach adjust armrest    .........  .........  .........  ...........  ...........
                               base.
K0018...  A                   Detach adjust armrst     .........  .........  .........  ...........  ...........
                               upper.
K0019...  A                   Arm pad each...........  .........  .........  .........  ...........  ...........
K0020...  A                   Fixed adjust armrest     .........  .........  .........  ...........  ...........
                               pair.
K0021...  A                   Anti-tipping device      .........  .........  .........  ...........  ...........
                               each.
K0022...  A                   Reinforced back          .........  .........  .........  ...........  ...........
                               upholstery.
K0023...  A                   Planr back insrt foam w/ .........  .........  .........  ...........  ...........
                               strp.
K0024...  A                   Plnr back insrt foam w/  .........  .........  .........  ...........  ...........
                               hrdwr.
K0025...  A                   Hook-on headrest         .........  .........  .........  ...........  ...........
                               extension.
K0026...  A                   Back upholst lgtwt       .........  .........  .........  ...........  ...........
                               whlchr.
K0027...  A                   Back upholst other       .........  .........  .........  ...........  ...........
                               whlchr.
K0028...  A                   Fully reclining back...  .........  .........  .........  ...........  ...........
K0029...  A                   Reinforced seat          .........  .........  .........  ...........  ...........
                               upholstery.
K0030...  A                   Solid plnr seat sngl     .........  .........  .........  ...........  ...........
                               dnsfoam.
K0031...  A                   Safety belt/pelvic       .........  .........  .........  ...........  ...........
                               strap.
K0032...  A                   Seat uphols lgtwt        .........  .........  .........  ...........  ...........
                               whlchr.
K0033...  A                   Seat upholstery other    .........  .........  .........  ...........  ...........
                               whlchr.
K0034...  A                   Heel loop each.........  .........  .........  .........  ...........  ...........
K0035...  A                   Heel loop with ankle     .........  .........  .........  ...........  ...........
                               strap.
K0036...  A                   Toe loop each..........  .........  .........  .........  ...........  ...........
K0037...  A                   High mount flip-up       .........  .........  .........  ...........  ...........
                               footrest.
K0038...  A                   Leg strap each.........  .........  .........  .........  ...........  ...........
K0039...  A                   Leg strap h style each.  .........  .........  .........  ...........  ...........
K0040...  A                   Adjustable angle         .........  .........  .........  ...........  ...........
                               footplate.
K0041...  A                   Large size footplate     .........  .........  .........  ...........  ...........
                               each.
K0042...  A                   Standard size footplate  .........  .........  .........  ...........  ...........
                               each.
K0043...  A                   Ftrst lower extension    .........  .........  .........  ...........  ...........
                               tube.
K0044...  A                   Ftrst upper hanger       .........  .........  .........  ...........  ...........
                               bracket.
K0045...  A                   Footrest complete        .........  .........  .........  ...........  ...........
                               assembly.
K0046...  A                   Elevat legrst low        .........  .........  .........  ...........  ...........
                               extension.
K0047...  A                   Elevat legrst up hangr   .........  .........  .........  ...........  ...........
                               brack.
K0048...  A                   Elevate legrest          .........  .........  .........  ...........  ...........
                               complete.
K0049...  A                   Calf pad each..........  .........  .........  .........  ...........  ...........
K0050...  A                   Ratchet assembly.......  .........  .........  .........  ...........  ...........
K0051...  A                   Cam relese assem ftrst/  .........  .........  .........  ...........  ...........
                               lgrst.
K0052...  A                   Swingaway detach         .........  .........  .........  ...........  ...........
                               footrest.
K0053...  A                   Elevate footrest         .........  .........  .........  ...........  ...........
                               articulate.
K0054...  A                   Seat wdth 10-12/15/17/   .........  .........  .........  ...........  ...........
                               20 wc.
K0055...  A                   Seat dpth 15/17/18 ltwt  .........  .........  .........  ...........  ...........
                               wc.
K0056...  A                   Seat ht <17 or <=21      .........  .........  .........  ...........  ...........
                               ltwt wc.
K0057...  A                   Seat wdth 19/20 hvy dty  .........  .........  .........  ...........  ...........
                               wc.
K0058...  A                   Seat dpth 17/18 power    .........  .........  .........  ...........  ...........
                               wc.
K0059...  A                   Plastic coated handrim   .........  .........  .........  ...........  ...........
                               each.
K0060...  A                   Steel handrim each.....  .........  .........  .........  ...........  ...........
K0061...  A                   Aluminum handrim each..  .........  .........  .........  ...........  ...........
K0062...  A                   Handrim 8-10 vert/obliq  .........  .........  .........  ...........  ...........
                               proj.
K0063...  A                   Hndrm 12-16 vert/obliq   .........  .........  .........  ...........  ...........
                               proj.
K0064...  A                   Zero pressure tube flat  .........  .........  .........  ...........  ...........
                               free.
K0065...  A                   Spoke protectors.......  .........  .........  .........  ...........  ...........
K0066...  A                   Solid tire any size      .........  .........  .........  ...........  ...........
                               each.

[[Page 47745]]


K0067...  A                   Pneumatic tire any size  .........  .........  .........  ...........  ...........
                               each.
K0068...  A                   Pneumatic tire tube      .........  .........  .........  ...........  ...........
                               each.
K0069...  A                   Rear whl complete solid  .........  .........  .........  ...........  ...........
                               tire.
K0070...  A                   Rear whl compl pneum     .........  .........  .........  ...........  ...........
                               tire.
K0071...  A                   Front castr compl pneum  .........  .........  .........  ...........  ...........
                               tire.
K0072...  A                   Frnt cstr cmpl sem-      .........  .........  .........  ...........  ...........
                               pneum tir.
K0073...  A                   Caster pin lock each...  .........  .........  .........  ...........  ...........
K0074...  A                   Pneumatic caster tire    .........  .........  .........  ...........  ...........
                               each.
K0075...  A                   Semi-pneumatic caster    .........  .........  .........  ...........  ...........
                               tire.
K0076...  A                   Solid caster tire each.  .........  .........  .........  ...........  ...........
K0077...  A                   Front caster assem       .........  .........  .........  ...........  ...........
                               complete.
K0078...  A                   Pneumatic caster tire    .........  .........  .........  ...........  ...........
                               tube.
K0079...  A                   Wheel lock extension     .........  .........  .........  ...........  ...........
                               pair.
K0080...  A                   Anti-rollback device     .........  .........  .........  ...........  ...........
                               pair.
K0081...  A                   Wheel lock assembly      .........  .........  .........  ...........  ...........
                               complete.
K0082...  A                   22 nf deep cycl acid     .........  .........  .........  ...........  ...........
                               battery.
K0083...  A                   22 nf gel cell battery   .........  .........  .........  ...........  ...........
                               each.
K0084...  A                   Grp 24 deep cycl acid    .........  .........  .........  ...........  ...........
                               battry.
K0085...  A                   Group 24 gel cell        .........  .........  .........  ...........  ...........
                               battery.
K0086...  A                   U-1 lead acid battery    .........  .........  .........  ...........  ...........
                               each.
K0087...  A                   U-1 gel cell battery     .........  .........  .........  ...........  ...........
                               each.
K0088...  A                   Battry chrgr acid/gel    .........  .........  .........  ...........  ...........
                               cell.
K0089...  A                   Battery charger dual     .........  .........  .........  ...........  ...........
                               mode.
K0090...  A                   Rear tire power          .........  .........  .........  ...........  ...........
                               wheelchair.
K0091...  A                   Rear tire tube power     .........  .........  .........  ...........  ...........
                               whlchr.
K0092...  A                   Rear assem cmplt powr    .........  .........  .........  ...........  ...........
                               whlchr.
K0093...  A                   Rear zero pressure tire  .........  .........  .........  ...........  ...........
                               tube.
K0094...  A                   Wheel tire for power     .........  .........  .........  ...........  ...........
                               base.
K0095...  A                   Wheel tire tube each     .........  .........  .........  ...........  ...........
                               base.
K0096...  A                   Wheel assem powr base    .........  .........  .........  ...........  ...........
                               complt.
K0097...  A                   Wheel zero presure tire  .........  .........  .........  ...........  ...........
                               tube.
K0098...  A                   Drive belt power         .........  .........  .........  ...........  ...........
                               wheelchair.
K0099...  A                   Front caster power       .........  .........  .........  ...........  ...........
                               whelchair.
K0100...  A                   Amputee adapter pair...  .........  .........  .........  ...........  ...........
K0101...  A                   One-arm drive            .........  .........  .........  ...........  ...........
                               attachment.
K0102...  A                   Crutch and cane holder.  .........  .........  .........  ...........  ...........
K0103...  A                   Transfer board < 25''..  .........  .........  .........  ...........  ...........
K0104...  A                   Cylinder tank carrier..  .........  .........  .........  ...........  ...........
K0105...  A                   Iv hanger..............  .........  .........  .........  ...........  ...........
K0106...  A                   Arm trough each........  .........  .........  .........  ...........  ...........
K0107...  A                   Wheelchair tray........  .........  .........  .........  ...........  ...........
K0108...  A                   Other accessories......  .........  .........  .........  ...........  ...........
K0109...  A                   Customize whlchr base    .........  .........  .........  ...........  ...........
                               frame.
K0112...  A                   Trunk vest supprt innr   .........  .........  .........  ...........  ...........
                               frame.
K0113...  A                   Trunk vest suprt w/o     .........  .........  .........  ...........  ...........
                               inr frm.
K0114...  A                   Whlchr back suprt inr    .........  .........  .........  ...........  ...........
                               frame.
K0115...  A                   Back module orthotic     .........  .........  .........  ...........  ...........
                               system.
K0116...  A                   Back & seat modul        .........  .........  .........  ...........  ...........
                               orthot sys.
K0119...  N                   Azathioprine oral tab    .........  .........  .........  ...........  ...........
                               50 MG.
K0120...  N                   Azathioprine prentrl     .........  .........  .........  ...........  ...........
                               100 MG.
K0121...  N                   Cyclosporine oral 25 MG  .........  .........  .........  ...........  ...........
K0122...  N                   Cyclosporine prentrl     .........  .........  .........  ...........  ...........
                               250 MG.
K0123...  N                   Imun/antitymocyt glob    .........  .........  .........  ...........  ...........
                               250 MG.
K0137...  A                   Skin barrier liquid per  .........  .........  .........  ...........  ...........
                               oz.
K0138...  A                   Skin barrier paste per   .........  .........  .........  ...........  ...........
                               oz.
K0139...  A                   Skin barrier powder per  .........  .........  .........  ...........  ...........
                               oz.
K0168...  A                   Disposable nebulizer     .........  .........  .........  ...........  ...........
                               set.
K0169...  A                   Disposable nebulizer     .........  .........  .........  ...........  ...........
                               small.
K0170...  A                   Non disposable           .........  .........  .........  ...........  ...........
                               nebulizer set.
K0171...  A                   Filtered nebulizer set.  .........  .........  .........  ...........  ...........
K0172...  A                   Disposable nebulizer     .........  .........  .........  ...........  ...........
                               unfill.
K0173...  A                   Disposable nebulizer     .........  .........  .........  ...........  ...........
                               prefill.
K0174...  A                   Reservoir bottle w       .........  .........  .........  ...........  ...........
                               nebulizer.
K0175...  A                   Disposable corrugated    .........  .........  .........  ...........  ...........
                               tubing.
K0176...  A                   Non dispos corrugated    .........  .........  .........  ...........  ...........
                               tubing.
K0177...  A                   Water collec dev w       .........  .........  .........  ...........  ...........
                               nebulizer.
K0178...  A                   Disposbl filter w        .........  .........  .........  ...........  ...........
                               compressor.
K0179...  A                   Non-dispos filter w/     .........  .........  .........  ...........  ...........
                               compress.
K0180...  A                   Aerosol mask with        .........  .........  .........  ...........  ...........
                               nebulizer.
K0181...  A                   Dome & mouthpiece w/     .........  .........  .........  ...........  ...........
                               nebuliz.
K0182...  A                   Water distilled w/       .........  .........  .........  ...........  ...........
                               nebulizer.
K0183...  A                   Nasal application with   .........  .........  .........  ...........  ...........
                               cpap.
K0184...  A                   Nasal pillows/seals      .........  .........  .........  ...........  ...........
                               pair.
K0185...  A                   Headgear with cpap       .........  .........  .........  ...........  ...........
                               device.
K0186...  A                   Chin strap with cpap     .........  .........  .........  ...........  ...........
                               device.

[[Page 47746]]


K0187...  A                   Tubing with cpap device  .........  .........  .........  ...........  ...........
K0188...  A                   Filter disposable with   .........  .........  .........  ...........  ...........
                               cpap.
K0189...  A                   Filter non-disposable w/ .........  .........  .........  ...........  ...........
                               cpap.
K0190...  A                   Disposable canister w/   .........  .........  .........  ...........  ...........
                               pump.
K0191...  A                   Non-disposbl canister w/ .........  .........  .........  ...........  ...........
                               pump.
K0192...  A                   Tubing used w/ suction   .........  .........  .........  ...........  ...........
                               pump.
K0193...  A                   Airway pressure dev/w    .........  .........  .........  ...........  ...........
                               hmdfer.
K0194...  A                   Assist device w/         .........  .........  .........  ...........  ...........
                               humidifier.
K0195...  A                   Elevating whlchair leg   .........  .........  .........  ...........  ...........
                               rests.
K0268...  A                   Humidifier with cpap     .........  .........  .........  ...........  ...........
                               device.
K0269...  A                   Aerosol compressor cpap  .........  .........  .........  ...........  ...........
                               dev.
K0270...  A                   Ultrasonic generator w   .........  .........  .........  ...........  ...........
                               nebul.
K0277...  A                   Skin barrier solid 4x4   .........  .........  .........  ...........  ...........
                               equiv.
K0278...  A                   Skin barrier with        .........  .........  .........  ...........  ...........
                               flange.
K0279...  A                   Skin barrier extended    .........  .........  .........  ...........  ...........
                               wear.
K0280...  A                   Extension drainage       .........  .........  .........  ...........  ...........
                               tubing.
K0281...  A                   Lubricant catheter       .........  .........  .........  ...........  ...........
                               insertion.
K0283...  A                   Saline solution          .........  .........  .........  ...........  ...........
                               dispenser.
K0284...  A                   External infusion pump   .........  .........  .........  ...........  ...........
                               reuse.
K0400...  A                   Skin support attachment  .........  .........  .........  ...........  ...........
                               each.
K0401...  A                   Diabetic deluxe shoe...  .........  .........  .........  ...........  ...........
K0407...  A                   Urinary cath skin        .........  .........  .........  ...........  ...........
                               attachment.
K0408...  A                   Urinary cath leg strap.  .........  .........  .........  ...........  ...........
K0409...  A                   Sterile H2O irrigation   .........  .........  .........  ...........  ...........
                               solut.
K0410...  A                   Male ext cath w/adh      .........  .........  .........  ...........  ...........
                               coating.
K0411...  A                   Male ext cath w/adh      .........  .........  .........  ...........  ...........
                               strip.
K0412...  N                   Mycophenolate mofetil    .........  .........  .........  ...........  ...........
                               25o mg.
K0415...  N                   RX antiemetic drg, oral  .........  .........  .........  ...........  ...........
                               NOS.
K0416...  N                   Rx antiemetic            .........  .........  .........  ...........  ...........
                               drg,rectal NOS.
K0417...  A                   Mech infus pump sht trm  .........  .........  .........  ...........  ...........
                               drug.
K0418...  N                   Oral cyclosporin.......  .........  .........  .........  ...........  ...........
K0419...  A                   Drainable plstic pch w   .........  .........  .........  ...........  ...........
                               fcplt.
K0420...  A                   Drainable rubber pch w   .........  .........  .........  ...........  ...........
                               fcplt.
K0421...  A                   drainable plstic pch w/  .........  .........  .........  ...........  ...........
                               o fp.
K0422...  A                   Drainable rubber pch w/  .........  .........  .........  ...........  ...........
                               o fp.
K0423...  A                   Urinary plstic pouch w   .........  .........  .........  ...........  ...........
                               fcplt.
K0424...  A                   Urinary rubber pouch w   .........  .........  .........  ...........  ...........
                               fcplt.
K0425...  A                   Urinary plstic pouch w/  .........  .........  .........  ...........  ...........
                               o fp.
K0426...  A                   Urinary hvy plstc pch w/ .........  .........  .........  ...........  ...........
                               o fp.
K0427...  A                   Urinary rubber pouch w/  .........  .........  .........  ...........  ...........
                               o fp.
K0428...  A                   Ostomy faceplt/silicone  .........  .........  .........  ...........  ...........
                               ring.
K0429...  A                   Skin barrier solid ext   .........  .........  .........  ...........  ...........
                               wear.
K0430...  A                   Skin barrier w flang ex  .........  .........  .........  ...........  ...........
                               wear.
K0431...  A                   Closed pouch w st wear   .........  .........  .........  ...........  ...........
                               bar.
K0432...  A                   Drainable pch w ex wear  .........  .........  .........  ...........  ...........
                               bar.
K0433...  A                   Drainable pch w st wear  .........  .........  .........  ...........  ...........
                               bar.
K0434...  A                   Drainable pch ex wear    .........  .........  .........  ...........  ...........
                               convex.
K0435...  A                   Urinary pouch w ex wear  .........  .........  .........  ...........  ...........
                               bar.
K0436...  A                   Urinary pouch w st wear  .........  .........  .........  ...........  ...........
                               bar.
K0437...  A                   Urine pch w ex wear bar  .........  .........  .........  ...........  ...........
                               conv.
K0438...  A                   Ostomy pouch liq         .........  .........  .........  ...........  ...........
                               deodorant.
K0439...  A                   Ostomy pouch solid       .........  .........  .........  ...........  ...........
                               deodorant.
K0440...  A                   Nasal prosthesis.......  .........  .........  .........  ...........  ...........
K0441...  A                   Midfacial prosthesis...  .........  .........  .........  ...........  ...........
K0442...  A                   Orbital prosthesis.....  .........  .........  .........  ...........  ...........
K0443...  A                   Upper facial prosthesis  .........  .........  .........  ...........  ...........
K0444...  A                   Hemi-facial prosthesis.  .........  .........  .........  ...........  ...........
K0445...  S                   Auricular prosthesis...        031       1.33     $70.52       $14.10       $14.10
K0446...  A                   Partial facial           .........  .........  .........  ...........  ...........
                               prosthesis.
K0447...  A                   Nasal septal prosthesis  .........  .........  .........  ...........  ...........
K0448...  A                   Unspec maxillofacial     .........  .........  .........  ...........  ...........
                               prosth.
K0449...  A                   Repair maxillofacial     .........  .........  .........  ...........  ...........
                               prosth.
K0450...  A                   Liq adhes for facial     .........  .........  .........  ...........  ...........
                               prosth.
K0451...  A                   Adhesive remover wipes.  .........  .........  .........  ...........  ...........
K0452...  A                   Wheelchair bearings....  .........  .........  .........  ...........  ...........
K0453...  N                   Amphotericin B.........  .........  .........  .........  ...........  ...........
K0455...  A                   Pump uninterrupted       .........  .........  .........  ...........  ...........
                               infusion.
K0501...  A                   Aerosol compressor for   .........  .........  .........  ...........  ...........
                               svneb.
K0503...  A                   Acetylcysteine inh sol   .........  .........  .........  ...........  ...........
                               u d.
K0504...  A                   Albuterol inh sol con..  .........  .........  .........  ...........  ...........
K0505...  A                   Albuterol inh sol u d..  .........  .........  .........  ...........  ...........
K0506...  A                   Atropine inh sol con...  .........  .........  .........  ...........  ...........
K0507...  A                   Atropine inh sol u d...  .........  .........  .........  ...........  ...........
K0508...  A                   Bitolterol mes inh sol   .........  .........  .........  ...........  ...........
                               con.
K0509...  A                   Bitolterol mes inh sol   .........  .........  .........  ...........  ...........
                               u d.

[[Page 47747]]


K0511...  A                   Cromolyn sodium inh sol  .........  .........  .........  ...........  ...........
                               u d.
K0512...  A                   Dexamethasone inh sol    .........  .........  .........  ...........  ...........
                               con.
K0513...  A                   Dexamethasone inh sol u  .........  .........  .........  ...........  ...........
                               d.
K0514...  A                   Dornase alpha inh sol u  .........  .........  .........  ...........  ...........
                               d.
K0515...  A                   Glycopyrrolate inh sol   .........  .........  .........  ...........  ...........
                               con.
K0516...  A                   Glycopyrrolate inh sol   .........  .........  .........  ...........  ...........
                               u d.
K0518...  A                   Ipratropium brom inh     .........  .........  .........  ...........  ...........
                               sol u d.
K0519...  A                   Isoetharine HCl inh sol  .........  .........  .........  ...........  ...........
                               con.
K0520...  A                   Isoetharine HCl inh sol  .........  .........  .........  ...........  ...........
                               u d.
K0521...  A                   IsoproterenolHCl inh     .........  .........  .........  ...........  ...........
                               sol con.
K0522...  A                   IsoproterenolHCl inh     .........  .........  .........  ...........  ...........
                               sol u d.
K0523...  A                   Metaproterenol inh sol   .........  .........  .........  ...........  ...........
                               con.
K0524...  A                   Metaproterenol inh sol   .........  .........  .........  ...........  ...........
                               u d.
K0525...  A                   Terbutaline SO4 inh sol  .........  .........  .........  ...........  ...........
                               con.
K0526...  A                   Terbutaline SO4 inh sol  .........  .........  .........  ...........  ...........
                               u d.
K0527...  A                   Triamcinolone inh sol    .........  .........  .........  ...........  ...........
                               con.
K0528...  A                   Triamcinolone inh sol u  .........  .........  .........  ...........  ...........
                               d.
K0529...  A                   Sterile H20 or nss w lv  .........  .........  .........  ...........  ...........
                               neb.
K0530...  A                   Nebulizer not used w     .........  .........  .........  ...........  ...........
                               oxygen.
L0100...  A                   Cerv craniosten helmet   .........  .........  .........  ...........  ...........
                               mold.
L0110...  A                   Cerv craniostenosis hel  .........  .........  .........  ...........  ...........
                               non-.
L0120...  A                   Cerv flexible non-       .........  .........  .........  ...........  ...........
                               adjustable.
L0130...  A                   Flex thermoplastic       .........  .........  .........  ...........  ...........
                               collar mo.
L0140...  A                   Cervical semi-rigid      .........  .........  .........  ...........  ...........
                               adjustab.
L0150...  A                   Cerv semi-rig adj        .........  .........  .........  ...........  ...........
                               molded chn.
L0160...  A                   Cerv semi-rig wire occ/  .........  .........  .........  ...........  ...........
                               mand.
L0170...  A                   Cervical collar molded   .........  .........  .........  ...........  ...........
                               to pt.
L0172...  A                   Cerv col thermplas foam  .........  .........  .........  ...........  ...........
                               2 pi.
L0174...  A                   Cerv col foam 2 piece w  .........  .........  .........  ...........  ...........
                               thor.
L0180...  A                   Cer post col occ/man     .........  .........  .........  ...........  ...........
                               sup adj.
L0190...  A                   Cerv collar supp adj     .........  .........  .........  ...........  ...........
                               cerv ba.
L0200...  A                   Cerv col supp adj bar &  .........  .........  .........  ...........  ...........
                               thor.
L0210...  A                   Thoracic rib belt......  .........  .........  .........  ...........  ...........
L0220...  A                   Thor rib belt custom     .........  .........  .........  ...........  ...........
                               fabrica.
L0300...  A                   TLSO flex surgical       .........  .........  .........  ...........  ...........
                               support.
L0310...  A                   Tlso flexible custom     .........  .........  .........  ...........  ...........
                               fabrica.
L0315...  A                   Tlso flex elas rigid     .........  .........  .........  ...........  ...........
                               post pa.
L0317...  A                   Tlso flex hypext elas    .........  .........  .........  ...........  ...........
                               post p.
L0320...  A                   Tlso a-p contrl w apron  .........  .........  .........  ...........  ...........
                               frnt.
L0330...  A                   Tlso ant-pos-lateral     .........  .........  .........  ...........  ...........
                               control.
L0340...  A                   Tlso a-p-l-rotary with   .........  .........  .........  ...........  ...........
                               apron.
L0350...  A                   Tlso flex compress       .........  .........  .........  ...........  ...........
                               jacket cu.
L0360...  A                   Tlso flex compress       .........  .........  .........  ...........  ...........
                               jacket mo.
L0370...  A                   Tlso a-p-l-rotary        .........  .........  .........  ...........  ...........
                               hyperexten.
L0380...  A                   Tlso a-p-l-rot w/ pos    .........  .........  .........  ...........  ...........
                               extens.
L0390...  A                   Tlso a-p-l control       .........  .........  .........  ...........  ...........
                               molded.
L0400...  A                   Tlso a-p-l w interface   .........  .........  .........  ...........  ...........
                               mater.
L0410...  A                   Tlso a-p-l two piece     .........  .........  .........  ...........  ...........
                               constr.
L0420...  A                   Tlso a-p-l 2 piece w     .........  .........  .........  ...........  ...........
                               interfa.
L0430...  A                   Tlso a-p-l w interface   .........  .........  .........  ...........  ...........
                               custm.
L0440...  A                   Tlso a-p-l overlap frnt  .........  .........  .........  ...........  ...........
                               cust.
L0500...  A                   Lso flex surgical        .........  .........  .........  ...........  ...........
                               support.
L0510...  A                   Lso flexible custom      .........  .........  .........  ...........  ...........
                               fabricat.
L0515...  A                   Lso flex elas w/ rig     .........  .........  .........  ...........  ...........
                               post pa.
L0520...  A                   Lso a-p-l control with   .........  .........  .........  ...........  ...........
                               apron.
L0530...  A                   Lso ant-pos control w    .........  .........  .........  ...........  ...........
                               apron.
L0540...  A                   Lso lumbar flexion a-p-  .........  .........  .........  ...........  ...........
                               l.
L0550...  A                   Lso a-p-l control        .........  .........  .........  ...........  ...........
                               molded.
L0560...  A                   Lso a-p-l w interface..  .........  .........  .........  ...........  ...........
L0565...  A                   Lso a-p-l control        .........  .........  .........  ...........  ...........
                               custom.
L0600...  A                   Sacroiliac flex surg     .........  .........  .........  ...........  ...........
                               support.
L0610...  A                   Sacroiliac flexible      .........  .........  .........  ...........  ...........
                               custm fa.
L0620...  A                   Sacroiliac semi-rig w    .........  .........  .........  ...........  ...........
                               apron.
L0700...  A                   Ctlso a-p-l control      .........  .........  .........  ...........  ...........
                               molded.
L0710...  A                   Ctlso a-p-l control w/   .........  .........  .........  ...........  ...........
                               inter.
L0810...  A                   Halo cervical into jckt  .........  .........  .........  ...........  ...........
                               vest.
L0820...  A                   Halo cervical into body  .........  .........  .........  ...........  ...........
                               jack.
L0830...  A                   Halo cerv into           .........  .........  .........  ...........  ...........
                               milwaukee typ.
L0860...  A                   Magnetic resonanc image  .........  .........  .........  ...........  ...........
                               comp.
L0900...  A                   Torso/ptosis support...  .........  .........  .........  ...........  ...........
L0910...  A                   Torso & ptosis supp      .........  .........  .........  ...........  ...........
                               custm fa.
L0920...  A                   Torso/pendulous abd      .........  .........  .........  ...........  ...........
                               support.
L0930...  A                   Pendulous abdomen supp   .........  .........  .........  ...........  ...........
                               custm.
L0940...  A                   Torso/postsurgical       .........  .........  .........  ...........  ...........
                               support.
L0950...  A                   Post surg support        .........  .........  .........  ...........  ...........
                               custom fab.

[[Page 47748]]


L0960...  A                   Post surgical support    .........  .........  .........  ...........  ...........
                               pads.
L0970...  A                   Tlso corset front......  .........  .........  .........  ...........  ...........
L0972...  A                   Lso corset front.......  .........  .........  .........  ...........  ...........
L0974...  A                   Tlso full corset.......  .........  .........  .........  ...........  ...........
L0976...  A                   Lso full corset........  .........  .........  .........  ...........  ...........
L0978...  A                   Axillary crutch          .........  .........  .........  ...........  ...........
                               extension.
L0980...  A                   Peroneal straps pair...  .........  .........  .........  ...........  ...........
L0982...  A                   Stocking supp grips set  .........  .........  .........  ...........  ...........
                               of f.
L0984...  A                   Protective body sock     .........  .........  .........  ...........  ...........
                               each.
L0999...  A                   Add to spinal orthosis   .........  .........  .........  ...........  ...........
                               NOS.
L1000...  A                   Ctlso milwauke initial   .........  .........  .........  ...........  ...........
                               model.
L1010...  A                   Ctlso axilla sling.....  .........  .........  .........  ...........  ...........
L1020...  A                   Kyphosis pad...........  .........  .........  .........  ...........  ...........
L1025...  A                   Kyphosis pad floating..  .........  .........  .........  ...........  ...........
L1030...  A                   Lumbar bolster pad.....  .........  .........  .........  ...........  ...........
L1040...  A                   Lumbar or lumbar rib     .........  .........  .........  ...........  ...........
                               pad.
L1050...  A                   Sternal pad............  .........  .........  .........  ...........  ...........
L1060...  A                   Thoracic pad...........  .........  .........  .........  ...........  ...........
L1070...  A                   Trapezius sling........  .........  .........  .........  ...........  ...........
L1080...  A                   Outrigger..............  .........  .........  .........  ...........  ...........
L1085...  A                   Outrigger bil w/ vert    .........  .........  .........  ...........  ...........
                               extens.
L1090...  A                   Lumbar sling...........  .........  .........  .........  ...........  ...........
L1100...  A                   Ring flange plastic/     .........  .........  .........  ...........  ...........
                               leather.
L1110...  A                   Ring flange plas/        .........  .........  .........  ...........  ...........
                               leather mol.
L1120...  A                   Covers for upright each  .........  .........  .........  ...........  ...........
L1200...  A                   Furnsh initial orthosis  .........  .........  .........  ...........  ...........
                               only.
L1210...  A                   Lateral thoracic         .........  .........  .........  ...........  ...........
                               extension.
L1220...  A                   Anterior thoracic        .........  .........  .........  ...........  ...........
                               extension.
L1230...  A                   Milwaukee type           .........  .........  .........  ...........  ...........
                               superstructur.
L1240...  A                   Lumbar derotation pad..  .........  .........  .........  ...........  ...........
L1250...  A                   Anterior asis pad......  .........  .........  .........  ...........  ...........
L1260...  A                   Anterior thoracic        .........  .........  .........  ...........  ...........
                               derotation.
L1270...  A                   Abdominal pad..........  .........  .........  .........  ...........  ...........
L1280...  A                   Rib gusset (elastic)     .........  .........  .........  ...........  ...........
                               each.
L1290...  A                   Lateral trochanteric     .........  .........  .........  ...........  ...........
                               pad.
L1300...  A                   Body jacket mold to      .........  .........  .........  ...........  ...........
                               patient.
L1310...  A                   Post-operative body      .........  .........  .........  ...........  ...........
                               jacket.
L1499...  A                   Spinal orthosis NOS....  .........  .........  .........  ...........  ...........
L1500...  A                   Thkao mobility frame...  .........  .........  .........  ...........  ...........
L1510...  A                   Thkao standing frame...  .........  .........  .........  ...........  ...........
L1520...  A                   Thkao swivel walker....  .........  .........  .........  ...........  ...........
L1600...  A                   Abduct hip flex frejka   .........  .........  .........  ...........  ...........
                               w cvr.
L1610...  A                   Abduct hip flex frejka   .........  .........  .........  ...........  ...........
                               covr.
L1620...  A                   Abduct hip flex pavlik   .........  .........  .........  ...........  ...........
                               harne.
L1630...  A                   Abduct control hip semi- .........  .........  .........  ...........  ...........
                               flex.
L1640...  A                   Pelv band/spread bar     .........  .........  .........  ...........  ...........
                               thigh c.
L1650...  A                   HO abduction hip         .........  .........  .........  ...........  ...........
                               adjustable.
L1660...  A                   HO abduction static      .........  .........  .........  ...........  ...........
                               plastic.
L1680...  A                   Pelvic & hip control     .........  .........  .........  ...........  ...........
                               thigh c.
L1685...  A                   Post-op hip abduct       .........  .........  .........  ...........  ...........
                               custom fa.
L1686...  A                   HO post-op hip           .........  .........  .........  ...........  ...........
                               abduction.
L1700...  A                   Leg perthes orth         .........  .........  .........  ...........  ...........
                               toronto typ.
L1710...  A                   Legg perthes orth        .........  .........  .........  ...........  ...........
                               newington.
L1720...  A                   Legg perthes orthosis    .........  .........  .........  ...........  ...........
                               trilat.
L1730...  A                   Legg perthes orth        .........  .........  .........  ...........  ...........
                               scottish r.
L1750...  A                   Legg perthes sling.....  .........  .........  .........  ...........  ...........
L1755...  A                   Legg perthes patten      .........  .........  .........  ...........  ...........
                               bottom t.
L1800...  A                   Knee orthoses elas w     .........  .........  .........  ...........  ...........
                               stays.
L1810...  A                   Ko elastic with joints.  .........  .........  .........  ...........  ...........
L1815...  A                   Elastic with condylar    .........  .........  .........  ...........  ...........
                               pads.
L1820...  A                   Ko elas w/ condyle pads  .........  .........  .........  ...........  ...........
                               & jo.
L1825...  A                   Ko elastic knee cap....  .........  .........  .........  ...........  ...........
L1830...  A                   Ko immobilizer canvas    .........  .........  .........  ...........  ...........
                               longit.
L1832...  A                   KO adj jnt pos rigid     .........  .........  .........  ...........  ...........
                               support.
L1834...  A                   Ko w/0 joint rigid       .........  .........  .........  ...........  ...........
                               molded to.
L1840...  A                   Ko derot ant cruciate    .........  .........  .........  ...........  ...........
                               custom.
L1843...  A                   KO single upright        .........  .........  .........  ...........  ...........
                               custom fit.
L1844...  A                   Ko w/adj jt rot cntrl    .........  .........  .........  ...........  ...........
                               molded.
L1845...  A                   Ko w/ adj flex/ext       .........  .........  .........  ...........  ...........
                               rotat cus.
L1846...  A                   Ko w adj flex/ext rotat  .........  .........  .........  ...........  ...........
                               mold.
L1850...  A                   Ko swedish type........  .........  .........  .........  ...........  ...........
L1855...  A                   Ko plas doub upright     .........  .........  .........  ...........  ...........
                               jnt mol.
L1858...  A                   Ko polycentric           .........  .........  .........  ...........  ...........
                               pneumatic pad.
L1860...  A                   Ko supracondylar socket  .........  .........  .........  ...........  ...........
                               mold.
L1870...  A                   Ko doub upright lacers   .........  .........  .........  ...........  ...........
                               molde.

[[Page 47749]]


L1880...  A                   Ko doub upright cuffs/   .........  .........  .........  ...........  ...........
                               lacers.
L1885...  A                   Knee upright w/          .........  .........  .........  ...........  ...........
                               resistance.
L1900...  A                   Afo sprng wir drsflx     .........  .........  .........  ...........  ...........
                               calf bd.
L1902...  A                   Afo ankle gauntlet.....  .........  .........  .........  ...........  ...........
L1904...  A                   Afo molded ankle         .........  .........  .........  ...........  ...........
                               gauntlet.
L1906...  A                   Afo multiligamentus      .........  .........  .........  ...........  ...........
                               ankle su.
L1910...  A                   Afo sing bar clasp       .........  .........  .........  ...........  ...........
                               attach sh.
L1920...  A                   Afo sing upright w/      .........  .........  .........  ...........  ...........
                               adjust s.
L1930...  A                   Afo plastic............  .........  .........  .........  ...........  ...........
L1940...  A                   Afo molded to patient    .........  .........  .........  ...........  ...........
                               plasti.
L1945...  A                   Afo molded plas rig ant  .........  .........  .........  ...........  ...........
                               tib.
L1950...  A                   Afo spiral molded to pt  .........  .........  .........  ...........  ...........
                               plas.
L1960...  A                   Afo pos solid ank        .........  .........  .........  ...........  ...........
                               plastic mo.
L1970...  A                   Afo plastic molded w/    .........  .........  .........  ...........  ...........
                               ankle j.
L1980...  A                   Afo sing solid stirrup   .........  .........  .........  ...........  ...........
                               calf.
L1990...  A                   Afo doub solid stirrup   .........  .........  .........  ...........  ...........
                               calf.
L2000...  A                   Kafo sing fre stirr thi/ .........  .........  .........  ...........  ...........
                               calf.
L2010...  A                   Kafo sng solid stirrup   .........  .........  .........  ...........  ...........
                               w/o j.
L2020...  A                   Kafo dbl solid stirrup   .........  .........  .........  ...........  ...........
                               band/.
L2030...  A                   Kafo dbl solid stirrup   .........  .........  .........  ...........  ...........
                               w/o j.
L2035...  A                   KAFO plastic pediatric   .........  .........  .........  ...........  ...........
                               size.
L2036...  A                   Kafo plas doub free      .........  .........  .........  ...........  ...........
                               knee mol.
L2037...  A                   Kafo plas sing free      .........  .........  .........  ...........  ...........
                               knee mol.
L2038...  A                   Kafo w/o joint multi-    .........  .........  .........  ...........  ...........
                               axis an.
L2039...  A                   KAFO, plstic, medlat     .........  .........  .........  ...........  ...........
                               rotat con.
L2040...  A                   Hkafo torsion bil rot    .........  .........  .........  ...........  ...........
                               straps.
L2050...  A                   Hkafo torsion cable hip  .........  .........  .........  ...........  ...........
                               pelv.
L2060...  A                   Hkafo torsion ball       .........  .........  .........  ...........  ...........
                               bearing j.
L2070...  A                   Hkafo torsion unilat     .........  .........  .........  ...........  ...........
                               rot str.
L2080...  A                   Hkafo unilat torsion     .........  .........  .........  ...........  ...........
                               cable.
L2090...  A                   Hkafo unilat torsion     .........  .........  .........  ...........  ...........
                               ball br.
L2102...  A                   Afo tibial fx cast       .........  .........  .........  ...........  ...........
                               plstr mol.
L2104...  A                   Afo tib fx cast          .........  .........  .........  ...........  ...........
                               synthetic mo.
L2106...  A                   Afo tib fx cast plaster  .........  .........  .........  ...........  ...........
                               mold.
L2108...  A                   Afo tib fx cast molded   .........  .........  .........  ...........  ...........
                               to pt.
L2112...  A                   Afo tibial fracture      .........  .........  .........  ...........  ...........
                               soft.
L2114...  A                   Afo tib fx semi-rigid..  .........  .........  .........  ...........  ...........
L2116...  A                   Afo tibial fracture      .........  .........  .........  ...........  ...........
                               rigid.
L2122...  A                   Kafo fem fx cast         .........  .........  .........  ...........  ...........
                               plaster mol.
L2124...  A                   Kafo fem fx cast         .........  .........  .........  ...........  ...........
                               synthet mol.
L2126...  A                   Kafo fem fx cast         .........  .........  .........  ...........  ...........
                               thermoplas.
L2128...  A                   Kafo fem fx cast molded  .........  .........  .........  ...........  ...........
                               to p.
L2132...  A                   Kafo femoral fx cast     .........  .........  .........  ...........  ...........
                               soft.
L2134...  A                   Kafo fem fx cast semi-   .........  .........  .........  ...........  ...........
                               rigid.
L2136...  A                   Kafo femoral fx cast     .........  .........  .........  ...........  ...........
                               rigid.
L2180...  A                   Plas shoe insert w ank   .........  .........  .........  ...........  ...........
                               joint.
L2182...  A                   Drop lock knee.........  .........  .........  .........  ...........  ...........
L2184...  A                   Limited motion knee      .........  .........  .........  ...........  ...........
                               joint.
L2186...  A                   Adj motion knee jnt      .........  .........  .........  ...........  ...........
                               lerman t.
L2188...  A                   Quadrilateral brim.....  .........  .........  .........  ...........  ...........
L2190...  A                   Waist belt.............  .........  .........  .........  ...........  ...........
L2192...  A                   Pelvic band & belt       .........  .........  .........  ...........  ...........
                               thigh fla.
L2200...  A                   Limited ankle motion ea  .........  .........  .........  ...........  ...........
                               jnt.
L2210...  A                   Dorsiflexion assist      .........  .........  .........  ...........  ...........
                               each joi.
L2220...  A                   Dorsi & plantar flex     .........  .........  .........  ...........  ...........
                               ass/res.
L2230...  A                   Split flat caliper       .........  .........  .........  ...........  ...........
                               stirr & p.
L2240...  A                   Round caliper and plate  .........  .........  .........  ...........  ...........
                               atta.
L2250...  A                   Foot plate molded        .........  .........  .........  ...........  ...........
                               stirrup at.
L2260...  A                   Reinforced solid         .........  .........  .........  ...........  ...........
                               stirrup.
L2265...  A                   Long tongue stirrup....  .........  .........  .........  ...........  ...........
L2270...  A                   Varus/valgus strap       .........  .........  .........  ...........  ...........
                               padded/li.
L2275...  A                   Plastic mod low ext pad/ .........  .........  .........  ...........  ...........
                               line.
L2280...  A                   Molded inner boot......  .........  .........  .........  ...........  ...........
L2300...  A                   Abduction bar jointed    .........  .........  .........  ...........  ...........
                               adjust.
L2310...  A                   Abduction bar-straight.  .........  .........  .........  ...........  ...........
L2320...  A                   Non-molded lacer.......  .........  .........  .........  ...........  ...........
L2330...  A                   Lacer molded to patient  .........  .........  .........  ...........  ...........
                               mode.
L2335...  A                   Anterior swing band....  .........  .........  .........  ...........  ...........
L2340...  A                   Pre-tibial shell molded  .........  .........  .........  ...........  ...........
                               to p.
L2350...  A                   Prosthetic type socket   .........  .........  .........  ...........  ...........
                               molde.
L2360...  A                   Extended steel shank...  .........  .........  .........  ...........  ...........
L2370...  A                   Patten bottom..........  .........  .........  .........  ...........  ...........
L2375...  A                   Torsion ank & half       .........  .........  .........  ...........  ...........
                               solid sti.
L2380...  A                   Torsion straight knee    .........  .........  .........  ...........  ...........
                               joint.
L2385...  A                   Straight knee joint      .........  .........  .........  ...........  ...........
                               heavy du.

[[Continued on page 47751]]