[Federal Register: October 31, 1997 (Rules and Regulations)]
[Page 59197-59246]
From the Federal Register Online via GPO Access


[[pp. 59197-59246]] Medicare Program; Revisions to Payment Policies and Adjustments
to the Relative Value Units Under the Physician Fee Schedule, Other
Part B Payment Policies, and Establishment of the Clinical Psychologist
Fee Schedule for Calendar Year 1998

[[Continued from page 59196]]

[[Page 59197]]


82595...  ..................  X                   Assay cryoglobulin......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82600...  ..................  X                   Assay cyanide...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82607...  ..................  X                   Vitamin B-12............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82608...  ..................  X                   B-12 binding capacity...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82615...  ..................  X                   Test for urine cystines.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82626...  ..................  X                   Dehydroepiandrosterone..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82627...  ..................  X                   Dehydroepiandrosterone..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82633...  ..................  X                   Desoxycorticosterone....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82634...  ..................  X                   Deoxycortisol...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82638...  ..................  X                   Assay dibucaine number..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82646...  ..................  X                   Assay of                        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dihydrocodeinone.
82649...  ..................  X                   Assay of                        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dihydromorphinone.
82651...  ..................  X                   Dihydrotestosterone             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
82652...  ..................  X                   Assay, dihydroxyvitamin         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   D.
82654...  ..................  X                   Assay of dimethadione...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82664...  ..................  X                   Electrophoretic test....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82666...  ..................  X                   Epiandrosterone assay...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82668...  ..................  X                   Erythropoietin..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82670...  ..................  X                   Estradiol...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82671...  ..................  X                   Estrogens assay.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82672...  ..................  X                   Estrogen assay..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82677...  ..................  X                   Estriol.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82679...  ..................  X                   Estrone.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82690...  ..................  X                   Ethchlorvynol...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82693...  ..................  X                   Ethylene glycol.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82696...  ..................  X                   Etiocholanolone.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82705...  ..................  X                   Fats/lipids, feces,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   qualitativ.
82710...  ..................  X                   Fats/lipids, feces,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quantitati.
82715...  ..................  X                   Fecal fat assay.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82725...  ..................  X                   Assay blood fatty acids.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82728...  ..................  X                   Assay ferritin..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82735...  ..................  X                   Assay fluoride..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82742...  ..................  X                   Assay of flurazepam.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82746...  ..................  X                   Blood folic acid serum..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82747...  ..................  X                   Folic acid, RBC.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82757...  ..................  X                   Assay semen fructose....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82759...  ..................  X                   RBC galactokinase assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82760...  ..................  X                   Assay galactose.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82775...  ..................  X                   Assay galactose                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transferase.
82776...  ..................  X                   Galactose transferase           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
82784...  ..................  X                   Assay gammaglobulin IgM.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82785...  ..................  X                   Assay, gammaglobulin IgE        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82787...  ..................  X                   IgG1, 2, 3 and 4........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82800...  ..................  X                   Blood pH................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82803...  ..................  X                   Blood gases: pH, pO2 &          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pCO2.
82805...  ..................  X                   Blood gases W/02                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   saturation.
82810...  ..................  X                   Blood gases, O2 sat only        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82820...  ..................  X                   Hemoglobin-oxygen               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   affinity.
82926...  ..................  X                   Assay gastric acid......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82928...  ..................  X                   Assay gastric acid......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82938...  ..................  X                   Gastrin test............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82941...  ..................  X                   Assay of gastrin........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82943...  ..................  X                   Assay of glucagon.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82946...  ..................  X                   Glucagon tolerance test.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82947...  ..................  X                   Assay quantitative,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   glucose.
82948...  ..................  X                   Reagent strip/blood             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   glucose.
82950...  ..................  X                   Glucose test............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82951...  ..................  X                   Glucose tolerance test          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (GTT).
82952...  ..................  X                   GTT-added samples.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82953...  ..................  X                   Glucose-tolbutamide test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82955...  ..................  X                   Assay G6PD enzyme.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82960...  ..................  X                   Test for G6PD enzyme....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82962...  ..................  X                   Glucose blood test......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82963...  ..................  X                   Glucosidase assay.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82965...  ..................  X                   Assay GDH enzyme........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82975...  ..................  X                   Assay glutamine.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82977...  ..................  X                   Assay of GGT............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82978...  ..................  X                   Glutathione assay.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82979...  ..................  X                   Assay RBC glutathione           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   enzyme.
82980...  ..................  X                   Assay of glutethimide...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
82985...  ..................  X                   Glycated protein........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83001...  ..................  X                   Gonadotropin (FSH)......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83002...  ..................  X                   Gonadotropin (LH).......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83003...  ..................  X                   Assay growth hormone            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (HGH).

[[Page 59198]]


83008...  ..................  X                   Assay guanosine.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83010...  ..................  X                   Quant assay haptoglobin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83012...  ..................  X                   Assay haptoglobins......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83015...  ..................  X                   Heavy metal screen......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83018...  ..................  X                   Quantitative screen,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metals.
83019...  ..................  X                   Breath isotope test.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83020...  ..................  X                   Assay hemoglobin........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83020...  26                  A                   Assay hemoglobin........        0.37       0.20       0.20       0.01       0.58       0.58        XXX
83026...  ..................  X                   Hemoglobin, copper              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sulfate.
83030...  ..................  X                   Fetal hemoglobin assay..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83033...  ..................  X                   Fetal fecal hemoglobin          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
83036...  ..................  X                   Glycated hemoglobin test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83045...  ..................  X                   Blood methemoglobin test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83050...  ..................  X                   Blood methemoglobin             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
83051...  ..................  X                   Assay plasma hemoglobin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83055...  ..................  X                   Blood sulfhemoglobin            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
83060...  ..................  X                   Blood sulfhemoglobin            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
83065...  ..................  X                   Hemoglobin heat assay...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83068...  ..................  X                   Hemoglobin stability            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
83069...  ..................  X                   Assay urine hemoglobin..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83070...  ..................  X                   Qualt assay hemosiderin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83071...  ..................  X                   Quant assay of                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hemosiderin.
83088...  ..................  X                   Assay histamine.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83150...  ..................  X                   Assay for HVA...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83491...  ..................  X                   Assay of corticosteroids        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83497...  ..................  X                   Assay 5-HIAA............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83498...  ..................  X                   Assay of progesterone...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83499...  ..................  X                   Assay of progesterone...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83500...  ..................  X                   Assay free                      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydroxyproline.
83505...  ..................  X                   Assay total                     0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydroxyproline.
83516...  ..................  X                   Immunoassay, nonantibody        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83518...  ..................  X                   Immunoassay, dipstick...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83519...  ..................  X                   Immunoassay nonantibody.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83520...  ..................  X                   Immunoassay, RIA........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83525...  ..................  X                   Assay of insulin........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83527...  ..................  X                   Assay of insulin........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83528...  ..................  X                   Assay intrinsic factor..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83540...  ..................  X                   Assay iron..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83550...  ..................  X                   Iron binding test.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83570...  ..................  X                   Assay IDH enzyme........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83582...  ..................  X                   Assay ketogenic steroids        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83586...  ..................  X                   Assay 17-(17-                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   KS)ketosteroids.
83593...  ..................  X                   Fractionation                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ketosteroids.
83605...  ..................  X                   Lactic acid assay.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83615...  ..................  X                   Lactate (LD) (LDH)              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   enzyme.
83625...  ..................  X                   Assay LDH enzymes.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83632...  ..................  X                   Placental lactogen......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83633...  ..................  X                   Test urine for lactose..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83634...  ..................  X                   Assay urine for lactose.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83655...  ..................  X                   Assay for lead..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83661...  ..................  X                   Assay L/S ratio.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83662...  ..................  X                   L/S ratio, foam                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stability.
83670...  ..................  X                   Assay LAP enzyme........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83690...  ..................  X                   Assay lipase............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83715...  ..................  X                   Assay blood lipoproteins        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83717...  ..................  X                   Assay blood lipoproteins        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83718...  ..................  X                   Blood lipoprotein assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83719...  ..................  X                   Blood lipoprotein assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83721...  ..................  X                   Blood lipoprotein assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83727...  ..................  X                   LRH hormone assay.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83735...  ..................  X                   Assay magnesium.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83775...  ..................  X                   Assay of md enzyme......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83785...  ..................  X                   Assay of manganese......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83805...  ..................  X                   Assay of meprobamate....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83825...  ..................  X                   Assay mercury...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83835...  ..................  X                   Assay metanephrines.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83840...  ..................  X                   Assay methadone.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83857...  ..................  X                   Assay methemalbumin.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83858...  ..................  X                   Assay methsuximide......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83864...  ..................  X                   Mucopolysaccharides.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83866...  ..................  X                   Mucopolysaccharides             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
83872...  ..................  X                   Assay synovial fluid            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mucin.
83873...  ..................  X                   Assay, CSF protein......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83874...  ..................  X                   Myoglobin...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59199]]


83883...  ..................  X                   Nephelometry, not               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   specified.
83885...  ..................  X                   Assay for nickel........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83887...  ..................  X                   Assay nicotine..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83890...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83892...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83894...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83896...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83898...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83902...  ..................  X                   Molecular diagnostics...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83912...  ..................  X                   Genetic examination.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83912...  26                  A                   Genetic examination.....        0.37       0.20       0.20       0.01       0.58       0.58        XXX
83915...  ..................  X                   Assay nucleotidase......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83916...  ..................  X                   Oligoclonal bands.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83918...  ..................  X                   Assay organic acids.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83925...  ..................  X                   Opiates.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83930...  ..................  X                   Assay blood osmolality..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83935...  ..................  X                   Assay urine osmolality..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83937...  ..................  X                   Assay for osteocalcin...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83945...  ..................  X                   Assay oxalate...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83970...  ..................  X                   Assay of parathormone...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83986...  ..................  X                   Assay body fluid acidity        0.00       0.00       0.00       0.00       0.00       0.00        XXX
83992...  ..................  X                   Assay for phencyclidine.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84022...  ..................  X                   Assay of phenothiazine..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84030...  ..................  X                   Assay blood PKU.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84035...  ..................  X                   Assay phenylketones.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84060...  ..................  X                   Assay acid phosphatase..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84061...  ..................  X                   Phosphatase, forensic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   exam.
84066...  ..................  X                   Assay prostate                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phosphatase.
84075...  ..................  X                   Assay alkaline                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phosphatase.
84078...  ..................  X                   Assay alkaline                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phosphatase.
84080...  ..................  X                   Assay alkaline                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phosphatases.
84081...  ..................  X                   Amniotic fluid enzyme           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
84085...  ..................  X                   Assay RBC PG6D enzyme...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84087...  ..................  X                   Assay phosphohexose             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   enzymes.
84100...  ..................  X                   Assay phosphorus........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84105...  ..................  X                   Assay urine phosphorus..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84106...  ..................  X                   Test for porphobilinogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84110...  ..................  X                   Assay porphobilinogen...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84119...  ..................  X                   Test urine for                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   porphyrins.
84120...  ..................  X                   Assay urine porphyrins..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84126...  ..................  X                   Assay feces porphyrins..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84127...  ..................  X                   Porphyrins, feces.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84132...  ..................  X                   Assay serum potassium...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84133...  ..................  X                   Assay urine potassium...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84134...  ..................  X                   Prealbumin..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84135...  ..................  X                   Assay pregnanediol......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84138...  ..................  X                   Assay pregnanetriol.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84140...  ..................  X                   Assay for pregnenolone..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84143...  ..................  X                   Assay/17-                       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydroxypregnenolone.
84144...  ..................  X                   Assay progesterone......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84146...  ..................  X                   Assay for prolactin.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84150...  ..................  X                   Assay of prostaglandin..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84153...  ..................  X                   Prostate specific               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antigen.
84155...  ..................  X                   Assay protein...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84160...  ..................  X                   Assay serum protein.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84165...  ..................  X                   Assay serum proteins....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84165...  26                  A                   Assay serum proteins....        0.37       0.20       0.20       0.01       0.58       0.58        XXX
84181...  ..................  X                   Western blot test.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84181...  26                  A                   Western blot test.......        0.37       0.20       0.20       0.01       0.58       0.58        XXX
84182...  ..................  X                   Protein, western blot           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
84182...  26                  A                   Protein, western blot           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   test.
84202...  ..................  X                   Assay RBC protoporphyrin        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84203...  ..................  X                   Test RBC protoporphyrin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84206...  ..................  X                   Assay of proinsulin.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84207...  ..................  X                   Assay vitamin B-6.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84210...  ..................  X                   Assay pyruvate..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84220...  ..................  X                   Assay pyruvate kinase...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84228...  ..................  X                   Assay quinine...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84233...  ..................  X                   Assay estrogen..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84234...  ..................  X                   Assay progesterone......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84235...  ..................  X                   Assay endocrine hormone.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84238...  ..................  X                   Assay non-endocrine             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   receptor.
84244...  ..................  X                   Assay of renin..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84252...  ..................  X                   Assay vitamin B-2.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59200]]


84255...  ..................  X                   Assay selenium..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84260...  ..................  X                   Assay serotonin.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84270...  ..................  X                   Sex hormone globulin            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (SHBG).
84275...  ..................  X                   Assay sialic acid.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84285...  ..................  X                   Assay silica............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84295...  ..................  X                   Assay serum sodium......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84300...  ..................  X                   Assay urine sodium......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84305...  ..................  X                   Somatomedin.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84307...  ..................  X                   Somatostatin............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84311...  ..................  X                   Spectrophotometry.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84315...  ..................  X                   Body fluid specific             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gravity.
84375...  ..................  X                   Chromatogram assay,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sugars.
84392...  ..................  X                   Assay urine sulfate.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84402...  ..................  X                   Testosterone............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84403...  ..................  X                   Assay total testosterone        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84425...  ..................  X                   Assay vitamin B-1.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84430...  ..................  X                   Assay thiocyanate.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84432...  ..................  X                   Thyroglobulin...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84436...  ..................  X                   Assay, total thyroxine..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84437...  ..................  X                   Assay neonatal thyroxine        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84439...  ..................  X                   Assay, free thyroxine...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84442...  ..................  X                   Thyroid activity (TBG)          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
84443...  ..................  X                   Assay thyroid stim              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hormone.
84445...  ..................  X                   Thyroid immunoglobulins         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   TSI.
84446...  ..................  X                   Assay vitamin E.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84449...  ..................  X                   Assay for transcortin...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84450...  ..................  X                   Transferase (AST) (SGOT)        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84460...  ..................  X                   Alanine amino (ALT)             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (SGPT).
84466...  ..................  X                   Transferrin.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84478...  ..................  X                   Assay triglycerides.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84479...  ..................  X                   Assay thyroid (t-3 or t-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4).
84480...  ..................  X                   Assay triiodothyronine          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (t-3).
84481...  ..................  X                   Free assay (FT-3).......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84482...  ..................  X                   T3 reverse..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84484...  ..................  X                   Troponin, quant.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84485...  ..................  X                   Assay duodenal fluid            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   trypsin.
84488...  ..................  X                   Test feces for trypsin..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84490...  ..................  X                   Assay feces for trypsin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84510...  ..................  X                   Assay tyrosine..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84512...  ..................  X                   Troponin, qual..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84520...  ..................  X                   Assay urea nitrogen.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84525...  ..................  X                   Urea nitrogen semi-quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84540...  ..................  X                   Assay urine urea-N......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84545...  ..................  X                   Urea-N clearance test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84550...  ..................  X                   Assay blood uric acid...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84560...  ..................  X                   Assay urine uric acid...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84577...  ..................  X                   Assay feces urobilinogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84578...  ..................  X                   Test urine urobilinogen.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84580...  ..................  X                   Assay urine urobilinogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84583...  ..................  X                   Assay urine urobilinogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84585...  ..................  X                   Assay urine VMA.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84586...  ..................  X                   VIP assay...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84588...  ..................  X                   Assay vasopressin.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84590...  ..................  X                   Assay vitamin-A.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84597...  ..................  X                   Assay vitamin-K.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84600...  ..................  X                   Assay for volatiles.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84620...  ..................  X                   Xylose tolerance test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84630...  ..................  X                   Assay zinc..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84681...  ..................  X                   Assay C-peptide.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84702...  ..................  X                   Chorionic gonadotropin          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
84703...  ..................  X                   Chorionic gonadotropin          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
84830...  ..................  X                   Ovulation tests.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
84999...  ..................  X                   Clinical chemistry test.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85002...  ..................  X                   Bleeding time test......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85007...  ..................  X                   Differential WBC count..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85008...  ..................  X                   Nondifferential WBC             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   count.
85009...  ..................  X                   Differential WBC count..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85013...  ..................  X                   Hematocrit..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85014...  ..................  X                   Hematocrit..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85018...  ..................  X                   Hemoglobin..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85021...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85022...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85023...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85024...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59201]]


85025...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85027...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85029...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85030...  ..................  X                   Automated hemogram......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85031...  ..................  X                   Manual hemogram,                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete cbc.
85041...  ..................  X                   Red blood cell (RBC)            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   count.
85044...  ..................  X                   Reticulocyte count......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85045...  ..................  X                   Reticulocyte count......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85048...  ..................  X                   White blood cell (WBC)          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   count.
85060...  ..................  A                   Blood smear                     0.45       0.22       0.22       0.02       0.69       0.69        XXX
                                                   interpretation.
85095...  ..................  A                   Bone marrow aspiration..        1.08       0.67       0.67       0.05       1.80       1.80        XXX
85097...  ..................  A                   Bone marrow                     0.94       0.48       0.48       0.04       1.46       1.46        XXX
                                                   interpretation.
85102...  ..................  A                   Bone marrow biopsy......        1.37       0.80       0.80       0.05       2.22       2.22        XXX
85130...  ..................  X                   Chromogenic substrate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
85170...  ..................  X                   Blood clot retraction...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85175...  ..................  X                   Blood clot lysis time...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85210...  ..................  X                   Blood clot factor II            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85220...  ..................  X                   Blood clot factor V test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85230...  ..................  X                   Blood clot factor VII           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85240...  ..................  X                   Blood clot factor VIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85244...  ..................  X                   Blood clot factor VIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85245...  ..................  X                   Blood clot factor VIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85246...  ..................  X                   Blood clot factor VIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85247...  ..................  X                   Blood clot factor VIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85250...  ..................  X                   Blood clot factor IX            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85260...  ..................  X                   Blood clot factor X test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85270...  ..................  X                   Blood clot factor XI            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85280...  ..................  X                   Blood clot factor XII           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85290...  ..................  X                   Blood clot factor XIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85291...  ..................  X                   Blood clot factor XIII          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85292...  ..................  X                   Blood clot factor assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85293...  ..................  X                   Blood clot factor assay.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85300...  ..................  X                   Antithrombin III test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85301...  ..................  X                   Antithrombin III test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85302...  ..................  X                   Blood clot inhibitor            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antigen.
85303...  ..................  X                   Blood clot inhibitor            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85305...  ..................  X                   Blood clot inhibitor            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
85306...  ..................  X                   Blood clot inhibitor            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
85335...  ..................  X                   Factor inhibitor test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85337...  ..................  X                   Thrombomodulin..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85345...  ..................  X                   Coagulation time........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85347...  ..................  X                   Coagulation time........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85348...  ..................  X                   Coagulation time........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85360...  ..................  X                   Euglobulin lysis........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85362...  ..................  X                   Fibrin degradation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   products.
85366...  ..................  X                   Fibrinogen test.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85370...  ..................  X                   Fibrinogen test.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85378...  ..................  X                   Fibrin degradation......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85379...  ..................  X                   Fibrin degradation......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85384...  ..................  X                   Fibrinogen..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85385...  ..................  X                   Fibrinogen..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85390...  ..................  X                   Fibrinolysins screen....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85390...  26                  A                   Fibrinolysins screen....        0.37       0.20       0.20       0.01       0.58       0.58        XXX
85400...  ..................  X                   Fibrinolytic plasmin....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85410...  ..................  X                   Fibrinolytic antiplasmin        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85415...  ..................  X                   Fibrinolytic plasminogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85420...  ..................  X                   Fibrinolytic plasminogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85421...  ..................  X                   Fibrinolytic plasminogen        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85441...  ..................  X                   Heinz bodies; direct....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85445...  ..................  X                   Heinz bodies; induced...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85460...  ..................  X                   Hemoglobin, fetal.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85461...  ..................  X                   Hemoglobin, fetal.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85475...  ..................  X                   Hemolysin...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85520...  ..................  X                   Heparin assay...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85525...  ..................  X                   Heparin.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85530...  ..................  X                   Heparin-protamine               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tolerance.
85535...  ..................  X                   Iron stain, blood cells.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85540...  ..................  X                   Wbc alkaline phosphatase        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85547...  ..................  X                   RBC mechanical fragility        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85549...  ..................  X                   Muramidase..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85555...  ..................  X                   RBC osmotic fragility...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85557...  ..................  X                   RBC osmotic fragility...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85576...  ..................  X                   Blood platelet                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   aggregation.
85576...  26                  A                   Blood platelet                  0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   aggregation.

[[Page 59202]]


85585...  ..................  X                   Blood platelet                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   estimation.
85590...  ..................  X                   Platelet manual count...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85595...  ..................  X                   Platelet count,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   automated.
85597...  ..................  X                   Platelet neutralization.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85610...  ..................  X                   Prothrombin time........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85611...  ..................  X                   Prothrombin test........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85612...  ..................  X                   Viper venom prothrombin         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   time.
85613...  ..................  X                   Russell viper venom,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   diluted.
85635...  ..................  X                   Reptilase test..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85651...  ..................  X                   Rbc sed rate, nonauto...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85652...  ..................  X                   Rbc sed rate, auto......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85660...  ..................  X                   RBC sickle cell test....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85670...  ..................  X                   Thrombin time, plasma...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85675...  ..................  X                   Thrombin time, titer....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
85705...  ..................  X                   Thromboplastin                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inhibition.
85730...  ..................  X                   Thromboplastin time,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   partial.
85732...  ..................  X                   Thromboplastin time,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   partial.
85810...  ..................  X                   Blood viscosity                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   examination.
85999...  ..................  X                   Hematology procedure....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86000...  ..................  X                   Agglutinins; febrile....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86003...  ..................  X                   Allergen specific IgE...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86005...  ..................  X                   Allergen specific IgE...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86021...  ..................  X                   WBC antibody                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   identification.
86022...  ..................  X                   Platelet antibodies.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86023...  ..................  X                   Immunoglobulin assay....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86038...  ..................  X                   Antinuclear antibodies..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86039...  ..................  X                   Antinuclear antibodies          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (ANA).
86060...  ..................  X                   Antistreptolysin O titer        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86063...  ..................  X                   Antistreptolysin O              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
86077...  ..................  A                   Physician blood bank            0.94       0.30       0.30       0.02       1.26       1.26        XXX
                                                   service.
86078...  ..................  A                   Physician blood bank            0.94       0.34       0.34       0.02       1.30       1.30        XXX
                                                   service.
86079...  ..................  A                   Physician blood bank            0.94       0.33       0.33       0.02       1.29       1.29        XXX
                                                   service.
86140...  ..................  X                   C-reactive protein......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86147...  ..................  X                   Cardiolipin antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86148...  ..................  X                   Phospholipid antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86155...  ..................  X                   Chemotaxis assay........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86156...  ..................  X                   Cold agglutinin screen..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86157...  ..................  X                   Cold agglutinin, titer..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86160...  ..................  X                   Complement, antigen.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86161...  ..................  X                   Complement/function             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   activity.
86162...  ..................  X                   Complement, total (CH50)        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86171...  ..................  X                   Complement fixation,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   each.
86185...  ..................  X                   Counterimmunoelectrophor        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   esis.
86215...  ..................  X                   Deoxyribonuclease,              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antibody.
86225...  ..................  X                   DNA antibody............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86226...  ..................  X                   DNA antibody, single            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   strand.
86235...  ..................  X                   Nuclear antigen antibody        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86243...  ..................  X                   Fc receptor.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86255...  ..................  X                   Fluorescent antibody;           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
86255...  26                  A                   Fluorescent antibody;           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   screen.
86256...  ..................  X                   Fluorescent antibody;           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   titer.
86256...  26                  A                   Fluorescent antibody;           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   titer.
86277...  ..................  X                   Growth hormone antibody.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86280...  ..................  X                   Hemagglutination                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inhibition.
86287...  ..................  D                   12/Hepatitis B (HBsAg)..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86289...  ..................  D                   Hepatitis BC antibody           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86290...  ..................  D                   12/Hepatitis BC antibody        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86291...  ..................  D                   Hepatitis BS antibody           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86293...  ..................  D                   Hepatitis Be antibody           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86295...  ..................  D                   12/Hepatitis Be antibody        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86296...  ..................  D                   Hepatitis A antibody            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86299...  ..................  D                   Hepatitis A antibody            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86302...  ..................  D                   Hepatitis C antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86303...  ..................  D                   Hepatitis C antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86306...  ..................  D                   Hepatitis, delta agent..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86308...  ..................  X                   Heterophile antibodies..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86309...  ..................  X                   Heterophile antibodies..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86310...  ..................  X                   Heterophile antibodies..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86311...  ..................  D                   12/31/97HIV antigen test        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86313...  ..................  D                   Immunoassay, infectious         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.
86315...  ..................  D                   Immunoassay, infectious         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.
86316...  ..................  X                   Immunoassay, tumor              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antigen.
86317...  ..................  X                   Immunoassay, infectious         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.
86318...  ..................  X                   Immunoassay, infectious         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.

[[Page 59203]]


86320...  ..................  X                   Serum                           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunoelectrophoresis.
86320...  26                  A                   Serum                           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   immunoelectrophoresis.
86325...  ..................  X                   Other                           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunoelectrophoresis.
86325...  26                  A                   Other                           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   immunoelectrophoresis.
86327...  ..................  X                   Immunoelectrophoresis           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
86327...  26                  A                   Immunoelectrophoresis           0.42       0.20       0.20       0.01       0.63       0.63        XXX
                                                   assay.
86329...  ..................  X                   Immunodiffusion.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86331...  ..................  X                   Immunodiffusion                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ouchterlony.
86332...  ..................  X                   Immune complex assay....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86334...  ..................  X                   Immunofixation procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86334...  26                  A                   Immunofixation procedure        0.37       0.20       0.20       0.01       0.58       0.58        XXX
86337...  ..................  X                   Insulin antibodies......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86340...  ..................  X                   Intrinsic factor                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antibody.
86341...  ..................  X                   Islet cell antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86343...  ..................  X                   Leukocyte histamine             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   release.
86344...  ..................  X                   Leukocyte phagocytosis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86353...  ..................  X                   Lymphocyte                      0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transformation.
86359...  ..................  X                   T cells, total count....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86360...  ..................  X                   T cell absolute count/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ratio.
86361...  ..................  X                   T cell absolute count...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86376...  ..................  X                   Microsomal antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86378...  ..................  X                   Migration inhibitory            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   factor.
86382...  ..................  X                   Neutralization test,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   viral.
86384...  ..................  X                   Nitroblue tetrazolium           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dye.
86403...  ..................  X                   Particle agglutination          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86406...  ..................  X                   Particle agglutination          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86430...  ..................  X                   Rheumatoid factor test..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86431...  ..................  X                   Rheumatoid factor, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86485...  ..................  C                   Skin test, candida......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86490...  ..................  A                   Coccidioidomycosis skin         0.00       0.28       0.28       0.02       0.30       0.30        XXX
                                                   test.
86510...  ..................  A                   Histoplasmosis skin test        0.00       0.30       0.30       0.02       0.32       0.32        XXX
86580...  ..................  A                   TB intradermal test.....        0.00       0.24       0.24       0.02       0.26       0.26        XXX
86585...  ..................  A                   TB tine test............        0.00       0.19       0.19       0.01       0.20       0.20        XXX
86586...  ..................  C                   Skin test, unlisted.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86588...  ..................  X                   Streptocollus, direct           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
86590...  ..................  X                   Streptokinase, antibody.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86592...  ..................  X                   Blood serology,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   qualitative.
86593...  ..................  X                   Blood serology,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quantitative.
86602...  ..................  X                   Antinomyces antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86603...  ..................  X                   Adenovirus, antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86606...  ..................  X                   Aspergillus antibody....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86609...  ..................  X                   Bacterium, antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86612...  ..................  X                   Blastomyces, antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86615...  ..................  X                   Bordetella antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86617...  ..................  X                   Lyme disease antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86618...  ..................  X                   Lyme disease antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86619...  ..................  X                   Borrelia antibody.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86622...  ..................  X                   Brucella, antibody......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86625...  ..................  X                   Campylobacter, antibody.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86628...  ..................  X                   Candida, antibody.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86631...  ..................  X                   Chlamydia, antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86632...  ..................  X                   Chlamydia, IgM, antibody        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86635...  ..................  X                   Coccidioides, antibody..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86638...  ..................  X                   Q fever antibody........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86641...  ..................  X                   Cryptococcus antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86644...  ..................  X                   CMV antibody............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86645...  ..................  X                   CMV antibody, IgM.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86648...  ..................  X                   Diphtheria antibody.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86651...  ..................  X                   Encephalitis antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86652...  ..................  X                   Encephalitis antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86653...  ..................  X                   Encephalitis, antibody..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86654...  ..................  X                   Encephalitis, antibody..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86658...  ..................  X                   Enterovirus, antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86663...  ..................  X                   Epstein-barr antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86664...  ..................  X                   Epstein-barr antibody...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86665...  ..................  X                   Epstein-barr, antibody..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86668...  ..................  X                   Francisella tularensis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86671...  ..................  X                   Fungus, antibody........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86674...  ..................  X                   Giardia lamblia.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86677...  ..................  X                   Helicobacter pylori.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86682...  ..................  X                   Helminth, antibody......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86684...  ..................  X                   Hemophilus influenza....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86687...  ..................  X                   HTLV I..................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86688...  ..................  X                   HTLV-II.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59204]]


86689...  ..................  X                   HTLV/HIV confirmatory           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86692...  ..................  X                   Hepatitis, delta agent..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86694...  ..................  X                   Herpes simplex test.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86695...  ..................  X                   Herpes simplex test.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86698...  ..................  X                   Histoplasma.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86701...  ..................  X                   HIV-1...................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86702...  ..................  X                   HIV-2...................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86703...  ..................  X                   HIV-1/HIV-2, single             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   assay.
86704...  ..................  X                   Hep b core ab test, igg         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   & m.
86705...  ..................  X                   Hep b core ab test, igm.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86706...  ..................  X                   Hepatitis b surface ab          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86707...  ..................  X                   Hepatitis be ab test....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86708...  ..................  X                   Hep a ab test, igg & m..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86709...  ..................  X                   Hep a ab test, igm......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86710...  ..................  X                   Influenza virus.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86713...  ..................  X                   Legionella..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86717...  ..................  X                   Leishmania..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86720...  ..................  X                   Leptospira..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86723...  ..................  X                   Listeria monocytogenes..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86727...  ..................  X                   Lymph choriomeningitis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86729...  ..................  X                   Lympho venereum.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86732...  ..................  X                   Mucormycosis............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86735...  ..................  X                   Mumps...................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86738...  ..................  X                   Mycoplasma..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86741...  ..................  X                   Neisseria meningitidis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86744...  ..................  X                   Nocardia................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86747...  ..................  X                   Parvovirus..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86750...  ..................  X                   Malaria.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86753...  ..................  X                   Protozoa, not elsewhere.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86756...  ..................  X                   Respiratory virus.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86759...  ..................  X                   Rotavirus...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86762...  ..................  X                   Rubella.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86765...  ..................  X                   Rubeola.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86768...  ..................  X                   Salmonella..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86771...  ..................  X                   Shigella................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86774...  ..................  X                   Tetanus.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86777...  ..................  X                   Toxoplasma..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86778...  ..................  X                   Toxoplasma, IgM.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86781...  ..................  X                   Treponema pallidum              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   confirm.
86784...  ..................  X                   Trichinella.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86787...  ..................  X                   Varicella-zoster........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86790...  ..................  X                   Virus, not specified....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86793...  ..................  X                   Yersinia................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86800...  ..................  X                   Thyroglobulin antibody..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86803...  ..................  X                   Hepatitis c ab test.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86804...  ..................  X                   Hep c ab test, confirm..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86805...  ..................  X                   Lymphocytotoxicity assay        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86806...  ..................  X                   Lymphocytotoxicity assay        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86807...  ..................  X                   Cytotoxic antibody              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screening.
86808...  ..................  X                   Cytotoxic antibody              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screening.
86812...  ..................  X                   HLA typing, A, B, or C..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86813...  ..................  X                   HLA typing, A, B, or C..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86816...  ..................  X                   HLA typing, DR/DQ.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86817...  ..................  X                   HLA typing, DR/DQ.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86821...  ..................  X                   Lymphocyte culture,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mixed.
86822...  ..................  X                   Lymphocyte culture,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primed.
86849...  ..................  X                   Immunology procedure....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86850...  ..................  X                   RBC antibody screen.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86860...  ..................  X                   RBC antibody elution....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86870...  ..................  X                   RBC antibody                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   identification.
86880...  ..................  X                   Coombs test.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86885...  ..................  X                   Coombs test.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86886...  ..................  X                   Coombs test.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86890...  ..................  X                   Autologous blood process        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86891...  ..................  X                   Autologous blood, op            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   salvage.
86900...  ..................  X                   Blood typing, ABO.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86901...  ..................  X                   Blood typing, Rh (D)....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86903...  ..................  X                   Blood typing, antigen           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
86904...  ..................  X                   Blood typing, patient           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   serum.
86905...  ..................  X                   Blood typing, RBC               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antigens.
86906...  ..................  X                   Blood typing, Rh                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phenotype.
86910...  ..................  N                   Blood typing, paternity         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
86911...  ..................  N                   Blood typing, antigen           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   system.
86915...  ..................  X                   Bone marrow.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59205]]


86920...  ..................  X                   Compatibility test......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86921...  ..................  X                   Compatibility test......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86922...  ..................  X                   Compatibility test......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86927...  ..................  X                   Plasma, fresh frozen....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86930...  ..................  X                   Frozen blood prep.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86931...  ..................  X                   Frozen blood thaw.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86932...  ..................  X                   Frozen blood, freeze/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   thaw.
86940...  ..................  X                   Hemolysins/agglutinins          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   auto.
86941...  ..................  X                   Hemolysins/agglutinins..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86945...  ..................  X                   Blood product/                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   irradiation.
86950...  ..................  X                   Leukacyte transfusion...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86965...  ..................  X                   Pooling blood platelets.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86970...  ..................  X                   RBC pretreatment........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86971...  ..................  X                   RBC pretreatment........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86972...  ..................  X                   RBC pretreatment........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86975...  ..................  X                   RBC pretreatment, serum.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86976...  ..................  X                   RBC pretreatment, serum.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86977...  ..................  X                   RBC pretreatment, serum.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86978...  ..................  X                   RBC pretreatment, serum.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86985...  ..................  X                   Split blood or products.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
86999...  ..................  X                   Transfusion procedure...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87001...  ..................  X                   Small animal inoculation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87003...  ..................  X                   Small animal inoculation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87015...  ..................  X                   Specimen concentration..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87040...  ..................  X                   Blood culture for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bacteria.
87045...  ..................  X                   Stool culture for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bacteria.
87060...  ..................  X                   Nose/throat                     0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   culture,bacteria.
87070...  ..................  X                   Culture specimen,               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bacteria.
87072...  ..................  X                   Culture of specimen by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
87075...  ..................  X                   Culture specimen,               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bacteria.
87076...  ..................  X                   Bacteria identification.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87081...  ..................  X                   Bacteria culture screen.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87082...  ..................  X                   Culture of specimen by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
87083...  ..................  X                   Culture of specimen by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
87084...  ..................  X                   Culture of specimen by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
87085...  ..................  X                   Culture of specimen by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
87086...  ..................  X                   Urine culture, colony           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   count.
87087...  ..................  X                   Urine bacteria culture..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87088...  ..................  X                   Urine bacteria culture..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87101...  ..................  X                   Skin fungus culture.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87102...  ..................  X                   Fungus isolation culture        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87103...  ..................  X                   Blood fungus culture....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87106...  ..................  X                   Fungus identification...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87109...  ..................  X                   Mycoplasma culture......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87110...  ..................  X                   Culture, chlamydia......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87116...  ..................  X                   Mycobacteria culture....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87117...  ..................  X                   Mycobacteria culture....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87118...  ..................  X                   Mycobacteria                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   identification.
87140...  ..................  X                   Culture typing,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fluorescent.
87143...  ..................  X                   Culture typing, GLC             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   method.
87145...  ..................  X                   Culture typing, phage           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   method.
87147...  ..................  X                   Culture typing,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   serologic.
87151...  ..................  X                   Culture typing,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   serologic.
87155...  ..................  X                   Culture typing,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   precipitin.
87158...  ..................  X                   Culture typing, added           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   method.
87163...  ..................  X                   Special microbiology            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   culture.
87164...  ..................  X                   Dark field examination..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87164...  26                  A                   Dark field examination..        0.37       0.20       0.20       0.01       0.58       0.58        XXX
87166...  ..................  X                   Dark field examination..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87174...  ..................  X                   Endotoxin, bacterial....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87175...  ..................  X                   Assay, endotoxin,               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bacterial.
87176...  ..................  X                   Endotoxin, bacterial....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87177...  ..................  X                   Ova and parasites smears        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87178...  ..................  D                   Microbe identification..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87179...  ..................  D                   Microbe identification..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87181...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   each.
87184...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   each.
87186...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MIC.
87187...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MBC.
87188...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   each.
87190...  ..................  X                   TB antibiotic                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sensitivity.
87192...  ..................  X                   Antibiotic sensitivity,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   each.
87197...  ..................  X                   Bactericidal level,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   serum.
87205...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59206]]


87206...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87207...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87207...  26                  A                   Smear, stain & interpret        0.37       0.20       0.20       0.01       0.58       0.58        XXX
87208...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87210...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87211...  ..................  X                   Smear, stain & interpret        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87220...  ..................  X                   Tissue exam for fungi...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87230...  ..................  X                   Assay, toxin or                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antitoxin.
87250...  ..................  X                   Virus inoculation for           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
87252...  ..................  X                   Virus inoculation for           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
87253...  ..................  X                   Virus inoculation for           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
87260...  ..................  X                   Adenovirus ag, dfa......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87265...  ..................  X                   Pertussis ag, dfa.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87270...  ..................  X                   Chylmd trach ag, dfa....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87272...  ..................  X                   Cryptosporidum ag, dfa..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87274...  ..................  X                   Herpes simplex ag, dfa..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87276...  ..................  X                   Influenza ag, dfa.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87278...  ..................  X                   Legion pneumo ag, dfa...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87280...  ..................  X                   Resp syncytial ag, dfa..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87285...  ..................  X                   Trepon pallidum ag, dfa.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87290...  ..................  X                   Varicella ag, dfa.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87299...  ..................  X                   Ag detection nos, dfa...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87301...  ..................  X                   Adenovirus ag, eia......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87320...  ..................  X                   Chylmd trach ag, eia....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87324...  ..................  X                   Clostridium ag, eia.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87328...  ..................  X                   Cryptospor ag, eia......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87332...  ..................  X                   Cytomegalovirus ag, eia.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87335...  ..................  X                   E coli 0157 ag, eia.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87340...  ..................  X                   Hepatitis b surface ag,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eia.
87350...  ..................  X                   Hepatitis b ag, eia.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87380...  ..................  X                   Hepatitis delta ag, eia.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87385...  ..................  X                   Histoplasma capsul ag,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eia.
87390...  ..................  X                   HIV-1 ag, eia...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87391...  ..................  X                   HIV-2 ag, eia...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87420...  ..................  X                   Resp syncytial ag, eia..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87425...  ..................  X                   Rotavirus ag, eia.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87430...  ..................  X                   Strep a ag, eia.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87449...  ..................  X                   Ag detect nos, eia, mult        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87450...  ..................  X                   Ag detect nos, eia,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   single.
87470...  ..................  X                   Bartonella, dna, dir            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87471...  ..................  X                   Bartonella, dna, amp            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87472...  ..................  X                   Bartonella, dna, quant..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87475...  ..................  X                   Lyme dis, dna, dir probe        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87476...  ..................  X                   Lyme dis, dna, amp probe        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87477...  ..................  X                   Lyme dis, dna, quant....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87480...  ..................  X                   Candida, dna, dir probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87481...  ..................  X                   Candida, dna, amp probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87482...  ..................  X                   Candida, dna, quant.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87485...  ..................  X                   Chylmd pneum, dna, dir          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87486...  ..................  X                   Chylmd pneum, dna, amp          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87487...  ..................  X                   Chylmd pneum, dna, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87490...  ..................  X                   Chylmd trach, dna, dir          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87491...  ..................  X                   Chylmd trach, dna, amp          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87492...  ..................  X                   Chylmd trach, dna, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87495...  ..................  X                   Cytomeg, dna, dir probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87496...  ..................  X                   Cytomeg, dna, amp probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87497...  ..................  X                   Cytomeg, dna, quant.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87510...  ..................  X                   Gardner vag, dna, dir           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87511...  ..................  X                   Gardner vag, dna, amp           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87512...  ..................  X                   Gardner vag, dna, quant.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87515...  ..................  X                   Hepatitis b, dna, dir           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87516...  ..................  X                   Hepatitis b, dna, amp           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87517...  ..................  X                   Hepatitis b, dna, quant.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87520...  ..................  X                   Hepatitis c, rna, dir           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87521...  ..................  X                   Hepatitis c, rna, amp           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87522...  ..................  X                   Hepatitis c, rna, quant.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87525...  ..................  X                   Hepatitis g , dna, dir          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87526...  ..................  X                   Hepatitis g, dna, amp           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87527...  ..................  X                   Hepatitis g, dna, quant.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87528...  ..................  X                   Hsv, dna, dir probe.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87529...  ..................  X                   Hsv, dna, amp probe.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87530...  ..................  X                   Hsv, dna, quant.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87531...  ..................  X                   Hhv-6, dna, dir probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87532...  ..................  X                   Hhv-6, dna, amp probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59207]]


87533...  ..................  X                   Hhv-6, dna, quant.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87534...  ..................  X                   Hiv-1, dna, dir probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87535...  ..................  X                   Hiv-1, dna, amp probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87536...  ..................  X                   Hiv-1, dna, quant.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87537...  ..................  X                   Hiv-2, dna, dir probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87538...  ..................  X                   Hiv-2, dna, amp probe...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87539...  ..................  X                   Hiv-2, dna, quant.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87540...  ..................  X                   Legion pneumo, dna, dir         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87541...  ..................  X                   Legion pneumo, dna, amp         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87542...  ..................  X                   Legion pneumo, dna,             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quant.
87550...  ..................  X                   Mycobacteria, dna, dir          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87551...  ..................  X                   Mycobacteria, dna, amp          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87552...  ..................  X                   Mycobacteria, dna, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87555...  ..................  X                   M. tuberculo, dna, dir          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87556...  ..................  X                   M. tuberculo, dna, amp          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87557...  ..................  X                   M. tuberculo, dna, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87560...  ..................  X                   M. avium-intra, dna, dir        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87561...  ..................  X                   M. avium-intra, dna, amp        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87562...  ..................  X                   M. avium-intra, dna,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quant.
87580...  ..................  X                   M. pneumon, dna, dir            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87581...  ..................  X                   M. pneumon, dna, amp            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   probe.
87582...  ..................  X                   M. pneumon, dna, quant..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87590...  ..................  X                   N. gonorrhoeae, dna, dir        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87591...  ..................  X                   N. gonorrhoeae, dna, amp        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prob.
87592...  ..................  X                   N. gonorrhoeae, dna,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quant.
87620...  ..................  X                   Hpv, dna, dir probe.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87621...  ..................  X                   Hpv, dna, amp probe.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87622...  ..................  X                   Hpv, dna, quant.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87650...  ..................  X                   Strep a, dna, dir probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87651...  ..................  X                   Strep a, dna, amp probe.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87652...  ..................  X                   Strep a, dna, quant.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87797...  ..................  X                   Detect agent nos, dna,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dir.
87798...  ..................  X                   Detect agent nos, dna,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   amp.
87799...  ..................  X                   Detect agent nos, dna,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quant.
87810...  ..................  X                   Chylmd trach assay w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   optic.
87850...  ..................  X                   N. gonorrhoeae assay w/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   optic.
87880...  ..................  X                   Strep a assay w/optic...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87899...  ..................  X                   Agent nos assay w/optic.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
87999...  ..................  X                   Microbiology procedure..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88000...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88005...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88007...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88012...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88014...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88016...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gross.
88020...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.
88025...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.
88027...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.
88028...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.
88029...  ..................  N                   Autopsy (necropsy),             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.
88036...  ..................  N                   Limited autopsy.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88037...  ..................  N                   Limited autopsy.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88040...  ..................  N                   Forensic autopsy                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (necropsy).
88045...  ..................  N                   Coroner's autopsy               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   (necropsy).
88099...  ..................  N                   Necropsy (autopsy)              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
88104...  ..................  A                   Cytopathology, fluids...        0.56       0.44       0.44       0.04       1.04       1.04        XXX
88104...  TC                  A                   Cytopathology, fluids...        0.00       0.21       0.21       0.02       0.23       0.23        XXX
88104...  26                  A                   Cytopathology, fluids...        0.56       0.23       0.23       0.02       0.81       0.81        XXX
88106...  ..................  A                   Cytopathology, fluids...        0.56       0.37       0.37       0.03       0.96       0.96        XXX
88106...  TC                  A                   Cytopathology, fluids...        0.00       0.17       0.17       0.02       0.19       0.19        XXX
88106...  26                  A                   Cytopathology, fluids...        0.56       0.20       0.20       0.01       0.77       0.77        XXX
88107...  ..................  A                   Cytopathology, fluids...        0.76       0.47       0.47       0.04       1.27       1.27        XXX
88107...  TC                  A                   Cytopathology, fluids...        0.00       0.23       0.23       0.02       0.25       0.25        XXX
88107...  26                  A                   Cytopathology, fluids...        0.76       0.24       0.24       0.02       1.02       1.02        XXX
88108...  ..................  A                   Cytopath, concentrate           0.56       0.47       0.47       0.04       1.07       1.07        XXX
                                                   tech.
88108...  TC                  A                   Cytopath, concentrate           0.00       0.23       0.23       0.02       0.25       0.25        XXX
                                                   tech.
88108...  26                  A                   Cytopath, concentrate           0.56       0.24       0.24       0.02       0.82       0.82        XXX
                                                   tech.
88125...  ..................  A                   Forensic cytopathology..        0.26       0.11       0.11       0.00       0.37       0.37        XXX
88125...  TC                  A                   Forensic cytopathology..        0.00       0.04       0.04       0.00       0.04       0.04        XXX
88125...  26                  A                   Forensic cytopathology..        0.26       0.07       0.07       0.00       0.33       0.33        XXX
88130...  ..................  X                   Sex chromatin                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   identification.
88140...  ..................  X                   Sex chromatin                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   identification.
88141...  ..................  A                   Cytopath cerv/vag               0.42       0.32       0.32       0.04       0.78       0.78        XXX
                                                   interpret.
88142...  ..................  X                   Cytopath cerv/vag thin          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   layer.

[[Page 59208]]


88150...  ..................  X                   Cytopath cerv/vag.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88151...  ..................  D                   Cytopathology                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   interpretation.
88151...  26                  D                   Cytopathology                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   interpretation.
88152...  ..................  X                   Cytopath cerv/vag auto..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88155...  ..................  X                   Cytopath cerv/vag index.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88156...  ..................  X                   Cytopath cerv/vag tbs...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88157...  ..................  D                   1TBS smear (bethesda            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   system).
88157...  26                  D                   1TBS smear (bethesda            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   system).
88158...  ..................  X                   Cytopath cerv/vag tbs           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   auto.
88160...  ..................  A                   Cytopath smear, other           0.50       0.33       0.33       0.03       0.86       0.86        XXX
                                                   source.
88160...  TC                  A                   Cytopath smear, other           0.00       0.16       0.16       0.02       0.18       0.18        XXX
                                                   source.
88160...  26                  A                   Cytopath smear, other           0.50       0.17       0.17       0.01       0.68       0.68        XXX
                                                   source.
88161...  ..................  A                   Cytopath smear, other           0.50       0.39       0.39       0.03       0.92       0.92        XXX
                                                   source.
88161...  TC                  A                   Cytopath smear, other           0.00       0.19       0.19       0.02       0.21       0.21        XXX
                                                   source.
88161...  26                  A                   Cytopath smear, other           0.50       0.20       0.20       0.01       0.71       0.71        XXX
                                                   source.
88162...  ..................  A                   Cytopath smear, other           0.76       0.79       0.79       0.05       1.60       1.60        XXX
                                                   source.
88162...  TC                  A                   Cytopath smear, other           0.00       0.38       0.38       0.02       0.40       0.40        XXX
                                                   source.
88162...  26                  A                   Cytopath smear, other           0.76       0.41       0.41       0.03       1.20       1.20        XXX
                                                   source.
88170...  ..................  A                   Fine needle aspiration..        1.27       0.99       0.99       0.09       2.35       2.35        XXX
88170...  TC                  A                   Fine needle aspiration..        0.00       0.47       0.47       0.04       0.51       0.51        XXX
88170...  26                  A                   Fine needle aspiration..        1.27       0.52       0.52       0.05       1.84       1.84        XXX
88171...  ..................  A                   Fine needle aspiration..        1.27       1.35       1.35       0.09       2.71       2.71        XXX
88171...  TC                  A                   Fine needle aspiration..        0.00       0.64       0.64       0.04       0.68       0.68        XXX
88171...  26                  A                   Fine needle aspiration..        1.27       0.71       0.71       0.05       2.03       2.03        XXX
88172...  ..................  A                   Evaluation of smear.....        0.60       0.71       0.71       0.05       1.36       1.36        XXX
88172...  TC                  A                   Evaluation of smear.....        0.00       0.35       0.35       0.02       0.37       0.37        XXX
88172...  26                  A                   Evaluation of smear.....        0.60       0.36       0.36       0.03       0.99       0.99        XXX
88173...  ..................  A                   Interpretation of smear.        1.39       0.87       0.87       0.05       2.31       2.31        XXX
88173...  TC                  A                   Interpretation of smear.        0.00       0.42       0.42       0.02       0.44       0.44        XXX
88173...  26                  A                   Interpretation of smear.        1.39       0.45       0.45       0.03       1.87       1.87        XXX
88180...  ..................  A                   Cell marker study.......        0.36       0.33       0.33       0.03       0.72       0.72        XXX
88180...  TC                  A                   Cell marker study.......        0.00       0.16       0.16       0.02       0.18       0.18        XXX
88180...  26                  A                   Cell marker study.......        0.36       0.17       0.17       0.01       0.54       0.54        XXX
88182...  ..................  A                   Cell marker study.......        0.77       0.89       0.89       0.07       1.73       1.73        XXX
88182...  TC                  A                   Cell marker study.......        0.00       0.44       0.44       0.04       0.48       0.48        XXX
88182...  26                  A                   Cell marker study.......        0.77       0.45       0.45       0.03       1.25       1.25        XXX
88199...  ..................  C                   Cytopathology procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88199...  TC                  C                   Cytopathology procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88199...  26                  C                   Cytopathology procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88230...  ..................  X                   Tissue culture,                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lymphocyte.
88233...  ..................  X                   Tissue culture, skin/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   biopsy.
88235...  ..................  X                   Tissue culture, placenta        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88237...  ..................  X                   Tissue culture, bone            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   marrow.
88239...  ..................  X                   Tissue culture, other...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88245...  ..................  X                   Chromosome analysis.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88248...  ..................  X                   Chromosome analysis.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88250...  ..................  X                   Chromosome analysis.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88260...  ..................  X                   Chromosome analysis: 5          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cells.
88261...  ..................  X                   Chromosome analysis: 5          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cells.
88262...  ..................  X                   Chromosome count: 15-20         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cells.
88263...  ..................  X                   Chromosome analysis: 45         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cells.
88267...  ..................  X                   Chromosome analysis:            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   placenta.
88269...  ..................  X                   Chromosome analysis:            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   amniotic.
88280...  ..................  X                   Chromosome karyotype            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   study.
88283...  ..................  X                   Chromosome banding study        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88285...  ..................  X                   Chromosome count:               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   additional.
88289...  ..................  X                   Chromosome study:               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   additional.
88299...  ..................  C                   Cytogenetic study.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88300...  ..................  A                   Surg path, gross........        0.08       0.20       0.20       0.01       0.29       0.29        XXX
88300...  TC                  A                   Surg path, gross........        0.00       0.10       0.10       0.00       0.10       0.10        XXX
88300...  26                  A                   Surg path, gross........        0.08       0.10       0.10       0.01       0.19       0.19        XXX
88302...  ..................  A                   Tissue exam by                  0.13       0.40       0.40       0.04       0.57       0.57        XXX
                                                   pathologist.
88302...  TC                  A                   Tissue exam by                  0.00       0.23       0.23       0.02       0.25       0.25        XXX
                                                   pathologist.
88302...  26                  A                   Tissue exam by                  0.13       0.17       0.17       0.02       0.32       0.32        XXX
                                                   pathologist.
88304...  ..................  A                   Tissue exam by                  0.22       0.57       0.57       0.04       0.83       0.83        XXX
                                                   pathologist.
88304...  TC                  A                   Tissue exam by                  0.00       0.33       0.33       0.02       0.35       0.35        XXX
                                                   pathologist.
88304...  26                  A                   Tissue exam by                  0.22      #0.24      #0.24       0.02       0.48       0.48        XXX
                                                   pathologist.
88305...  ..................  A                   Tissue exam by                  0.75       1.03       1.03       0.08       1.86       1.86        XXX
                                                   pathologist.
88305...  TC                  A                   Tissue exam by                  0.00       0.50       0.50       0.04       0.54       0.54        XXX
                                                   pathologist.
88305...  26                  A                   Tissue exam by                  0.75       0.53       0.53       0.04       1.32       1.32        XXX
                                                   pathologist.
88307...  ..................  A                   Tissue exam by                  1.59       1.52       1.52       0.12       3.23       3.23        XXX
                                                   pathologist.
88307...  TC                  A                   Tissue exam by                  0.00       0.74       0.74       0.06       0.80       0.80        XXX
                                                   pathologist.
88307...  26                  A                   Tissue exam by                  1.59       0.78       0.78       0.06       2.43       2.43        XXX
                                                   pathologist.
88309...  ..................  A                   Tissue exam by                  2.28       1.92       1.92       0.13       4.33       4.33        XXX
                                                   pathologist.

[[Page 59209]]


88309...  TC                  A                   Tissue exam by                  0.00       0.93       0.93       0.06       0.99       0.99        XXX
                                                   pathologist.
88309...  26                  A                   Tissue exam by                  2.28       0.99       0.99       0.07       3.34       3.34        XXX
                                                   pathologist.
88311...  ..................  A                   Decalcify tissue........        0.24       0.21       0.21       0.01       0.46       0.46        XXX
88311...  TC                  A                   Decalcify tissue........        0.00       0.10       0.10       0.00       0.10       0.10        XXX
88311...  26                  A                   Decalcify tissue........        0.24       0.11       0.11       0.01       0.36       0.36        XXX
88312...  ..................  A                   Special stains..........        0.54       0.26       0.26       0.01       0.81       0.81        XXX
88312...  TC                  A                   Special stains..........        0.00       0.12       0.12       0.00       0.12       0.12        XXX
88312...  26                  A                   Special stains..........        0.54       0.14       0.14       0.01       0.69       0.69        XXX
88313...  ..................  A                   Special stains..........        0.24       0.21       0.21       0.01       0.46       0.46        XXX
88313...  TC                  A                   Special stains..........        0.00       0.10       0.10       0.00       0.10       0.10        XXX
88313...  26                  A                   Special stains..........        0.24       0.11       0.11       0.01       0.36       0.36        XXX
88314...  ..................  A                   Histochemical stain.....        0.45       0.62       0.62       0.04       1.11       1.11        XXX
88314...  TC                  A                   Histochemical stain.....        0.00       0.27       0.27       0.02       0.29       0.29        XXX
88314...  26                  A                   Histochemical stain.....        0.45       0.35       0.35       0.02       0.82       0.82        XXX
88318...  ..................  A                   Chemical histochemistry.        0.42       0.24       0.24       0.01       0.67       0.67        XXX
88318...  TC                  A                   Chemical histochemistry.        0.00       0.12       0.12       0.00       0.12       0.12        XXX
88318...  26                  A                   Chemical histochemistry.        0.42       0.12       0.12       0.01       0.55       0.55        XXX
88319...  ..................  A                   Enzyme histochemistry...        0.53       0.49       0.49       0.04       1.06       1.06        XXX
88319...  TC                  A                   Enzyme histochemistry...        0.00       0.23       0.23       0.02       0.25       0.25        XXX
88319...  26                  A                   Enzyme histochemistry...        0.53       0.26       0.26       0.02       0.81       0.81        XXX
88321...  ..................  A                   Microslide consultation.        1.30       0.41       0.41       0.03       1.74       1.74        XXX
88323...  ..................  A                   Microslide consultation.        1.35       0.72       0.72       0.05       2.12       2.12        XXX
88323...  TC                  A                   Microslide consultation.        0.00       0.33       0.33       0.02       0.35       0.35        XXX
88323...  26                  A                   Microslide consultation.        1.35       0.39       0.39       0.03       1.77       1.77        XXX
88325...  ..................  A                   Comprehensive review of         2.22       0.47       0.47       0.04       2.73       2.73        XXX
                                                   data.
88329...  ..................  A                   Pathology consult in            0.67       0.37       0.37       0.03       1.07       1.07        XXX
                                                   surgery.
88331...  ..................  A                   Pathology consult in            1.19       1.10       1.10       0.08       2.37       2.37        XXX
                                                   surgery.
88331...  TC                  A                   Pathology consult in            0.00       0.54       0.54       0.04       0.58       0.58        XXX
                                                   surgery.
88331...  26                  A                   Pathology consult in            1.19       0.56       0.56       0.04       1.79       1.79        XXX
                                                   surgery.
88332...  ..................  A                   Pathology consult in            0.59       0.56       0.56       0.04       1.19       1.19        XXX
                                                   surgery.
88332...  TC                  A                   Pathology consult in            0.00       0.27       0.27       0.02       0.29       0.29        XXX
                                                   surgery.
88332...  26                  A                   Pathology consult in            0.59       0.29       0.29       0.02       0.90       0.90        XXX
                                                   surgery.
88342...  ..................  A                   Immunocytochemistry.....        0.85       0.64       0.64       0.04       1.53       1.53        XXX
88342...  TC                  A                   Immunocytochemistry.....        0.00       0.31       0.31       0.02       0.33       0.33        XXX
88342...  26                  A                   Immunocytochemistry.....        0.85       0.33       0.33       0.02       1.20       1.20        XXX
88346...  ..................  A                   Immunofluorescent study.        0.86       0.58       0.58       0.04       1.48       1.48        XXX
88346...  TC                  A                   Immunofluorescent study.        0.00       0.27       0.27       0.02       0.29       0.29        XXX
88346...  26                  A                   Immunofluorescent study.        0.86       0.31       0.31       0.02       1.19       1.19        XXX
88347...  ..................  A                   Immunofluorescent study.        0.86       0.42       0.42       0.04       1.32       1.32        XXX
88347...  TC                  A                   Immunofluorescent study.        0.00       0.27       0.27       0.02       0.29       0.29        XXX
88347...  26                  A                   Immunofluorescent study.        0.86       0.15       0.15       0.02       1.03       1.03        XXX
88348...  ..................  A                   Electron microscopy.....        1.51       2.28       2.28       0.16       3.95       3.95        XXX
88348...  TC                  A                   Electron microscopy.....        0.00       1.09       1.09       0.08       1.17       1.17        XXX
88348...  26                  A                   Electron microscopy.....        1.51       1.19       1.19       0.08       2.78       2.78        XXX
88349...  ..................  A                   Scanning electron               0.76       1.55       1.55       0.12       2.43       2.43        XXX
                                                   microscopy.
88349...  TC                  A                   Scanning electron               0.00       0.76       0.76       0.06       0.82       0.82        XXX
                                                   microscopy.
88349...  26                  A                   Scanning electron               0.76       0.79       0.79       0.06       1.61       1.61        XXX
                                                   microscopy.
88355...  ..................  A                   Analysis, skeletal              1.85       1.74       1.74       0.13       3.72       3.72        XXX
                                                   muscle.
88355...  TC                  A                   Analysis, skeletal              0.00       0.82       0.82       0.06       0.88       0.88        XXX
                                                   muscle.
88355...  26                  A                   Analysis, skeletal              1.85       0.92       0.92       0.07       2.84       2.84        XXX
                                                   muscle.
88356...  ..................  A                   Analysis, nerve.........        3.02       2.66       2.66       0.18       5.86       5.86        XXX
88356...  TC                  A                   Analysis, nerve.........        0.00       1.27       1.27       0.08       1.35       1.35        XXX
88356...  26                  A                   Analysis, nerve.........        3.02       1.39       1.39       0.10       4.51       4.51        XXX
88358...  ..................  A                   Analysis, tumor.........        2.82       2.32       2.32       0.16       5.30       5.30        XXX
88358...  TC                  A                   Analysis, tumor.........        0.00       1.16       1.16       0.08       1.24       1.24        XXX
88358...  26                  A                   Analysis, tumor.........        2.82       1.16       1.16       0.08       4.06       4.06        XXX
88362...  ..................  A                   Nerve teasing                   2.17       1.97       1.97       0.13       4.27       4.27        XXX
                                                   preparations.
88362...  TC                  A                   Nerve teasing                   0.00       0.97       0.97       0.06       1.03       1.03        XXX
                                                   preparations.
88362...  26                  A                   Nerve teasing                   2.17       1.00       1.00       0.07       3.24       3.24        XXX
                                                   preparations.
88365...  ..................  A                   Tissue hybridization....        0.93       0.75       0.75       0.05       1.73       1.73        XXX
88365...  TC                  A                   Tissue hybridization....        0.00       0.37       0.37       0.02       0.39       0.39        XXX
88365...  26                  A                   Tissue hybridization....        0.93       0.38       0.38       0.03       1.34       1.34        XXX
88371...  ..................  X                   Protein, western blot           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tissue.
88371...  26                  A                   Protein, western blot           0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   tissue.
88372...  ..................  X                   Protein analysis w/probe        0.00       0.00       0.00       0.00       0.00       0.00        XXX
88372...  26                  A                   Protein analysis w/probe        0.37       0.20       0.20       0.01       0.58       0.58        XXX
88399...  ..................  C                   Surgical pathology              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
88399...  TC                  C                   Surgical pathology              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
88399...  26                  C                   Surgical pathology              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
89050...  ..................  X                   Body fluid cell count...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89051...  ..................  X                   Body fluid cell count...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89060...  ..................  X                   Exam, synovial fluid            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   crystals.
89060...  26                  A                   Exam, synovial fluid            0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   crystals.
89100...  ..................  A                   Sample intestinal               0.60       0.42       0.42       0.03       1.05       1.05        XXX
                                                   contents.

[[Page 59210]]


89105...  ..................  A                   Sample intestinal               0.50       0.39       0.39       0.03       0.92       0.92        XXX
                                                   contents.
89125...  ..................  X                   Specimen fat stain......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89130...  ..................  A                   Sample stomach contents.        0.45       0.41       0.41       0.03       0.89       0.89        XXX
89132...  ..................  A                   Sample stomach contents.        0.19       0.19       0.19       0.02       0.40       0.40        XXX
89135...  ..................  A                   Sample stomach contents.        0.79       0.58       0.58       0.04       1.41       1.41        XXX
89136...  ..................  A                   Sample stomach contents.        0.21       0.22       0.22       0.02       0.45       0.45        XXX
89140...  ..................  A                   Sample stomach contents.        0.94       0.81       0.81       0.07       1.82       1.82        XXX
89141...  ..................  A                   Sample stomach contents.        0.85       0.73       0.73       0.06       1.64       1.64        XXX
89160...  ..................  X                   Exam feces for meat             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fibers.
89190...  ..................  X                   Nasal smear for                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eosinophils.
89250...  ..................  X                   Fertilization of oocyte.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89251...  ..................  X                   Culture oocyte w/embryos        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89252...  ..................  X                   Assist oocyte                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fertilization.
89253...  ..................  X                   Embryo hatching.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89254...  ..................  X                   Oocyte identification...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89255...  ..................  X                   Prepare embryo for              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transfer.
89256...  ..................  X                   Prepare cryopreserved           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   embryo.
89257...  ..................  X                   Sperm identification....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89258...  ..................  X                   Cryopreservation, embryo        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89259...  ..................  X                   Cryopreservation, sperm.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89260...  ..................  X                   Sperm isolation, simple.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89261...  ..................  X                   Sperm isolation, complex        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89300...  ..................  X                   Semen analysis..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89310...  ..................  X                   Semen analysis..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89320...  ..................  X                   Semen analysis..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89325...  ..................  X                   Sperm antibody test.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89329...  ..................  X                   Sperm evaluation test...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89330...  ..................  X                   Evaluation, cervical            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mucus.
89350...  ..................  A                   Sputum specimen                 0.00       0.39       0.39       0.03       0.42       0.42        XXX
                                                   collection.
89355...  ..................  X                   Exam feces for starch...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89360...  ..................  A                   Collect sweat for test..        0.00       0.43       0.43       0.03       0.46       0.46        XXX
89365...  ..................  X                   Water load test.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89399...  ..................  C                   Pathology lab procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89399...  TC                  C                   Pathology lab procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
89399...  26                  C                   Pathology lab procedure.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90700...  ..................  E                   DTaP immunization.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90701...  ..................  E                   DTP immunization........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90702...  ..................  E                   DT immunization.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90703...  ..................  E                   Tetanus immunization....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90704...  ..................  E                   Mumps immunization......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90705...  ..................  E                   Measles immunization....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90706...  ..................  E                   Rubella immunization....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90707...  ..................  E                   MMR virus immunization..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90708...  ..................  E                   Measles-rubella                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90709...  ..................  E                   Rubella & mumps                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90710...  ..................  E                   Combined vaccine........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90711...  ..................  E                   Combined vaccine........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90712...  ..................  E                   Oral poliovirus                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90713...  ..................  E                   Poliomyelitis                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90714...  ..................  E                   Typhoid immunization....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90716...  ..................  E                   Chicken pox vaccine.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90717...  ..................  E                   Yellow fever                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90718...  ..................  E                   Td immunization.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90719...  ..................  E                   Diphtheria immunization.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90720...  ..................  E                   DTP/HIB vaccine.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90721...  ..................  E                   Dtap/hib vaccine........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90724...  ..................  X                   Influenza immunization..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90725...  ..................  E                   Cholera immunization....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90726...  ..................  E                   Rabies immunization.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90727...  ..................  E                   Plague immunization.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90728...  ..................  E                   BCG immunization........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90730...  ..................  E                   Hepatitis A vaccine.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90732...  ..................  X                   Pneumococcal                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90733...  ..................  E                   Meningococcal                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90735...  ..................  E                   Encephalitis virus              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vaccine.
90737...  ..................  E                   Influenza B immunization        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90741...  ..................  E                   Passive immunization,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ISG.
90742...  ..................  E                   Special passive                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   immunization.
90744...  ..................  X                   Hepatitis B vaccine,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   under 11.
90745...  ..................  X                   Hepatitis B vaccine, 11-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   19.
90746...  ..................  X                   Hepatitis B vaccine,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   over 20.
90747...  ..................  X                   Hepatitis B vaccine, ill        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pat.
90748...  ..................  X                   Hepatitis b/hib vaccine.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90749...  ..................  C                   Immunization procedure..        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59211]]


90780...  ..................  A                   IV infusion therapy, 1          0.00       1.06       1.06       0.08       1.14       1.14        XXX
                                                   hour.
90781...  ..................  A                   IV infusion, additional         0.00       0.53       0.53       0.04       0.57       0.57        XXX
                                                   hour.
90782...  ..................  T                   Injection (SC)/(IM).....        0.00       0.10       0.10       0.01       0.11       0.11        XXX
90783...  ..................  T                   Injection (IA)..........        0.00       0.39       0.39       0.03       0.42       0.42        XXX
90784...  ..................  T                   Injection (IV)..........        0.00       0.45       0.45       0.04       0.49       0.49        XXX
90788...  ..................  T                   Injection of antibiotic.        0.00       0.11       0.11       0.01       0.12       0.12        XXX
90799...  ..................  C                   Therapeutic/diag                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
90801...  ..................  A                   Psy dx interview........        2.80       0.67       0.67       0.09       3.56       3.56        XXX
90802...  ..................  A                   Intac psy dx interview..        3.01       0.38       0.38       0.05       3.44       3.44        XXX
90804...  ..................  A                   Psytx, office (20-30)...        1.11       0.35       0.35       0.05       1.51       1.51        XXX
90805...  ..................  A                   Psytx, office (20-30) w/        1.47       0.35       0.35       0.05       1.87       1.87        XXX
                                                   e&m.
90806...  ..................  A                   Psytx, office (45-50)...        1.73       0.54       0.54       0.08       2.35       2.35        XXX
90807...  ..................  A                   Psytx, office (45-50) w/        2.00       0.54       0.54       0.08       2.62       2.62        XXX
                                                   e&m.
90808...  ..................  A                   Psytx, office (75-80)...        2.76       1.05       1.05       0.15       3.96       3.96        XXX
90809...  ..................  A                   Psytx, office (75-80) w/        3.15       1.05       1.05       0.15       4.35       4.35        XXX
                                                   e&m.
90810...  ..................  A                   Intac psytx, office (20-        1.19       0.59       0.59       0.09       1.87       1.87        XXX
                                                   30).
90811...  ..................  A                   Intac psytx, off 20-30 w/       1.58       0.59       0.59       0.09       2.26       2.26        XXX
                                                   e&m.
90812...  ..................  A                   Intac psytx, office (45-        1.86       0.59       0.59       0.09       2.54       2.54        XXX
                                                   50).
90813...  ..................  A                   Intac psytx, off 45-50 w/       2.15       0.59       0.59       0.09       2.83       2.83        XXX
                                                   e&m.
90814...  ..................  A                   Intac psytx, office (75-        2.97       0.59       0.59       0.09       3.65       3.65        XXX
                                                   80).
90815...  ..................  A                   Intac psytx, off 75-80 w/       3.39       0.59       0.59       0.09       4.07       4.07        XXX
                                                   e&m.
90816...  ..................  A                   Psytx, hosp (20-30).....        1.24       0.35       0.35       0.05       1.64       1.64        XXX
90817...  ..................  A                   Psytx, hosp (20-30) w/          1.65       0.35       0.35       0.05       2.05       2.05        XXX
                                                   e&m.
90818...  ..................  A                   Psytx, hosp (45-50).....        1.94       0.54       0.54       0.08       2.56       2.56        XXX
90819...  ..................  A                   Psytx, hosp (45-50) w/          2.24       0.54       0.54       0.08       2.86       2.86        XXX
                                                   e&m.
90820...  ..................  D                   Diagnostic interview....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90821...  ..................  A                   Psytx, hosp (75-80).....        3.09       1.05       1.05       0.15       4.29       4.29        XXX
90822...  ..................  A                   Psytx, hosp (75-80) w/          3.53       1.05       1.05       0.15       4.73       4.73        XXX
                                                   e&m.
90823...  ..................  A                   Intac psytx, hosp (20-          1.33       0.59       0.59       0.09       2.01       2.01        XXX
                                                   30).
90824...  ..................  A                   Intac psytx, hsp 20-30 w/       1.77       0.59       0.59       0.09       2.45       2.45        XXX
                                                   e&m.
90825...  ..................  D                   1Evaluation of tests/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   records.
90826...  ..................  A                   Intac psytx, hosp (45-          2.08       0.59       0.59       0.09       2.76       2.76        XXX
                                                   50).
90827...  ..................  A                   Intac psytx, hsp 45-50 w/       2.41       0.59       0.59       0.09       3.09       3.09        XXX
                                                   e&m.
90828...  ..................  A                   Intac psytx, hosp (75-          3.32       0.59       0.59       0.09       4.00       4.00        XXX
                                                   80).
90829...  ..................  A                   Intac psytx, hsp 75-80 w/       3.80       0.59       0.59       0.09       4.48       4.48        XXX
                                                   e&m.
90835...  ..................  D                   Special interview.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90841...  ..................  D                   Psychotherapy...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90842...  ..................  D                   Psychotherapy, 75-80            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   min..
90843...  ..................  D                   Psychotherapy, 20-30            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   min..
90844...  ..................  D                   Psychotherapy, 45-50            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   min..
90845...  ..................  A                   Psychoanalysis..........        1.79       0.41       0.41       0.05       2.25       2.25        XXX
90846...  ..................  R                   Family psytx w/o patient        1.83       0.62       0.62       0.08       2.53       2.53        XXX
90847...  ..................  R                   Family psytx w/patient..        2.21       0.58       0.58       0.08       2.87       2.87        XXX
90849...  ..................  R                   Multiple family group           0.59       0.26       0.26       0.03       0.88       0.88        XXX
                                                   psytx.
90853...  ..................  A                   Group psychotherapy.....        0.59       0.26       0.26       0.03       0.88       0.88        XXX
90855...  ..................  D                   12/3 Individual                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   psychotherapy.
90857...  ..................  A                   Intac group psytx.......        0.63       0.15       0.15       0.02       0.80       0.80        XXX
90862...  ..................  A                   Medication management...        0.95       0.37       0.37       0.05       1.37       1.37        XXX
90865...  ..................  A                   Narcosynthesis..........        2.84       0.50       0.50       0.07       3.41       3.41        XXX
90870...  ..................  A                   Electroconvulsive               1.88       0.55       0.55       0.08       2.51       2.51        000
                                                   therapy.
90871...  ..................  A                   Electroconvulsive               2.72       0.83       0.83       0.13       3.68       3.68        000
                                                   therapy.
90875...  ..................  N                   Psychophysiological             1.20       0.00       0.00       0.00       1.20       1.20        XXX
                                                   therapy.
90876...  ..................  N                   Psychophysiological             1.90       0.00       0.00       0.00       1.90       1.90        XXX
                                                   therapy.
90880...  ..................  A                   Hypnotherapy............        2.19       0.64       0.64       0.07       2.90       2.90        XXX
90882...  ..................  N                   Environmental                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   manipulation.
90885...  ..................  B                   Psy evaluation of              +0.97       0.31       0.31       0.04       1.32       1.32        XXX
                                                   records.
90887...  ..................  B                   Consultation with family       +1.48       0.33       0.33       0.04       1.85       1.85        XXX
90889...  ..................  B                   Preparation of report...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
90899...  ..................  C                   Psychiatric service/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   therapy.
90901...  ..................  A                   Biofeedback, any method.        0.41       0.97       0.97       0.07       1.45       1.45        000
90911...  ..................  A                   Biofeedback peri/uro/           0.89       1.13       1.13       0.27       2.29       2.29        000
                                                   rectal.
90918...  ..................  A                   ESRD related services,         11.18       2.19       2.19       0.14      13.51      13.51        XXX
                                                   month.
90919...  ..................  A                   ESRD related services,          8.54       2.19       2.19       0.14      10.87      10.87        XXX
                                                   month.
90920...  ..................  A                   ESRD related services,          7.27       2.19       2.19       0.14       9.60       9.60        XXX
                                                   month.
90921...  ..................  A                   ESRD related services,          4.47       2.19       2.19       0.14       6.80       6.80        XXX
                                                   month.
90922...  ..................  A                   ESRD related services,          0.37       0.07       0.07       0.01       0.45       0.45        XXX
                                                   day.
90923...  ..................  A                   Esrd related services,          0.28       0.07       0.07       0.01       0.36       0.36        XXX
                                                   day.
90924...  ..................  A                   Esrd related services,          0.24       0.07       0.07       0.01       0.32       0.32        XXX
                                                   day.
90925...  ..................  A                   Esrd related services,          0.15       0.07       0.07       0.01       0.23       0.23        XXX
                                                   day.
90935...  ..................  A                   Hemodialysis, one               1.22      #1.34      #1.34       0.10       2.66       2.66        000
                                                   evaluation.
90937...  ..................  A                   Hemodialysis, repeated          2.11      #2.32      #2.32       0.18       4.61       4.61        000
                                                   eval..
90945...  ..................  A                   Dialysis, one evaluation        1.28       1.27       1.27       0.08       2.63       2.63        000
90947...  ..................  A                   Dialysis, repeated eval.        2.16       2.09       2.09       0.14       4.39       4.39        000
90989...  ..................  X                   Dialysis training/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complete.

[[Page 59212]]


90993...  ..................  X                   Dialysis training/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   incomplete.
90997...  ..................  A                   Hemoperfusion...........        1.84      #2.02      #2.02       0.16       4.02       4.02        000
90999...  ..................  C                   Dialysis procedure......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
91000...  ..................  A                   Esophageal intubation...        0.73       0.66       0.66       0.06       1.45       1.45        000
91000...  TC                  A                   Esophageal intubation...        0.00       0.07       0.07       0.01       0.08       0.08        000
91000...  26                  A                   Esophageal intubation...        0.73       0.59       0.59       0.05       1.37       1.37        000
91010...  ..................  A                   Esophagus motility study        1.25       2.16       2.16       0.17       3.58       3.58        000
91010...  TC                  A                   Esophagus motility study        0.00       0.78       0.78       0.06       0.84       0.84        000
91010...  26                  A                   Esophagus motility study        1.25      #1.38      #1.38       0.11       2.74       2.74        000
91011...  ..................  A                   Esophagus motility study        1.50       2.63       2.63       0.18       4.31       4.31        000
91011...  TC                  A                   Esophagus motility study        0.00       0.98       0.98       0.07       1.05       1.05        000
91011...  26                  A                   Esophagus motility study        1.50      #1.65      #1.65       0.11       3.26       3.26        000
91012...  ..................  A                   Esophagus motility study        1.46       2.71       2.71       0.23       4.40       4.40        000
91012...  TC                  A                   Esophagus motility study        0.00       1.10       1.10       0.08       1.18       1.18        000
91012...  26                  A                   Esophagus motility study        1.46      #1.61      #1.61       0.15       3.22       3.22        000
91020...  ..................  A                   Gastric motility........        1.44       2.31       2.31       0.18       3.93       3.93        000
91020...  TC                  A                   Gastric motility........        0.00       0.73       0.73       0.06       0.79       0.79        000
91020...  26                  A                   Gastric motility........        1.44      #1.58      #1.58       0.12       3.14       3.14        000
91030...  ..................  A                   Acid perfusion of               0.91       0.56       0.56       0.05       1.52       1.52        000
                                                   esophagus.
91030...  TC                  A                   Acid perfusion of               0.00       0.21       0.21       0.02       0.23       0.23        000
                                                   esophagus.
91030...  26                  A                   Acid perfusion of               0.91       0.35       0.35       0.03       1.29       1.29        000
                                                   esophagus.
91032...  ..................  A                   Esophagus, acid reflux          1.21       1.96       1.96       0.16       3.33       3.33        000
                                                   test.
91032...  TC                  A                   Esophagus, acid reflux          0.00       0.71       0.71       0.06       0.77       0.77        000
                                                   test.
91032...  26                  A                   Esophagus, acid reflux          1.21       1.25       1.25       0.10       2.56       2.56        000
                                                   test.
91033...  ..................  A                   Prolonged acid reflux           1.30       2.71       2.71       0.25       4.26       4.26        000
                                                   test.
91033...  TC                  A                   Prolonged acid reflux           0.00       1.28       1.28       0.11       1.39       1.39        000
                                                   test.
91033...  26                  A                   Prolonged acid reflux           1.30      #1.43      #1.43       0.14       2.87       2.87        000
                                                   test.
91052...  ..................  A                   Gastric analysis test...        0.79       0.82       0.82       0.07       1.68       1.68        000
91052...  TC                  A                   Gastric analysis test...        0.00       0.32       0.32       0.03       0.35       0.35        000
91052...  26                  A                   Gastric analysis test...        0.79       0.50       0.50       0.04       1.33       1.33        000
91055...  ..................  A                   Gastric intubation for          0.94       0.80       0.80       0.06       1.80       1.80        000
                                                   smear.
91055...  TC                  A                   Gastric intubation for          0.00       0.29       0.29       0.02       0.31       0.31        000
                                                   smear.
91055...  26                  A                   Gastric intubation for          0.94       0.51       0.51       0.04       1.49       1.49        000
                                                   smear.
91060...  ..................  A                   Gastric saline load test        0.45       0.71       0.71       0.06       1.22       1.22        000
91060...  TC                  A                   Gastric saline load test        0.00       0.21       0.21       0.02       0.23       0.23        000
91060...  26                  A                   Gastric saline load test        0.45       0.50       0.50       0.04       0.99       0.99        000
91065...  ..................  A                   Breath hydrogen test....        0.20       0.56       0.56       0.05       0.81       0.81        000
91065...  TC                  A                   Breath hydrogen test....        0.00       0.34       0.34       0.02       0.36       0.36        000
91065...  26                  A                   Breath hydrogen test....        0.20      #0.22      #0.22       0.03       0.45       0.45        000
91100...  ..................  A                   Pass intestine bleeding         1.08       0.56       0.56       0.05       1.69       1.69        000
                                                   tube.
91105...  ..................  A                   Gastric intubation              0.37      #0.41      #0.41       0.04       0.82       0.82        000
                                                   treatment.
91122...  ..................  A                   Anal pressure record....        1.77       1.73       1.73       0.22       3.72       3.72        000
91122...  TC                  A                   Anal pressure record....        0.00       0.67       0.67       0.09       0.76       0.76        000
91122...  26                  A                   Anal pressure record....        1.77       1.06       1.06       0.13       2.96       2.96        000
91299...  ..................  C                   Gastroenterology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
91299...  TC                  C                   Gastroenterology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
91299...  26                  C                   Gastroenterology                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
92002...  ..................  A                   Eye exam, new patient...        0.88       0.49       0.49       0.02       1.39       1.39        XXX
92004...  ..................  A                   Eye exam, new patient...        1.67       0.57       0.57       0.02       2.26       2.26        XXX
92012...  ..................  A                   Eye exam established pt.        0.67       0.44       0.44       0.02       1.13       1.13        XXX
92014...  ..................  A                   Eye exam & treatment....        1.10       0.54       0.54       0.02       1.66       1.66        XXX
92015...  ..................  N                   Refraction..............       +0.38       0.32       0.32       0.02       0.72       0.72        XXX
92018...  ..................  A                   New eye exam & treatment        1.51       0.47       0.47       0.03       2.01       2.01        XXX
92019...  ..................  A                   Eye exam & treatment....        1.31       0.47       0.47       0.03       1.81       1.81        XXX
92020...  ..................  A                   Special eye evaluation..        0.37       0.29       0.29       0.01       0.67       0.67        XXX
92060...  ..................  A                   Special eye evaluation..        0.69       0.39       0.39       0.02       1.10       1.10        XXX
92060...  TC                  A                   Special eye evaluation..        0.00       0.18       0.18       0.01       0.19       0.19        XXX
92060...  26                  A                   Special eye evaluation..        0.69       0.21       0.21       0.01       0.91       0.91        XXX
92065...  ..................  A                   Orthoptic/pleoptic              0.37       0.36       0.36       0.01       0.74       0.74        XXX
                                                   training.
92065...  TC                  A                   Orthoptic/pleoptic              0.00       0.16       0.16       0.00       0.16       0.16        XXX
                                                   training.
92065...  26                  A                   Orthoptic/pleoptic              0.37       0.20       0.20       0.01       0.58       0.58        XXX
                                                   training.
92070...  ..................  A                   Fitting of contact lens.        0.70       1.20       1.20       0.06       1.96       1.96        XXX
92081...  ..................  A                   Visual field                    0.36       0.32       0.32       0.01       0.69       0.69        XXX
                                                   examination(s).
92081...  TC                  A                   Visual field                    0.00       0.15       0.15       0.00       0.15       0.15        XXX
                                                   examination(s).
92081...  26                  A                   Visual field                    0.36       0.17       0.17       0.01       0.54       0.54        XXX
                                                   examination(s).
92082...  ..................  A                   Visual field                    0.44       0.49       0.49       0.02       0.95       0.95        XXX
                                                   examination(s).
92082...  TC                  A                   Visual field                    0.00       0.19       0.19       0.01       0.20       0.20        XXX
                                                   examination(s).
92082...  26                  A                   Visual field                    0.44       0.30       0.30       0.01       0.75       0.75        XXX
                                                   examination(s).
92083...  ..................  A                   Visual field                    0.50       0.83       0.83       0.04       1.37       1.37        XXX
                                                   examination(s).
92083...  TC                  A                   Visual field                    0.00       0.28       0.28       0.01       0.29       0.29        XXX
                                                   examination(s).
92083...  26                  A                   Visual field                    0.50       0.55       0.55       0.03       1.08       1.08        XXX
                                                   examination(s).
92100...  ..................  A                   Serial tonometry exam(s)        0.92       0.25       0.25       0.01       1.18       1.18        XXX
92120...  ..................  A                   Tonography & eye                0.81       0.31       0.31       0.02       1.14       1.14        XXX
                                                   evaluation.
92130...  ..................  A                   Water provocation               0.81       0.49       0.49       0.02       1.32       1.32        XXX
                                                   tonography.

[[Page 59213]]


92140...  ..................  A                   Glaucoma provocative            0.50       0.30       0.30       0.01       0.81       0.81        XXX
                                                   tests.
92225...  ..................  A                   Special eye exam,               0.38       0.45       0.45       0.02       0.85       0.85        XXX
                                                   initial.
92226...  ..................  A                   Special eye exam,               0.33       0.40       0.40       0.02       0.75       0.75        XXX
                                                   subsequent.
92230...  ..................  A                   Eye exam with photos....        0.60       0.69       0.69       0.04       1.33       1.33        XXX
92235...  ..................  A                   Eye exam with photos....        0.81       1.58       1.58       0.09       2.48       2.48        XXX
92235...  TC                  A                   Eye exam with photos....        0.00       0.99       0.99       0.06       1.05       1.05        XXX
92235...  26                  A                   Eye exam with photos....        0.81       0.59       0.59       0.03       1.43       1.43        XXX
92240...  ..................  A                   Icg angiography.........        1.10       1.58       1.58       0.09       2.77       2.77        XXX
92240...  TC                  A                   Icg angiography.........        0.00       0.99       0.99       0.06       1.05       1.05        XXX
92240...  26                  A                   Icg angiography.........        1.10       0.59       0.59       0.03       1.72       1.72        XXX
92250...  ..................  A                   Eye exam with photos....        0.44       0.42       0.42       0.02       0.88       0.88        XXX
92250...  TC                  A                   Eye exam with photos....        0.00       0.17       0.17       0.01       0.18       0.18        XXX
92250...  26                  A                   Eye exam with photos....        0.44       0.25       0.25       0.01       0.70       0.70        XXX
92260...  ..................  A                   Ophthalmoscopy/                 0.20       0.54       0.54       0.03       0.77       0.77        XXX
                                                   dynamometry.
92265...  ..................  A                   Eye muscle evaluation...        0.81       0.29       0.29       0.02       1.12       1.12        XXX
92265...  TC                  A                   Eye muscle evaluation...        0.00       0.22       0.22       0.02       0.24       0.24        XXX
92265...  26                  A                   Eye muscle evaluation...        0.81       0.07       0.07       0.00       0.88       0.88        XXX
92270...  ..................  A                   Electro-oculography.....        0.81       0.67       0.67       0.05       1.53       1.53        XXX
92270...  TC                  A                   Electro-oculography.....        0.00       0.30       0.30       0.02       0.32       0.32        XXX
92270...  26                  A                   Electro-oculography.....        0.81       0.37       0.37       0.03       1.21       1.21        XXX
92275...  ..................  A                   Electroretinography.....        1.01       0.90       0.90       0.05       1.96       1.96        XXX
92275...  TC                  A                   Electroretinography.....        0.00       0.39       0.39       0.02       0.41       0.41        XXX
92275...  26                  A                   Electroretinography.....        1.01       0.51       0.51       0.03       1.55       1.55        XXX
92283...  ..................  A                   Color vision examination        0.17       0.29       0.29       0.01       0.47       0.47        XXX
92283...  TC                  A                   Color vision examination        0.00       0.12       0.12       0.00       0.12       0.12        XXX
92283...  26                  A                   Color vision examination        0.17       0.17       0.17       0.01       0.35       0.35        XXX
92284...  ..................  A                   Dark adaptation eye exam        0.24       0.45       0.45       0.02       0.71       0.71        XXX
92284...  TC                  A                   Dark adaptation eye exam        0.00       0.17       0.17       0.01       0.18       0.18        XXX
92284...  26                  A                   Dark adaptation eye exam        0.24       0.28       0.28       0.01       0.53       0.53        XXX
92285...  ..................  A                   Eye photography.........        0.20       0.29       0.29       0.01       0.50       0.50        XXX
92285...  TC                  A                   Eye photography.........        0.00       0.11       0.11       0.00       0.11       0.11        XXX
92285...  26                  A                   Eye photography.........        0.20       0.18       0.18       0.01       0.39       0.39        XXX
92286...  ..................  A                   Internal eye photography        0.66       1.22       1.22       0.07       1.95       1.95        XXX
92286...  TC                  A                   Internal eye photography        0.00       0.39       0.39       0.02       0.41       0.41        XXX
92286...  26                  A                   Internal eye photography        0.66       0.83       0.83       0.05       1.54       1.54        XXX
92287...  ..................  A                   Internal eye photography        0.81       1.52       1.52       0.08       2.41       2.41        XXX
92310...  ..................  N                   Contact lens fitting....       +1.17      #1.29      #1.29       0.00       2.46       2.46        XXX
92311...  ..................  A                   Contact lens fitting....        1.08       0.90       0.90       0.03       2.01       2.01        XXX
92312...  ..................  A                   Contact lens fitting....        1.26       1.16       1.16       0.03       2.45       2.45        XXX
92313...  ..................  A                   Contact lens fitting....        0.92       0.88       0.88       0.03       1.83       1.83        XXX
92314...  ..................  N                   Prescription of contact        +0.69      #0.76      #0.76       0.00       1.45       1.45        XXX
                                                   lens.
92315...  ..................  A                   Prescription of contact         0.45       0.66       0.66       0.03       1.14       1.14        XXX
                                                   lens.
92316...  ..................  A                   Prescription of contact         0.68       0.95       0.95       0.04       1.67       1.67        XXX
                                                   lens.
92317...  ..................  A                   Prescription of contact         0.45       0.39       0.39       0.02       0.86       0.86        XXX
                                                   lens.
92325...  ..................  A                   Modification of contact         0.00       0.38       0.38       0.01       0.39       0.39        XXX
                                                   lens.
92326...  ..................  A                   Replacement of contact          0.00       1.56       1.56       0.06       1.62       1.62        XXX
                                                   lens.
92330...  ..................  A                   Fitting of artificial           1.08       1.13       1.13       0.09       2.30       2.30        XXX
                                                   eye.
92335...  ..................  A                   Fitting of artificial           0.45       1.97       1.97       0.11       2.53       2.53        XXX
                                                   eye.
92340...  ..................  N                   Fitting of spectacles...       +0.37       0.42      #0.41       0.00       0.79       0.78        XXX
92341...  ..................  N                   Fitting of spectacles...       +0.47       0.53      #0.52       0.00       1.00       0.99        XXX
92342...  ..................  N                   Fitting of spectacles...       +0.53       0.60      #0.58       0.00       1.13       1.11        XXX
92352...  ..................  B                   Special spectacles             +0.37       0.30       0.30       0.01       0.68       0.68        XXX
                                                   fitting.
92353...  ..................  B                   Special spectacles             +0.50       0.40       0.40       0.01       0.91       0.91        XXX
                                                   fitting.
92354...  ..................  B                   Special spectacles             +0.00       8.44       8.44       0.10       8.54       8.54        XXX
                                                   fitting.
92355...  ..................  B                   Special spectacles             +0.00       4.13       4.13       0.01       4.14       4.14        XXX
                                                   fitting.
92358...  ..................  B                   Eye prosthesis service..       +0.00       0.92       0.92       0.05       0.97       0.97        XXX
92370...  ..................  N                   Repair & adjust                +0.32       0.36      #0.35       0.00       0.68       0.67        XXX
                                                   spectacles.
92371...  ..................  B                   Repair & adjust                +0.00       0.59       0.59       0.02       0.61       0.61        XXX
                                                   spectacles.
92390...  ..................  N                   Supply of spectacles....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92391...  ..................  N                   Supply of contact lenses        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92392...  ..................  I                   Supply of low vision           +0.00       3.85       3.85       0.02       3.87       3.87        XXX
                                                   aids.
92393...  ..................  I                   Supply of artificial eye       +0.00      11.96      11.96       0.67      12.63      12.63        XXX
92395...  ..................  I                   Supply of spectacles....       +0.00       1.31       1.31       0.10       1.41       1.41        XXX
92396...  ..................  I                   Supply of contact lenses       +0.00       2.19       2.19       0.08       2.27       2.27        XXX
92499...  ..................  C                   Eye service or procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92499...  TC                  C                   Eye service or procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92499...  26                  C                   Eye service or procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92502...  ..................  A                   Ear and throat                  1.51       1.12       1.12       0.12       2.75       2.75        000
                                                   examination.
92504...  ..................  A                   Ear microscopy                  0.18       0.26       0.26       0.02       0.46       0.46        XXX
                                                   examination.
92506...  ..................  A                   Speech & hearing                0.86       0.52       0.52       0.05       1.43       1.43        XXX
                                                   evaluation.
92507...  ..................  A                   Speech/hearing therapy..        0.52       0.33       0.33       0.03       0.88       0.88        XXX
92508...  ..................  A                   Speech/hearing therapy..        0.26       0.18       0.18       0.02       0.46       0.46        XXX
92510...  ..................  A                   Rehab for ear implant...        1.50       1.36       1.36       0.15       3.01       3.01        XXX
92511...  ..................  A                   Nasopharyngoscopy.......        0.84       0.85       0.85       0.09       1.78       1.78        000

[[Page 59214]]


92512...  ..................  A                   Nasal function studies..        0.55       0.47       0.47       0.05       1.07       1.07        XXX
92516...  ..................  A                   Facial nerve function           0.43       0.39       0.39       0.04       0.86       0.86        XXX
                                                   test.
92520...  ..................  A                   Laryngeal function              0.76       0.53       0.53       0.05       1.34       1.34        XXX
                                                   studies.
92525...  ..................  A                   Oral function evaluation        1.50       1.02       1.02       0.11       2.63       2.63        XXX
92526...  ..................  A                   Oral function therapy...        0.55       0.47       0.47       0.05       1.07       1.07        XXX
92531...  ..................  B                   Spontaneous nystagmus           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   study.
92532...  ..................  B                   Positional nystagmus            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   study.
92533...  ..................  B                   Caloric vestibular test.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92534...  ..................  B                   Optokinetic nystagmus...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92541...  ..................  A                   Spontaneous nystagmus           0.40       0.67       0.67       0.07       1.14       1.14        XXX
                                                   test.
92541...  TC                  A                   Spontaneous nystagmus           0.00       0.22       0.22       0.02       0.24       0.24        XXX
                                                   test.
92541...  26                  A                   Spontaneous nystagmus           0.40       0.45       0.45       0.05       0.90       0.90        XXX
                                                   test.
92542...  ..................  A                   Positional nystagmus            0.33       0.61       0.61       0.07       1.01       1.01        XXX
                                                   test.
92542...  TC                  A                   Positional nystagmus            0.00       0.25       0.25       0.03       0.28       0.28        XXX
                                                   test.
92542...  26                  A                   Positional nystagmus            0.33       0.36       0.36       0.04       0.73       0.73        XXX
                                                   test.
92543...  ..................  A                   Caloric vestibular test.        0.38       0.82       0.82       0.09       1.29       1.29        XXX
92543...  TC                  A                   Caloric vestibular test.        0.00       0.40       0.40       0.04       0.44       0.44        XXX
92543...  26                  A                   Caloric vestibular test.        0.38       0.42       0.42       0.05       0.85       0.85        XXX
92544...  ..................  A                   Optokinetic nystagmus           0.26       0.47       0.47       0.05       0.78       0.78        XXX
                                                   test.
92544...  TC                  A                   Optokinetic nystagmus           0.00       0.20       0.20       0.02       0.22       0.22        XXX
                                                   test.
92544...  26                  A                   Optokinetic nystagmus           0.26       0.27       0.27       0.03       0.56       0.56        XXX
                                                   test.
92545...  ..................  A                   Oscillating tracking            0.23       0.40       0.40       0.04       0.67       0.67        XXX
                                                   test.
92545...  TC                  A                   Oscillating tracking            0.00       0.20       0.20       0.02       0.22       0.22        XXX
                                                   test.
92545...  26                  A                   Oscillating tracking            0.23       0.20       0.20       0.02       0.45       0.45        XXX
                                                   test.
92546...  ..................  A                   Sinusoidal rotational           0.29       0.53       0.53       0.05       0.87       0.87        XXX
                                                   test.
92546...  TC                  A                   Sinusoidal rotational           0.00       0.23       0.23       0.02       0.25       0.25        XXX
                                                   test.
92546...  26                  A                   Sinusoidal rotational           0.29       0.30       0.30       0.03       0.62       0.62        XXX
                                                   test.
92547...  ..................  A                   Supplemental electrical         0.00       0.53       0.53       0.06       0.59       0.59        XXX
                                                   test.
92548...  ..................  A                   Posturography...........        0.50       1.85       1.85       0.19       2.54       2.54        XXX
92548...  TC                  A                   Posturography...........        0.00       1.40       1.40       0.14       1.54       1.54        XXX
92548...  26                  A                   Posturography...........        0.50       0.45       0.45       0.05       1.00       1.00        XXX
92551...  ..................  N                   Pure tone hearing test,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   air.
92552...  ..................  A                   Pure tone audiometry,           0.00       0.42       0.42       0.04       0.46       0.46        XXX
                                                   air.
92553...  ..................  A                   Audiometry, air & bone..        0.00       0.63       0.63       0.07       0.70       0.70        XXX
92555...  ..................  A                   Speech threshold                0.00       0.36       0.36       0.04       0.40       0.40        XXX
                                                   audiometry.
92556...  ..................  A                   Speech audiometry,              0.00       0.54       0.54       0.06       0.60       0.60        XXX
                                                   complete.
92557...  ..................  A                   Comprehensive hearing           0.00       1.13       1.13       0.13       1.26       1.26        XXX
                                                   test.
92559...  ..................  N                   Group audiometric               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   testing.
92560...  ..................  N                   Bekesy audiometry,              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   screen.
92561...  ..................  A                   Bekesy audiometry,              0.00       0.68       0.68       0.07       0.75       0.75        XXX
                                                   diagnosis.
92562...  ..................  A                   Loudness balance test...        0.00       0.39       0.39       0.04       0.43       0.43        XXX
92563...  ..................  A                   Tone decay hearing test.        0.00       0.36       0.36       0.04       0.40       0.40        XXX
92564...  ..................  A                   Sisi hearing test.......        0.00       0.45       0.45       0.05       0.50       0.50        XXX
92565...  ..................  A                   Stenger test, pure tone.        0.00       0.38       0.38       0.04       0.42       0.42        XXX
92567...  ..................  A                   Tympanometry............        0.00       0.50       0.50       0.06       0.56       0.56        XXX
92568...  ..................  A                   Acoustic reflex testing.        0.00       0.36       0.36       0.04       0.40       0.40        XXX
92569...  ..................  A                   Acoustic reflex decay           0.00       0.39       0.39       0.04       0.43       0.43        XXX
                                                   test.
92571...  ..................  A                   Filtered speech hearing         0.00       0.37       0.37       0.04       0.41       0.41        XXX
                                                   test.
92572...  ..................  A                   Staggered spondaic word         0.00       0.08       0.08       0.01       0.09       0.09        XXX
                                                   test.
92573...  ..................  A                   Lombard test............        0.00       0.33       0.33       0.04       0.37       0.37        XXX
92575...  ..................  A                   Sensorineural acuity            0.00       0.29       0.29       0.03       0.32       0.32        XXX
                                                   test.
92576...  ..................  A                   Synthetic sentence test.        0.00       0.42       0.42       0.05       0.47       0.47        XXX
92577...  ..................  A                   Stenger test, speech....        0.00       0.68       0.68       0.08       0.76       0.76        XXX
92579...  ..................  A                   Visual audiometry (vra).        0.00       0.69       0.69       0.07       0.76       0.76        XXX
92582...  ..................  A                   Conditioning play               0.00       0.69       0.69       0.07       0.76       0.76        XXX
                                                   audiometry.
92583...  ..................  A                   Select picture                  0.00       0.85       0.85       0.09       0.94       0.94        XXX
                                                   audiometry.
92584...  ..................  A                   Electrocochleography....        0.00       2.36       2.36       0.25       2.61       2.61        XXX
92585...  ..................  A                   Auditory evoked                 0.50       3.25       3.25       0.31       4.06       4.06        XXX
                                                   potential.
92585...  TC                  A                   Auditory evoked                 0.00       1.76       1.76       0.17       1.93       1.93        XXX
                                                   potential.
92585...  26                  A                   Auditory evoked                 0.50       1.49       1.49       0.14       2.13       2.13        XXX
                                                   potential.
92587...  ..................  A                   Evoked auditory test....        0.13       1.35       1.35       0.13       1.61       1.61        XXX
92587...  TC                  A                   Evoked auditory test....        0.00       1.24       1.24       0.12       1.36       1.36        XXX
92587...  26                  A                   Evoked auditory test....        0.13       0.11       0.11       0.01       0.25       0.25        XXX
92588...  ..................  A                   Evoked auditory test....        0.36       1.70       1.70       0.16       2.22       2.22        XXX
92588...  TC                  A                   Evoked auditory test....        0.00       1.40       1.40       0.14       1.54       1.54        XXX
92588...  26                  A                   Evoked auditory test....        0.36       0.30       0.30       0.02       0.68       0.68        XXX
92589...  ..................  A                   Auditory function               0.00       0.51       0.51       0.06       0.57       0.57        XXX
                                                   test(s).
92590...  ..................  N                   Hearing aid exam, one           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ear.
92591...  ..................  N                   Hearing aid exam, both          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ears.
92592...  ..................  N                   Hearing aid check, one          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ear.
92593...  ..................  N                   Hearing aid check, both         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ears.
92594...  ..................  N                   Electro hearing aid             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test, one.
92595...  ..................  N                   Electro hearing aid             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test, both.
92596...  ..................  A                   Ear protector evaluation        0.00       0.56       0.56       0.06       0.62       0.62        XXX

[[Page 59215]]


92597...  ..................  A                   Oral speech device eval.        1.35       1.01       1.01       0.11       2.47       2.47        XXX
92598...  ..................  A                   Modify oral speech              0.99       0.66       0.66       0.07       1.72       1.72        XXX
                                                   device.
92599...  ..................  C                   ENT procedure/service...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92599...  TC                  C                   ENT procedure/service...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92599...  26                  C                   ENT procedure/service...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
92950...  ..................  A                   Heart/lung resuscitation        3.80       2.27       2.27       0.17       6.24       6.24        000
                                                   (CPR).
92953...  ..................  A                   Temporary external              0.23      #0.25      #0.25       0.15       0.63       0.63        000
                                                   pacing.
92960...  ..................  A                   Heart electroconversion.        2.25       1.88       1.88       0.16       4.29       4.29        000
92970...  ..................  A                   Cardioassist, internal..        3.52       3.47       3.47       0.41       7.40       7.40        000
92971...  ..................  A                   Cardioassist, external..        1.77       1.11       1.11       0.08       2.96       2.96        000
92975...  ..................  A                   Dissolve clot, heart            7.25       5.71       5.71       0.42      13.38      13.38        000
                                                   vessel.
92977...  ..................  A                   Dissolve clot, heart            0.00       7.68       7.68       0.54       8.22       8.22        XXX
                                                   vessel.
92978...  ..................  A                   Intravas us, heart (add-        1.80       5.41       5.41       0.36       7.57       7.57        ZZZ
                                                   on).
92978...  TC                  A                   Intravas us, heart (add-        0.00       4.35       4.35       0.28       4.63       4.63        ZZZ
                                                   on).
92978...  26                  A                   Intravas us, heart (add-        1.80       1.06       1.06       0.08       2.94       2.94        ZZZ
                                                   on).
92979...  ..................  A                   Intravas us, heart (add-        1.44       3.03       3.03       0.20       4.67       4.67        ZZZ
                                                   on).
92979...  TC                  A                   Intravas us, heart (add-        0.00       2.18       2.18       0.14       2.32       2.32        ZZZ
                                                   on).
92979...  26                  A                   Intravas us, heart (add-        1.44       0.85       0.85       0.06       2.35       2.35        ZZZ
                                                   on).
92980...  ..................  A                   Insert intracoronary           14.84     #16.32     #16.32       1.22      32.38      32.38        000
                                                   stent.
92981...  ..................  A                   Insert intracoronary            4.17      #4.59      #4.59       0.44       9.20       9.20        ZZZ
                                                   stent.
92982...  ..................  A                   Coronary artery dilation       10.98     #12.08     #12.08       1.22      24.28      24.28        000
92984...  ..................  A                   Coronary artery dilation        2.97      #3.27      #3.27       0.44       6.68       6.68        ZZZ
92986...  ..................  A                   Revision of aortic valve      *21.80      12.04      12.04       0.90      34.74      34.74        090
92987...  ..................  A                   Revision of mitral valve      *22.70      12.20      12.20       0.91      35.81      35.81        090
92990...  ..................  A                   Revision of pulmonary         *17.34       9.59       9.59       0.71      27.64      27.64        090
                                                   valve.
92992...  ..................  C                   Revision of heart               0.00       0.00       0.00       0.00       0.00       0.00        090
                                                   chamber.
92993...  ..................  C                   Revision of heart               0.00       0.00       0.00       0.00       0.00       0.00        090
                                                   chamber.
92995...  ..................  A                   Coronary atherectomy....       12.09     #13.30     #13.30       1.22      26.61      26.61        000
92996...  ..................  A                   Coronary atherectomy....        3.26      #3.59      #3.59       0.44       7.29       7.29        ZZZ
92997...  ..................  A                   Pul art balloon repair,        12.00     #13.20     #13.20       1.22      26.42      26.42        000
                                                   perc.
92998...  ..................  A                   Pul art balloon repair,         6.00       3.80       3.80       0.44      10.24      10.24        ZZZ
                                                   perc.
93000...  ..................  A                   Electrocardiogram,              0.17       0.59       0.59       0.04       0.80       0.80        XXX
                                                   complete.
93005...  ..................  A                   Electrocardiogram,              0.00       0.43       0.43       0.03       0.46       0.46        XXX
                                                   tracing.
93010...  ..................  A                   Electrocardiogram report        0.17       0.16       0.16       0.01       0.34       0.34        XXX
93012...  ..................  A                   Transmission of ecg.....        0.00       2.25       2.25       0.22       2.47       2.47        XXX
93014...  ..................  A                   Report on transmitted           0.52       0.40       0.40       0.05       0.97       0.97        XXX
                                                   ecg.
93015...  ..................  A                   Cardiovascular stress           0.75       2.32       2.32       0.18       3.25       3.25        XXX
                                                   test.
93016...  ..................  A                   Cardiovascular stress           0.45       0.39       0.39       0.03       0.87       0.87        XXX
                                                   test.
93017...  ..................  A                   Cardiovascular stress           0.00       1.60       1.60       0.12       1.72       1.72        XXX
                                                   test.
93018...  ..................  A                   Cardiovascular stress           0.30      #0.33      #0.33       0.03       0.66       0.66        XXX
                                                   test.
93024...  ..................  A                   Cardiac drug stress test        1.17       2.36       2.36       0.23       3.76       3.76        XXX
93024...  TC                  A                   Cardiac drug stress test        0.00       1.07       1.07       0.09       1.16       1.16        XXX
93024...  26                  A                   Cardiac drug stress test        1.17      #1.29      #1.29       0.14       2.60       2.60        XXX
93040...  ..................  A                   Rhythm ECG with report..        0.16       0.26       0.26       0.02       0.44       0.44        XXX
93041...  ..................  A                   Rhythm ECG, tracing.....        0.00       0.14       0.14       0.01       0.15       0.15        XXX
93042...  ..................  A                   Rhythm ECG, report......        0.16       0.12       0.12       0.01       0.29       0.29        XXX
93224...  ..................  A                   ECG monitor/report, 24          0.52       3.83       3.83       0.31       4.66       4.66        XXX
                                                   hrs.
93225...  ..................  A                   ECG monitor/record, 24          0.00       1.18       1.18       0.09       1.27       1.27        XXX
                                                   hrs.
93226...  ..................  A                   ECG monitor/report, 24          0.00       2.08       2.08       0.16       2.24       2.24        XXX
                                                   hrs.
93227...  ..................  A                   ECG monitor/review, 24          0.52      #0.57      #0.57       0.06       1.15       1.15        XXX
                                                   hrs.
93230...  ..................  A                   ECG monitor/report, 24          0.52       4.09       4.09       0.34       4.95       4.95        XXX
                                                   hrs.
93231...  ..................  A                   ECG monitor/record, 24          0.00       1.45       1.45       0.11       1.56       1.56        XXX
                                                   hrs.
93232...  ..................  A                   ECG monitor/report, 24          0.00       2.07       2.07       0.15       2.22       2.22        XXX
                                                   hrs.
93233...  ..................  A                   ECG monitor/review, 24          0.52      #0.57      #0.57       0.08       1.17       1.17        XXX
                                                   hrs.
93235...  ..................  A                   ECG monitor/report, 24          0.45       3.00       3.00       0.23       3.68       3.68        XXX
                                                   hrs.
93236...  ..................  A                   ECG monitor/report, 24          0.00       2.50       2.50       0.17       2.67       2.67        XXX
                                                   hrs.
93237...  ..................  A                   ECG monitor/review, 24          0.45      #0.50      #0.50       0.06       1.01       1.01        XXX
                                                   hrs.
93268...  ..................  A                   ECG record/review.......        0.52       3.83       3.83       0.36       4.71       4.71        XXX
93270...  ..................  A                   ECG recording...........        0.00       1.18       1.18       0.09       1.27       1.27        XXX
93271...  ..................  A                   ECG/monitoring and              0.00       2.25       2.25       0.22       2.47       2.47        XXX
                                                   anaylsis.
93272...  ..................  A                   ECG/review, interpret           0.52       0.40       0.40       0.05       0.97       0.97        XXX
                                                   only.
93278...  ..................  A                   ECG/signal-averaged.....        0.25       1.38       1.38       0.18       1.81       1.81        XXX
93278...  TC                  A                   ECG/signal-averaged.....        0.00       1.10       1.10       0.12       1.22       1.22        XXX
93278...  26                  A                   ECG/signal-averaged.....        0.25      #0.28      #0.28       0.06       0.59       0.59        XXX
93303...  ..................  A                   Echo transthoracic......        1.30       4.68       4.68       0.36       6.34       6.34        XXX
93303...  TC                  A                   Echo transthoracic......        0.00       3.68       3.68       0.27       3.95       3.95        XXX
93303...  26                  A                   Echo transthoracic......        1.30       1.00       1.00       0.09       2.39       2.39        XXX
93304...  ..................  A                   Echo transthoracic......        0.75       2.53       2.53       0.19       3.47       3.47        XXX
93304...  TC                  A                   Echo transthoracic......        0.00       1.85       1.85       0.14       1.99       1.99        XXX
93304...  26                  A                   Echo transthoracic......        0.75       0.68       0.68       0.05       1.48       1.48        XXX
93307...  ..................  A                   Echo exam of heart......        0.92       4.68       4.68       0.36       5.96       5.96        XXX
93307...  TC                  A                   Echo exam of heart......        0.00       3.68       3.68       0.27       3.95       3.95        XXX
93307...  26                  A                   Echo exam of heart......        0.92       1.00       1.00       0.09       2.01       2.01        XXX
93308...  ..................  A                   Echo exam of heart......        0.53       2.43       2.43       0.19       3.15       3.15        XXX

[[Page 59216]]


93308...  TC                  A                   Echo exam of heart......        0.00       1.85       1.85       0.14       1.99       1.99        XXX
93308...  26                  A                   Echo exam of heart......        0.53      #0.58      #0.58       0.05       1.16       1.16        XXX
93312...  ..................  A                   Echo transesophageal....        2.20       4.95       4.95       0.45       7.60       7.60        XXX
93312...  TC                  A                   Echo transesophageal....        0.00       3.60       3.60       0.33       3.93       3.93        XXX
93312...  26                  A                   Echo transesophageal....        2.20       1.35       1.35       0.12       3.67       3.67        XXX
93313...  ..................  A                   Echo transesophageal....        0.95       0.67       0.67       0.06       1.68       1.68        XXX
93314...  ..................  A                   Echo transesophageal....        1.25       4.27       4.27       0.39       5.91       5.91        XXX
93314...  TC                  A                   Echo transesophageal....        0.00       3.60       3.60       0.33       3.93       3.93        XXX
93314...  26                  A                   Echo transesophageal....        1.25       0.67       0.67       0.06       1.98       1.98        XXX
93315...  ..................  A                   Echo transesophageal....        2.78       4.95       4.95       0.45       8.18       8.18        XXX
93315...  TC                  A                   Echo transesophageal....        0.00       3.60       3.60       0.33       3.93       3.93        XXX
93315...  26                  A                   Echo transesophageal....        2.78       1.35       1.35       0.12       4.25       4.25        XXX
93316...  ..................  A                   Echo transesophageal....        0.95       0.67       0.67       0.06       1.68       1.68        XXX
93317...  ..................  A                   Echo transesophageal....        1.83       4.27       4.27       0.39       6.49       6.49        XXX
93317...  TC                  A                   Echo transesophageal....        0.00       3.60       3.60       0.33       3.93       3.93        XXX
93317...  26                  A                   Echo transesophageal....        1.83       0.67       0.67       0.06       2.56       2.56        XXX
93320...  ..................  A                   Doppler echo exam, heart        0.38       2.05       2.05       0.18       2.61       2.61        ZZZ
93320...  TC                  A                   Doppler echo exam, heart        0.00       1.63       1.63       0.13       1.76       1.76        ZZZ
93320...  26                  A                   Doppler echo exam, heart        0.38      #0.42      #0.42       0.05       0.85       0.85        ZZZ
93321...  ..................  A                   Doppler echo exam, heart        0.15       1.23       1.23       0.11       1.49       1.49        ZZZ
93321...  TC                  A                   Doppler echo exam, heart        0.00       1.06       1.06       0.09       1.15       1.15        ZZZ
93321...  26                  A                   Doppler echo exam, heart        0.15      #0.17      #0.17       0.02       0.34       0.34        ZZZ
93325...  ..................  A                   Doppler color flow......        0.07       2.80       2.80       0.25       3.12       3.12        ZZZ
93325...  TC                  A                   Doppler color flow......        0.00       2.76       2.76       0.24       3.00       3.00        ZZZ
93325...  26                  A                   Doppler color flow......        0.07       0.04       0.04       0.01       0.12       0.12        ZZZ
93350...  ..................  A                   Echo transthoracic......        0.78       2.54       2.54       0.24       3.56       3.56        XXX
93350...  TC                  A                   Echo transthoracic......        0.00       1.68       1.68       0.14       1.82       1.82        XXX
93350...  26                  A                   Echo transthoracic......        0.78      #0.86      #0.86       0.10       1.74       1.74        XXX
93501...  ..................  A                   Right heart                     3.02      19.43      19.43       1.54      23.99      23.99        000
                                                   catheterization.
93501...  TC                  A                   Right heart                     0.00      16.11      16.11       1.20      17.31      17.31        000
                                                   catheterization.
93501...  26                  A                   Right heart                     3.02      #3.32      #3.32       0.34       6.68       6.68        000
                                                   catheterization.
93503...  ..................  A                   Insert/place heart              2.91       2.37       2.37       0.36       5.64       5.64        000
                                                   catheter.
93505...  ..................  A                   Biopsy of heart lining..        4.38       4.92       4.92       0.46       9.76       9.76        000
93505...  TC                  A                   Biopsy of heart lining..        0.00       1.89       1.89       0.18       2.07       2.07        000
93505...  26                  A                   Biopsy of heart lining..        4.38       3.03       3.03       0.28       7.69       7.69        000
93508...  ..................  A                   Cath placement,                 4.10      14.79      14.79       0.98      19.87      19.87        000
                                                   angiography.
93508...  TC                  A                   Cath placement,                 0.00      12.01      12.01       0.75      12.76      12.76        000
                                                   angiography.
93508...  26                  A                   Cath placement,                 4.10       2.78       2.78       0.23       7.11       7.11        000
                                                   angiography.
93510...  ..................  A                   Left heart                      4.33      38.28      38.28       2.86      45.47      45.47        000
                                                   catheterization.
93510...  TC                  A                   Left heart                      0.00      35.22      35.22       2.63      37.85      37.85        000
                                                   catheterization.
93510...  26                  A                   Left heart                      4.33       3.06       3.06       0.23       7.62       7.62        000
                                                   catheterization.
93511...  ..................  A                   Left heart                      5.03      36.91      36.91       2.76      44.70      44.70        000
                                                   catheterization.
93511...  TC                  A                   Left heart                      0.00      34.29      34.29       2.56      36.85      36.85        000
                                                   catheterization.
93511...  26                  A                   Left heart                      5.03       2.62       2.62       0.20       7.85       7.85        000
                                                   catheterization.
93514...  ..................  A                   Left heart                      7.05      38.84      38.84       2.94      48.83      48.83        000
                                                   catheterization.
93514...  TC                  A                   Left heart                      0.00      34.29      34.29       2.56      36.85      36.85        000
                                                   catheterization.
93514...  26                  A                   Left heart                      7.05       4.55       4.55       0.38      11.98      11.98        000
                                                   catheterization.
93524...  ..................  A                   Left heart                      6.95      49.45      49.45       3.69      60.09      60.09        000
                                                   catheterization.
93524...  TC                  A                   Left heart                      0.00      44.80      44.80       3.35      48.15      48.15        000
                                                   catheterization.
93524...  26                  A                   Left heart                      6.95       4.65       4.65       0.34      11.94      11.94        000
                                                   catheterization.
93526...  ..................  A                   Rt & Lt heart catheters.        5.99      51.48      51.48       3.83      61.30      61.30        000
93526...  TC                  A                   Rt & Lt heart catheters.        0.00      46.03      46.03       3.44      49.47      49.47        000
93526...  26                  A                   Rt & Lt heart catheters.        5.99       5.45       5.45       0.39      11.83      11.83        000
93527...  ..................  A                   Rt & Lt heart catheters.        7.28      51.94      51.94       3.85      63.07      63.07        000
93527...  TC                  A                   Rt & Lt heart catheters.        0.00      44.80      44.80       3.35      48.15      48.15        000
93527...  26                  A                   Rt & Lt heart catheters.        7.28       7.14       7.14       0.50      14.92      14.92        000
93528...  ..................  A                   Rt & Lt heart catheters.        9.00      49.23      49.23       3.68      61.91      61.91        000
93528...  TC                  A                   Rt & Lt heart catheters.        0.00      44.80      44.80       3.35      48.15      48.15        000
93528...  26                  A                   Rt & Lt heart catheters.        9.00       4.43       4.43       0.33      13.76      13.76        000
93529...  ..................  A                   Rt, Lt heart                    4.80      47.73      47.73       3.57      56.10      56.10        000
                                                   catheterization.
93529...  TC                  A                   Rt, Lt heart                    0.00      44.80      44.80       3.35      48.15      48.15        000
                                                   catheterization.
93529...  26                  A                   Rt, Lt heart                    4.80       2.93       2.93       0.22       7.95       7.95        000
                                                   catheterization.
93530...  ..................  A                   Rt heart cath,                  4.23      19.72      19.72       1.54      25.49      25.49        000
                                                   congenital.
93530...  TC                  A                   Rt heart cath,                  0.00      16.11      16.11       1.20      17.31      17.31        000
                                                   congenital.
93530...  26                  A                   Rt heart cath,                  4.23       3.61       3.61       0.34       8.18       8.18        000
                                                   congenital.
93531...  ..................  A                   R & l heart cath,               8.35      51.48      51.48       3.83      63.66      63.66        000
                                                   congenital.
93531...  TC                  A                   R & l heart cath,               0.00      46.03      46.03       3.44      49.47      49.47        000
                                                   congenital.
93531...  26                  A                   R & l heart cath,               8.35       5.45       5.45       0.39      14.19      14.19        000
                                                   congenital.
93532...  ..................  A                   R & l heart cath,              10.00      51.94      51.94       3.85      65.79      65.79        000
                                                   congenital.
93532...  TC                  A                   R & l heart cath,               0.00      44.80      44.80       3.35      48.15      48.15        000
                                                   congenital.
93532...  26                  A                   R & l heart cath,              10.00       7.14       7.14       0.50      17.64      17.64        000
                                                   congenital.
93533...  ..................  A                   R & l heart cath,               6.70      47.73      47.73       3.57      58.00      58.00        000
                                                   congenital.
93533...  TC                  A                   R & l heart cath,               0.00      44.80      44.80       3.35      48.15      48.15        000
                                                   congenital.
93533...  26                  A                   R & l heart cath,               6.70       2.93       2.93       0.22       9.85       9.85        000
                                                   congenital.

[[Page 59217]]


93536...  ..................  A                   Insert circulation assi.        4.85      #5.34      #5.34       0.71      10.90      10.90        000
93539...  ..................  A                   Injection, cardiac cath.        0.40       0.88      #0.44       0.20       1.48       1.04        000
93540...  ..................  A                   Injection, cardiac cath.        0.43       0.88      #0.47       0.20       1.51       1.10        000
93541...  ..................  A                   Injection for lung              0.29      #0.32      #0.32       0.16       0.77       0.77        000
                                                   angiogram.
93542...  ..................  A                   Injection for heart x-          0.29      #0.32      #0.32       0.16       0.77       0.77        000
                                                   rays.
93543...  ..................  A                   Injection for heart x-          0.29       0.57      #0.32       0.11       0.97       0.72        000
                                                   rays.
93544...  ..................  A                   Injection for                   0.25       0.57      #0.28       0.11       0.93       0.64        000
                                                   aortography.
93545...  ..................  A                   Injection for coronary x-       0.40      #0.44      #0.44       0.24       1.08       1.08        000
                                                   rays.
93555...  ..................  A                   Imaging, cardiac cath...        0.81       6.25       6.25       0.42       7.48       7.48        XXX
93555...  TC                  A                   Imaging, cardiac cath...        0.00       5.98       5.98       0.38       6.36       6.36        XXX
93555...  26                  A                   Imaging, cardiac cath...        0.81       0.27       0.27       0.04       1.12       1.12        XXX
93556...  ..................  A                   Imaging, cardiac cath...        0.83       9.88       9.88       0.65      11.36      11.36        XXX
93556...  TC                  A                   Imaging, cardiac cath...        0.00       9.43       9.43       0.58      10.01      10.01        XXX
93556...  26                  A                   Imaging, cardiac cath...        0.83       0.45       0.45       0.07       1.35       1.35        XXX
93561...  ..................  A                   Cardiac output                  0.50       1.05       1.05       0.16       1.71       1.71        000
                                                   measurement.
93561...  TC                  A                   Cardiac output                  0.00       0.50       0.50       0.07       0.57       0.57        000
                                                   measurement.
93561...  26                  A                   Cardiac output                  0.50      #0.55      #0.55       0.09       1.14       1.14        000
                                                   measurement.
93562...  ..................  A                   Cardiac output                  0.16       0.48       0.48       0.10       0.74       0.74        000
                                                   measurement.
93562...  TC                  A                   Cardiac output                  0.00       0.30       0.30       0.04       0.34       0.34        000
                                                   measurement.
93562...  26                  A                   Cardiac output                  0.16      #0.18      #0.18       0.06       0.40       0.40        000
                                                   measurement.
93600...  ..................  A                   Bundle of His recording.        2.12       4.19       4.19       0.38       6.69       6.69        000
93600...  TC                  A                   Bundle of His recording.        0.00       1.86       1.86       0.14       2.00       2.00        000
93600...  26                  A                   Bundle of His recording.        2.12      #2.33      #2.33       0.24       4.69       4.69        000
93602...  ..................  A                   Intra-atrial recording..        2.12       2.83       2.83       0.22       5.17       5.17        000
93602...  TC                  A                   Intra-atrial recording..        0.00       1.06       1.06       0.08       1.14       1.14        000
93602...  26                  A                   Intra-atrial recording..        2.12       1.77       1.77       0.14       4.03       4.03        000
93603...  ..................  A                   Right ventricular               2.12       3.79       3.79       0.28       6.19       6.19        000
                                                   recording.
93603...  TC                  A                   Right ventricular               0.00       1.60       1.60       0.12       1.72       1.72        000
                                                   recording.
93603...  26                  A                   Right ventricular               2.12       2.19       2.19       0.16       4.47       4.47        000
                                                   recording.
93607...  ..................  A                   Right ventricular               3.26       3.63       3.63       0.28       7.17       7.17        000
                                                   recording.
93607...  TC                  A                   Right ventricular               0.00       1.42       1.42       0.11       1.53       1.53        000
                                                   recording.
93607...  26                  A                   Right ventricular               3.26       2.21       2.21       0.17       5.64       5.64        000
                                                   recording.
93609...  ..................  A                   Mapping of tachycardia..       10.07       6.43       6.43       0.47      16.97      16.97        000
93609...  TC                  A                   Mapping of tachycardia..        0.00       2.59       2.59       0.19       2.78       2.78        000
93609...  26                  A                   Mapping of tachycardia..       10.07       3.84       3.84       0.28      14.19      14.19        000
93610...  ..................  A                   Intra-atrial pacing.....        3.02       3.60       3.60       0.27       6.89       6.89        000
93610...  TC                  A                   Intra-atrial pacing.....        0.00       1.29       1.29       0.10       1.39       1.39        000
93610...  26                  A                   Intra-atrial pacing.....        3.02       2.31       2.31       0.17       5.50       5.50        000
93612...  ..................  A                   Intraventricular pacing.        3.02       3.88       3.88       0.29       7.19       7.19        000
93612...  TC                  A                   Intraventricular pacing.        0.00       1.54       1.54       0.12       1.66       1.66        000
93612...  26                  A                   Intraventricular pacing.        3.02       2.34       2.34       0.17       5.53       5.53        000
93615...  ..................  A                   Esophageal recording....        0.99       0.65       0.65       0.04       1.68       1.68        000
93615...  TC                  A                   Esophageal recording....        0.00       0.30       0.30       0.02       0.32       0.32        000
93615...  26                  A                   Esophageal recording....        0.99       0.35       0.35       0.02       1.36       1.36        000
93616...  ..................  A                   Esophageal recording....        1.49       1.66       1.66       0.10       3.25       3.25        000
93616...  TC                  A                   Esophageal recording....        0.00       0.30       0.30       0.02       0.32       0.32        000
93616...  26                  A                   Esophageal recording....        1.49       1.36       1.36       0.08       2.93       2.93        000
93618...  ..................  A                   Heart rhythm pacing.....        4.26       8.47       8.47       0.72      13.45      13.45        000
93618...  TC                  A                   Heart rhythm pacing.....        0.00       3.78       3.78       0.28       4.06       4.06        000
93618...  26                  A                   Heart rhythm pacing.....        4.26      #4.69      #4.69       0.44       9.39       9.39        000
93619...  ..................  A                   Electrophysiology               7.32      15.39      15.39       1.40      24.11      24.11        000
                                                   evaluation.
93619...  TC                  A                   Electrophysiology               0.00       7.34       7.34       0.54       7.88       7.88        000
                                                   evaluation.
93619...  26                  A                   Electrophysiology               7.32      #8.05      #8.05       0.86      16.23      16.23        000
                                                   evaluation.
93620...  ..................  A                   Electrophysiology              11.59      21.29      21.29       1.55      34.43      34.43        000
                                                   evaluation.
93620...  TC                  A                   Electrophysiology               0.00       8.54       8.54       0.60       9.14       9.14        000
                                                   evaluation.
93620...  26                  A                   Electrophysiology              11.59     #12.75     #12.75       0.95      25.29      25.29        000
                                                   evaluation.
93621...  ..................  C                   Electrophysiology               0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   evaluation.
93621...  TC                  C                   Electrophysiology               0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   evaluation.
93621...  26                  A                   Electrophysiology              12.66     #13.93     #13.93       1.11      27.70      27.70        000
                                                   evaluation.
93622...  ..................  C                   Electrophysiology               0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   evaluation.
93622...  TC                  C                   Electrophysiology               0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   evaluation.
93622...  26                  A                   Electrophysiology              12.74     #14.01     #14.01       1.07      27.82      27.82        000
                                                   evaluation.
93623...  ..................  C                   Stimulation, pacing             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   heart.
93623...  TC                  C                   Stimulation, pacing             0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   heart.
93623...  26                  A                   Stimulation, pacing             2.85       2.78       2.78       0.20       5.83       5.83        000
                                                   heart.
93624...  ..................  A                   Electrophysiologic study        4.81       4.88       4.88       0.35      10.04      10.04        000
93624...  TC                  A                   Electrophysiologic study        0.00       1.89       1.89       0.14       2.03       2.03        000
93624...  26                  A                   Electrophysiologic study        4.81       2.99       2.99       0.21       8.01       8.01        000
93631...  ..................  A                   Heart pacing, mapping...        7.60      11.62      11.62       1.37      20.59      20.59        000
93631...  TC                  A                   Heart pacing, mapping...        0.00       5.86       5.86       0.70       6.56       6.56        000
93631...  26                  A                   Heart pacing, mapping...        7.60       5.76       5.76       0.67      14.03      14.03        000
93640...  ..................  A                   Evaluation heart device.        3.52      10.71      10.71       1.09      15.32      15.32        000
93640...  TC                  A                   Evaluation heart device.        0.00       6.84       6.84       0.48       7.32       7.32        000
93640...  26                  A                   Evaluation heart device.        3.52      #3.87      #3.87       0.61       8.00       8.00        000

[[Page 59218]]


93641...  ..................  A                   Electrophysiology               5.93      13.36      13.36       1.09      20.38      20.38        000
                                                   evaluation.
93641...  TC                  A                   Electrophysiology               0.00       6.84       6.84       0.48       7.32       7.32        000
                                                   evaluation.
93641...  26                  A                   Electrophysiology               5.93      #6.52      #6.52       0.61      13.06      13.06        000
                                                   evaluation.
93642...  ..................  A                   Electrophysiology               4.89      12.22      12.22       1.09      18.20      18.20        000
                                                   evaluation.
93642...  TC                  A                   Electrophysiology               0.00       6.84       6.84       0.48       7.32       7.32        000
                                                   evaluation.
93642...  26                  A                   Electrophysiology               4.89      #5.38      #5.38       0.61      10.88      10.88        000
                                                   evaluation.
93650...  ..................  A                   Ablate heart dysrhythm         10.51     #11.56     #11.56       1.34      23.41      23.41        000
                                                   focus.
93651...  ..................  A                   Ablate heart dysrhythm         16.25      17.83      17.83       1.34      35.42      35.42        000
                                                   focus.
93652...  ..................  A                   Ablate heart dysrhythm         17.68      17.83      17.83       1.34      36.85      36.85        000
                                                   focus.
93660...  ..................  C                   Tilt table evaluation...        0.00       0.00       0.00       0.00       0.00       0.00        000
93660...  TC                  C                   Tilt table evaluation...        0.00       0.00       0.00       0.00       0.00       0.00        000
93660...  26                  A                   Tilt table evaluation...        1.89       1.44       1.44       0.17       3.50       3.50        000
93720...  ..................  A                   Total body                      0.17       0.89       0.86       0.10       1.16       1.13        XXX
                                                   plethysmography.
93721...  ..................  A                   Plethysmography tracing.        0.00       0.67       0.67       0.07       0.74       0.74        XXX
93722...  ..................  A                   Plethysmography report..        0.17       0.22      #0.19       0.03       0.42       0.39        XXX
93724...  ..................  A                   Analyze pacemaker system        4.89       6.66       6.66       0.50      12.05      12.05        000
93724...  TC                  A                   Analyze pacemaker system        0.00       3.78       3.78       0.28       4.06       4.06        000
93724...  26                  A                   Analyze pacemaker system        4.89       2.88       2.88       0.22       7.99       7.99        000
93731...  ..................  A                   Analyze pacemaker system        0.45       0.79       0.79       0.07       1.31       1.31        XXX
93731...  TC                  A                   Analyze pacemaker system        0.00       0.47       0.47       0.04       0.51       0.51        XXX
93731...  26                  A                   Analyze pacemaker system        0.45       0.32       0.32       0.03       0.80       0.80        XXX
93732...  ..................  A                   Analyze pacemaker system        0.92       0.91       0.91       0.08       1.91       1.91        XXX
93732...  TC                  A                   Analyze pacemaker system        0.00       0.49       0.49       0.04       0.53       0.53        XXX
93732...  26                  A                   Analyze pacemaker system        0.92       0.42       0.42       0.04       1.38       1.38        XXX
93733...  ..................  A                   Telephone analysis,             0.17       0.88       0.88       0.08       1.13       1.13        XXX
                                                   pacemaker.
93733...  TC                  A                   Telephone analysis,             0.00       0.69       0.69       0.06       0.75       0.75        XXX
                                                   pacemaker.
93733...  26                  A                   Telephone analysis,             0.17      #0.19      #0.19       0.02       0.38       0.38        XXX
                                                   pacemaker.
93734...  ..................  A                   Analyze pacemaker system        0.38       0.64       0.64       0.06       1.08       1.08        XXX
93734...  TC                  A                   Analyze pacemaker system        0.00       0.33       0.33       0.03       0.36       0.36        XXX
93734...  26                  A                   Analyze pacemaker system        0.38       0.31       0.31       0.03       0.72       0.72        XXX
93735...  ..................  A                   Analyze pacemaker system        0.74       0.85       0.85       0.08       1.67       1.67        XXX
93735...  TC                  A                   Analyze pacemaker system        0.00       0.42       0.42       0.04       0.46       0.46        XXX
93735...  26                  A                   Analyze pacemaker system        0.74       0.43       0.43       0.04       1.21       1.21        XXX
93736...  ..................  A                   Telephone analysis,             0.15       0.77       0.77       0.09       1.01       1.01        XXX
                                                   pacemaker.
93736...  TC                  A                   Telephone analysis,             0.00       0.60       0.60       0.06       0.66       0.66        XXX
                                                   pacemaker.
93736...  26                  A                   Telephone analysis,             0.15      #0.17      #0.17       0.03       0.35       0.35        XXX
                                                   pacemaker.
93737...  ..................  A                   Analyze cardio/                 0.45       0.74       0.74       0.06       1.25       1.25        XXX
                                                   defibrillator.
93737...  TC                  A                   Analyze cardio/                 0.00       0.47       0.47       0.04       0.51       0.51        XXX
                                                   defibrillator.
93737...  26                  A                   Analyze cardio/                 0.45       0.27       0.27       0.02       0.74       0.74        XXX
                                                   defibrillator.
93738...  ..................  A                   Analyze cardio/                 0.92       0.88       0.88       0.07       1.87       1.87        XXX
                                                   defibrillator.
93738...  TC................  A                   Analyze cardio/                 0.00       0.49       0.49       0.04       0.53       0.53        XXX
                                                   defibrillator.
93738...  26                  A                   Analyze cardio/                 0.92       0.39       0.39       0.03       1.34       1.34        XXX
                                                   defibrillator.
93740...  ..................  A                   Temperature gradient            0.16       0.45       0.45       0.04       0.65       0.65        XXX
                                                   studies.
93740...  TC                  A                   Temperature gradient            0.00       0.15       0.15       0.01       0.16       0.16        XXX
                                                   studies.
93740...  26                  A                   Temperature gradient            0.16       0.30       0.30       0.03       0.49       0.49        XXX
                                                   studies.
93760...  ..................  N                   Cephalic thermogram.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93762...  ..................  N                   Peripheral thermogram...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93770...  ..................  A                   Measure venous pressure.        0.16       0.20       0.20       0.02       0.38       0.38        XXX
93770...  TC                  A                   Measure venous pressure.        0.00       0.03       0.03       0.00       0.03       0.03        XXX
93770...  26                  A                   Measure venous pressure.        0.16       0.17       0.17       0.02       0.35       0.35        XXX
93784...  ..................  N                   Ambulatory BP monitoring        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93786...  ..................  N                   Ambulatory BP recording.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93788...  ..................  N                   Ambulatory BP analysis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93790...  ..................  N                   Review/report BP                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   recording.
93797...  ..................  A                   Cardiac rehab...........        0.18      #0.20      #0.20       0.02       0.40       0.40        000
93798...  ..................  A                   Cardiac rehab/monitor...        0.28       0.47       0.47       0.04       0.79       0.79        000
93799...  ..................  C                   Cardiovascular procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93799...  TC                  C                   Cardiovascular procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93799...  26                  C                   Cardiovascular procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
93875...  ..................  A                   Extracranial study......        0.22       1.29       1.29       0.18       1.69       1.69        XXX
93875...  TC                  A                   Extracranial study......        0.00       1.05       1.05       0.12       1.17       1.17        XXX
93875...  26                  A                   Extracranial study......        0.22      #0.24      #0.24       0.06       0.52       0.52        XXX
93880...  ..................  A                   Extracranial study......        0.60       3.94       3.94       0.44       4.98       4.98        XXX
93880...  TC                  A                   Extracranial study......        0.00       3.55       3.55       0.40       3.95       3.95        XXX
93880...  26                  A                   Extracranial study......        0.60       0.39       0.39       0.04       1.03       1.03        XXX
93882...  ..................  A                   Extracranial study......        0.40       2.62       2.62       0.29       3.31       3.31        XXX
93882...  TC                  A                   Extracranial study......        0.00       2.36       2.36       0.26       2.62       2.62        XXX
93882...  26                  A                   Extracranial study......        0.40       0.26       0.26       0.03       0.69       0.69        XXX
93886...  ..................  A                   Intracranial study......        0.94       4.44       4.44       0.50       5.88       5.88        XXX
93886...  TC                  A                   Intracranial study......        0.00       4.02       4.02       0.45       4.47       4.47        XXX
93886...  26                  A                   Intracranial study......        0.94       0.42       0.42       0.05       1.41       1.41        XXX
93888...  ..................  A                   Intracranial study......        0.62       2.96       2.96       0.34       3.92       3.92        XXX
93888...  TC                  A                   Intracranial study......        0.00       2.68       2.68       0.31       2.99       2.99        XXX
93888...  26                  A                   Intracranial study......        0.62       0.28       0.28       0.03       0.93       0.93        XXX

[[Page 59219]]


93922...  ..................  A                   Extremity study.........        0.25       1.38       1.38       0.19       1.82       1.82        XXX
93922...  TC                  A                   Extremity study.........        0.00       1.10       1.10       0.14       1.24       1.24        XXX
93922...  26                  A                   Extremity study.........        0.25       0.28       0.28       0.05       0.58       0.58        XXX
93923...  ..................  A                   Extremity study.........        0.45       2.58       2.58       0.35       3.38       3.38        XXX
93923...  TC                  A                   Extremity study.........        0.00       2.08       2.08       0.26       2.34       2.34        XXX
93923...  26                  A                   Extremity study.........        0.45      #0.50      #0.50       0.09       1.04       1.04        XXX
93924...  ..................  A                   Extremity study.........        0.50       2.81       2.81       0.39       3.70       3.70        XXX
93924...  TC                  A                   Extremity study.........        0.00       2.26       2.26       0.29       2.55       2.55        XXX
93924...  26                  A                   Extremity study.........        0.50      #0.55      #0.55       0.10       1.15       1.15        XXX
93925...  ..................  A                   Lower extremity study...        0.58       3.96       3.96       0.44       4.98       4.98        XXX
93925...  TC                  A                   Lower extremity study...        0.00       3.57       3.57       0.40       3.97       3.97        XXX
93925...  26                  A                   Lower extremity study...        0.58       0.39       0.39       0.04       1.01       1.01        XXX
93926...  ..................  A                   Lower extremity study...        0.39       2.64       2.64       0.30       3.33       3.33        XXX
93926...  TC                  A                   Lower extremity study...        0.00       2.38       2.38       0.27       2.65       2.65        XXX
93926...  26                  A                   Lower extremity study...        0.39       0.26       0.26       0.03       0.68       0.68        XXX
93930...  ..................  A                   Upper extremity study...        0.46       4.18       4.18       0.47       5.11       5.11        XXX
93930...  TC                  A                   Upper extremity study...        0.00       3.79       3.79       0.42       4.21       4.21        XXX
93930...  26                  A                   Upper extremity study...        0.46       0.39       0.39       0.05       0.90       0.90        XXX
93931...  ..................  A                   Upper extremity study...        0.31       2.78       2.78       0.31       3.40       3.40        XXX
93931...  TC                  A                   Upper extremity study...        0.00       2.52       2.52       0.28       2.80       2.80        XXX
93931...  26                  A                   Upper extremity study...        0.31       0.26       0.26       0.03       0.60       0.60        XXX
93965...  ..................  A                   Extremity study.........        0.35       1.43       1.43       0.19       1.97       1.97        XXX
93965...  TC                  A                   Extremity study.........        0.00       1.04       1.04       0.13       1.17       1.17        XXX
93965...  26                  A                   Extremity study.........        0.35      #0.39      #0.39       0.06       0.80       0.80        XXX
93970...  ..................  A                   Extremity study.........        0.68       4.33       4.33       0.51       5.52       5.52        XXX
93970...  TC                  A                   Extremity study.........        0.00       3.93       3.93       0.46       4.39       4.39        XXX
93970...  26                  A                   Extremity study.........        0.68       0.40       0.40       0.05       1.13       1.13        XXX
93971...  ..................  A                   Extremity study.........        0.45       2.89       2.89       0.34       3.68       3.68        XXX
93971...  TC                  A                   Extremity study.........        0.00       2.62       2.62       0.31       2.93       2.93        XXX
93971...  26                  A                   Extremity study.........        0.45       0.27       0.27       0.03       0.75       0.75        XXX
93975...  ..................  A                   Vascular study..........        1.80       4.90       4.90       0.55       7.25       7.25        XXX
93975...  TC                  A                   Vascular study..........        0.00       4.48       4.48       0.50       4.98       4.98        XXX
93975...  26                  A                   Vascular study..........        1.80       0.42       0.42       0.05       2.27       2.27        XXX
93976...  ..................  A                   Vascular study..........        1.21       3.27       3.27       0.37       4.85       4.85        XXX
93976...  TC                  A                   Vascular study..........        0.00       2.99       2.99       0.34       3.33       3.33        XXX
93976...  26                  A                   Vascular study..........        1.21       0.28       0.28       0.03       1.52       1.52        XXX
93978...  ..................  A                   Vascular study..........        0.65       4.06       4.06       0.47       5.18       5.18        XXX
93978...  TC                  A                   Vascular study..........        0.00       3.67       3.67       0.42       4.09       4.09        XXX
93978...  26                  A                   Vascular study..........        0.65       0.39       0.39       0.05       1.09       1.09        XXX
93979...  ..................  A                   Vascular study..........        0.44       2.70       2.70       0.31       3.45       3.45        XXX
93979...  TC                  A                   Vascular study..........        0.00       2.44       2.44       0.28       2.72       2.72        XXX
93979...  26                  A                   Vascular study..........        0.44       0.26       0.26       0.03       0.73       0.73        XXX
93980...  ..................  A                   Penile vascular study...        1.25       4.15       4.15       0.45       5.85       5.85        XXX
93980...  TC                  A                   Penile vascular study...        0.00       3.33       3.33       0.38       3.71       3.71        XXX
93980...  26                  A                   Penile vascular study...        1.25       0.82       0.82       0.07       2.14       2.14        XXX
93981...  ..................  A                   Penile vascular study...        0.44       3.47       3.47       0.39       4.30       4.30        XXX
93981...  TC                  A                   Penile vascular study...        0.00       3.07       3.07       0.36       3.43       3.43        XXX
93981...  26                  A                   Penile vascular study...        0.44       0.40       0.40       0.03       0.87       0.87        XXX
93990...  ..................  A                   Doppler flow testing....        0.25       2.57       2.57       0.29       3.11       3.11        XXX
93990...  TC                  A                   Doppler flow testing....        0.00       2.38       2.38       0.27       2.65       2.65        XXX
93990...  26                  A                   Doppler flow testing....        0.25       0.19       0.19       0.02       0.46       0.46        XXX
94010...  ..................  A                   Breathing capacity test.        0.17       0.68       0.68       0.05       0.90       0.90        XXX
94010...  TC                  A                   Breathing capacity test.        0.00       0.40       0.40       0.03       0.43       0.43        XXX
94010...  26                  A                   Breathing capacity test.        0.17       0.28       0.28       0.02       0.47       0.47        XXX
94060...  ..................  A                   Evaluation of wheezing..        0.31       1.23       1.23       0.09       1.63       1.63        XXX
94060...  TC                  A                   Evaluation of wheezing..        0.00       0.89       0.89       0.06       0.95       0.95        XXX
94060...  26                  A                   Evaluation of wheezing..        0.31      #0.34      #0.34       0.03       0.68       0.68        XXX
94070...  ..................  A                   Evaluation of wheezing..        0.60       1.77       1.77       0.13       2.50       2.50        XXX
94070...  TC                  A                   Evaluation of wheezing..        0.00       1.39       1.39       0.10       1.49       1.49        XXX
94070...  26                  A                   Evaluation of wheezing..        0.60       0.38       0.38       0.03       1.01       1.01        XXX
94150...  ..................  B                   Vital capacity test.....       +0.07       0.16       0.16       0.02       0.25       0.25        XXX
94150...  TC                  B                   Vital capacity test.....       +0.00       0.08       0.08       0.01       0.09       0.09        XXX
94150...  26                  B                   Vital capacity test.....       +0.07      #0.08      #0.08       0.01       0.16       0.16        XXX
94200...  ..................  A                   Lung function test (MBC/        0.11       0.36       0.36       0.03       0.50       0.50        XXX
                                                   MVV).
94200...  TC                  A                   Lung function test (MBC/        0.00       0.24       0.24       0.02       0.26       0.26        XXX
                                                   MVV).
94200...  26                  A                   Lung function test (MBC/        0.11      #0.12      #0.12       0.01       0.24       0.24        XXX
                                                   MVV).
94240...  ..................  A                   Residual lung capacity..        0.26       0.88       0.88       0.07       1.21       1.21        XXX
94240...  TC                  A                   Residual lung capacity..        0.00       0.65       0.65       0.05       0.70       0.70        XXX
94240...  26                  A                   Residual lung capacity..        0.26       0.23       0.23       0.02       0.51       0.51        XXX
94250...  ..................  A                   Expired gas collection..        0.11       0.25       0.25       0.02       0.38       0.38        XXX
94250...  TC                  A                   Expired gas collection..        0.00       0.13       0.13       0.01       0.14       0.14        XXX
94250...  26                  A                   Expired gas collection..        0.11      #0.12      #0.12       0.01       0.24       0.24        XXX
94260...  ..................  A                   Thoracic gas volume.....        0.13       0.66       0.66       0.06       0.85       0.85        XXX
94260...  TC                  A                   Thoracic gas volume.....        0.00       0.52       0.52       0.04       0.56       0.56        XXX

[[Page 59220]]


94260...  26                  A                   Thoracic gas volume.....        0.13      #0.14      #0.14       0.02       0.29       0.29        XXX
94350...  ..................  A                   Lung nitrogen washout           0.26       0.73       0.73       0.05       1.04       1.04        XXX
                                                   curve.
94350...  TC                  A                   Lung nitrogen washout           0.00       0.52       0.52       0.04       0.56       0.56        XXX
                                                   curve.
94350...  26                  A                   Lung nitrogen washout           0.26       0.21       0.21       0.01       0.48       0.48        XXX
                                                   curve.
94360...  ..................  A                   Measure airflow                 0.26       1.11       1.11       0.07       1.44       1.44        XXX
                                                   resistance.
94360...  TC                  A                   Measure airflow                 0.00       0.92       0.92       0.06       0.98       0.98        XXX
                                                   resistance.
94360...  26                  A                   Measure airflow                 0.26       0.19       0.19       0.01       0.46       0.46        XXX
                                                   resistance.
94370...  ..................  A                   Breath airway closing           0.26       0.40       0.40       0.03       0.69       0.69        XXX
                                                   volume.
94370...  TC                  A                   Breath airway closing           0.00       0.26       0.26       0.02       0.28       0.28        XXX
                                                   volume.
94370...  26                  A                   Breath airway closing           0.26       0.14       0.14       0.01       0.41       0.41        XXX
                                                   volume.
94375...  ..................  A                   Respiratory flow volume         0.31       0.67       0.67       0.04       1.02       1.02        XXX
                                                   loop.
94375...  TC                  A                   Respiratory flow volume         0.00       0.46       0.46       0.03       0.49       0.49        XXX
                                                   loop.
94375...  26                  A                   Respiratory flow volume         0.31       0.21       0.21       0.01       0.53       0.53        XXX
                                                   loop.
94400...  ..................  A                   CO2 breathing response          0.40       0.77       0.77       0.19       1.36       1.36        XXX
                                                   curve.
94400...  TC                  A                   CO2 breathing response          0.00       0.30       0.30       0.06       0.36       0.36        XXX
                                                   curve.
94400...  26                  A                   CO2 breathing response          0.40       0.47       0.47       0.13       1.00       1.00        XXX
                                                   curve.
94450...  ..................  A                   Hypoxia response curve..        0.40       0.61       0.61       0.05       1.06       1.06        XXX
94450...  TC                  A                   Hypoxia response curve..        0.00       0.37       0.37       0.03       0.40       0.40        XXX
94450...  26                  A                   Hypoxia response curve..        0.40       0.24       0.24       0.02       0.66       0.66        XXX
94620...  ..................  A                   Pulmonary stress testing        0.88       2.05       2.05       0.15       3.08       3.08        XXX
94620...  TC                  A                   Pulmonary stress testing        0.00       1.35       1.35       0.10       1.45       1.45        XXX
94620...  26                  A                   Pulmonary stress testing        0.88       0.70       0.70       0.05       1.63       1.63        XXX
94640...  ..................  A                   Airway inhalation               0.00       0.39       0.39       0.03       0.42       0.42        XXX
                                                   treatment.
94642...  ..................  C                   Aerosol inhalation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   treatment.
94650...  ..................  A                   Pressure breathing              0.00       0.37       0.37       0.03       0.40       0.40        XXX
                                                   (IPPB).
94651...  ..................  A                   Pressure breathing              0.00       0.36       0.36       0.03       0.39       0.39        XXX
                                                   (IPPB).
94652...  ..................  A                   Pressure breathing              0.00       0.41       0.41       0.08       0.49       0.49        XXX
                                                   (IPPB).
94656...  ..................  A                   Initial ventilator mgmt.        1.22       1.13       1.13       0.12       2.47       2.47        XXX
94657...  ..................  A                   Cont. ventilator........        0.83       0.62       0.62       0.05       1.50       1.50        XXX
94660...  ..................  A                   Pos airway pressure,            0.76       0.71       0.71       0.06       1.53       1.53        XXX
                                                   CPAP.
94662...  ..................  A                   Neg pressure                    0.76       0.30       0.30       0.02       1.08       1.08        XXX
                                                   ventilation, cnp.
94664...  ..................  A                   Aerosol or vapor                0.00       0.50       0.50       0.04       0.54       0.54        XXX
                                                   inhalations.
94665...  ..................  A                   Aerosol or vapor                0.00       0.46       0.46       0.05       0.51       0.51        XXX
                                                   inhalations.
94667...  ..................  A                   Chest wall manipulation.        0.00       0.55       0.55       0.05       0.60       0.60        XXX
94668...  ..................  A                   Chest wall manipulation.        0.00       0.34       0.34       0.03       0.37       0.37        XXX
94680...  ..................  A                   Exhaled air analysis: O2        0.26       0.78       0.78       0.10       1.14       1.14        XXX
94680...  TC                  A                   Exhaled air analysis: O2        0.00       0.49       0.49       0.07       0.56       0.56        XXX
94680...  26                  A                   Exhaled air analysis: O2        0.26      #0.29      #0.29       0.03       0.58       0.58        XXX
94681...  ..................  A                   Exhaled air analysis:           0.20       1.54       1.54       0.17       1.91       1.91        XXX
                                                   O2, CO2.
94681...  TC                  A                   Exhaled air analysis:           0.00       1.32       1.32       0.13       1.45       1.45        XXX
                                                   O2, CO2.
94681...  26                  A                   Exhaled air analysis:           0.20      #0.22      #0.22       0.04       0.46       0.46        XXX
                                                   O2, CO2.
94690...  ..................  A                   Exhaled air analysis....        0.07       0.56       0.56       0.04       0.67       0.67        XXX
94690...  TC                  A                   Exhaled air analysis....        0.00       0.51       0.51       0.04       0.55       0.55        XXX
94690...  26                  A                   Exhaled air analysis....        0.07       0.05       0.05       0.00       0.12       0.12        XXX
94720...  ..................  A                   Monoxide diffusing              0.26       1.03       1.03       0.08       1.37       1.37        XXX
                                                   capacity.
94720...  TC                  A                   Monoxide diffusing              0.00       0.80       0.80       0.06       0.86       0.86        XXX
                                                   capacity.
94720...  26                  A                   Monoxide diffusing              0.26       0.23       0.23       0.02       0.51       0.51        XXX
                                                   capacity.
94725...  ..................  A                   Membrane diffusion              0.26       1.84       1.84       0.14       2.24       2.24        XXX
                                                   capacity.
94725...  TC                  A                   Membrane diffusion              0.00       1.66       1.66       0.13       1.79       1.79        XXX
                                                   capacity.
94725...  26                  A                   Membrane diffusion              0.26       0.18       0.18       0.01       0.45       0.45        XXX
                                                   capacity.
94750...  ..................  A                   Pulmonary compliance            0.23       0.80       0.80       0.06       1.09       1.09        XXX
                                                   study.
94750...  TC                  A                   Pulmonary compliance            0.00       0.55       0.55       0.04       0.59       0.59        XXX
                                                   study.
94750...  26                  A                   Pulmonary compliance            0.23      #0.25      #0.25       0.02       0.50       0.50        XXX
                                                   study.
94760...  ..................  A                   Measure blood oxygen            0.00       0.25       0.25       0.02       0.27       0.27        XXX
                                                   level.
94761...  ..................  A                   Measure blood oxygen            0.00       0.64       0.64       0.06       0.70       0.70        XXX
                                                   level.
94762...  ..................  A                   Measure blood oxygen            0.00       1.08       1.08       0.10       1.18       1.18        XXX
                                                   level.
94770...  ..................  A                   Exhaled carbon dioxide          0.15       0.40       0.40       0.11       0.66       0.66        XXX
                                                   test.
94770...  TC                  A                   Exhaled carbon dioxide          0.00       0.29       0.29       0.08       0.37       0.37        XXX
                                                   test.
94770...  26                  A                   Exhaled carbon dioxide          0.15       0.11       0.11       0.03       0.29       0.29        XXX
                                                   test.
94772...  ..................  C                   Breath recording, infant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
94772...  TC                  C                   Breath recording, infant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
94772...  26                  C                   Breath recording, infant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
94799...  ..................  C                   Pulmonary service/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
94799...  TC                  C                   Pulmonary service/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
94799...  26                  C                   Pulmonary service/              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
95004...  ..................  A                   Allergy skin tests......        0.00       0.09       0.09       0.01       0.10       0.10        XXX
95010...  ..................  A                   Sensitivity skin tests..        0.15       0.11       0.11       0.01       0.27       0.27        XXX
95015...  ..................  A                   Sensitivity skin tests..        0.15       0.11       0.11       0.01       0.27       0.27        XXX
95024...  ..................  A                   Allergy skin tests......        0.00       0.14       0.14       0.01       0.15       0.15        XXX
95027...  ..................  A                   Skin end point titration        0.00       0.14       0.14       0.01       0.15       0.15        XXX
95028...  ..................  A                   Allergy skin tests......        0.00       0.22       0.22       0.01       0.23       0.23        XXX
95044...  ..................  A                   Allergy patch tests.....        0.00       0.19       0.19       0.01       0.20       0.20        XXX
95052...  ..................  A                   Photo patch test........        0.00       0.24       0.24       0.01       0.25       0.25        XXX
95056...  ..................  A                   Photosensitivity tests..        0.00       0.17       0.17       0.01       0.18       0.18        XXX

[[Page 59221]]


95060...  ..................  A                   Eye allergy tests.......        0.00       0.33       0.33       0.02       0.35       0.35        XXX
95065...  ..................  A                   Nose allergy test.......        0.00       0.19       0.19       0.01       0.20       0.20        XXX
95070...  ..................  A                   Bronchial allergy tests.        0.00       2.17       2.17       0.02       2.19       2.19        XXX
95071...  ..................  A                   Bronchial allergy tests.        0.00       2.78       2.78       0.02       2.80       2.80        XXX
95075...  ..................  A                   Ingestion challenge test        0.95       1.97       1.97       0.02       2.94       2.94        XXX
95078...  ..................  A                   Provocative testing.....        0.00       0.24       0.24       0.02       0.26       0.26        XXX
95115...  ..................  A                   Immunotherapy, one              0.00       0.37       0.37       0.02       0.39       0.39        000
                                                   injection.
95117...  ..................  A                   Immunotherapy injections        0.00       0.48       0.48       0.02       0.50       0.50        000
95120...  ..................  I                   Immunotherapy, one              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
95125...  ..................  I                   Immunotherapy, many             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   antigens.
95130...  ..................  I                   Immunotherapy, insect           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   venom.
95131...  ..................  I                   Immunotherapy, insect           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   venoms.
95132...  ..................  I                   Immunotherapy, insect           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   venoms.
95133...  ..................  I                   Immunotherapy, insect           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   venoms.
95134...  ..................  I                   Immunotherapy, insect           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   venoms.
95144...  ..................  A                   Antigen therapy services        0.06       0.13       0.13       0.01       0.20       0.20        000
95145...  ..................  A                   Antigen therapy services        0.06       0.34       0.34       0.03       0.43       0.43        000
95146...  ..................  A                   Antigen therapy services        0.06       0.61       0.61       0.03       0.70       0.70        000
95147...  ..................  A                   Antigen therapy services        0.06       0.91       0.91       0.03       1.00       1.00        000
95148...  ..................  A                   Antigen therapy services        0.06       0.91       0.91       0.03       1.00       1.00        000
95149...  ..................  A                   Antigen therapy services        0.06       1.14       1.14       0.03       1.23       1.23        000
95165...  ..................  A                   Antigen therapy services        0.06       0.10       0.10       0.01       0.17       0.17        000
95170...  ..................  A                   Antigen therapy services        0.06       0.35       0.35       0.03       0.44       0.44        000
95180...  ..................  A                   Rapid desensitization...        2.01       0.14       0.14       0.01       2.16       2.16        000
95199...  ..................  C                   Allergy immunology              0.00       0.00       0.00       0.00       0.00       0.00        000
                                                   services.
95805...  ..................  A                   Multiple sleep latency          1.88       5.51       5.51       0.45       7.84       7.84        XXX
                                                   test.
95805...  TC                  A                   Multiple sleep latency          0.00       4.95       4.95       0.38       5.33       5.33        XXX
                                                   test.
95805...  26                  A                   Multiple sleep latency          1.88       0.56       0.56       0.07       2.51       2.51        XXX
                                                   test.
95806...  ..................  A                   Sleep study, unattended.        1.66       7.18       6.56       0.55       9.39       8.77        XXX
95806...  TC                  A                   Sleep study, unattended.        0.00       4.73       4.73       0.36       5.09       5.09        XXX
95806...  26                  A                   Sleep study, unattended.        1.66       2.45      #1.83       0.19       4.30       3.68        XXX
95807...  ..................  A                   Sleep study, attended...        1.66       8.13       8.13       0.67      10.46      10.46        XXX
95807...  TC                  A                   Sleep study, attended...        0.00       6.30       6.30       0.48       6.78       6.78        XXX
95807...  26                  A                   Sleep study, attended...        1.66      #1.83      #1.83       0.19       3.68       3.68        XXX
95808...  ..................  A                   Polysomnography, 1-3....        2.65       8.75       8.75       0.67      12.07      12.07        XXX
95808...  TC                  A                   Polysomnography, 1-3....        0.00       6.30       6.30       0.48       6.78       6.78        XXX
95808...  26                  A                   Polysomnography, 1-3....        2.65       2.45       2.45       0.19       5.29       5.29        XXX
95810...  ..................  A                   Polysomnography, 4 or           3.53       8.75       8.75       0.67      12.95      12.95        XXX
                                                   more.
95810...  TC                  A                   Polysomnography, 4 or           0.00       6.30       6.30       0.48       6.78       6.78        XXX
                                                   more.
95810...  26                  A                   Polysomnography, 4 or           3.53       2.45       2.45       0.19       6.17       6.17        XXX
                                                   more.
95811...  ..................  A                   Polysomnography w/cpap..        3.80       9.19       9.19       0.70      13.69      13.69        XXX
95811...  TC                  A                   Polysomnography w/cpap..        0.00       6.62       6.62       0.50       7.12       7.12        XXX
95811...  26                  A                   Polysomnography w/cpap..        3.80       2.57       2.57       0.20       6.57       6.57        XXX
95812...  ..................  A                   Electroencephalogram            1.08       1.85       1.85       0.15       3.08       3.08        XXX
                                                   (EEG).
95812...  TC                  A                   Electroencephalogram            0.00       1.35       1.35       0.11       1.46       1.46        XXX
                                                   (EEG).
95812...  26                  A                   Electroencephalogram            1.08       0.50       0.50       0.04       1.62       1.62        XXX
                                                   (EEG).
95813...  ..................  A                   Electroencephalogram            1.73       1.85       1.85       0.15       3.73       3.73        XXX
                                                   (EEG).
95813...  TC                  A                   Electroencephalogram            0.00       1.35       1.35       0.11       1.46       1.46        XXX
                                                   (EEG).
95813...  26                  A                   Electroencephalogram            1.73       0.50       0.50       0.04       2.27       2.27        XXX
                                                   (EEG).
95816...  ..................  A                   Electroencephalogram            1.08       1.54       1.54       0.13       2.75       2.75        XXX
                                                   (EEG).
95816...  TC                  A                   Electroencephalogram            0.00       1.26       1.26       0.10       1.36       1.36        XXX
                                                   (EEG).
95816...  26                  A                   Electroencephalogram            1.08       0.28       0.28       0.03       1.39       1.39        XXX
                                                   (EEG).
95819...  ..................  A                   Electroencephalogram            1.08       1.80       1.80       0.14       3.02       3.02        XXX
                                                   (EEG).
95819...  TC                  A                   Electroencephalogram            0.00       1.30       1.30       0.10       1.40       1.40        XXX
                                                   (EEG).
95819...  26                  A                   Electroencephalogram            1.08       0.50       0.50       0.04       1.62       1.62        XXX
                                                   (EEG).
95822...  ..................  A                   Sleep                           1.08       2.28       2.28       0.18       3.54       3.54        XXX
                                                   electroencephalogram.
95822...  TC                  A                   Sleep                           0.00       1.72       1.72       0.14       1.86       1.86        XXX
                                                   electroencephalogram.
95822...  26                  A                   Sleep                           1.08       0.56       0.56       0.04       1.68       1.68        XXX
                                                   electroencephalogram.
95824...  ..................  A                   Electroencephalography..        0.74       0.98       0.98       0.07       1.79       1.79        XXX
95824...  TC                  A                   Electroencephalography..        0.00       0.40       0.40       0.03       0.43       0.43        XXX
95824...  26                  A                   Electroencephalography..        0.74       0.58       0.58       0.04       1.36       1.36        XXX
95827...  ..................  A                   Night                           1.08       3.06       3.06       0.24       4.38       4.38        XXX
                                                   electroencephalogram.
95827...  TC                  A                   Night                           0.00       2.18       2.18       0.17       2.35       2.35        XXX
                                                   electroencephalogram.
95827...  26                  A                   Night                           1.08       0.88       0.88       0.07       2.03       2.03        XXX
                                                   electroencephalogram.
95829...  ..................  A                   Surgery                         6.21       0.59       0.59       0.05       6.85       6.85        XXX
                                                   electrocorticogram.
95829...  TC                  A                   Surgery                         0.00       0.14       0.14       0.02       0.16       0.16        XXX
                                                   electrocorticogram.
95829...  26                  A                   Surgery                         6.21       0.45       0.45       0.03       6.69       6.69        XXX
                                                   electrocorticogram.
95830...  ..................  A                   Insert electrodes for           1.70       0.78       0.78       0.07       2.55       2.55        XXX
                                                   EEG.
95831...  ..................  A                   Limb muscle testing,            0.28       0.29       0.29       0.03       0.60       0.60        XXX
                                                   manual.
95832...  ..................  A                   Hand muscle testing,            0.29       0.25       0.25       0.02       0.56       0.56        XXX
                                                   manual.
95833...  ..................  A                   Body muscle testing,            0.47       0.38       0.38       0.05       0.90       0.90        XXX
                                                   manual.
95834...  ..................  A                   Body muscle testing,            0.60       0.61       0.61       0.06       1.27       1.27        XXX
                                                   manual.
95851...  ..................  A                   Range of motion                 0.16       0.24       0.24       0.02       0.42       0.42        XXX
                                                   measurements.
95852...  ..................  A                   Range of motion                 0.11       0.15       0.15       0.02       0.28       0.28        XXX
                                                   measurements.

[[Page 59222]]


95857...  ..................  A                   Tensilon test...........        0.53       0.50       0.50       0.04       1.07       1.07        XXX
95858...  ..................  A                   Tensilon test & myogram.        1.56       1.02       1.02       0.09       2.67       2.67        XXX
95858...  TC                  A                   Tensilon test & myogram.        0.00       0.38       0.38       0.04       0.42       0.42        XXX
95858...  26                  A                   Tensilon test & myogram.        1.56       0.64       0.64       0.05       2.25       2.25        XXX
95860...  ..................  A                   Muscle test, one limb...        0.96       1.09       1.09       0.09       2.14       2.14        XXX
95860...  TC                  A                   Muscle test, one limb...        0.00       0.36       0.36       0.03       0.39       0.39        XXX
95860...  26                  A                   Muscle test, one limb...        0.96       0.73       0.73       0.06       1.75       1.75        XXX
95861...  ..................  A                   Muscle test, two limbs..        1.54       1.97       1.97       0.16       3.67       3.67        XXX
95861...  TC                  A                   Muscle test, two limbs..        0.00       0.70       0.70       0.06       0.76       0.76        XXX
95861...  26                  A                   Muscle test, two limbs..        1.54       1.27       1.27       0.10       2.91       2.91        XXX
95863...  ..................  A                   Muscle test, 3 limbs....        1.87       2.30       2.30       0.18       4.35       4.35        XXX
95863...  TC                  A                   Muscle test, 3 limbs....        0.00       0.89       0.89       0.07       0.96       0.96        XXX
95863...  26                  A                   Muscle test, 3 limbs....        1.87       1.41       1.41       0.11       3.39       3.39        XXX
95864...  ..................  A                   Muscle test, 4 limbs....        1.99       3.45       3.45       0.27       5.71       5.71        XXX
95864...  TC                  A                   Muscle test, 4 limbs....        0.00       1.70       1.70       0.13       1.83       1.83        XXX
95864...  26                  A                   Muscle test, 4 limbs....        1.99       1.75       1.75       0.14       3.88       3.88        XXX
95867...  ..................  A                   Muscle test, head or            0.79       1.13       1.13       0.09       2.01       2.01        XXX
                                                   neck.
95867...  TC                  A                   Muscle test, head or            0.00       0.55       0.55       0.04       0.59       0.59        XXX
                                                   neck.
95867...  26                  A                   Muscle test, head or            0.79       0.58       0.58       0.05       1.42       1.42        XXX
                                                   neck.
95868...  ..................  A                   Muscle test, head or            1.18       1.92       1.92       0.15       3.25       3.25        XXX
                                                   neck.
95868...  TC                  A                   Muscle test, head or            0.00       0.66       0.66       0.05       0.71       0.71        XXX
                                                   neck.
95868...  26                  A                   Muscle test, head or            1.18       1.26       1.26       0.10       2.54       2.54        XXX
                                                   neck.
95869...  ..................  A                   Muscle test, thor               0.37       0.53       0.53       0.05       0.95       0.95        XXX
                                                   paraspinal.
95869...  TC                  A                   Muscle test, thor               0.00       0.20       0.20       0.02       0.22       0.22        XXX
                                                   paraspinal.
95869...  26                  A                   Muscle test, thor               0.37       0.33       0.33       0.03       0.73       0.73        XXX
                                                   paraspinal.
95870...  ..................  A                   Muscle test, non-               0.37       0.53       0.53       0.05       0.95       0.95        XXX
                                                   paraspinal.
95870...  TC                  A                   Muscle test, non-               0.00       0.20       0.20       0.02       0.22       0.22        XXX
                                                   paraspinal.
95870...  26                  A                   Muscle test, non-               0.37       0.33       0.33       0.03       0.73       0.73        XXX
                                                   paraspinal.
95872...  ..................  A                   Muscle test, one fiber..        1.50       1.25       1.25       0.11       2.86       2.86        XXX
95872...  TC                  A                   Muscle test, one fiber..        0.00       0.57       0.57       0.05       0.62       0.62        XXX
95872...  26                  A                   Muscle test, one fiber..        1.50       0.68       0.68       0.06       2.24       2.24        XXX
95875...  ..................  A                   Limb exercise test......        1.34       0.60       0.60       0.10       2.04       2.04        XXX
95875...  TC                  A                   Limb exercise test......        0.00       0.38       0.38       0.06       0.44       0.44        XXX
95875...  26                  A                   Limb exercise test......        1.34       0.22       0.22       0.04       1.60       1.60        XXX
95900...  ..................  A                   Motor nerve conduction          0.42       0.62       0.62       0.05       1.09       1.09        XXX
                                                   test.
95900...  TC                  A                   Motor nerve conduction          0.00       0.27       0.27       0.02       0.29       0.29        XXX
                                                   test.
95900...  26                  A                   Motor nerve conduction          0.42       0.35       0.35       0.03       0.80       0.80        XXX
                                                   test.
95903...  ..................  A                   Motor nerve conduction          0.60       0.59       0.59       0.05       1.24       1.24        XXX
                                                   test.
95903...  TC                  A                   Motor nerve conduction          0.00       0.24       0.24       0.02       0.26       0.26        XXX
                                                   test.
95903...  26                  A                   Motor nerve conduction          0.60       0.35       0.35       0.03       0.98       0.98        XXX
                                                   test.
95904...  ..................  A                   Sense nerve conduction          0.34       0.55       0.55       0.05       0.94       0.94        XXX
                                                   test.
95904...  TC                  A                   Sense nerve conduction          0.00       0.21       0.21       0.02       0.23       0.23        XXX
                                                   test.
95904...  26                  A                   Sense nerve conduction          0.34       0.34       0.34       0.03       0.71       0.71        XXX
                                                   test.
95920...  ..................  A                   Intraoperative nerve            2.11       2.67       2.67       0.20       4.98       4.98        XXX
                                                   testing.
95920...  TC                  A                   Intraoperative nerve            0.00       1.24       1.24       0.08       1.32       1.32        XXX
                                                   testing.
95920...  26                  A                   Intraoperative nerve            2.11       1.43       1.43       0.12       3.66       3.66        XXX
                                                   testing.
95921...  ..................  A                   Autonomic nervous func          0.90       0.68       0.68       0.05       1.63       1.63        XXX
                                                   test.
95921...  TC                  A                   Autonomic nervous func          0.00       0.36       0.36       0.03       0.39       0.39        XXX
                                                   test.
95921...  26                  A                   Autonomic nervous func          0.90       0.32       0.32       0.02       1.24       1.24        XXX
                                                   test.
95922...  ..................  A                   Autonomic nervous func          0.96       0.70       0.70       0.06       1.72       1.72        XXX
                                                   test.
95922...  TC                  A                   Autonomic nervous func          0.00       0.36       0.36       0.03       0.39       0.39        XXX
                                                   test.
95922...  26                  A                   Autonomic nervous func          0.96       0.34       0.34       0.03       1.33       1.33        XXX
                                                   test.
95923...  ..................  A                   Autonomic nervous func          0.90       0.68       0.68       0.05       1.63       1.63        XXX
                                                   test.
95923...  TC                  A                   Autonomic nervous func          0.00       0.36       0.36       0.03       0.39       0.39        XXX
                                                   test.
95923...  26                  A                   Autonomic nervous func          0.90       0.32       0.32       0.02       1.24       1.24        XXX
                                                   test.
95925...  ..................  A                   Somatosensory testing...        0.54       1.51       1.51       0.12       2.17       2.17        XXX
95925...  TC                  A                   Somatosensory testing...        0.00       0.87       0.87       0.07       0.94       0.94        XXX
95925...  26                  A                   Somatosensory testing...        0.54       0.64       0.64       0.05       1.23       1.23        XXX
95926...  ..................  A                   Somatosensory testing...        0.54       1.51       1.51       0.12       2.17       2.17        XXX
95926...  TC                  A                   Somatosensory testing...        0.00       0.87       0.87       0.07       0.94       0.94        XXX
95926...  26                  A                   Somatosensory testing...        0.54       0.64       0.64       0.05       1.23       1.23        XXX
95927...  ..................  A                   Somatosensory testing...        0.54       1.51       1.51       0.12       2.17       2.17        XXX
95927...  TC                  A                   Somatosensory testing...        0.00       0.87       0.87       0.07       0.94       0.94        XXX
95927...  26                  A                   Somatosensory testing...        0.54       0.64       0.64       0.05       1.23       1.23        XXX
95930...  ..................  A                   Visual evoked potential         0.35       0.83       0.83       0.05       1.23       1.23        XXX
                                                   test.
95930...  TC                  A                   Visual evoked potential         0.00       0.25       0.25       0.01       0.26       0.26        XXX
                                                   test.
95930...  26                  A                   Visual evoked potential         0.35       0.58       0.58       0.04       0.97       0.97        XXX
                                                   test.
95933...  ..................  A                   Blink reflex test.......        0.59       1.25       1.25       0.10       1.94       1.94        XXX
95933...  TC                  A                   Blink reflex test.......        0.00       0.75       0.75       0.06       0.81       0.81        XXX
95933...  26                  A                   Blink reflex test.......        0.59       0.50       0.50       0.04       1.13       1.13        XXX
95934...  ..................  A                   h reflex test...........        0.51       0.54       0.54       0.05       1.10       1.10        XXX
95934...  TC                  A                   h reflex test...........        0.00       0.20       0.20       0.02       0.22       0.22        XXX
95934...  26                  A                   h reflex test...........        0.51       0.34       0.34       0.03       0.88       0.88        XXX
95936...  ..................  A                   h reflex test...........        0.55       0.54       0.54       0.05       1.14       1.14        XXX

[[Page 59223]]


95936...  TC                  A                   h reflex test...........        0.00       0.20       0.20       0.02       0.22       0.22        XXX
95936...  26                  A                   h reflex test...........        0.55       0.34       0.34       0.03       0.92       0.92        XXX
95937...  ..................  A                   Neuromuscular junction          0.65       0.77       0.77       0.07       1.49       1.49        XXX
                                                   test.
95937...  TC                  A                   Neuromuscular junction          0.00       0.32       0.32       0.03       0.35       0.35        XXX
                                                   test.
95937...  26                  A                   Neuromuscular junction          0.65       0.45       0.45       0.04       1.14       1.14        XXX
                                                   test.
95950...  ..................  A                   Ambulatory eeg                  1.51       7.25       7.25       0.60       9.36       9.36        XXX
                                                   monitoring.
95950...  TC                  A                   Ambulatory eeg                  0.00       6.04       6.04       0.50       6.54       6.54        XXX
                                                   monitoring.
95950...  26                  A                   Ambulatory eeg                  1.51       1.21       1.21       0.10       2.82       2.82        XXX
                                                   monitoring.
95951...  ..................  A                   EEG monitoring/                 6.00       8.83       8.83       0.64      15.47      15.47        XXX
                                                   videorecord.
95951...  TC                  A                   EEG monitoring/                 0.00       7.33       7.33       0.53       7.86       7.86        XXX
                                                   videorecord.
95951...  26                  A                   EEG monitoring/                 6.00       1.50       1.50       0.11       7.61       7.61        XXX
                                                   videorecord.
95953...  ..................  A                   EEG monitoring/computer.        3.08       7.25       7.25       0.60      10.93      10.93        XXX
95953...  TC                  A                   EEG monitoring/computer.        0.00       6.04       6.04       0.50       6.54       6.54        XXX
95953...  26                  A                   EEG monitoring/computer.        3.08       1.21       1.21       0.10       4.39       4.39        XXX
95954...  ..................  A                   EEG monitoring/giving           2.45       2.32       2.32       0.28       5.05       5.05        XXX
                                                   drugs.
95954...  TC                  A                   EEG monitoring/giving           0.00       0.45       0.45       0.06       0.51       0.51        XXX
                                                   drugs.
95954...  26                  A                   EEG monitoring/giving           2.45       1.87       1.87       0.22       4.54       4.54        XXX
                                                   drugs.
95955...  ..................  A                   EEG during surgery......        1.01       2.90       2.90       0.30       4.21       4.21        XXX
95955...  TC                  A                   EEG during surgery......        0.00       1.87       1.87       0.19       2.06       2.06        XXX
95955...  26                  A                   EEG during surgery......        1.01       1.03       1.03       0.11       2.15       2.15        XXX
95956...  ..................  A                   EEG monitoring/cable/           3.08       7.54       7.54       0.61      11.23      11.23        XXX
                                                   radio.
95956...  TC                  A                   EEG monitoring/cable/           0.00       6.04       6.04       0.50       6.54       6.54        XXX
                                                   radio.
95956...  26                  A                   EEG monitoring/cable/           3.08       1.50       1.50       0.11       4.69       4.69        XXX
                                                   radio.
95957...  ..................  A                   EEG digital analysis....        1.98       2.25       2.25       0.18       4.41       4.41        XXX
95957...  TC                  A                   EEG digital analysis....        0.00       1.62       1.62       0.13       1.75       1.75        XXX
95957...  26                  A                   EEG digital analysis....        1.98       0.63       0.63       0.05       2.66       2.66        XXX
95958...  ..................  A                   EEG monitoring/function         4.25       4.89       4.89       0.52       9.66       9.66        XXX
                                                   test.
95958...  TC                  A                   EEG monitoring/function         0.00       1.66       1.66       0.14       1.80       1.80        XXX
                                                   test.
95958...  26                  A                   EEG monitoring/function         4.25       3.23       3.23       0.38       7.86       7.86        XXX
                                                   test.
95961...  ..................  A                   Electrode stimulation,          2.97       2.67       2.67       0.20       5.84       5.84        XXX
                                                   brain.
95961...  TC                  A                   Electrode stimulation,          0.00       1.24       1.24       0.08       1.32       1.32        XXX
                                                   brain.
95961...  26                  A                   Electrode stimulation,          2.97       1.43       1.43       0.12       4.52       4.52        XXX
                                                   brain.
95962...  ..................  A                   Electrode stimulation,          3.21       2.67       2.67       0.20       6.08       6.08        XXX
                                                   brain.
95962...  TC                  A                   Electrode stimulation,          0.00       1.24       1.24       0.08       1.32       1.32        XXX
                                                   brain.
95962...  26                  A                   Electrode stimulation,          3.21       1.43       1.43       0.12       4.76       4.76        XXX
                                                   brain.
95999...  ..................  C                   Neurological procedure..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
96100...  ..................  A                   Psychological testing...        0.00       1.68       1.68       0.20       1.88       1.88        XXX
96105...  ..................  A                   Assessment of aphasia...        0.00       1.68       1.68       0.20       1.88       1.88        XXX
96110...  ..................  C                   Developmental test, lim.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
96111...  ..................  A                   Developmental test,             0.00       1.68       1.68       0.20       1.88       1.88        XXX
                                                   extend.
96115...  ..................  A                   Neurobehavior status            0.00       1.68       1.68       0.20       1.88       1.88        XXX
                                                   exam.
96117...  ..................  A                   Neuropsych test battery.        0.00       1.68       1.68       0.20       1.88       1.88        XXX
96400...  ..................  A                   Chemotherapy, (SC)/(IM).        0.00       0.13       0.13       0.01       0.14       0.14        XXX
96405...  ..................  A                   Intralesional chemo             0.52       0.38       0.38       0.03       0.93       0.93        000
                                                   admin.
96406...  ..................  A                   Intralesional chemo             0.80       0.56       0.56       0.04       1.40       1.40        000
                                                   admin.
96408...  ..................  A                   Chemotherapy, push              0.00       0.92       0.92       0.06       0.98       0.98        XXX
                                                   technique.
96410...  ..................  A                   Chemotherapy, infusion          0.00       1.47       1.47       0.09       1.56       1.56        XXX
                                                   method.
96412...  ..................  A                   Chemotherapy, infusion          0.00       1.10       1.10       0.08       1.18       1.18        XXX
                                                   method.
96414...  ..................  A                   Chemotherapy, infusion          0.00       1.27       1.27       0.09       1.36       1.36        XXX
                                                   method.
96420...  ..................  A                   Chemotherapy, push              0.00       1.19       1.19       0.09       1.28       1.28        XXX
                                                   technique.
96422...  ..................  A                   Chemotherapy, infusion          0.00       1.17       1.17       0.09       1.26       1.26        XXX
                                                   method.
96423...  ..................  A                   Chemotherapy, infusion          0.00       0.46       0.46       0.03       0.49       0.49        XXX
                                                   method.
96425...  ..................  A                   Chemotherapy, infusion          0.00       1.36       1.36       0.09       1.45       1.45        XXX
                                                   method.
96440...  ..................  A                   Chemotherapy,                   2.37       0.81       0.81       0.06       3.24       3.24        000
                                                   intracavitary.
96445...  ..................  A                   Chemotherapy,                   2.20       0.98       0.98       0.09       3.27       3.27        000
                                                   intracavitary.
96450...  ..................  A                   Chemotherapy, into CNS..        1.89       0.87       0.87       0.06       2.82       2.82        000
96520...  ..................  A                   Pump refilling,                 0.00       0.85       0.85       0.06       0.91       0.91        XXX
                                                   maintenance.
96530...  ..................  A                   Pump refilling,                 0.00       1.01       1.01       0.07       1.08       1.08        XXX
                                                   maintenance.
96542...  ..................  A                   Chemotherapy injection..        1.42       1.09       1.09       0.13       2.64       2.64        XXX
96545...  ..................  B                   Provide chemotherapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.
96549...  ..................  C                   Chemotherapy,                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unspecified.
96900...  ..................  A                   Ultraviolet light               0.00       0.38       0.38       0.03       0.41       0.41        XXX
                                                   therapy.
96902...  ..................  B                   Trichogram..............       +0.41       0.29       0.29       0.02       0.72       0.72        XXX
96910...  ..................  A                   Photochemotherapy with          0.00       0.55       0.55       0.04       0.59       0.59        XXX
                                                   UV-B.
96912...  ..................  A                   Photochemotherapy with          0.00       0.63       0.63       0.05       0.68       0.68        XXX
                                                   UV-A.
96913...  ..................  A                   Photochemotherapy, UV-A         0.00       1.29       1.29       0.10       1.39       1.39        XXX
                                                   or B.
96999...  ..................  C                   Dermatological procedure        0.00       0.00       0.00       0.00       0.00       0.00        XXX
97001...  ..................  A                   Pt evaluation...........        1.20       0.35       0.35       0.11       1.66       1.66        XXX
97002...  ..................  A                   Pt re-evaluation........        0.60       0.04       0.04       0.01       0.65       0.65        XXX
97003...  ..................  A                   Ot evaluation...........        1.20       0.35       0.35       0.11       1.66       1.66        XXX
97004...  ..................  A                   Ot re-evaluation........        0.60       0.04       0.04       0.01       0.65       0.65        XXX
97010...  ..................  B                   Hot or cold packs              +0.06       0.21       0.21       0.02       0.29       0.29        XXX
                                                   therapy.
97012...  ..................  A                   Mechanical traction             0.25       0.19       0.19       0.02       0.46       0.46        XXX
                                                   therapy.
97014...  ..................  A                   Electric stimulation            0.18       0.20       0.20       0.02       0.40       0.40        XXX
                                                   therapy.

[[Page 59224]]


97016...  ..................  A                   Vasopneumatic device            0.18       0.25       0.25       0.02       0.45       0.45        XXX
                                                   therapy.
97018...  ..................  A                   Paraffin bath therapy...        0.06       0.24       0.24       0.03       0.33       0.33        XXX
97020...  ..................  A                   Microwave therapy.......        0.06       0.20       0.20       0.02       0.28       0.28        XXX
97022...  ..................  A                   Whirlpool therapy.......        0.17       0.19       0.19       0.02       0.38       0.38        XXX
97024...  ..................  A                   Diathermy treatment.....        0.06       0.21       0.21       0.02       0.29       0.29        XXX
97026...  ..................  A                   Infrared therapy........        0.06       0.19       0.19       0.02       0.27       0.27        XXX
97028...  ..................  A                   Ultraviolet therapy.....        0.08       0.19       0.19       0.01       0.28       0.28        XXX
97032...  ..................  A                   Electrical stimulation..        0.25       0.14       0.14       0.01       0.40       0.40        XXX
97033...  ..................  A                   Electric current therapy        0.26       0.14       0.14       0.02       0.42       0.42        XXX
97034...  ..................  A                   Contrast bath therapy...        0.21       0.10       0.10       0.01       0.32       0.32        XXX
97035...  ..................  A                   Ultrasound therapy......        0.21       0.11       0.11       0.01       0.33       0.33        XXX
97036...  ..................  A                   Hydrotherapy............        0.28       0.21       0.21       0.02       0.51       0.51        XXX
97039...  ..................  A                   Physical therapy                0.20       0.24       0.24       0.03       0.47       0.47        XXX
                                                   treatment.
97110...  ..................  A                   Therapeutic exercises...        0.45       0.13       0.13       0.02       0.60       0.60        XXX
97112...  ..................  A                   Neuromuscular                   0.45       0.13       0.13       0.01       0.59       0.59        XXX
                                                   reeducation.
97113...  ..................  A                   Aquatic therapy/                0.44       0.20       0.20       0.02       0.66       0.66        XXX
                                                   exercises.
97116...  ..................  A                   Gait training therapy...        0.40       0.11       0.11       0.01       0.52       0.52        XXX
97122...  ..................  A                   Manual traction therapy.        0.42       0.11       0.11       0.01       0.54       0.54        XXX
97124...  ..................  A                   Massage therapy.........        0.35       0.11       0.11       0.01       0.47       0.47        XXX
97139...  ..................  A                   Physical medicine               0.21       0.16       0.16       0.02       0.39       0.39        XXX
                                                   procedure.
97150...  ..................  A                   Group therapeutic               0.27       0.20       0.20       0.02       0.49       0.49        XXX
                                                   procedures.
97250...  ..................  A                   Myofascial release......        0.45       0.35       0.35       0.04       0.84       0.84        000
97260...  ..................  A                   Regional manipulation...        0.19       0.20       0.20       0.02       0.41       0.41        000
97261...  ..................  A                   Supplemental                    0.12       0.11       0.11       0.01       0.24       0.24        000
                                                   manipulations.
97265...  ..................  A                   Joint mobilization......        0.45       0.35       0.35       0.04       0.84       0.84        XXX
97504...  ..................  A                   Orthotic training.......        0.45       0.14       0.14       0.02       0.61       0.61        XXX
97520...  ..................  A                   Prosthetic training.....        0.45       0.15       0.15       0.02       0.62       0.62        XXX
97530...  ..................  A                   Therapeutic activities..        0.44       0.17       0.17       0.02       0.63       0.63        XXX
97535...  ..................  A                   Self care mngment               0.45       0.17       0.17       0.02       0.64       0.64        XXX
                                                   training.
97537...  ..................  A                   Community/work                  0.45       0.17       0.17       0.02       0.64       0.64        XXX
                                                   reintegration.
97542...  ..................  A                   Wheelchair mngement             0.25       0.17       0.17       0.02       0.44       0.44        XXX
                                                   training.
97545...  ..................  R                   Work hardening..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
97546...  ..................  R                   Work hardening..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
97703...  ..................  A                   Prosthetic checkout.....        0.25       0.18       0.18       0.03       0.46       0.46        XXX
97750...  ..................  A                   Physical performance            0.45       0.24       0.24       0.03       0.72       0.72        XXX
                                                   test.
97770...  ..................  A                   Cognitive skills                0.44       0.28       0.28       0.03       0.75       0.75        XXX
                                                   development.
97780...  ..................  N                   Acupuncture w/o stim....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
97781...  ..................  N                   Acupuncture w/stim......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
97799...  ..................  C                   Physical medicine               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
98925...  ..................  A                   Osteopathic manipulation        0.45       0.25       0.25       0.02       0.72       0.72        000
98926...  ..................  A                   Osteopathic manipulation        0.65       0.40       0.40       0.03       1.08       1.08        000
98927...  ..................  A                   Osteopathic manipulation        0.87       0.38       0.38       0.03       1.28       1.28        000
98928...  ..................  A                   Osteopathic manipulation        1.03       0.42       0.42       0.04       1.49       1.49        000
98929...  ..................  A                   Osteopathic manipulation        1.19       0.39       0.39       0.03       1.61       1.61        000
98940...  ..................  A                   Chiropractic                    0.45       0.29       0.29       0.01       0.75       0.75        000
                                                   manipulation.
98941...  ..................  A                   Chiropractic                    0.65       0.29       0.29       0.01       0.95       0.95        000
                                                   manipulation.
98942...  ..................  A                   Chiropractic                    0.87       0.29       0.29       0.01       1.17       1.17        000
                                                   manipulation.
98943...  ..................  N                   Chiropractic                   +0.40       0.29       0.29       0.01       0.70       0.70        XXX
                                                   manipulation.
99000...  ..................  B                   Specimen handling.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99001...  ..................  B                   Specimen handling.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99002...  ..................  B                   Device handling.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99024...  ..................  B                   Post-op follow-up visit.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99025...  ..................  B                   Initial surgical                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   evaluation.
99050...  ..................  B                   Medical services after          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hrs.
99052...  ..................  B                   Medical services at             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   night.
99054...  ..................  B                   Medical services,               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unusual hrs.
99056...  ..................  B                   Non-office medical              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   services.
99058...  ..................  B                   Office emergency care...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99070...  ..................  B                   Special supplies........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99071...  ..................  B                   Patient education               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   materials.
99075...  ..................  N                   Medical testimony.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99078...  ..................  B                   Group health education..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99080...  ..................  B                   Special reports or forms        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99082...  ..................  C                   Unusual physician travel        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99090...  ..................  B                   Computer data analysis..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99100...  ..................  B                   Special anesthesia              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   service.
99116...  ..................  B                   Anesthesia with                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hypothermia.
99135...  ..................  B                   Special anesthesia              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedure.
99140...  ..................  B                   Emergency anesthesia....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99141...  ..................  B                   Sedation, iv/im or             +0.80       0.83       0.83       0.05       1.68       1.68        XXX
                                                   inhalant.
99142...  ..................  B                   Sedation, oral/rectal/         +0.60       0.62       0.62       0.04       1.26       1.26        XXX
                                                   nasal.
99175...  ..................  A                   Induction of vomiting...        0.00       1.33       1.33       0.10       1.43       1.43        XXX
99183...  ..................  A                   Hyperbaric oxygen               2.34       1.67       1.67       0.11       4.12       4.12        XXX
                                                   therapy.
99185...  ..................  A                   Regional hypothermia....        0.00       0.61       0.61       0.04       0.65       0.65        XXX

[[Page 59225]]


99186...  ..................  A                   Total body hypothermia..        0.00       1.70       1.70       0.52       2.22       2.22        XXX
99190...  ..................  X                   Special pump services...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99191...  ..................  X                   Special pump services...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99192...  ..................  X                   Special pump services...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99195...  ..................  A                   Phlebotomy..............        0.00       0.42       0.42       0.03       0.45       0.45        XXX
99199...  ..................  C                   Special service or              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   report.
99201...  ..................  A                   Office/outpatient visit,        0.45       0.42       0.37       0.04       0.91       0.86        XXX
                                                   new.
99202...  ..................  A                   Office/outpatient visit,        0.88       0.51       0.45       0.05       1.44       1.38        XXX
                                                   new.
99203...  ..................  A                   Office/outpatient visit,        1.34       0.59       0.52       0.06       1.99       1.92        XXX
                                                   new.
99204...  ..................  A                   Office/outpatient visit,        2.00       0.88       0.78       0.08       2.96       2.86        XXX
                                                   new.
99205...  ..................  A                   Office/outpatient visit,        2.67       0.96       0.85       0.09       3.72       3.61        XXX
                                                   new.
99211...  ..................  A                   Office/outpatient visit,        0.17       0.21       0.19       0.02       0.40       0.38        XXX
                                                   est.
99212...  ..................  A                   Office/outpatient visit,        0.45       0.32       0.28       0.02       0.79       0.75        XXX
                                                   est.
99213...  ..................  A                   Office/outpatient visit,        0.67       0.43       0.38       0.03       1.13       1.08        XXX
                                                   est.
99214...  ..................  A                   Office/outpatient visit,        1.10       0.57       0.50       0.04       1.71       1.64        XXX
                                                   est.
99215...  ..................  A                   Office/outpatient visit,        1.77       0.86       0.76       0.07       2.70       2.60        XXX
                                                   est.
99217...  ..................  A                   Observation care                1.28       0.52       0.52       0.04       1.84       1.84        XXX
                                                   discharge.
99218...  ..................  A                   Observation care........        1.28       0.68       0.68       0.06       2.02       2.02        XXX
99219...  ..................  A                   Observation care........        2.14       1.05       1.05       0.09       3.28       3.28        XXX
99220...  ..................  A                   Observation care........        2.99       1.14       1.14       0.09       4.22       4.22        XXX
99221...  ..................  A                   Initial hospital care...        1.28       0.67       0.67       0.06       2.01       2.01        XXX
99222...  ..................  A                   Initial hospital care...        2.14       1.04       1.04       0.09       3.27       3.27        XXX
99223...  ..................  A                   Initial hospital care...        2.99       1.13       1.13       0.08       4.20       4.20        XXX
99231...  ..................  A                   Subsequent hospital care        0.64       0.38       0.38       0.03       1.05       1.05        XXX
99232...  ..................  A                   Subsequent hospital care        1.06       0.45       0.45       0.04       1.55       1.55        XXX
99233...  ..................  A                   Subsequent hospital care        1.51       0.60       0.60       0.05       2.16       2.16        XXX
99234...  ..................  A                   Observ/hosp same date...        2.56       0.68       0.68       0.06       3.30       3.30        XXX
99235...  ..................  A                   Observ/hosp same date...        3.42       1.05       1.05       0.09       4.56       4.56        XXX
99236...  ..................  A                   Observ/hosp same date...        4.27       1.14       1.14       0.09       5.50       5.50        XXX
99238...  ..................  A                   Hospital discharge day..        1.28       0.51       0.51       0.04       1.83       1.83        XXX
99239...  ..................  A                   Hospital discharge day..        1.75       0.51       0.51       0.04       2.30       2.30        XXX
99241...  ..................  A                   Office consultation.....        0.64       0.64       0.64       0.08       1.36       1.36        XXX
99242...  ..................  A                   Office consultation.....        1.29       0.77       0.77       0.09       2.15       2.15        XXX
99243...  ..................  A                   Office consultation.....        1.72       0.97       0.97       0.10       2.79       2.79        XXX
99244...  ..................  A                   Office consultation.....        2.58       1.23       1.23       0.11       3.92       3.92        XXX
99245...  ..................  A                   Office consultation.....        3.43       1.69       1.69       0.16       5.28       5.28        XXX
99251...  ..................  A                   Initial inpatient               0.66       0.67       0.67       0.08       1.41       1.41        XXX
                                                   consult.
99252...  ..................  A                   Initial inpatient               1.32       0.76       0.76       0.09       2.17       2.17        XXX
                                                   consult.
99253...  ..................  A                   Initial inpatient               1.82       0.95       0.95       0.10       2.87       2.87        XXX
                                                   consult.
99254...  ..................  A                   Initial inpatient               2.64       1.20       1.20       0.11       3.95       3.95        XXX
                                                   consult.
99255...  ..................  A                   Initial inpatient               3.65       1.57       1.57       0.14       5.36       5.36        XXX
                                                   consult.
99261...  ..................  A                   Follow-up inpatient             0.42       0.33       0.33       0.03       0.78       0.78        XXX
                                                   consult.
99262...  ..................  A                   Follow-up inpatient             0.85       0.46       0.46       0.04       1.35       1.35        XXX
                                                   consult.
99263...  ..................  A                   Follow-up inpatient             1.27       0.67       0.67       0.04       1.98       1.98        XXX
                                                   consult.
99271...  ..................  A                   Confirmatory                    0.45       0.58       0.58       0.07       1.10       1.10        XXX
                                                   consultation.
99272...  ..................  A                   Confirmatory                    0.84       0.71       0.71       0.09       1.64       1.64        XXX
                                                   consultation.
99273...  ..................  A                   Confirmatory                    1.19       1.02       1.02       0.11       2.32       2.32        XXX
                                                   consultation.
99274...  ..................  A                   Confirmatory                    1.73       1.22       1.22       0.11       3.06       3.06        XXX
                                                   consultation.
99275...  ..................  A                   Confirmatory                    2.31       1.74       1.74       0.17       4.22       4.22        XXX
                                                   consultation.
99281...  ..................  A                   Emergency dept visit....        0.33       0.28       0.28       0.01       0.62       0.62        XXX
99282...  ..................  A                   Emergency dept visit....        0.55       0.38       0.38       0.03       0.96       0.96        XXX
99283...  ..................  A                   Emergency dept visit....        1.24       0.49       0.49       0.04       1.77       1.77        XXX
99284...  ..................  A                   Emergency dept visit....        1.95       0.70       0.70       0.06       2.71       2.71        XXX
99285...  ..................  A                   Emergency dept visit....        3.06       1.13       1.13       0.08       4.27       4.27        XXX
99288...  ..................  B                   Direct advanced life            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   support.
99291...  ..................  A                   Critical care, first            4.00       1.43       1.43       0.11       5.54       5.54        XXX
                                                   hour.
99292...  ..................  A                   Critical care, addl 30          2.00       0.63       0.63       0.04       2.67       2.67        XXX
                                                   min.
99295...  ..................  A                   Neonatal critical care..       16.00       5.08       5.08       1.55      22.63      22.63        XXX
99296...  ..................  A                   Neonatal critical care..        8.00       2.46       2.46       0.77      11.23      11.23        XXX
99297...  ..................  A                   Neonatal critical care..        4.00       1.23       1.23       0.38       5.61       5.61        XXX
99301...  ..................  A                   Nursing facility care...        1.20       0.45       0.45       0.03       1.68       1.68        XXX
99302...  ..................  A                   Nursing facility care...        1.61       0.50       0.50       0.04       2.15       2.15        XXX
99303...  ..................  A                   Nursing facility care...        2.01       0.95       0.95       0.07       3.03       3.03        XXX
99311...  ..................  A                   Nursing facility care,          0.60       0.34       0.34       0.03       0.97       0.97        XXX
                                                   subseq.
99312...  ..................  A                   Nursing facility care,          1.00       0.41       0.41       0.03       1.44       1.44        XXX
                                                   subseq.
99313...  ..................  A                   Nursing facility care,          1.42       0.46       0.46       0.04       1.92       1.92        XXX
                                                   subseq.
99315...  ..................  A                   Nursing fac discharge           1.13       0.51       0.51       0.04       1.68       1.68        XXX
                                                   day.
99316...  ..................  A                   Nursing fac discharge           1.50       0.51       0.51       0.04       2.05       2.05        XXX
                                                   day.
99321...  ..................  A                   Rest home visit, new            0.71       0.37       0.37       0.03       1.11       1.11        XXX
                                                   patient.
99322...  ..................  A                   Rest home visit, new            1.01       0.51       0.51       0.05       1.57       1.57        XXX
                                                   patient.
99323...  ..................  A                   Rest home visit, new            1.28       0.73       0.73       0.06       2.07       2.07        XXX
                                                   patient.
99331...  ..................  A                   Rest home visit, estab          0.60       0.28       0.28       0.02       0.90       0.90        XXX
                                                   pat.
99332...  ..................  A                   Rest home visit, estab          0.80       0.36       0.36       0.03       1.19       1.19        XXX
                                                   pat.
99333...  ..................  A                   Rest home visit, estab          1.00       0.44       0.44       0.02       1.46       1.46        XXX
                                                   pat.

[[Page 59226]]


99341...  ..................  A                   Home visit, new patient.        1.01       0.53       0.53       0.05       1.59       1.59        XXX
99342...  ..................  A                   Home visit, new patient.        1.52       0.60       0.60       0.05       2.17       2.17        XXX
99343...  ..................  A                   Home visit, new patient.        2.27       0.77       0.77       0.06       3.10       3.10        XXX
99344...  ..................  A                   Home visit, new patient.        3.03       0.85       0.85       0.09       3.97       3.97        XXX
99345...  ..................  A                   Home visit, new patient.        3.79       0.85       0.85       0.09       4.73       4.73        XXX
99347...  ..................  A                   Home visit, estab               0.76       0.45       0.45       0.04       1.25       1.25        XXX
                                                   patient.
99348...  ..................  A                   Home visit, estab               1.26       0.53       0.53       0.04       1.83       1.83        XXX
                                                   patient.
99349...  ..................  A                   Home visit, estab               2.02       0.61       0.61       0.05       2.68       2.68        XXX
                                                   patient.
99350...  ..................  A                   Home visit, estab               3.03       0.76       0.76       0.07       3.86       3.86        XXX
                                                   patient.
99351...  ..................  D                   Home visit, estab               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   patient.
99352...  ..................  D                   Home visit, estab               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   patient.
99353...  ..................  D                   12/Home visit, estab            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   patient.
99354...  ..................  A                   Prolonged service,              1.77       0.76       0.76       0.07       2.60       2.60        XXX
                                                   office.
99355...  ..................  A                   Prolonged service,              1.77       0.76       0.76       0.07       2.60       2.60        XXX
                                                   office.
99356...  ..................  A                   Prolonged service,              1.71       0.85       0.85       0.08       2.64       2.64        XXX
                                                   inpatient.
99357...  ..................  A                   Prolonged service,              1.71       0.85       0.85       0.08       2.64       2.64        XXX
                                                   inpatient.
99358...  ..................  B                   Prolonged serv, w/o             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   contact.
99359...  ..................  B                   Prolonged serv, w/o             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   contact.
99360...  ..................  X                   Physician standby               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   services.
99361...  ..................  B                   Physician/team                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   conference.
99362...  ..................  B                   Physician/team                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   conference.
99371...  ..................  B                   Physician phone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   consultation.
99372...  ..................  B                   Physician phone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   consultation.
99373...  ..................  B                   Physician phone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   consultation.
99374...  ..................  B                   Home health care               +1.10       0.51       0.51       0.04       1.65       1.65        XXX
                                                   supervision.
99375...  ..................  A                   Home health care                1.73       0.51       0.51       0.04       2.28       2.28        XXX
                                                   supervision.
99376...  ..................  D                   1Care plan oversight/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   over 60.
99377...  ..................  B                   Hospice care supervision       +1.10       0.51       0.51       0.04       1.65       1.65        XXX
99378...  ..................  A                   Hospice care supervision        1.73       0.51       0.51       0.04       2.28       2.28        XXX
99379...  ..................  B                   Nursing fac care               +1.10       0.51       0.51       0.04       1.65       1.65        XXX
                                                   supervision.
99380...  ..................  B                   Nursing fac care               +1.73       0.51       0.51       0.04       2.28       2.28        XXX
                                                   supervision.
99381...  ..................  N                   Preventive visit, new,         +1.19       1.23       1.23       0.08       2.50       2.50        XXX
                                                   infant.
99382...  ..................  N                   Preventive visit, new,         +1.36       1.41       1.41       0.09       2.86       2.86        XXX
                                                   age 1-4.
99383...  ..................  N                   Preventive visit, new,         +1.36       1.41       1.41       0.09       2.86       2.86        XXX
                                                   age 5-11.
99384...  ..................  N                   Preventive visit, new,         +1.53       1.59       1.59       0.10       3.22       3.22        XXX
                                                   12-17.
99385...  ..................  N                   Preventive visit, new,         +1.53       1.40       1.40       0.09       3.02       3.02        XXX
                                                   18-39.
99386...  ..................  N                   Preventive visit, new,         +1.88       1.72       1.72       0.10       3.70       3.70        XXX
                                                   40-64.
99387...  ..................  N                   Preventive visit, new,         +2.06       1.88       1.88       0.11       4.05       4.05        XXX
                                                   65 & over.
99391...  ..................  N                   Preventive visit, est,         +1.02       1.06       1.06       0.07       2.15       2.15        XXX
                                                   infant.
99392...  ..................  N                   Preventive visit, est,         +1.19       1.23       1.23       0.08       2.50       2.50        XXX
                                                   age 1-4.
99393...  ..................  N                   Preventive visit, est,         +1.19       1.23       1.23       0.08       2.50       2.50        XXX
                                                   age 5-11.
99394...  ..................  N                   Preventive visit, est,         +1.36       1.41       1.41       0.09       2.86       2.86        XXX
                                                   12-17.
99395...  ..................  N                   Preventive visit, est,         +1.36       1.25       1.25       0.08       2.69       2.69        XXX
                                                   18-39.
99396...  ..................  N                   Preventive visit, est,         +1.53       1.40       1.40       0.09       3.02       3.02        XXX
                                                   40-64.
99397...  ..................  N                   Preventive visit, est,         +1.71       1.56       1.56       0.10       3.37       3.37        XXX
                                                   65 & over.
99401...  ..................  N                   Preventive counseling,         +0.48       0.45       0.45       0.03       0.96       0.96        XXX
                                                   indiv.
99402...  ..................  N                   Preventive counseling,         +0.98       0.89       0.89       0.05       1.92       1.92        XXX
                                                   indiv.
99403...  ..................  N                   Preventive counseling,         +1.46       1.34       1.34       0.08       2.88       2.88        XXX
                                                   indiv.
99404...  ..................  N                   Preventive counseling,         +1.95       1.78       1.78       0.11       3.84       3.84        XXX
                                                   indiv.
99411...  ..................  N                   Preventive counseling,         +0.15       0.14       0.14       0.01       0.30       0.30        XXX
                                                   group.
99412...  ..................  N                   Preventive counseling,         +0.25       0.23       0.23       0.01       0.49       0.49        XXX
                                                   group.
99420...  ..................  N                   Health risk assessment          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
99429...  ..................  N                   Unlisted preventive             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   service.
99431...  ..................  A                   Initial care, normal            1.17       1.21       1.21       0.08       2.46       2.46        XXX
                                                   newborn.
99432...  ..................  A                   Newborn care not in             1.26       1.31       1.31       0.08       2.65       2.65        XXX
                                                   hospital.
99433...  ..................  A                   Normal newborn care,            0.62       0.64       0.64       0.04       1.30       1.30        XXX
                                                   hospital.
99435...  ..................  A                   Hospital NB discharge           1.50       1.55       1.55       0.10       3.15       3.15        XXX
                                                   day.
99436...  ..................  A                   Attendance, birth.......        1.50       1.55       1.55       0.10       3.15       3.15        XXX
99440...  ..................  A                   Newborn resuscitation...        2.93       3.04       3.04       0.19       6.16       6.16        XXX
99450...  ..................  N                   Life/disability                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   evaluation.
99455...  ..................  R                   Disability examination..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99456...  ..................  R                   Disability examination..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
99499...  ..................  C                   Unlisted E/M service....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A0021...  ..................  I                   Outside state ambulance         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   serv.
A0030...  ..................  X                   Air ambulance service...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A0040...  ..................  X                   Helicopter ambulance            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   service.
A0050...  ..................  X                   Water amb service               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   emergency.
A0080...  ..................  I                   Noninterest escort in           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   non er.
A0090...  ..................  I                   Interest escort in non          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   er.
A0100...  ..................  I                   Nonemergency transport          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   taxi.
A0110...  ..................  I                   Nonemergency transport          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bus.
A0120...  ..................  I                   Noner transport mini-bus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A0130...  ..................  I                   Noner transport wheelch         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   van.
A0140...  ..................  I                   Nonemergency transport          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   air.

[[Page 59227]]


A0160...  ..................  I                   Noner transport case            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   worker.
A0170...  ..................  I                   Noner transport parking         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fees.
A0180...  ..................  I                   Noner transport lodgng          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   recip.
A0190...  ..................  I                   Noner transport meals           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   recip.
A0200...  ..................  I                   Noner transport lodgng          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   escrt.
A0210...  ..................  I                   Noner transport meals           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   escort.
A0225...  ..................  X                   Neonatal emergency              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transport.
A0300...  ..................  X                   Ambulance basic non-emer        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   all.
A0302...  ..................  X                   Ambulance basic emergeny        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   all.
A0304...  ..................  X                   Amb adv non-er no serv          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   all.
A0306...  ..................  X                   Amb adv non-er spec serv        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   all.
A0308...  ..................  X                   Amb adv er no spec serv         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   all.
A0310...  ..................  X                   Amb adv er spec serv all        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A0320...  ..................  X                   Amb basic non-er +              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A0322...  ..................  X                   Amb basic emerg +               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A0324...  ..................  X                   Adv non-er serv sep             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0326...  ..................  X                   Adv non-er no serv sep          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mile.
A0328...  ..................  X                   Adv er no serv sep              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0330...  ..................  X                   Adv er spec serv sep            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mile.
A0340...  ..................  X                   Amb basic non-er +              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0342...  ..................  X                   Ambul basic emer +              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0344...  ..................  X                   Amb adv non-er no serv          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   +mile.
A0346...  ..................  X                   Amb adv non-er serv +           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mile.
A0348...  ..................  X                   Adv emer no spec serv +         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mile.
A0350...  ..................  X                   Adv emer spec serv +            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0360...  ..................  X                   Basic non-er sep mile &         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supp.
A0362...  ..................  X                   Basic emer sep mile &           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supply.
A0364...  ..................  X                   Adv non-er no serv sep          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mi & su.
A0366...  ..................  X                   Adv non-er serv sep mil         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   & supp.
A0368...  ..................  X                   Adv er no serv sep mile         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   & supp.
A0370...  ..................  X                   Adv er spec serv sep mi         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   & supp.
A0380...  ..................  X                   Basic life support              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0382...  ..................  X                   Basic support routine           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   suppls.
A0384...  ..................  X                   Bls defibrillation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A0390...  ..................  X                   Advanced life support           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileag.
A0392...  ..................  X                   Als defibrillation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A0394...  ..................  X                   Als IV drug therapy             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A0396...  ..................  X                   Als esophageal intub            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   suppls.
A0398...  ..................  X                   Als routine disposble           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   suppls.
A0420...  ..................  X                   Ambulance waiting 1/2 hr        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A0422...  ..................  X                   Ambulance 02 life               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sustaining.
A0424...  ..................  X                   Extra ambulance                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   attendant.
A0888...  ..................  N                   Noncovered ambulance            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mileage.
A0999...  ..................  X                   Unlisted ambulance              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   service.
A2000...  ..................  D                   Chiropractor manip of           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   spine.
A4206...  ..................  P                   1 CC sterile syringe &          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4207...  ..................  P                   2 CC sterile syringe &          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4208...  ..................  P                   3 CC sterile syringe &          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4209...  ..................  P                   5+ CC sterile syringe &         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4210...  ..................  N                   Nonneedle injection             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   device.
A4211...  ..................  P                   Supp for self-adm               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injections.
A4212...  ..................  P                   Non coring needle or            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stylet.
A4213...  ..................  P                   20+ CC syringe only.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4214...  ..................  P                   30 CC sterile water/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   saline.
A4215...  ..................  P                   Sterile needle..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4220...  ..................  P                   Infusion pump refill kit        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4221...  ..................  X                   Maint drug infus cath           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   per wk.
A4222...  ..................  X                   Drug infusion pump              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supplies.
A4230...  ..................  N                   Infus insulin pump non          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4231...  ..................  N                   Infusion insulin pump           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   needle.
A4232...  ..................  N                   Syringe w/needle insulin        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   3cc.
A4244...  ..................  P                   Alcohol or peroxide per         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pint.
A4245...  ..................  P                   Alcohol wipes per box...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4246...  ..................  P                   Betadine/phisohex               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
A4247...  ..................  P                   Betadine/iodine swabs/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wipes.
A4250...  ..................  N                   Urine reagent strips/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tablets.
A4253...  ..................  P                   Blood glucose/reagent           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   strips.
A4254...  ..................  X                   Battery for glucose             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   monitor.
A4255...  ..................  X                   Glucose monitor                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   platforms.
A4256...  ..................  P                   Calibrator solution/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chips.
A4258...  ..................  P                   Lancet device each......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4259...  ..................  P                   Lancets per box.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4260...  ..................  N                   Levonorgestrel implant..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4262...  ..................  B                   Temporary tear duct plug        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59228]]


A4263...  ..................  A                   Permanent tear duct plug        0.00       0.95       0.95       0.00       0.95       0.95        XXX
A4265...  ..................  P                   Paraffin................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4270...  ..................  B                   Disposable endoscope            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sheath.
A4300...  ..................  A                   Cath impl vasc access           0.00       0.95       0.95       0.00       0.95       0.95        XXX
                                                   portal.
A4301...  ..................  P                   Implantable access syst         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   perc.
A4305...  ..................  P                   Drug delivery system            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   >=50 ML.
A4306...  ..................  P                   Drug delivery system <=5        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
A4310...  ..................  P                   Insert tray w/o bag/cath        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4311...  ..................  P                   Catheter w/o bag 2-way          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   latex.
A4312...  ..................  P                   Cath w/o bag 2-way              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   silicone.
A4313...  ..................  P                   Catheter w/bag 3-way....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4314...  ..................  P                   Cath w/drainage 2-way           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   latex.
A4315...  ..................  P                   Cath w/drainage 2-way           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   silcne.
A4316...  ..................  P                   Cath w/drainage 3-way...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4320...  ..................  P                   Irrigation tray.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4321...  ..................  X                   Cath therapeutic irrig          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   agent.
A4322...  ..................  P                   Irrigation syringe......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4323...  ..................  P                   Saline irrigation               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
A4326...  ..................  P                   Male external catheter..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4327...  ..................  P                   Fem urinary collect dev         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cup.
A4328...  ..................  P                   Fem urinary collect             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pouch.
A4329...  ..................  P                   External catheter start         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   set.
A4330...  ..................  P                   Stool collection pouch..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4335...  ..................  P                   Incontinence supply.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4338...  ..................  P                   Indwelling catheter             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   latex.
A4340...  ..................  P                   Indwelling catheter             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   special.
A4344...  ..................  P                   Cath indw foley 2 way           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   silicn.
A4346...  ..................  P                   Cath indw foley 3 way...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4347...  ..................  P                   Male external catheter..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4351...  ..................  P                   Straight tip urine              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   catheter.
A4352...  ..................  P                   Coude tip urinary               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   catheter.
A4353...  ..................  X                   Intermittent urinary            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cath.
A4354...  ..................  P                   Cath insertion tray w/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bag.
A4355...  ..................  P                   Bladder irrigation              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tubing.
A4356...  ..................  P                   Ext ureth clmp or compr         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dvc.
A4357...  ..................  P                   Bedside drainage bag....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4358...  ..................  P                   Urinary leg bag.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4359...  ..................  P                   Urinary suspensory w/o          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   leg b.
A4361...  ..................  P                   Ostomy face plate.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4362...  ..................  P                   Solid skin barrier......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4363...  ..................  P                   Liquid skin barrier.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4364...  ..................  P                   Ostomy/cath adhesive....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4365...  ..................  X                   Ostomy adhesive remover         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wipe.
A4367...  ..................  P                   Ostomy belt.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4368...  ..................  X                   Ostomy filter...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4397...  ..................  P                   Irrigation supply sleeve        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4398...  ..................  P                   Ostomy irrigation bag...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4399...  ..................  P                   Ostomy irrig cone/cath w        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   brs.
A4400...  ..................  P                   Ostomy irrigation set...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4402...  ..................  P                   Lubricant per ounce.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4404...  ..................  P                   Ostomy ring each........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4421...  ..................  P                   Ostomy supply misc......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4454...  ..................  P                   Tape all types all sizes        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4455...  ..................  P                   Adhesive remover per            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ounce.
A4460...  ..................  P                   Elastic compression             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bandage.
A4462...  ..................  X                   Abdmnl drssng holder/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   binder.
A4465...  ..................  P                   Non-elastic extremity           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   binder.
A4470...  ..................  P                   Gravlee jet washer......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4480...  ..................  P                   Vabra aspirator.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4481...  ..................  X                   Tracheostoma filter.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4490...  ..................  N                   Above knee surgical             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stocking.
A4495...  ..................  N                   Thigh length surg               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stocking.
A4500...  ..................  N                   Below knee surgical             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stocking.
A4510...  ..................  N                   Full length surg                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   stocking.
A4550...  ..................  A                   Surgical trays..........        0.00       0.95       0.95       0.00       0.95       0.95        XXX
A4554...  ..................  N                   Disposable underpads....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4556...  ..................  P                   Electrodes..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4557...  ..................  P                   Lead wires..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4558...  ..................  P                   Conductive paste or gel.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4560...  ..................  X                   Pessary.................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4565...  ..................  X                   Slings..................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4570...  ..................  X                   Splint..................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4572...  ..................  X                   Rib belt................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4575...  ..................  N                   Hyperbaric o2 chamber           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   disps.

[[Page 59229]]


A4580...  ..................  X                   Cast supplies (plaster).        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4590...  ..................  X                   Special casting material        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4595...  ..................  X                   TENS suppl 2 lead per           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   month.
A4611...  ..................  X                   Heavy duty battery......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4612...  ..................  X                   Battery cables..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4613...  ..................  X                   Battery charger.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4615...  ..................  X                   Cannula nasal...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4616...  ..................  X                   Tubing (oxygen) per foot        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4617...  ..................  X                   Mouth piece.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4618...  ..................  X                   Breathing circuits......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4619...  ..................  X                   Face tent...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4620...  ..................  X                   Variable concentration          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mask.
A4621...  ..................  X                   Tracheotomy mask or             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   collar.
A4622...  ..................  X                   Tracheostomy or                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   larngectomy.
A4623...  ..................  X                   Tracheostomy inner              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cannula.
A4624...  ..................  X                   Tracheal suction tube...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4625...  ..................  X                   Trach care kit for new          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   trach.
A4626...  ..................  X                   Tracheostomy cleaning           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   brush.
A4627...  ..................  N                   Spacer bag/reservoir....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4628...  ..................  X                   Oropharyngeal suction           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cath.
A4629...  ..................  X                   Tracheostomy care kit...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4630...  ..................  X                   Repl bat t.e.n.s. own by        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pt.
A4631...  ..................  X                   Wheelchair battery......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4635...  ..................  X                   Underarm crutch pad.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4636...  ..................  X                   Handgrip for cane etc...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4637...  ..................  X                   Repl tip cane/crutch/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   walker.
A4640...  ..................  X                   Alternating pressure pad        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4641...  ..................  E                   Diagnostic imaging agent        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4642...  ..................  E                   Satumomab pendetide per         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dose.
A4643...  ..................  E                   High dose contrast MRI..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4644...  ..................  E                   Contrast 100-199 MGs            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   iodine.
A4645...  ..................  E                   Contrast 200-299 MGs            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   iodine.
A4646...  ..................  E                   Contrast 300-399 MGs            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   iodine.
A4647...  ..................  B                   Supp- paramagnetic contr        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mat.
A4649...  ..................  P                   Surgical supplies.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4650...  ..................  X                   Supp esrd centrifuge....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4655...  ..................  X                   Esrd syringe/needle.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4660...  ..................  X                   Esrd blood pressure             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   device.
A4663...  ..................  X                   Esrd blood pressure cuff        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4670...  ..................  N                   Auto blood pressure             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   monitor.
A4680...  ..................  X                   Activated carbon filters        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4690...  ..................  X                   Dialyzers...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4700...  ..................  X                   Standard dialysate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
A4705...  ..................  X                   Bicarb dialysate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
A4712...  ..................  X                   Sterile water...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4714...  ..................  X                   Treated water for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dialysis.
A4730...  ..................  X                   Fistula cannulation set         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dial.
A4735...  ..................  X                   Local/topical                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anesthetics.
A4740...  ..................  X                   Esrd shunt accessory....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4750...  ..................  X                   Arterial or venous              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tubing.
A4755...  ..................  X                   Arterial and venous             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tubing.
A4760...  ..................  X                   Standard testing                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
A4765...  ..................  X                   Dialysate concentrate...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4770...  ..................  X                   Blood testing supplies..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4771...  ..................  X                   Blood clotting time tube        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4772...  ..................  X                   Dextrostick/glucose             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   strips.
A4773...  ..................  X                   Hemostix................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4774...  ..................  X                   Ammonia test paper......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4780...  ..................  X                   Esrd sterilizing agent..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4790...  ..................  X                   Esrd cleansing agents...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4800...  ..................  X                   Heparin/antidote                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dialysis.
A4820...  ..................  X                   Supplies hemodialysis           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   kit.
A4850...  ..................  X                   Rubber tipped hemostats.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4860...  ..................  X                   Disposable catheter caps        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4870...  ..................  X                   Plumbing/electrical work        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4880...  ..................  X                   Water storage tanks.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4890...  ..................  R                   Contracts/repair/               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maintenance.
A4900...  ..................  X                   Capd supply kit.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4901...  ..................  X                   Ccpd supply kit.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4905...  ..................  X                   Ipd supply kit..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4910...  ..................  X                   Esrd nonmedical supplies        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4912...  ..................  X                   Gomco drain bottle......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4913...  ..................  X                   Esrd supply.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4914...  ..................  X                   Preparation kit.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59230]]


A4918...  ..................  X                   Venous pressure clamp...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4919...  ..................  X                   Supp dialysis dialyzer          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   holde.
A4920...  ..................  X                   Harvard pressure clamp..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4921...  ..................  X                   Measuring cylinder......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A4927...  ..................  X                   Gloves..................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5051...  ..................  P                   Pouch clsd w barr               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   attached.
A5052...  ..................  P                   Clsd ostomy pouch w/o           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   barr.
A5053...  ..................  P                   Clsd ostomy pouch               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   faceplate.
A5054...  ..................  P                   Clsd ostomy pouch w/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   flange.
A5055...  ..................  P                   Stoma cap...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5061...  ..................  P                   Pouch drainable w               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   barrier at.
A5062...  ..................  P                   Drnble ostomy pouch w/o         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   barr.
A5063...  ..................  P                   Drain ostomy pouch w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   flange.
A5064...  ..................  I                   Drain ostomy pouch w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fceplte.
A5065...  ..................  I                   Drain ostomy pouch on           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fcplte.
A5071...  ..................  P                   Urinary pouch w/barrier.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5072...  ..................  P                   Urinary pouch w/o               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   barrier.
A5073...  ..................  P                   Urinary pouch on barr w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   flng.
A5074...  ..................  I                   Urinary pouch w/                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   faceplate.
A5075...  ..................  I                   Urinary pouch on                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   faceplate.
A5081...  ..................  P                   Continent stoma plug....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5082...  ..................  P                   Continent stoma catheter        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5093...  ..................  P                   Ostomy accessory convex         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inse.
A5102...  ..................  P                   Bedside drain btl w/wo          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tube.
A5105...  ..................  P                   Urinary suspensory......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5112...  ..................  P                   Urinary leg bag.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5113...  ..................  P                   Latex leg strap.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5114...  ..................  P                   Foam/fabric leg strap...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5119...  ..................  P                   Skin barrier wipes box          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pr 50.
A5121...  ..................  P                   Solid skin barrier 6x6..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5122...  ..................  P                   Solid skin barrier 8x8..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5123...  ..................  P                   Skin barrier with flange        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5126...  ..................  P                   Adhesive disc/foam pad..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5131...  ..................  P                   Appliance cleaner.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5149...  ..................  P                   Incontinence/ostomy             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supply.
A5500...  ..................  X                   Diab shoe for density           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   insert.
A5501...  ..................  X                   Diabetic custom molded          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   shoe.
A5502...  ..................  X                   Diabetic shoe density           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   insert.
A5503...  ..................  X                   Diabetic shoe w/roller/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   rockr.
A5504...  ..................  X                   Diabetic shoe with wedge        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A5505...  ..................  X                   Diab shoe w/metatarsal          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bar.
A5506...  ..................  X                   Diabetic shoe w/off set         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   heel.
A5507...  ..................  X                   Modification diabetic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   shoe.
A6020...  ..................  P                   Collagen dressing cover         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ea.
A6025...  ..................  I                   Silicone gel sheet, each        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6154...  ..................  P                   Wound pouch each........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6196...  ..................  P                   Alginate dressing <=16          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6197...  ..................  P                   Alginate drsg <ls-thn-          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eq>16 <=48 sq in.
A6198...  ..................  P                   alginate dressing > 48          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6199...  ..................  P                   Alginate drsg wound             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   filler.
A6203...  ..................  P                   Composite drsg <=16 sq          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   in.
A6204...  ..................  P                   Composite drsg >16<=48          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6205...  ..................  P                   Composite drsg >48 sq in        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6206...  ..................  P                   Contact layer <=16 sq in        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6207...  ..................  P                   Contact layer >16<=48 sq        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   in.
A6208...  ..................  P                   Contact layer >48 sq in.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6209...  ..................  P                   Foam drsg <=16 sq in w/o        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6210...  ..................  P                   Foam drg >16<=48 sq in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6211...  ..................  P                   Foam drg >48 sq in w/o          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   brdr.
A6212...  ..................  P                   Foam drg <=16 sq in w/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   border.
A6213...  ..................  P                   Foam drg >16<=48 sq in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6214...  ..................  P                   Foam drg >48 sq in w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   border.
A6215...  ..................  P                   Foam dressing wound             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   filler.
A6216...  ..................  P                   Non-sterile gauze <=16          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6217...  ..................  P                   Non-sterile gauze               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   >16<=48 sq.
A6218...  ..................  P                   Non-sterile gauze >48 sq        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   in.
A6219...  ..................  P                   Gauze <=16 sq in w/             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   border.
A6220...  ..................  P                   Gauze >16 <=48 sq in w/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bordr.
A6221...  ..................  P                   Gauze >48 sq in w/border        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6222...  ..................  P                   Gauze <=16 in no w/sal w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6223...  ..................  P                   Gauze >16 <=48 no w/sal         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   w/o b.
A6224...  ..................  P                   Gauze >48 in no w/sal w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6228...  ..................  P                   Gauze <=16 sq in water/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sal.
A6229...  ..................  P                   Gauze >16 <=48 sq in            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   watr/sal.

[[Page 59231]]


A6230...  ..................  P                   Gauze >48 sq in water/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   salne.
A6234...  ..................  P                   Hydrocolld drg <=16 w/o         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6235...  ..................  P                   Hydrocolld drg >16 <=48         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   w/o b.
A6236...  ..................  P                   Hydrocolld drg >48 in w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6237...  ..................  P                   Hydrocolld drg <=16 in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6238...  ..................  P                   Hydrocolld drg >16<=48 w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6239...  ..................  P                   Hydrocolld drg >48 in w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6240...  ..................  P                   Hydrocolld drg filler           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   paste.
A6241...  ..................  P                   Hydrocolloid drg filler         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dry.
A6242...  ..................  P                   Hydrogel drg <=16 in w/o        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6243...  ..................  P                   Hydrogel drg >16<=48 w/o        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6244...  ..................  P                   Hydrogel drg >48 in w/o         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6245...  ..................  P                   Hydrogel drg <=16 in w/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6246...  ..................  P                   Hydrogel drg ><ls-thn-          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eq>16 <=48 in w/b.
A6247...  ..................  P                   Hydrogel drg >48 sq in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   b.
A6248...  ..................  P                   Hydrogel drsg gel filler        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6250...  ..................  P                   Skin seal protect               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   moisturizr.
A6251...  ..................  P                   Absorpt drg <=16 sq in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6252...  ..................  P                   Absorpt drg >16 <=48 w/o        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6253...  ..................  P                   Absorpt drg >48 sq in w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   o b.
A6254...  ..................  P                   Absorpt drg <=16 sq in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6255...  ..................  P                   Absorpt drg >16<=48 in w/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6256...  ..................  P                   Absorpt drg >48 sq in w/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bdr.
A6257...  ..................  P                   Transparent film <= 16          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6258...  ..................  P                   Transparent film >16<=48        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   in.
A6259...  ..................  P                   Transparent film >48 sq         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   in.
A6260...  ..................  P                   Wound cleanser any type/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   size.
A6261...  ..................  P                   Wound filler gel/paste/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   oz.
A6262...  ..................  P                   Wound filler dry form/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gram.
A6263...  ..................  P                   Non-sterile elastic             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gauze/yd.
A6264...  ..................  P                   Non-sterile no elastic          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gauze.
A6265...  ..................  P                   Tape per 18 sq inches...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6266...  ..................  P                   Impreg gauze no h20/sal/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   yard.
A6402...  ..................  P                   Sterile gauze <=16 sq in        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6403...  ..................  P                   Sterile gauze >16 <=48          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sq in.
A6404...  ..................  P                   Sterile gauze >48 sq in.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6405...  ..................  P                   Sterile elastic gauze/yd        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A6406...  ..................  P                   Sterile non-elastic             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gauze/yd.
A9150...  ..................  E                   Misc/exper non-prescript        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dru.
A9160...  ..................  N                   Podiatrist non-covered          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   servi.
A9170...  ..................  N                   Chiropractor non-covered        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ser.
A9190...  ..................  N                   Misc/expe personal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   comfort i.
A9270...  ..................  N                   Non-covered item or             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   service.
A9300...  ..................  N                   Exercise equipment......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
A9500...  ..................  E                   Technetium TC 99m               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sestamibi.
A9502...  ..................  X                   Technetium TC99M                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tetrofosmin.
A9503...  ..................  E                   Technetium TC 99m               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   medronate.
A9505...  ..................  E                   Thallous chloride TL 201/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mci.
A9600...  ..................  X                   Strontium-89 chloride...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0120...  ..................  N                   Periodic oral evaluation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0140...  ..................  N                   Limit oral eval problm          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   focus.
D0150...  ..................  R                   Comprehensve oral               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   evaluation.
D0160...  ..................  N                   Extensv oral eval prob          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   focus.
D0210...  ..................  I                   Intraor complete film           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   series.
D0220...  ..................  I                   Intraoral periapical            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   first f.
D0230...  ..................  I                   Intraoral periapical ea         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   add.
D0240...  ..................  R                   Intraoral occlusal film.        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D0250...  ..................  R                   Extraoral first film....        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D0260...  ..................  R                   Extraoral ea additional         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   film.
D0270...  ..................  R                   Dental bitewing single          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   film.
D0272...  ..................  R                   Dental bitewings two            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   films.
D0274...  ..................  R                   Dental bitewings four           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   films.
D0290...  ..................  I                   Dental film skull/facial        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bon.
D0310...  ..................  I                   Dental saliography......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0320...  ..................  I                   Dental tmj arthrogram           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   incl i.
D0321...  ..................  I                   Dental other tmj films..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0322...  ..................  I                   Dental tomographic              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   survey.
D0330...  ..................  I                   Dental panoramic film...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0340...  ..................  I                   Dental cephalometric            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   film.
D0415...  ..................  N                   Bacteriologic study.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0425...  ..................  N                   Caries susceptibility           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
D0460...  ..................  R                   Pulp vitality test......        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D0470...  ..................  N                   Diagnostic casts........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D0471...  ..................  R                   Diagnostic photographs..        0.00       0.00       0.00       0.00       0.00       0.00        YYY

[[Page 59232]]


D0501...  ..................  R                   Histopathologic                 0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   examinations.
D0502...  ..................  R                   Other oral pathology            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   procedu.
D0999...  ..................  R                   Unspecified diagnostic          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   proce.
D1110...  ..................  N                   Dental prophylaxis adult        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D1120...  ..................  N                   Dental prophylaxis child        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D1201...  ..................  N                   Topical fluor w prophy          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   child.
D1203...  ..................  N                   Topical fluor w/o prophy        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chi.
D1204...  ..................  N                   Topical fluor w/o prophy        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   adu.
D1205...  ..................  N                   Topical fluoride w/             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prophy a.
D1310...  ..................  N                   Nutri counsel-control           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   caries.
D1320...  ..................  N                   Tobacco counseling......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D1330...  ..................  N                   Oral hygiene instruction        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D1351...  ..................  N                   Dental sealant per tooth        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D1510...  ..................  R                   Space maintainer fxd            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   unilat.
D1515...  ..................  R                   Fixed bilat space               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   maintainer.
D1520...  ..................  R                   Remove unilat space             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   maintainer.
D1525...  ..................  R                   Remove bilat space              0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   maintainer.
D1550...  ..................  R                   Recement space                  0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   maintainer.
D2110...  ..................  N                   Amalgam one surface             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2120...  ..................  N                   Amalgam two surfaces            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2130...  ..................  N                   Amalgam three surfaces          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2131...  ..................  N                   Amalgam four/more surf          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2140...  ..................  N                   Amalgam one surface             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2150...  ..................  N                   Amalgam two surfaces            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2160...  ..................  N                   Amalgam three surfaces          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2161...  ..................  N                   Amalgam 4 or > surfaces         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2210...  ..................  N                   Silicate cement per             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   restorat.
D2330...  ..................  N                   Resin one surface-              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anterior.
D2331...  ..................  N                   Resin two surfaces-             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anterior.
D2332...  ..................  N                   Resin three surfaces-           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anterior.
D2335...  ..................  N                   Resin 4/> surf or w             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   incis an.
D2336...  ..................  N                   Composite resin crown...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2380...  ..................  N                   Resin one surf poster           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2381...  ..................  N                   Resin two surf poster           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D2382...  ..................  N                   Resin three/more surf           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   post p.
D2385...  ..................  N                   Resin one surf poster           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2386...  ..................  N                   Resin two surf poster           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permanent.
D2387...  ..................  N                   Resin three/more surf           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   post p.
D2410...  ..................  N                   Dental gold foil one            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2420...  ..................  N                   Dental gold foil two            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2430...  ..................  N                   Dental gold foil three          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2510...  ..................  N                   Dental inlay metallic 1         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surface.
D2520...  ..................  N                   Dental inlay metallic 2         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2530...  ..................  N                   Dental inlay metl 3/more        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2543...  ..................  N                   Dental onlay metallic 3         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surf.
D2544...  ..................  N                   Dental onlay metl 4/more        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2610...  ..................  N                   Inlay porcelain/ceramic         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1 su.
D2620...  ..................  N                   Inlay porcelain/ceramic         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2 su.
D2630...  ..................  N                   Dental onlay porc 3/more        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2642...  ..................  N                   Dental onlay porcelin 2         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surf.
D2643...  ..................  N                   Dental onlay porcelin 3         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surf.
D2644...  ..................  N                   Dental onlay porc 4/more        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2650...  ..................  N                   Inlay composite/resin           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   one su.
D2651...  ..................  N                   Inlay composite/resin           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   two su.
D2652...  ..................  N                   Dental inlay resin 3/mre        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2662...  ..................  N                   Dental onlay resin 2            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2663...  ..................  N                   Dental onlay resin 3            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D2664...  ..................  N                   Dental onlay resin 4/mre        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sur.
D2710...  ..................  N                   Crown resin laboratory..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2720...  ..................  N                   Crown resin w/high noble        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   me.
D2721...  ..................  N                   Crown resin w/base metal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2722...  ..................  N                   Crown resin w/noble             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D2740...  ..................  N                   Crown porcelain/ceramic         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   subs.
D2750...  ..................  N                   Crown porcelain w/h             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noble m.
D2751...  ..................  N                   Crown porcelain fused           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   base m.
D2752...  ..................  N                   Crown porcelain w/noble         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   met.
D2790...  ..................  N                   Crown full cast high            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noble m.
D2791...  ..................  N                   Crown full cast base            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D2792...  ..................  N                   Crown full cast noble           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D2810...  ..................  N                   Crown 3/4 cast metallic.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2910...  ..................  N                   Dental recement inlay...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2920...  ..................  N                   Dental recement crown...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2930...  ..................  N                   Prefab stnlss steel crwn        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pri.
D2931...  ..................  N                   Prefab stnlss steel             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   crown pe.

[[Page 59233]]


D2932...  ..................  N                   Prefabricated resin             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   crown.
D2933...  ..................  N                   Prefab stainless steel          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   crown.
D2940...  ..................  N                   Dental sedative filling.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2950...  ..................  N                   Core build-up incl any          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   pins.
D2951...  ..................  N                   Tooth pin retention.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2952...  ..................  N                   Post and core cast +            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   crown.
D2954...  ..................  N                   Prefab post/core + crown        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2955...  ..................  N                   Post removal............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2960...  ..................  N                   Laminate labial veneer..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2961...  ..................  N                   Lab labial veneer resin.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2962...  ..................  N                   Lab labial veneer               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   porcelain.
D2970...  ..................  R                   Temporary--fractured            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   tooth.
D2980...  ..................  N                   Crown repair............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D2999...  ..................  R                   Dental unspec                   0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   restorative pr.
D3110...  ..................  N                   Pulp cap direct.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3120...  ..................  N                   Pulp cap indirect.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3220...  ..................  N                   Therapeutic pulpotomy...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3230...  ..................  N                   Pulpal therapy anterior         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prim.
D3240...  ..................  N                   Pulpal therapy posterior        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prim.
D3310...  ..................  N                   Anterior................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3320...  ..................  N                   Root canal therapy 2            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   canals.
D3330...  ..................  N                   Root canal therapy 3            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   canals.
D3346...  ..................  N                   Retreat root canal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anterior.
D3347...  ..................  N                   Retreat root canal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bicuspid.
D3348...  ..................  N                   Retreat root canal molar        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3351...  ..................  N                   Apexification/recalc            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   initial.
D3352...  ..................  N                   Apexification/recalc            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   interim.
D3353...  ..................  N                   Apexification/recalc            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   final.
D3410...  ..................  N                   Apicoect/perirad surg           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anter.
D3421...  ..................  N                   Root surgery bicuspid...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3425...  ..................  N                   Root surgery molar......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3426...  ..................  N                   Root surgery ea add root        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3430...  ..................  N                   Retrograde filling......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3450...  ..................  N                   Root amputation.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3460...  ..................  R                   Endodontic endosseous           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   implant.
D3470...  ..................  N                   Intentional replantation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3910...  ..................  N                   Isolation-tooth w rubb          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dam.
D3920...  ..................  N                   Tooth splitting.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D3950...  ..................  N                   Canal prep/fitting of           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dowel.
D3960...  ..................  N                   Bleaching of discolored         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tooth.
D3999...  ..................  R                   Endodontic procedure....        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D4210...  ..................  I                   Gingivectomy/plasty per         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quad.
D4211...  ..................  I                   Gingivectomy/plasty per         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tooth.
D4220...  ..................  N                   Gingival curettage per          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   quadr.
D4240...  ..................  N                   Gingival flap proc w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   planing.
D4249...  ..................  N                   Crown lengthen hard             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tissue.
D4250...  ..................  R                   Mucogingival surg per           0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   quadra.
D4260...  ..................  R                   Osseous surgery per             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   quadrant.
D4263...  ..................  R                   Bone replce graft first         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   site.
D4264...  ..................  R                   Bone replce graft each          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   add.
D4266...  ..................  N                   Guided tiss regen               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   resorble.
D4267...  ..................  N                   Guided tiss regen               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   nonresorb.
D4270...  ..................  R                   Pedicle soft tissue             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   graft pr.
D4271...  ..................  R                   Free soft tissue graft          0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   proc.
D4273...  ..................  R                   Subepithelial tissue            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   graft.
D4274...  ..................  N                   Distal/proximal wedge           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   proc.
D4320...  ..................  N                   Provision splnt                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   intracoronal.
D4321...  ..................  N                   Provisional splint              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   extracoro.
D4341...  ..................  N                   Periodontal scaling &           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   root.
D4355...  ..................  R                   Full mouth debridement..        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D4381...  ..................  R                   Localized chemo delivery        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D4910...  ..................  N                   Periodontal maint               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   procedures.
D4920...  ..................  N                   Unscheduled dressing            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   change.
D4999...  ..................  N                   Unspecified periodontal         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   proc.
D5110...  ..................  N                   Dentures complete               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxillary.
D5120...  ..................  N                   Dentures complete               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandible.
D5130...  ..................  N                   Dentures immediat               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxillary.
D5140...  ..................  N                   Dentures immediat               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandible.
D5211...  ..................  N                   Dentures maxill part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   resin.
D5212...  ..................  N                   Dentures mand part resin        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5213...  ..................  N                   Dentures maxill part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D5214...  ..................  N                   Dentures mandibl part           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D5281...  ..................  N                   Removable partial               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   denture.
D5410...  ..................  N                   Dentures adjust cmplt           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxil.

[[Page 59234]]


D5411...  ..................  N                   Dentures adjust cmplt           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mand.
D5421...  ..................  N                   Dentures adjust part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxill.
D5422...  ..................  N                   Dentures adjust part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandbl.
D5510...  ..................  N                   Dentur repr broken compl        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bas.
D5520...  ..................  N                   Replace denture teeth           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   complt.
D5610...  ..................  N                   Dentures repair resin           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   base.
D5620...  ..................  N                   Rep part denture cast           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   frame.
D5630...  ..................  N                   Rep partial denture             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   clasp.
D5640...  ..................  N                   Replace part denture            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   teeth.
D5650...  ..................  N                   Add tooth to partial            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   denture.
D5660...  ..................  N                   Add clasp to partial            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   denture.
D5710...  ..................  N                   Dentures rebase cmplt           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxil.
D5711...  ..................  N                   Dentures rebase cmplt           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mand.
D5720...  ..................  N                   Dentures rebase part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxill.
D5721...  ..................  N                   Dentures rebase part            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandbl.
D5730...  ..................  N                   Denture reln cmplt maxil        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ch.
D5731...  ..................  N                   Denture reln cmplt mand         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chr.
D5740...  ..................  N                   Denture reln part maxil         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chr.
D5741...  ..................  N                   Denture reln part mand          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chr.
D5750...  ..................  N                   Denture reln cmplt max          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lab.
D5751...  ..................  N                   Denture reln cmplt mand         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lab.
D5760...  ..................  N                   Denture reln part maxil         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lab.
D5761...  ..................  N                   Denture reln part mand          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lab.
D5810...  ..................  N                   Denture interm cmplt            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxill.
D5811...  ..................  N                   Denture interm cmplt            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandbl.
D5820...  ..................  N                   Denture interm part             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxill.
D5821...  ..................  N                   Denture interm part             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandbl.
D5850...  ..................  N                   Denture tiss conditn            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxill.
D5851...  ..................  N                   Denture tiss condtin            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandbl.
D5860...  ..................  N                   Overdenture complete....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5861...  ..................  N                   Overdenture partial.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5862...  ..................  N                   Precision attachment....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5899...  ..................  N                   Removable prosthodontic         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   proc.
D5911...  ..................  R                   Facial moulage sectional        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5912...  ..................  R                   Facial moulage complete.        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5913...  ..................  I                   Nasal prosthesis........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5914...  ..................  I                   Auricular prosthesis....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5915...  ..................  I                   Orbital prosthesis......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5916...  ..................  I                   Ocular prosthesis.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5919...  ..................  I                   Facial prosthesis.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5922...  ..................  I                   Nasal septal prosthesis.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5923...  ..................  I                   Ocular prosthesis               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   interim.
D5924...  ..................  I                   Cranial prosthesis......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5925...  ..................  I                   Facial augmentation             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implant.
D5926...  ..................  I                   Replacement nasal               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prosthesis.
D5927...  ..................  I                   Auricular replacement...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5928...  ..................  I                   Orbital replacement.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5929...  ..................  I                   Facial replacement......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5931...  ..................  I                   Surgical obturator......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5932...  ..................  I                   Postsurgical obturator..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5933...  ..................  I                   Refitting of obturator..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5934...  ..................  I                   Mandibular flange               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prosthesis.
D5935...  ..................  I                   Mandibular denture              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prosth.
D5936...  ..................  I                   Temp obturator                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prosthesis.
D5937...  ..................  I                   Trismus appliance.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5951...  ..................  R                   Feeding aid.............        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5952...  ..................  I                   Pediatric speech aid....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5953...  ..................  I                   Adult speech aid........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5954...  ..................  I                   Superimposed prosthesis.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5955...  ..................  I                   Palatal lift prosthesis.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5958...  ..................  I                   Intraoral con def inter         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   plt.
D5959...  ..................  I                   Intraoral con def mod           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   palat.
D5960...  ..................  I                   Modify speech aid               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prosthesis.
D5982...  ..................  I                   Surgical stent..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5983...  ..................  R                   Radiation applicator....        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5984...  ..................  R                   Radiation shield........        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5985...  ..................  R                   Radiation cone locator..        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5986...  ..................  N                   Fluoride applicator.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5987...  ..................  R                   Commissure splint.......        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D5988...  ..................  I                   Surgical splint.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D5999...  ..................  I                   Maxillofacial prosthesis        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6010...  ..................  I                   Odontics endosteal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implant.
D6020...  ..................  I                   Odontics abutment               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   placement.
D6040...  ..................  I                   Odontics eposteal               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implant.

[[Page 59235]]


D6050...  ..................  I                   Odontics transosteal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implnt.
D6055...  ..................  I                   Implant connecting bar..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6080...  ..................  I                   Implant maintenance.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6090...  ..................  I                   Repair implant..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6095...  ..................  I                   Odontics repr abutment..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6100...  ..................  I                   Removal of implant......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6199...  ..................  I                   Implant procedure.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6210...  ..................  N                   Prosthodont high noble          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6211...  ..................  N                   Bridge base metal cast..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6212...  ..................  N                   Bridge noble metal cast.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6240...  ..................  N                   Bridge porcelain high           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noble.
D6241...  ..................  N                   Bridge porcelain base           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6242...  ..................  N                   Bridge porcelain nobel          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6250...  ..................  N                   Bridge resin w/high             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noble.
D6251...  ..................  N                   Bridge resin base metal.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6252...  ..................  N                   Bridge resin w/noble            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6520...  ..................  N                   Dental retainer two             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surfaces.
D6530...  ..................  N                   Retainer metallic 3+            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surface.
D6543...  ..................  N                   Dental retainr onlay 3          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surf.
D6544...  ..................  N                   Dental retainr onlay 4/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   more.
D6545...  ..................  N                   Dental retainr cast metl        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6720...  ..................  N                   Retain crown resin w hi         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   nble.
D6721...  ..................  N                   Crown resin w/base metal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6722...  ..................  N                   Crown resin w/noble             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6750...  ..................  N                   Crown porcelain high            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noble.
D6751...  ..................  N                   Crown porcelain base            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6752...  ..................  N                   Crown porcelain noble           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6780...  ..................  N                   Crown 3/4 high noble            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6790...  ..................  N                   Crown full high noble           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   metal.
D6791...  ..................  N                   Crown full base metal           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cast.
D6792...  ..................  N                   Crown full noble metal          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cast.
D6920...  ..................  R                   Dental connector bar....        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D6930...  ..................  N                   Dental recement bridge..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6940...  ..................  N                   Stress breaker..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6950...  ..................  N                   Precision attachment....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6970...  ..................  N                   Post & core plus                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   retainer.
D6971...  ..................  N                   Cast post bridge                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   retainer.
D6972...  ..................  N                   Prefab post & core plus         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   reta.
D6973...  ..................  N                   Core build up for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   retainer.
D6975...  ..................  N                   Coping metal............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6980...  ..................  N                   Bridge repair...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D6999...  ..................  N                   Fixed prosthodontic proc        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7110...  ..................  R                   Oral surgery single             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   tooth.
D7120...  ..................  R                   Each add tooth                  0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   extraction.
D7130...  ..................  R                   Tooth root removal......        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7210...  ..................  R                   Rem imp tooth w mucoper         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   flp.
D7220...  ..................  R                   Impact tooth remov soft         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   tiss.
D7230...  ..................  R                   Impact tooth remov part         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   bony.
D7240...  ..................  R                   Impact tooth remov comp         0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   bony.
D7241...  ..................  R                   Impact tooth rem bony w/        0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   comp.
D7250...  ..................  R                   Tooth root removal......        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7260...  ..................  R                   Oral antral fistula             0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   closure.
D7270...  ..................  N                   Tooth reimplantation....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7272...  ..................  N                   Tooth transplantation...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7280...  ..................  N                   Exposure impact tooth           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   orthod.
D7281...  ..................  N                   Exposure tooth aid              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eruption.
D7285...  ..................  I                   Biopsy of oral tissue           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hard.
D7286...  ..................  I                   Biopsy of oral tissue           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   soft.
D7290...  ..................  N                   Repositioning of teeth..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7291...  ..................  R                   Transseptal fiberotomy..        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D7310...  ..................  I                   Alveoplasty w/extraction        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7320...  ..................  I                   Alveoplasty w/o                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   extraction.
D7340...  ..................  I                   Vestibuloplasty ridge           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   extens.
D7350...  ..................  I                   Vestibuloplasty exten           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   graft.
D7410...  ..................  I                   Rad exc lesion up to            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1.25 cm.
D7420...  ..................  I                   Lesion >1.25 cm.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7430...  ..................  I                   Exc benign tumor to 1.25        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7431...  ..................  I                   Benign tumor exc >1.25          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7440...  ..................  I                   Malig tumor exc to 1.25         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7441...  ..................  I                   Malig tumor >1.25 cm....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7450...  ..................  I                   Rem odontogen cyst to           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1.25cm.
D7451...  ..................  I                   Rem odontogen cyst >1.25        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7460...  ..................  I                   Rem nonodonto cyst to           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1.25cm.
D7461...  ..................  I                   Rem nonodonto cyst >1.25        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.

[[Page 59236]]


D7465...  ..................  I                   Lesion destruction......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7470...  ..................  I                   Rem exostosis maxilla/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandib.
D7480...  ..................  I                   Partial ostectomy.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7490...  ..................  I                   Mandible resection......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7510...  ..................  I                   I&d absc intraoral soft         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tiss.
D7520...  ..................  I                   I&d abscess extraoral...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7530...  ..................  I                   Removal fb skin/areolar         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tiss.
D7540...  ..................  I                   Removal of fb reaction..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7550...  ..................  I                   Removal of sloughed off         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bone.
D7560...  ..................  I                   Maxillary sinusotomy....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7610...  ..................  I                   Maxilla open reduct             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   simple.
D7620...  ..................  I                   Clsd reduct simpl               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxilla fx.
D7630...  ..................  I                   Open red simpl mandible         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fx.
D7640...  ..................  I                   Clsd red simpl mandible         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fx.
D7650...  ..................  I                   Open red simp malar/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   zygom fx.
D7660...  ..................  I                   Clsd red simp malar/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   zygom fx.
D7670...  ..................  I                   Open red simple alveolus        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fx.
D7680...  ..................  I                   Reduct simple facial            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bone fx.
D7710...  ..................  I                   Maxilla open reduct             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   compound.
D7720...  ..................  I                   Clsd reduct compd               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   maxilla fx.
D7730...  ..................  I                   Open reduct compd               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandble fx.
D7740...  ..................  I                   Clsd reduct compd               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandble fx.
D7750...  ..................  I                   Open red comp malar/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   zygma fx.
D7760...  ..................  I                   Clsd red comp malar/            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   zygma fx.
D7770...  ..................  I                   Open reduc compd                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   alveolus fx.
D7780...  ..................  I                   Reduct compnd facial            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bone fx.
D7810...  ..................  I                   Tmj open reduct-                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   dislocation.
D7820...  ..................  I                   Closed tmp manipulation.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7830...  ..................  I                   Tmj manipulation under          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anest.
D7840...  ..................  I                   Removal of tmj condyle..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7850...  ..................  I                   Tmj meniscectomy........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7852...  ..................  I                   Tmj repair of joint disc        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7854...  ..................  I                   Tmj excisn of joint             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   membrane.
D7856...  ..................  I                   Tmj cutting of a muscle.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7858...  ..................  I                   Tmj reconstruction......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7860...  ..................  I                   Tmj cutting into joint..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7865...  ..................  I                   Tmj reshaping components        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7870...  ..................  I                   Tmj aspiration joint            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fluid.
D7872...  ..................  I                   Tmj diagnostic                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   arthroscopy.
D7873...  ..................  I                   Tmj arthroscopy lysis           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   adhesn.
D7874...  ..................  I                   Tmj arthroscopy disc            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   reposit.
D7875...  ..................  I                   Tmj arthroscopy                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   synovectomy.
D7876...  ..................  I                   Tmj arthroscopy                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   discectomy.
D7877...  ..................  I                   Tmj arthroscopy                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   debridement.
D7880...  ..................  I                   Occlusal orthotic               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   appliance.
D7899...  ..................  I                   Tmj unspecified therapy.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7910...  ..................  I                   Dent sutur recent wnd to        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   5cm.
D7911...  ..................  I                   Dental suture wound to 5        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7912...  ..................  I                   Suture complicate wnd >5        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   cm.
D7920...  ..................  I                   Dental skin graft.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7940...  ..................  R                   Reshaping bone                  0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   orthognathic.
D7941...  ..................  I                   Bone cutting ramus              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   closed.
D7942...  ..................  I                   Bone cutting ramus open.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7943...  ..................  I                   Cutting ramus open w/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   graft.
D7944...  ..................  I                   Bone cutting segmented..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7945...  ..................  I                   Bone cutting body               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mandible.
D7946...  ..................  I                   Reconstruction maxilla          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   total.
D7947...  ..................  I                   Reconstruct maxilla             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   segment.
D7948...  ..................  I                   Reconstruct midface no          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   graft.
D7949...  ..................  I                   Reconstruct midface w/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   graft.
D7950...  ..................  I                   Mandible graft..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7955...  ..................  I                   Repair maxillofacial            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   defects.
D7960...  ..................  I                   Frenulectomy/frenulotomy        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7970...  ..................  I                   Excision hyperplastic           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tissue.
D7971...  ..................  I                   Excision pericoronal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gingiva.
D7980...  ..................  I                   Sialolithotomy..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7981...  ..................  I                   Excision of salivary            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gland.
D7982...  ..................  I                   Sialodochoplasty........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7983...  ..................  I                   Closure of salivary             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fistula.
D7990...  ..................  I                   Emergency tracheotomy...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7991...  ..................  I                   Dental coronoidectomy...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D7995...  ..................  I                   Synthetic graft facial          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bones.
D7996...  ..................  I                   Implant mandible for            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   augment.
D7999...  ..................  I                   Oral surgery procedure..        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59237]]


D8010...  ..................  N                   Limited dental tx               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D8020...  ..................  N                   Limited dental tx               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transition.
D8030...  ..................  N                   Limited dental tx               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   adolescent.
D8040...  ..................  N                   Limited dental tx adult.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D8050...  ..................  N                   Intercep dental tx              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   primary.
D8060...  ..................  N                   Intercep dental tx              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transitn.
D8070...  ..................  N                   Compre dental tx                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transition.
D8080...  ..................  N                   Compre dental tx                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   adolescent.
D8090...  ..................  N                   Compre dental tx adult..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D8210...  ..................  N                   Orthodontic rem                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   appliance tx.
D8220...  ..................  N                   Fixed appliance therapy         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   habt.
D8660...  ..................  N                   Preorthodontic tx visit.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D8670...  ..................  N                   Periodic orthodontc tx          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   visit.
D8680...  ..................  N                   Orthodontic retention...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D8690...  ..................  N                   Orthodontic treatment...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D8999...  ..................  N                   Orthodontic procedure...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9110...  ..................  R                   Tx dental pain minor            0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   proc.
D9210...  ..................  I                   Dent anesthesia w/o             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   surgery.
D9211...  ..................  I                   Regional block                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anesthesia.
D9212...  ..................  I                   Trigeminal block                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   anesthesia.
D9215...  ..................  I                   Local anesthesia........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9220...  ..................  I                   General anesthesia......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9221...  ..................  I                   General anesthesia ea ad        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   15m.
D9230...  ..................  R                   Analgesia...............        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9240...  ..................  I                   Intravenous sedation....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9310...  ..................  I                   Dental consultation.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9410...  ..................  I                   Dental house call.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9420...  ..................  I                   Hospital call...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9430...  ..................  I                   Office visit during             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hours.
D9440...  ..................  I                   Office visit after hours        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9610...  ..................  I                   Dent therapeutic drug           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inject.
D9630...  ..................  R                   Other drugs/medicaments.        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9910...  ..................  N                   Dent appl desensitizing         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   med.
D9920...  ..................  N                   Behavior management.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9930...  ..................  R                   Treatment of                    0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   complications.
D9940...  ..................  R                   Dental occlusal guard...        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9941...  ..................  N                   Fabrication athletic            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   guard.
D9950...  ..................  R                   Occlusion analysis......        0.00       0.00       0.00       0.00       0.00       0.00        YYY
D9951...  ..................  R                   Limited occlusal                0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   adjustment.
D9952...  ..................  R                   Complete occlusal               0.00       0.00       0.00       0.00       0.00       0.00        YYY
                                                   adjustment.
D9970...  ..................  N                   Enamel microabrasion....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
D9999...  ..................  I                   Adjunctive procedure....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0001...  ..................  X                   Drawing blood for               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   specimen.
G0002...  ..................  A                   Temporary urinary               0.50       0.70       0.70       0.02       1.22       1.22        000
                                                   catheter.
G0004...  ..................  A                   ECG transm phys review &        0.52       7.31       7.31       0.65       8.48       8.48        XXX
                                                   int.
G0005...  ..................  A                   ECG 24 hour recording...        0.00       1.18       1.18       0.09       1.27       1.27        XXX
G0006...  ..................  A                   ECG transmission &              0.00       5.73       5.73       0.51       6.24       6.24        XXX
                                                   analysis.
G0007...  ..................  A                   ECG phy review &                0.52       0.40       0.40       0.05       0.97       0.97        XXX
                                                   interpret.
G0008...  ..................  X                   Admin influenza virus           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vac.
G0009...  ..................  X                   Admin pneumococcal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vaccine.
G0010...  ..................  X                   Admin hepatitis b               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vaccine.
G0015...  ..................  A                   Post symptom ECG tracing        0.00       5.73       5.73       0.51       6.24       6.24        XXX
G0016...  ..................  A                   Post symptom ECG md             0.52       0.40       0.40       0.05       0.97       0.97        XXX
                                                   review.
G0025...  ..................  A                   Collagen skin test kit..        0.00       0.95       0.95       0.00       0.95       0.95        XXX
G0026...  ..................  X                   Fecal leukocyte                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   examination.
G0027...  ..................  X                   Semen analysis..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0030...  ..................  C                   PET imaging prev PET            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   single.
G0030...  TC                  C                   PET imaging prev PET            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   single.
G0030...  26                  A                   PET imaging prev PET            1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   single.
G0031...  ..................  C                   PET imaging prev PET            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   multple.
G0031...  TC                  C                   PET imaging prev PET            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   multple.
G0031...  26                  A                   PET imaging prev PET            1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   multple.
G0032...  ..................  C                   PET follow SPECT 78464          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0032...  TC                  C                   PET follow SPECT 78464          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0032...  26                  A                   PET follow SPECT 78464          1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   singl.
G0033...  ..................  C                   PET follow SPECT 78464          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0033...  TC                  C                   PET follow SPECT 78464          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0033...  26                  A                   PET follow SPECT 78464          1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0034...  ..................  C                   PET follow SPECT 76865          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0034...  TC                  C                   PET follow SPECT 76865          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0034...  26                  A                   PET follow SPECT 76865          1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   singl.
G0035...  ..................  C                   PET follow SPECT 78465          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0035...  TC                  C                   PET follow SPECT 78465          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0035...  26                  A                   PET follow SPECT 78465          1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.

[[Page 59238]]


G0036...  ..................  C                   PET follow cornry angio         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0036...  TC                  C                   PET follow cornry angio         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0036...  26                  A                   PET follow cornry angio         1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   sing.
G0037...  ..................  C                   PET follow cornry angio         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0037...  TC                  C                   PET follow cornry angio         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0037...  26                  A                   PET follow cornry angio         1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0038...  ..................  C                   PET follow myocard perf         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0038...  TC                  C                   PET follow myocard perf         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0038...  26                  A                   PET follow myocard perf         1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   sing.
G0039...  ..................  C                   PET follow myocard perf         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0039...  TC                  C                   PET follow myocard perf         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0039...  26                  A                   PET follow myocard perf         1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0040...  ..................  C                   PET follow stress echo          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0040...  TC                  C                   PET follow stress echo          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0040...  26                  A                   PET follow stress echo          1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   singl.
G0041...  ..................  C                   PET follow stress echo          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0041...  TC                  C                   PET follow stress echo          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0041...  26                  A                   PET follow stress echo          1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0042...  ..................  C                   PET follow ventriculogm         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0042...  TC                  C                   PET follow ventriculogm         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
G0042...  26                  A                   PET follow ventriculogm         1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   sing.
G0043...  ..................  C                   PET follow ventriculogm         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0043...  TC                  C                   PET follow ventriculogm         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0043...  26                  A                   PET follow ventriculogm         1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0044...  ..................  C                   PET following rest ECG          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0044...  TC                  C                   PET following rest ECG          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0044...  26                  A                   PET following rest ECG          1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   singl.
G0045...  ..................  C                   PET following rest ECG          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0045...  TC                  C                   PET following rest ECG          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0045...  26                  A                   PET following rest ECG          1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0046...  ..................  C                   PET follow stress ECG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0046...  TC                  C                   PET follow stress ECG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
G0046...  26                  A                   PET follow stress ECG           1.50       0.48       0.48       0.07       2.05       2.05        XXX
                                                   singl.
G0047...  ..................  C                   PET follow stress ECG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0047...  TC                  C                   PET follow stress ECG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
G0047...  26                  A                   PET follow stress ECG           1.87       0.65       0.65       0.10       2.62       2.62        XXX
                                                   mult.
G0050...  ..................  A                   Residual urine by               0.00       0.81       0.81       0.05       0.86       0.86        XXX
                                                   ultrasound.
G0051...  ..................  D                   Destroy benign/premal          *0.00       0.00       0.00       0.00       0.00       0.00        010
                                                   lesion.
G0052...  ..................  D                   Destruction of added            0.00       0.00       0.00       0.00       0.00       0.00        ZZZ
                                                   lesions.
G0053...  ..................  D                   Destruction of added           *0.00       0.00       0.00       0.00       0.00       0.00        010
                                                   lesions.
G0058...  ..................  D                   Auto multichannel 20            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tests.
G0059...  ..................  D                   Auto multichannel 21            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tests.
G0060...  ..................  D                   Auto multichannel 22            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tests.
G0062...  ..................  D                   peripheral bone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0062...  TC                  D                   peripheral bone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0062...  26                  D                   peripheral bone                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0063...  ..................  D                   central bone                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0063...  TC                  D                   central bone                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0063...  26                  D                   central bone                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   densitometry.
G0064...  ..................  D                   care plan oversight, hme        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hlth.
G0065...  ..................  D                   care plan oversight,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hospice.
G0066...  ..................  D                   care plan oversight nurs        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   fac.
G0071...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0072...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0073...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0074...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0075...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0076...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0077...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0078...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0079...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0080...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0081...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   no E/M.
G0082...  ..................  D                   Psychotherapy, office,          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wth E/M.
G0083...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0084...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.
G0085...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0086...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.
G0087...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0088...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.
G0089...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0090...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.
G0091...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0092...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.

[[Page 59239]]


G0093...  ..................  D                   Psychotherapy, inpt, no         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   E/M.
G0094...  ..................  D                   Psychotherapy, inpt,            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   with E/M.
G0100...  ..................  D                   HIV-1, viral load, quant        0.00       0.00       0.00       0.00       0.00       0.00        XXX
G0101...  ..................  A                   CA screen; pelvic/breast        0.45       0.28       0.28       0.02       0.75       0.75        XXX
                                                   exam.
G0104...  ..................  A                   CA screen; flexi                0.96       1.23      #1.06       0.12       2.31       2.14        000
                                                   sigmoidscope.
G0105...  ..................  A                   Colorectal scrn; hi risk        3.70       4.13      #4.07       0.39       8.22       8.16        000
                                                   ind.
G0106...  ..................  A                   Colon CA screen; barium         0.99       2.58       2.58       0.21       3.78       3.78        XXX
                                                   enema.
G0106...  TC                  A                   Colon CA screen; barium         0.00       2.13       2.13       0.14       2.27       2.27        XXX
                                                   enema.
G0106...  26                  A                   Colon CA screen; barium         0.99       0.45       0.45       0.07       1.51       1.51        XXX
                                                   enema.
G0107...  ..................  X                   CA screen; fecal blood          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
G0110...  ..................  R                   Nett pulm-rehab educ;           0.90       0.26       0.26       0.04       1.20       1.20        XXX
                                                   ind.
G0111...  ..................  R                   Nett pulm-rehab educ;           0.27       0.20       0.20       0.02       0.49       0.49        XXX
                                                   group.
G0112...  ..................  R                   Nett; nutrition guid,           1.72       0.97       0.97       0.10       2.79       2.79        XXX
                                                   initial.
G0113...  ..................  R                   Nett; nutrition guid,           1.29       0.77       0.77       0.09       2.15       2.15        XXX
                                                   subseqnt.
G0114...  ..................  R                   Nett; psychosocial              1.20       0.35       0.35       0.11       1.66       1.66        XXX
                                                   consult.
G0115...  ..................  R                   Nett; psychological             1.20       0.35       0.35       0.11       1.66       1.66        XXX
                                                   testing.
G0116...  ..................  A                   Nett; psychosocial              1.11       0.35       0.35       0.05       1.51       1.51        XXX
                                                   counsel.
G0120...  ..................  A                   Colon ca scrn; barium           0.99       2.58       2.58       0.21       3.78       3.78        XXX
                                                   enema.
G0120...  TC                  A                   Colon ca scrn; barium           0.00       2.13       2.13       0.14       2.27       2.27        XXX
                                                   enema.
G0120...  26                  A                   Colon ca scrn; barium           0.99       0.45       0.45       0.07       1.51       1.51        XXX
                                                   enema.
G0121...  ..................  N                   Colon ca scrn; barium          +3.70       4.13      #4.07       0.39       8.22       8.16        XXX
                                                   enema.
G0122...  ..................  N                   Colon ca scrn; barium          +0.99       2.58       2.58       0.21       3.78       3.78        XXX
                                                   enema.
G0122...  TC                  N                   Colon ca scrn; barium          +0.00       2.13       2.13       0.14       2.27       2.27        XXX
                                                   enema.
G0122...  26                  N                   Colon ca scrn; barium          +0.99       0.45       0.45       0.07       1.51       1.51        XXX
                                                   enema.
H5300...  ..................  D                   Occupational therapy....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0120...  ..................  E                   Tetracyclin injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0150...  ..................  E                   Injection adenosine 6 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0170...  ..................  E                   Adrenalin epinephrin            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inject.
J0190...  ..................  E                   Inj biperiden lactate/5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J0205...  ..................  E                   Alglucerase injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0207...  ..................  E                   Amifostine..............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0210...  ..................  E                   Methyldopate hcl                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0256...  ..................  E                   Alpha 1-proteinase 500          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J0270...  ..................  E                   Alprostadil for                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0280...  ..................  E                   Aminophyllin 250 MG inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0290...  ..................  E                   Ampicillin 500 MG inj...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0295...  ..................  E                   Ampicillin sodium per           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1.5 gm.
J0300...  ..................  E                   Amobarbital 125 MG inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0330...  ..................  E                   Succinycholine chloride         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0340...  ..................  E                   Nandrolon phenpropionate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0350...  ..................  E                   Injection anistreplase          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   30 u.
J0360...  ..................  E                   Hydralazine hcl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0380...  ..................  E                   Inj metaraminol                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bitartrate.
J0390...  ..................  E                   Chloroquine injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0400...  ..................  E                   Inj trimethaphan                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   camsylate.
J0460...  ..................  E                   Atropine sulfate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0470...  ..................  E                   Dimecaprol injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0475...  ..................  E                   Baclofen 10 MG injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0500...  ..................  E                   Dicyclomine injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0510...  ..................  E                   Benzquinamide injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0515...  ..................  E                   Inj benztropine mesylate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0520...  ..................  E                   Bethanechol chloride            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inject.
J0530...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0540...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0550...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0560...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0570...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0580...  ..................  E                   Penicillin g benzathine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0585...  ..................  E                   Botulinum toxin a per           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
J0590...  ..................  E                   Ethylnorepinephrine hcl         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0600...  ..................  E                   Edetate calcium disodium        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0610...  ..................  E                   Calcium gluconate               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0620...  ..................  E                   Calcium glycer & lact/10        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
J0630...  ..................  E                   Calcitonin salmon               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0635...  ..................  E                   Calcitriol injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0640...  ..................  E                   Leucovorin calcium              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0670...  ..................  E                   Inj mepivacaine HCL/10          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ml.
J0690...  ..................  E                   Cefazolin sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0694...  ..................  E                   Cefoxitin sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0695...  ..................  E                   Cefonocid sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0696...  ..................  E                   Ceftriaxone sodium              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0697...  ..................  E                   Sterile cefuroxime              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0698...  ..................  E                   Cefotaxime sodium               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0702...  ..................  E                   Betamethasone acet&sod          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phosp.

[[Page 59240]]


J0704...  ..................  E                   Betamethasone sod phosp/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4 MG.
J0710...  ..................  E                   Cephapirin sodium               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0713...  ..................  E                   Inj ceftazidime per 500         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J0715...  ..................  E                   Ceftizoxime sodium / 500        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J0720...  ..................  E                   Chloramphenicol sodium          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injec.
J0725...  ..................  E                   Chorionic gonadotropin/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1000u.
J0730...  ..................  E                   Chlorpheniramin maleate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0735...  ..................  E                   Clonidine hydrochloride.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0740...  ..................  E                   Cidofovir injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0743...  ..................  E                   Cilastatin sodium               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0745...  ..................  E                   Inj codeine phosphate /         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   30 MG.
J0760...  ..................  E                   Colchicine injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0770...  ..................  E                   Colistimethate sodium           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0780...  ..................  E                   Prochlorperazine                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J0800...  ..................  E                   Corticotropin injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0810...  ..................  E                   Cortisone injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J0835...  ..................  E                   Inj cosyntropin per 0.25        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J0850...  ..................  E                   Cytomegalovirus imm IV /        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vial.
J0895...  ..................  E                   Deferoxamine mesylate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0900...  ..................  E                   Testosterone enanthate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0945...  ..................  E                   Brompheniramine maleate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J0970...  ..................  E                   Estradiol valerate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1000...  ..................  E                   Depo-estradiol cypionate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1020...  ..................  E                   Methylprednisolone 20 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1030...  ..................  E                   Methylprednisolone 40 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1040...  ..................  E                   Methylprednisolone 80 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1050...  ..................  E                   Medroxyprogesterone inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1055...  ..................  N                   Medrxyprogester acetate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1060...  ..................  E                   Testosterone cypionate 1        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
J1070...  ..................  E                   Testosterone cypionat           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   100 MG.
J1080...  ..................  E                   Testosterone cypionat           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   200 MG.
J1090...  ..................  E                   Testosterone cypionate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   50 MG.
J1095...  ..................  E                   Inj dexamethasone               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   acetate.
J1100...  ..................  E                   Dexamethosone sodium            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phos.
J1110...  ..................  E                   Inj dihydroergotamine           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mesylt.
J1120...  ..................  E                   Acetazolamid sodium             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injectio.
J1160...  ..................  E                   Digoxin injection.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1165...  ..................  E                   Phenytoin sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1170...  ..................  E                   Hydromorphone injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1180...  ..................  E                   Dyphylline injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1190...  ..................  E                   Dexrazoxane HCl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1200...  ..................  E                   Diphenhydramine hcl             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injectio.
J1205...  ..................  E                   Chlorothiazide sodium           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1212...  ..................  E                   Dimethyl sulfoxide 50%          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   50 ML.
J1230...  ..................  E                   Methadone injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1240...  ..................  E                   Dimenhydrinate injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1245...  ..................  E                   Dipyridamole injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1250...  ..................  E                   Inj dobutamine HCL/250          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J1320...  ..................  E                   Amitriptyline injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1325...  ..................  E                   Epoprostenol injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1330...  ..................  E                   Ergonovine maleate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1362...  ..................  E                   Erythromycin glucep /           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   250 MG.
J1364...  ..................  E                   Erythro lactobionate /          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   500 MG.
J1380...  ..................  E                   Estradiol valerate 10 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1390...  ..................  E                   Estradiol valerate 20 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1410...  ..................  E                   Inj estrogen conjugate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   25 MG.
J1435...  ..................  E                   Injection estrone per 1         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J1436...  ..................  E                   Etidronate disodium inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1440...  ..................  E                   Filgrastim 300 mcg              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injeciton.
J1441...  ..................  E                   Filgrastim 480 mcg              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1455...  ..................  E                   Foscarnet sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1460...  ..................  E                   Gamma globulin 1 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1470...  ..................  E                   Gamma globulin 2 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1480...  ..................  E                   Gamma globulin 3 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1490...  ..................  E                   Gamma globulin 4 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1500...  ..................  E                   Gamma globulin 5 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1510...  ..................  E                   Gamma globulin 6 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1520...  ..................  E                   Gamma globulin 7 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1530...  ..................  E                   Gamma globulin 8 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1540...  ..................  E                   Gamma globulin 9 CC inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1550...  ..................  E                   Gamma globulin 10 CC inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1560...  ..................  E                   Gamma globulin >10 CC           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1561...  ..................  E                   Immune globulin 500 mg..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1562...  ..................  E                   Immune globulin 5 gms...        0.00       0.00       0.00       0.00       0.00       0.00        XXX

[[Page 59241]]


J1565...  ..................  E                   RSV-ivig................        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1570...  ..................  E                   Ganciclovir sodium              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1580...  ..................  E                   Garamycin gentamicin inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1600...  ..................  E                   Gold sodium thiomaleate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1610...  ..................  E                   Glucagon hydrochloride/1        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J1620...  ..................  E                   Gonadorelin hydroch/ 100        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mcg.
J1625...  ..................  D                   Granisetron hydrochlor/1        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J1626...  ..................  E                   Granisetron HCl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1630...  ..................  E                   Haloperidol injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1631...  ..................  E                   Haloperidol decanoate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1642...  ..................  E                   Inj heparin sodium per          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   10 u.
J1644...  ..................  E                   Inj heparin sodium per          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   1000u.
J1645...  ..................  E                   Dalteparin sodium.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1650...  ..................  E                   Inj enoxaparin sodium 30        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J1670...  ..................  E                   Tetanus immune globulin         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1690...  ..................  E                   Prednisolone tebutate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1700...  ..................  E                   Hydrocortisone acetate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1710...  ..................  E                   Hydrocortisone sodium ph        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1720...  ..................  E                   Hydrocortisone sodium           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   succ i.
J1730...  ..................  E                   Diazoxide injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1739...  ..................  E                   Hydroxyprogesterone cap         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   125.
J1741...  ..................  E                   Hydroxyprogesterone cap         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   250.
J1742...  ..................  E                   Ibutilide fumarate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1760...  ..................  E                   Iron dextran 2 CC inj...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1770...  ..................  E                   Iron dextran 5 CC inj...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1780...  ..................  E                   Iron dextran 10 CC inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1785...  ..................  E                   Injection imiglucerase /        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
J1790...  ..................  E                   Droperidol injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1800...  ..................  E                   Propranolol injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1810...  ..................  E                   Droperidol/fentanyl inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1820...  ..................  E                   Insulin injection.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1825...  ..................  E                   Interferon beta-1a......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1830...  ..................  E                   Interferon beta-1b/.25          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J1840...  ..................  E                   Kanamycin sulfate 500 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1850...  ..................  E                   Kanamycin sulfate 75 MG         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1885...  ..................  E                   Ketorolac tromethamine          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J1890...  ..................  E                   Cephalothin sodium              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1910...  ..................  E                   Kutapressin injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1930...  ..................  E                   Propiomazine injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1940...  ..................  E                   Furosemide injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1950...  ..................  E                   Leuprolide acetate/3.75         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J1955...  ..................  E                   Inj levocarnitine per 1         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   gm.
J1960...  ..................  E                   Levorphanol tartrate inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1970...  ..................  E                   Methotrimeprazine               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J1980...  ..................  E                   Hyoscyamine sulfate inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J1990...  ..................  E                   Chlordiazepoxide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2000...  ..................  E                   Lidocaine injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2010...  ..................  E                   Lincomycin injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2060...  ..................  E                   Lorazepam injection.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2150...  ..................  E                   Mannitol injection......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2175...  ..................  E                   Meperidine hydrochl/100         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2180...  ..................  E                   Meperidine/promethazine         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2210...  ..................  E                   Methylergonovin maleate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2240...  ..................  E                   Metocurine iodide               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2250...  ..................  E                   Inj midazolam                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydrochloride.
J2260...  ..................  E                   Inj milrinone lactate/5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
J2270...  ..................  E                   Morphine sulfate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2275...  ..................  E                   Morphine sulfate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2300...  ..................  E                   Inj nalbuphine                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydrochloride.
J2310...  ..................  E                   Inj naloxone                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   hydrochloride.
J2320...  ..................  E                   Nandrolone decanoate 50         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2321...  ..................  E                   Nandrolone decanoate 100        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2322...  ..................  E                   Nandrolone decanoate 200        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2330...  ..................  E                   Thiothixene injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2350...  ..................  E                   Niacinamide/niacin              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2360...  ..................  E                   Orphenadrine injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2370...  ..................  E                   Phenylephrine hcl               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2400...  ..................  E                   Chloroprocaine hcl              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2405...  ..................  E                   Ondansetron hcl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2410...  ..................  E                   Oxymorphone hcl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2430...  ..................  E                   Pamidronate disodium/30         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2440...  ..................  E                   Papaverin hcl injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2460...  ..................  E                   Oxytetracycline                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2480...  ..................  E                   Hydrochlorides of opium         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.

[[Page 59242]]


J2510...  ..................  E                   Penicillin g procaine           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2512...  ..................  E                   Inj pentagastrin per 2          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
J2515...  ..................  E                   Pentobarbital sodium inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2540...  ..................  E                   Penicillin g potassium          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2545...  ..................  E                   Pentamidine isethionte/         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   300mg.
J2550...  ..................  E                   Promethazine hcl                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2560...  ..................  E                   Phenobarbital sodium inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2590...  ..................  E                   Oxytocin injection......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2597...  ..................  E                   Inj desmopressin acetate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2640...  ..................  E                   Prednisolone sodium ph          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2650...  ..................  E                   Prednisolone acetate inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2670...  ..................  E                   Totazoline hcl injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2675...  ..................  E                   Inj progesterone per 50         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2680...  ..................  E                   Fluphenazine decanoate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   25 MG.
J2690...  ..................  E                   Procainamide hcl                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2700...  ..................  E                   Oxacillin sodium                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2710...  ..................  E                   Neostigmine methylslfte         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2720...  ..................  E                   Inj protamine sulfate/10        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2725...  ..................  E                   Inj protirelin per 250          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mcg.
J2730...  ..................  E                   Pralidoxime chloride inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2760...  ..................  E                   Phentolaine mesylate inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2765...  ..................  E                   Metoclopramide hcl              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2790...  ..................  E                   Rho d immune globulin           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J2800...  ..................  E                   Methocarbamol injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2810...  ..................  E                   Inj theophylline per 40         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J2820...  ..................  E                   Sargramostim injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2860...  ..................  E                   Secobarbital sodium inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2910...  ..................  E                   Aurothioglucose                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2912...  ..................  E                   Sodium chloride                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2920...  ..................  E                   Methylprednisolone              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2930...  ..................  E                   Methylprednisolone              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2950...  ..................  E                   Promazine hcl injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J2970...  ..................  E                   Methicillin sodium              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J2995...  ..................  E                   Inj streptokinase/250000        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   IU.
J2996...  ..................  E                   Alteplase recombinant           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3000...  ..................  E                   Streptomycin injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3005...  ..................  D                   Strontium-89 chloride/10        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ML.
J3010...  ..................  E                   Fentanyl citrate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3030...  ..................  E                   Sumatriptan succinate/6         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J3070...  ..................  E                   Pentazocine hcl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injeciton.
J3080...  ..................  E                   Chlorprothixene                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3105...  ..................  E                   Terbutaline sulfate inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3120...  ..................  E                   Testosterone enanthate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3130...  ..................  E                   Testosterone enanthate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3140...  ..................  E                   Testosterone suspension         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3150...  ..................  E                   Testosteron propionate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3230...  ..................  E                   Chlorpromazine hcl              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3240...  ..................  E                   Thyrotropin injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3250...  ..................  E                   Trimethobenzamide hcl           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3260...  ..................  E                   Tobramycin sulfate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3265...  ..................  E                   Injection torsemide 10          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg/ml.
J3270...  ..................  E                   Imipramine hcl injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3280...  ..................  E                   Thiethylperazine maleate        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3301...  ..................  E                   Triamcinolone acetonide         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3302...  ..................  E                   Triamcinolone diacetate         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3303...  ..................  E                   Triamcinolone hexacetonl        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3305...  ..................  E                   Inj trimetrexate                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   glucoronate.
J3310...  ..................  E                   Perphenazine injeciton..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3320...  ..................  E                   Spectinomycn di-hcl inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3350...  ..................  E                   Urea injection..........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3360...  ..................  E                   Diazepam injection......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3364...  ..................  E                   Urokinase 5000 IU               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3365...  ..................  E                   Urokinase 250,000 IU inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3370...  ..................  R                   Vancomycin hcl injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3390...  ..................  E                   Methoxamine injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3400...  ..................  E                   Triflupromazine hcl inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3410...  ..................  E                   Hydroxyzine hcl                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J3420...  ..................  E                   Vitamin b12 injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3430...  ..................  E                   Vitamin k phytonadione          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3450...  ..................  E                   Mephentermine sulfate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J3470...  ..................  E                   Hyaluronidase injection.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3475...  ..................  E                   Inj magnesium sulfate...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3480...  ..................  E                   Inj potassium chloride..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3490...  ..................  E                   Drugs unclassified              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.

[[Page 59243]]


J3520...  ..................  N                   Edetate disodium per 150        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J3530...  ..................  E                   Nasal vaccine inhalation        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J3535...  ..................  N                   Metered dose inhaler            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   drug.
J3570...  ..................  N                   Laetrile amygdalin vit          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   B17.
J7030...  ..................  E                   Normal saline solution          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   infus.
J7040...  ..................  E                   Normal saline solution          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   infus.
J7042...  ..................  E                   5% dextrose/normal              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   saline.
J7050...  ..................  E                   Normal saline solution          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   infus.
J7051...  ..................  E                   Sterile saline/water....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7060...  ..................  E                   5% dextrose/water.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7070...  ..................  E                   D5w infusion............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7100...  ..................  E                   Dextran 40 infusion.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7110...  ..................  E                   Dextran 75 infusion.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7120...  ..................  E                   Ringers lactate infusion        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7130...  ..................  E                   Hypertonic saline               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   solution.
J7190...  ..................  X                   Factor viii.............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7191...  ..................  X                   Factor VIII (porcine)...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7192...  ..................  X                   Factor viii recombinant.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7194...  ..................  X                   Factor ix complex.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7196...  ..................  X                   Othr hemophilia clot            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   factors.
J7197...  ..................  X                   Antithrombin iii                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J7300...  ..................  N                   Intraut copper                  0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   contraceptive.
J7310...  ..................  E                   Ganciclovir long act            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implant.
J7500...  ..................  X                   Azathiop po tab 50mg            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   100s ea.
J7501...  ..................  X                   Azathioprine parenteral.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7503...  ..................  X                   Cyclosporine parenteral.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7504...  ..................  X                   Lymphocyte immune               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   globulin.
J7505...  ..................  X                   Monoclonal antibodies...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7506...  ..................  X                   Prednisone oral.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7507...  ..................  E                   Tacrolimus oral per 1 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7508...  ..................  E                   Tacrolimus oral per 5 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7509...  ..................  X                   Methylprednisolone oral.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7510...  ..................  X                   Prednisolone oral per 5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J7599...  ..................  X                   Immunosuppressive drug          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   noc.
J7610...  ..................  E                   Acetylcysteine 10%              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J7615...  ..................  E                   Acetylcysteine 20%              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J7620...  ..................  E                   Albuterol sulfate .083%/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ml.
J7625...  ..................  E                   Albuterol sulfate .5%           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J7627...  ..................  E                   Bitolterolmesylate inhal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sol.
J7630...  ..................  E                   Cromolyn sodium                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injeciton.
J7640...  ..................  E                   Epinephrine injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7645...  ..................  E                   Ipratropium bromide .02%/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ml.
J7650...  ..................  E                   Isoetharine hcl .1% inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7651...  ..................  E                   Isoetharine hcl .125%           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J7652...  ..................  E                   Isoetharine hcl .167%           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J7653...  ..................  E                   Isoetharine hcl .2%/ inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7654...  ..................  E                   Isoetharine hcl .25% inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7655...  ..................  E                   Isoetharine hcl 1% inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7660...  ..................  E                   Isoproterenol hcl .5%           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J7665...  ..................  E                   Isoproterenol hcl 1% inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J7670...  ..................  E                   Metaproterenol sulfate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   .4%.
J7672...  ..................  E                   Metaproterenol sulfate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   .6%.
J7675...  ..................  E                   Metaproterenol sulfate          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   5%.
J7699...  ..................  E                   Inhalation solution for         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   DME.
J7799...  ..................  E                   Non-inhalation drug for         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   DME.
J8499...  ..................  N                   Oral prescrip drug non          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chemo.
J8530...  ..................  E                   Cyclophosphamide oral 25        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J8560...  ..................  E                   Etoposide oral 50 MG....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J8600...  ..................  E                   Melphalan oral 2 MG.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J8610...  ..................  E                   Methotrexate oral 2.5 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J8999...  ..................  E                   Oral prescription drug          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chemo.
J9000...  ..................  E                   Doxorubic hcl 10 MG vl          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   chemo.
J9015...  ..................  E                   Aldesleukin/single use          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vial.
J9020...  ..................  E                   Asparaginase injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9031...  ..................  E                   Bcg live intravesical           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vac.
J9040...  ..................  E                   Bleomycin sulfate               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J9045...  ..................  E                   Carboplatin injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9050...  ..................  E                   Carmus bischl nitro inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9060...  ..................  E                   Cisplatin 10 MG                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J9062...  ..................  E                   Cisplatin 50 MG                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J9065...  ..................  E                   Inj cladribine per 1 MG.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9070...  ..................  E                   Cyclophosphamide 100 MG         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9080...  ..................  E                   Cyclophosphamide 200 MG         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9090...  ..................  E                   Cyclophosphamide 500 MG         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.

[[Page 59244]]


J9091...  ..................  E                   Cyclophosphamide 1.0 grm        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9092...  ..................  E                   Cyclophosphamide 2.0 grm        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9093...  ..................  E                   Cyclophosphamide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lyophilized.
J9094...  ..................  E                   Cyclophosphamide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lyophilized.
J9095...  ..................  E                   Cyclophosphamide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lyophilized.
J9096...  ..................  E                   Cyclophosphamide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lyophilized.
J9097...  ..................  E                   Cyclophosphamide                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lyophilized.
J9100...  ..................  E                   Cytarabine hcl 100 MG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9110...  ..................  E                   Cytarabine hcl 500 MG           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9120...  ..................  E                   Dactinomycin actinomycin        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   d.
J9130...  ..................  E                   Dacarbazine 10 MG inj...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9140...  ..................  E                   Dacarbazine 200 MG inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9150...  ..................  E                   Daunorubicin............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9165...  ..................  E                   Diethylstilbestrol              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J9170...  ..................  E                   Docetaxel...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9181...  ..................  E                   Etoposide 10 MG inj.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9182...  ..................  E                   Etoposide 100 MG inj....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9185...  ..................  E                   Fludarabine phosphate           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9190...  ..................  E                   Fluorouracil injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9200...  ..................  E                   Floxuridine injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9201...  ..................  E                   Gemcitabine HCl.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9202...  ..................  E                   Goserelin acetate               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   implant.
J9206...  ..................  E                   Irinotecan injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9208...  ..................  E                   Ifosfomide injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9209...  ..................  E                   Mesna injection.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9211...  ..................  E                   Idarubicin hcl injection        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9213...  ..................  E                   Interferon alfa-2a inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9214...  ..................  E                   Interferon alfa-2b inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9215...  ..................  E                   Interferon alfa-n3 inj..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9216...  ..................  E                   Interferon gamma 1-b inj        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9217...  ..................  E                   Leuprolide acetate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   suspnsion.
J9218...  ..................  E                   Leuprolide acetate              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   injection.
J9230...  ..................  E                   Mechlorethamine hcl inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9245...  ..................  E                   Inj melphalan hydrochl          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   50 MG.
J9250...  ..................  E                   Methotrexate sodium inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9260...  ..................  E                   Methotrexate sodium inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9265...  ..................  E                   Paclitaxel injection....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9266...  ..................  E                   Pegaspargase/singl dose         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vial.
J9268...  ..................  E                   Pentostatin injection...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9270...  ..................  E                   Plicamycin (mithramycin)        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9280...  ..................  E                   Mitomycin 5 MG inj......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9290...  ..................  E                   Mitomycin 20 MG inj.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9291...  ..................  E                   Mitomycin 40 MG inj.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9293...  ..................  E                   Mitoxantrone hydrochl/5         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   MG.
J9320...  ..................  E                   Streptozocin injection..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9340...  ..................  E                   Thiotepa injection......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9350...  ..................  E                   Topotecan...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9360...  ..................  E                   Vinblastine sulfate inj.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9370...  ..................  E                   Vincristine sulfate 1 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9375...  ..................  E                   Vincristine sulfate 2 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9380...  ..................  E                   Vincristine sulfate 5 MG        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
J9390...  ..................  E                   Vinorelbine tartrate/10         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mg.
J9600...  ..................  E                   Porfimer sodium.........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
J9999...  ..................  E                   Chemotherapy drug.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
M0005...  ..................  D                   Off visit 2/more                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   modalities.
M0006...  ..................  D                   One phys therapy                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   modality.
M0007...  ..................  D                   Combined phys ther mod &        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tx.
M0008...  ..................  D                   Combined phys ther mod &        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tx.
M0064...  ..................  A                   Visit for drug                  0.37       0.19       0.19       0.03       0.59       0.59        XXX
                                                   monitoring.
M0075...  ..................  N                   Cellular therapy........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
M0076...  ..................  N                   Prolotherapy............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
M0100...  ..................  N                   Intragastric hypothermia        0.00       0.00       0.00       0.00       0.00       0.00        XXX
M0101...  ..................  G                   Foot care hygienic/pm...        0.43       0.35       0.35       0.03       0.81       0.81        XXX
M0300...  ..................  N                   IV chelationtherapy.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
M0301...  ..................  N                   Fabric wrapping of              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   aneurysm.
M0302...  ..................  N                   Assessment of cardiac           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   output.
P2028...  ..................  X                   Cephalin floculation            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   test.
P2029...  ..................  X                   Congo red blood test....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P2031...  ..................  N                   Hair analysis...........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P2033...  ..................  X                   Blood thymol turbidity..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P2038...  ..................  X                   Blood mucoprotein.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P3000...  ..................  X                   Screen pap by tech w md         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   supv.
P3001...  ..................  X                   Screening pap smear by          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   phys.
P3001...  26                  A                   Screening pap smear by          0.42       0.32       0.32       0.04       0.78       0.78        XXX
                                                   phys.

[[Page 59245]]


P7001...  ..................  I                   Culture bacterial urine.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9010...  ..................  E                   Whole blood for                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   transfusion.
P9011...  ..................  E                   Blood split unit........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9012...  ..................  E                   Cryoprecipitate each            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
P9013...  ..................  E                   Unit/s blood fibrinogen.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9014...  ..................  E                   Gamma globulin 1 ML.....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9015...  ..................  E                   Rh immune globulin 1 ML.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9016...  ..................  E                   Leukocyte poor blood,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
P9017...  ..................  E                   One donor fresh frozn           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   plasma.
P9018...  ..................  E                   Plasma protein fract,           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
P9019...  ..................  E                   Platelet concentrate            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
P9020...  ..................  E                   Plaelet rich plasma unit        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9021...  ..................  E                   Red blood cells unit....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
P9022...  ..................  E                   Washed red blood cells          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   unit.
P9603...  ..................  X                   One-way allow prorated          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   miles.
P9604...  ..................  X                   One-way allow prorated          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   trip.
P9610...  ..................  X                   Urine specimen collect          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   singl.
P9615...  ..................  X                   Urine specimen collect          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   mult.
Q0034...  ..................  X                   Admin of influenza              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vaccine.
Q0035...  ..................  A                   Cardiokymography........        0.17       0.49       0.49       0.04       0.70       0.70        XXX
Q0035...  TC                  A                   Cardiokymography........        0.00       0.37       0.37       0.03       0.40       0.40        XXX
Q0035...  26                  A                   Cardiokymography........        0.17       0.12       0.12       0.01       0.30       0.30        XXX
Q0068...  ..................  A                   Extracorpeal                    1.67       1.27       1.27       0.16       3.10       3.10        000
                                                   plasmapheresis.
Q0091...  ..................  A                   Obtaining screen pap            0.37       0.28       0.28       0.03       0.68       0.68        XXX
                                                   smear.
Q0092...  ..................  A                   Set up port x-ray               0.00       0.30       0.30       0.01       0.31       0.31        XXX
                                                   equipment.
Q0103...  ..................  D                   Physical therapy                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   evaluation.
Q0104...  ..................  D                   Phys therapy re-                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   evaluation.
Q0109...  ..................  D                   Occupational therapy            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eval.
Q0110...  ..................  D                   Occupational therap re-         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   eval.
Q0111...  ..................  X                   Wet mounts/w                    0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   preparations.
Q0112...  ..................  X                   Potassium hydroxide             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   preps.
Q0113...  ..................  X                   Pinworm examinations....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q0114...  ..................  X                   Fern test...............        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q0115...  ..................  X                   Post-coital mucous exam.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q0132...  ..................  X                   Dispensing fee DME neb          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   drug.
Q0136...  ..................  X                   Non esrd epoetin alpha          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   inj.
Q0144...  ..................  N                   Azithromycin dihydrate,         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   oral.
Q0156...  ..................  X                   Human albumin 5%........        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q0157...  ..................  X                   Human albumin 25%.......        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q0158...  ..................  D                   Combined hib & hep B            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vaccine.
Q9920...  ..................  E                   Epoetin with hct <=20...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9921...  ..................  E                   Epoetin with hct =21....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9922...  ..................  E                   Epoetin with hct =22....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9923...  ..................  E                   Epoetin with hct =23....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9924...  ..................  E                   Epoetin with hct =24....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9925...  ..................  E                   Epoetin with hct =25....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9926...  ..................  E                   Epoetin with hct =26....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9927...  ..................  E                   Epoetin with hct =27....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9928...  ..................  E                   Epoetin with hct =28....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9929...  ..................  E                   Epoetin with hct =29....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9930...  ..................  E                   Epoetin with hct =30....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9931...  ..................  E                   Epoetin with hct =31....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9932...  ..................  E                   Epoetin with hct =32....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9933...  ..................  E                   Epoetin with hct =33....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9934...  ..................  E                   Epoetin with hct =34....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9935...  ..................  E                   Epoetin with hct =35....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9936...  ..................  E                   Epoetin with hct =36....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9937...  ..................  E                   Epoetin with hct =37....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9938...  ..................  E                   Epoetin with hct =38....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9939...  ..................  E                   Epoetin with hct =39....        0.00       0.00       0.00       0.00       0.00       0.00        XXX
Q9940...  ..................  E                   Epoetin with hct >=40...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
R0070...  ..................  C                   Transport portable x-ray        0.00       0.00       0.00       0.00       0.00       0.00        XXX
R0075...  ..................  C                   Transport port x-ray            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   multipl.
R0076...  ..................  C                   Transport portable EKG..        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2020...  ..................  X                   Vision svcs frames              0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   purchases.
V2025...  ..................  N                   Eyeglasses delux frames.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2100...  ..................  X                   Lens spher single plano         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.00.
V2101...  ..................  X                   Single visn sphere 4.12-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7.00.
V2102...  ..................  X                   Singl visn sphere 7.12-         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   20.00.
V2103...  ..................  X                   Spherocylindr 4.00-0.12-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.00d.
V2104...  ..................  X                   Spherocylindr 4.00d/2.12-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4d.
V2105...  ..................  X                   Spherocylinder 4.00d/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.25-6d.
V2106...  ..................  X                   Spherocylinder 4.00d/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   >6.00d.
V2107...  ..................  X                   Spherocylinder 4.25d/12-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2d.

[[Page 59246]]


V2108...  ..................  X                   Spherocylinder 4.25d/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.12-4d.
V2109...  ..................  X                   Spherocylinder 4.25d/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.25-6d.
V2110...  ..................  X                   Spherocylinder 4.25d/           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   over 6d.
V2111...  ..................  X                   Spherocylindr 7.25d/.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.25.
V2112...  ..................  X                   Spherocylindr 7.25d/2.25-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4d.
V2113...  ..................  X                   Spherocylindr 7.25d/4.25-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   6d.
V2114...  ..................  X                   Spherocylinder over             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   12.00d.
V2115...  ..................  X                   Lens lenticular bifocal.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2116...  ..................  X                   Nonaspheric lens bifocal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2117...  ..................  X                   Aspheric lens bifocal...        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2118...  ..................  X                   Lens aniseikonic single.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2199...  ..................  X                   Lens single vision not          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   oth c.
V2200...  ..................  X                   Lens spher bifoc plano          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.00d.
V2201...  ..................  X                   Lens sphere bifocal 4.12-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7.0.
V2202...  ..................  X                   Lens sphere bifocal 7.12-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   20..
V2203...  ..................  X                   Lens sphcyl bifocal             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.00d/.1.
V2204...  ..................  X                   Lens sphcy bifocal 4.00d/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.1.
V2205...  ..................  X                   Lens sphcy bifocal 4.00d/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.2.
V2206...  ..................  X                   Lens sphcy bifocal 4.00d/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ove.
V2207...  ..................  X                   Lens sphcy bifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7d/..
V2208...  ..................  X                   Lens sphcy bifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/2..
V2209...  ..................  X                   Lens sphcy bifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/4..
V2210...  ..................  X                   Lens sphcy bifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/ov.
V2211...  ..................  X                   Lens sphcy bifo 7.25-12/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   .25-.
V2212...  ..................  X                   Lens sphcyl bifo 7.25-12/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.2.
V2213...  ..................  X                   Lens sphcyl bifo 7.25-12/       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.2.
V2214...  ..................  X                   Lens sphcyl bifocal over        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   12..
V2215...  ..................  X                   Lens lenticular bifocal.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2216...  ..................  X                   Lens lenticular                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   nonaspheric.
V2217...  ..................  X                   Lens lenticular aspheric        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bif.
V2218...  ..................  X                   Lens aniseikonic bifocal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2219...  ..................  X                   Lens bifocal seg width          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   over.
V2220...  ..................  X                   Lens bifocal add over           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   3.25d.
V2299...  ..................  X                   Lens bifocal speciality.        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2300...  ..................  X                   Lens sphere trifocal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.00d.
V2301...  ..................  X                   Lens sphere trifocal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.12-7..
V2302...  ..................  X                   Lens sphere trifocal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7.12-20.
V2303...  ..................  X                   Lens sphcy trifocal 4.0/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   .12-.
V2304...  ..................  X                   Lens sphcy trifocal 4.0/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.25.
V2305...  ..................  X                   Lens sphcy trifocal 4.0/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.25.
V2306...  ..................  X                   Lens sphcyl trifocal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.00/>6.
V2307...  ..................  X                   Lens sphcy trifocal 4.25-       0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/..
V2308...  ..................  X                   Lens sphc trifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/2..
V2309...  ..................  X                   Lens sphc trifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/4..
V2310...  ..................  X                   Lens sphc trifocal 4.25-        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   7/>6.
V2311...  ..................  X                   Lens sphc trifo 7.25-12/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   .25-.
V2312...  ..................  X                   Lens sphc trifo 7.25-12/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   2.25.
V2313...  ..................  X                   Lens sphc trifo 7.25-12/        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   4.25.
V2314...  ..................  X                   Lens sphcyl trifocal            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   over 12.
V2315...  ..................  X                   Lens lenticular trifocal        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2316...  ..................  X                   Lens lenticular                 0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   nonaspheric.
V2317...  ..................  X                   Lens lenticular aspheric        0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   tri.
V2318...  ..................  X                   Lens aniseikonic                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   trifocal.
V2319...  ..................  X                   Lens trifocal seg width         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   >28.
V2320...  ..................  X                   Lens trifocal add over          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   3.25d.
V2399...  ..................  X                   Lens trifocal speciality        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2410...  ..................  X                   Lens variab asphericity         0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sing.
V2430...  ..................  X                   Lens variable                   0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   asphericity bi.
V2499...  ..................  X                   Variable asphericity            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   lens.
V2500...  ..................  X                   Contact lens pmma               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   spherical.
V2501...  ..................  X                   Cntct lens pmma-toric/          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   prism.
V2502...  ..................  X                   Contact lens pmma               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bifocal.
V2503...  ..................  X                   Cntct lens pmma color           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   vision.
V2510...  ..................  X                   Cntct gas permeable             0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   sphericl.
V2511...  ..................  X                   Cntct toric prism               0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   ballast.
V2512...  ..................  X                   Cntct lens gas permbl           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bifocl.
V2513...  ..................  X                   Contact lens extended           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   wear.
V2520...  ..................  P                   Contact lens hydrophilic        0.00       0.00       0.00       0.00       0.00       0.00        XXX
V2521...  ..................  X                   Cntct lens hydrophilic          0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   toric.
V2522...  ..................  X                   Cntct lens hydrophil            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   bifocl.
V2523...  ..................  X                   Cntct lens hydrophil            0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   extend.
V2530...  ..................  X                   Contact lens gas                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   impermeable.
V2531...  ..................  X                   Contact lens gas                0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   permeable.
V2599...  ..................  X                   Contact lens/es other           0.00       0.00       0.00       0.00       0.00       0.00        XXX
                                                   type.

[[Continued on page 59247]]