Addendum B.-Proposed OPPS Payment by HCPCS 

Code for CY 2012

HCPCS 

Code Short Descriptor CI SI APC

00100 Anesth salivary gland N

00102 Anesth repair of cleft lip N

00103 Anesth blepharoplasty N

00104 Anesth electroshock N

00120 Anesth ear surgery N

00124 Anesth ear exam N

00126 Anesth tympanotomy N

00140 Anesth procedures on eye N

00142 Anesth lens surgery N

00144 Anesth corneal transplant N

00145 Anesth vitreoretinal surg N

00147 Anesth iridectomy N

00148 Anesth eye exam N

00160 Anesth nose/sinus surgery N

00162 Anesth nose/sinus surgery N

00164 Anesth biopsy of nose N

00170 Anesth procedure on mouth N

00172 Anesth cleft palate repair N

00174 Anesth pharyngeal surgery N

00176 Anesth pharyngeal surgery C

00190 Anesth face/skull bone surg N

00192 Anesth facial bone surgery C

00210 Anesth cranial surg nos N

00211 Anesth cran surg hemotoma C

00212 Anesth skull drainage N

00214 Anesth skull drainage C

00215 Anesth skull repair/fract C

00216 Anesth head vessel surgery N

00218 Anesth special head surgery N

00220 Anesth intrcrn nerve N

00222 Anesth head nerve surgery N

00300 Anesth head/neck/ptrunk N

00320 Anesth neck organ 1 & over N

00322 Anesth biopsy of thyroid N

00326 Anesth larynx/trach < 1 yr N

00350 Anesth neck vessel surgery N

00352 Anesth neck vessel surgery N

00400 Anesth skin ext/per/atrunk N

00402 Anesth surgery of breast N

00404 Anesth surgery of breast N

00406 Anesth surgery of breast N

00410 Anesth correct heart rhythm N

00450 Anesth surgery of shoulder N

00452 Anesth surgery of shoulder C

00454 Anesth collar bone biopsy N

00470 Anesth removal of rib N

00472 Anesth chest wall repair N

00474 Anesth surgery of rib(s) C

00500 Anesth esophageal surgery N

00520 Anesth chest procedure N
00522 Anesth chest lining biopsy

N

00524 Anesth chest drainageC

00528 Anesth chest partition viewN

00529 Anesth chest partition view

N

00530 Anesth pacemaker insertionN

00532 Anesth vascular accessN

00534 Anesth cardioverter/defibN

00537 Anesth cardiac electrophysN

00539 Anesth trach-bronch reconstN

00540 Anesth chest surgeryC

00541 Anesth one lung ventilationN

00542 Anesth release of lungC

00546 Anesth lung chest wall surgC

00548 Anesth trachea bronchi surgN

00550 Anesth sternal debridementN

00560 Anesth heart surg w/o pumpC

00561 Anesth heart surg < 1 yrC

00562 Anesth hrt surg w/pmp age 1+C

00563 Anesth heart surg w/arrestN

00566 Anesth cabg w/o pumpN

00567 Anesth cabg w/pumpC

00580 Anesth heart/lung transplntC

00600 Anesth spine cord surgeryN

00604 Anesth sitting procedureC

00620 Anesth spine cord surgeryN

00622 Anesth removal of nervesC

00625 Anes spine tranthor w/o vent

N

00626 Anes spine transthor w/vent

N

00630 Anesth spine cord surgeryN

00632 Anesth removal of nervesC

00634 Anesth for chemonucleolysisN

00635 Anesth lumbar punctureN

00640 Anesth spine manipulationN

00670 Anesth spine cord surgeryC

00700 Anesth abdominal wall surgN

00702 Anesth for liver biopsyN

00730 Anesth abdominal wall surgN

00740 Anesth upper gi visualizeN

00750 Anesth repair of herniaN

00752 Anesth repair of herniaN

00754 Anesth repair of herniaN

00756 Anesth repair of herniaN

00770 Anesth blood vessel repairN

00790 Anesth surg upper abdomenN

00792 Anesth hemorr/excise liverC

00794 Anesth pancreas removalC

00796 Anesth for liver transplantC

00797 Anesth surgery for obesityN

00800 Anesth abdominal wall surgN

00802 Anesth fat layer removalC

00810 Anesth low intestine scopeN

00820 Anesth abdominal wall surgN

00830 Anesth repair of herniaN

00832 Anesth repair of herniaN

00834 Anesth hernia repair < 1 yrN
00836 Anesth hernia repair preemie

N

00840 Anesth surg lower abdomenN

00842 Anesth amniocentesisN

00844 Anesth pelvis surgeryC

00846 Anesth hysterectomyC

00848 Anesth pelvic organ surgC

00851 Anesth tubal ligationN

00860 Anesth surgery of abdomenN

00862 Anesth kidney/ureter surgN

00864 Anesth removal of bladderC

00865 Anesth removal of prostateC

00866 Anesth removal of adrenalC

00868 Anesth kidney transplantC

00870 Anesth bladder stone surgN

00872 Anesth kidney stone destructN

00873 Anesth kidney stone destructN

00880 Anesth abdomen vessel surgN

00882 Anesth major vein ligationC

00902 Anesth anorectal surgeryN

00904 Anesth perineal surgeryC

00906 Anesth removal of vulvaN

00908 Anesth removal of prostateC

00910 Anesth bladder surgeryN

00912 Anesth bladder tumor surgN

00914 Anesth removal of prostateN

00916 Anesth bleeding controlN

00918 Anesth stone removalN

00920 Anesth genitalia surgeryN

00921 Anesth vasectomyN

00922 Anesth sperm duct surgeryN

00924 Anesth testis explorationN

00926 Anesth removal of testisN

00928 Anesth removal of testisN

00930 Anesth testis suspensionN

00932 Anesth amputation of penisC

00934 Anesth penis nodes removalC

00936 Anesth penis nodes removalC

00938 Anesth insert penis deviceN

00940 Anesth vaginal proceduresN

00942 Anesth surg on vag/urethralN

00944 Anesth vaginal hysterectomyC

00948 Anesth repair of cervixN

00950 Anesth vaginal endoscopyN

00952 Anesth hysteroscope/graphN

01112 Anesth bone aspirate/bxN

01120 Anesth pelvis surgeryN

01130 Anesth body cast procedureN

01140 Anesth amputation at pelvisC

01150 Anesth pelvic tumor surgeryC

01160 Anesth pelvis procedureN

01170 Anesth pelvis surgeryN

01173 Anesth fx repair pelvis

N

01180 Anesth pelvis nerve removalN

01190 Anesth pelvis nerve removalN

01200 Anesth hip joint procedureN
01202 Anesth arthroscopy of hip

N

01210 Anesth hip joint surgeryN

01212 Anesth hip disarticulationC

01214 Anesth hip arthroplastyC

01215 Anesth revise hip repairN

01220 Anesth procedure on femurN

01230 Anesth surgery of femurN

01232 Anesth amputation of femurC

01234 Anesth radical femur surgC

01250 Anesth upper leg surgeryN

01260 Anesth upper leg veins surgN

01270 Anesth thigh arteries surgN

01272 Anesth femoral artery surgC

01274 Anesth femoral embolectomyC

01320 Anesth knee area surgeryN

01340 Anesth knee area procedureN

01360 Anesth knee area surgeryN

01380 Anesth knee joint procedureN

01382 Anesth dx knee arthroscopyN

01390 Anesth knee area procedureN

01392 Anesth knee area surgeryN

01400 Anesth knee joint surgeryN

01402 Anesth knee arthroplastyC

01404 Anesth amputation at kneeC

01420 Anesth knee joint castingN

01430 Anesth knee veins surgeryN

01432 Anesth knee vessel surgN

01440 Anesth knee arteries surgN

01442 Anesth knee artery surgC

01444 Anesth knee artery repairC

01462 Anesth lower leg procedureN

01464 Anesth ankle/ft arthroscopyN

01470 Anesth lower leg surgeryN

01472 Anesth achilles tendon surgN

01474 Anesth lower leg surgeryN

01480 Anesth lower leg bone surgN

01482 Anesth radical leg surgeryN

01484 Anesth lower leg revisionN

01486 Anesth ankle replacementC

01490 Anesth lower leg castingN

01500 Anesth leg arteries surgN

01502 Anesth lwr leg embolectomyC

01520 Anesth lower leg vein surgN

01522 Anesth lower leg vein surgN

01610 Anesth surgery of shoulderN

01620 Anesth shoulder procedureN

01622 Anes dx shoulder arthroscopyN

01630 Anesth surgery of shoulderN

01634 Anesth shoulder joint amputC

01636 Anesth forequarter amputC

01638 Anesth shoulder replacementC

01650 Anesth shoulder artery surgN

01652 Anesth shoulder vessel surgC

01654 Anesth shoulder vessel surgC

01656 Anesth arm-leg vessel surgC
01670 Anesth shoulder vein surg

N

01680 Anesth shoulder castingN

01682 Anesth airplane castN

01710 Anesth elbow area surgeryN

01712 Anesth uppr arm tendon surgN

01714 Anesth uppr arm tendon surgN

01716 Anesth biceps tendon repairN

01730 Anesth uppr arm procedureN

01732 Anesth dx elbow arthroscopyN

01740 Anesth upper arm surgeryN

01742 Anesth humerus surgeryN

01744 Anesth humerus repairN

01756 Anesth radical humerus surgC

01758 Anesth humeral lesion surgN

01760 Anesth elbow replacementN

01770 Anesth uppr arm artery surgN

01772 Anesth uppr arm embolectomyN

01780 Anesth upper arm vein surgN

01782 Anesth uppr arm vein repairN

01810 Anesth lower arm surgeryN

01820 Anesth lower arm procedureN

01829 Anesth dx wrist arthroscopyN

01830 Anesth lower arm surgeryN

01832 Anesth wrist replacementN

01840 Anesth lwr arm artery surgN

01842 Anesth lwr arm embolectomyN

01844 Anesth vascular shunt surgN

01850 Anesth lower arm vein surgN

01852 Anesth lwr arm vein repairN

01860 Anesth lower arm castingN

01916 Anesth dx arteriographyN

01920 Anesth catheterize heartN

01922 Anesth cat or mri scanN

01924 Anes ther interven rad artN

01925 Anes ther interven rad carN

01926 Anes tx interv rad hrt/cranN

01930 Anes ther interven rad veiN

01931 Anes ther interven rad tipN

01932 Anes tx interv rad th veinN

01933 Anes tx interv rad cran vN

01935 Anesth perc img dx sp procN

01936 Anesth perc img tx sp procN

01951 Anesth burn less 4 percentN

01952 Anesth burn 4-9 percentN

01953 Anesth burn each 9 percentN

01958 Anesth antepartum manipul

N

01960 Anesth vaginal deliveryN

01961 Anesth cs deliveryN

01962 Anesth emer hysterectomyN

01963 Anesth cs hysterectomyN

01965 Anesth inc/missed ab procN

01966 Anesth induced ab procedure N 

01967 Anesth/analg vag deliveryN

01968 Anes/analg cs deliver add-onN

01969 Anesth/analg cs hyst add-onN
01990 Support for organ donor

C

01991 Anesth nerve block/injN

01992 Anesth n block/inj proneN

01996 Hosp manage cont drug adminN

01999 Unlisted anesth procedureN

10021 Fna w/o imageT 0002

10022 Fna w/imageT 0004

10040 Acne surgeryT 0013

10060 Drainage of skin abscessT 0006

10061 Drainage of skin abscessT 0006

10080 Drainage of pilonidal cystT 0006

10081 Drainage of pilonidal cystT 0007

10120 Remove foreign bodyT 0016

10121 Remove foreign bodyT 0021

10140 Drainage of hematoma/fluidT 0007

10160 Puncture drainage of lesionT 0006

10180 Complex drainage woundT 0008

11000 Debride infected skinT 0016

11001 Debride infected skin add-onT 0013

11004 Debride genitalia & perineumC

11005 Debride abdom wallC

11006 Debride genit/per/abdom wallC

11008 Remove mesh from abd wallC

11010 Debride skin at fx siteT 0019

11011 Debride skin musc at fx siteT 0019

11012 Deb skin bone at fx siteT 0019

11042 Deb subq tissue 20 sq cm/<T 0016

11043 Deb musc/fascia 20 sq cm/<T 0016

11044 Deb bone 20 sq cm/<T 0020

11045 Deb subq tissue add-onT 0016

11046 Deb musc/fascia add-onT 0016

11047 Deb bone add-onT 0020

11055 Trim skin lesionT 0013

11056 Trim skin lesions 2 to 4T 0013

11057 Trim skin lesions over 4T 0013

11100 Biopsy skin lesionT 0015

11101 Biopsy skin add-onT 0013

11200 Removal of skin tagsT 0013

11201 Remove skin tags add-onT 0013

11300 Shave skin lesionT 0013

11301 Shave skin lesionT 0013

11302 Shave skin lesionT 0013

11303 Shave skin lesionT 0015

11305 Shave skin lesionT 0013

11306 Shave skin lesionT 0013

11307 Shave skin lesionT 0013

11308 Shave skin lesionT 0013

11310 Shave skin lesionT 0013

11311 Shave skin lesionT 0013

11312 Shave skin lesionT 0013

11313 Shave skin lesionT 0013

11400 Exc tr-ext b9+marg 0.5 < cmT 0019

11401 Exc tr-ext b9+marg 0.6-1 cmT 0019

11402 Exc tr-ext b9+marg 1.1-2 cmT 0019

11403 Exc tr-ext b9+marg 2.1-3 cmT 0020
11404 Exc tr-ext b9+marg 3.1-4 cm

T 0021

11406 Exc tr-ext b9+marg > 4.0 cmT 0021

11420 Exc h-f-nk-sp b9+marg 0.5 <T 0020

11421 Exc h-f-nk-sp b9+marg 0.6-1T 0020

11422 Exc h-f-nk-sp b9+marg 1.1-2T 0020

11423 Exc h-f-nk-sp b9+marg 2.1-3T 0021

11424 Exc h-f-nk-sp b9+marg 3.1-4T 0021

11426 Exc h-f-nk-sp b9+marg > 4 cmT 0022

11440 Exc face-mm b9+marg 0.5 < cmT 0019

11441 Exc face-mm b9+marg 0.6-1 cmT 0019

11442 Exc face-mm b9+marg 1.1-2 cmT 0020

11443 Exc face-mm b9+marg 2.1-3 cmT 0020

11444 Exc face-mm b9+marg 3.1-4 cmT 0020

11446 Exc face-mm b9+marg > 4 cmT 0022

11450 Removal sweat gland lesionT 0022

11451 Removal sweat gland lesionT 0022

11462 Removal sweat gland lesionT 0022

11463 Removal sweat gland lesionT 0022

11470 Removal sweat gland lesionT 0022

11471 Removal sweat gland lesionT 0022

11600 Exc tr-ext mlg+marg 0.5 < cmT 0020

11601 Exc tr-ext mlg+marg 0.6-1 cmT 0019

11602 Exc tr-ext mlg+marg 1.1-2 cmT 0019

11603 Exc tr-ext mlg+marg 2.1-3 cmT 0020

11604 Exc tr-ext mlg+marg 3.1-4 cmT 0020

11606 Exc tr-ext mlg+marg > 4 cmT 0021

11620 Exc h-f-nk-sp mlg+marg 0.5 <T 0020

11621 Exc h-f-nk-sp mlg+marg 0.6-1T 0019

11622 Exc h-f-nk-sp mlg+marg 1.1-2T 0020

11623 Exc h-f-nk-sp mlg+marg 2.1-3T 0021

11624 Exc h-f-nk-sp mlg+marg 3.1-4T 0021

11626 Exc h-f-nk-sp mlg+mar > 4 cmT 0022

11640 Exc face-mm malig+marg 0.5 <T 0019

11641 Exc face-mm malig+marg 0.6-1T 0019

11642 Exc face-mm malig+marg 1.1-2T 0019

11643 Exc face-mm malig+marg 2.1-3T 0020

11644 Exc face-mm malig+marg 3.1-4T 0021

11646 Exc face-mm mlg+marg > 4 cmT 0022

11719 Trim nail(s)T 0012

11720 Debride nail 1-5T 0013

11721 Debride nail 6 or moreT 0013

11730 Removal of nail plateT 0013

11732 Remove nail plate add-onT 0013

11740 Drain blood from under nailT 0012

11750 Removal of nail bedT 0019

11752 Remove nail bed/finger tipT 0022

11755 Biopsy nail unitT 0019

11760 Repair of nail bedT 0133

11762 Reconstruction of nail bedT 0136

11765 Excision of nail fold toeT 0013

11770 Removal of pilonidal lesionT 0022

11771 Removal of pilonidal lesionT 0022

11772 Removal of pilonidal lesionT 0022

11900 Injection into skin lesionsT 0013

11901 Added skin lesions injectionT 0013
11920 Correct skin color defects

T 0134

11921 Correct skin color defectsT 0134

11922 Correct skin color defectsT 0134

11950 Therapy for contour defects CH T 0134

11951 Therapy for contour defects CH T 0134

11952 Therapy for contour defects CH T 0134

11954 Therapy for contour defectsT 0133

11960 Insert tissue expander(s)T 0137

11970 Replace tissue expanderT 0051

11971 Remove tissue expander(s)T 0022

11975 Insert contraceptive capE

11976 Removal of contraceptive capT 0019

11977 Removal/reinsert contra capE

11980 Implant hormone pellet(s)X 0340

11981 Insert drug implant deviceX 0340

11982 Remove drug implant deviceX 0340

11983 Remove/insert drug implantX 0340

12001 Repair superficial wound(s)T 0133

12002 Repair superficial wound(s)T 0133

12004 Repair superficial wound(s)T 0133

12005 Repair superficial wound(s)T 0133

12006 Repair superficial wound(s)T 0133

12007 Repair superficial wound(s)T 0133

12011 Repair superficial wound(s)T 0133

12013 Repair superficial wound(s)T 0133

12014 Repair superficial wound(s)T 0133

12015 Repair superficial wound(s)T 0133

12016 Repair superficial wound(s)T 0133

12017 Repair superficial wound(s)T 0133

12018 Repair superficial wound(s) CH T 0134

12020 Closure of split woundT 0135

12021 Closure of split woundT 0134

12031 Intmd wnd repair s/tr/ext CH T 0134

12032 Intmd wnd repair s/tr/extT 0134

12034 Intmd wnd repair s/tr/ext CH T 0134

12035 Intmd wnd repair s/tr/ext CH T 0134

12036 Intmd wnd repair s/tr/extT 0134

12037 Intmd wnd repair s/tr/extT 0134

12041 Intmd wnd repair n-hf/genitT 0133

12042 Intmd wnd repair n-hg/genit CH T 0134

12044 Intmd wnd repair n-hg/genit CH T 0134

12045 Intmd wnd repair n-hg/genitT 0134

12046 Intmd wnd repair n-hg/genitT 0134

12047 Intmd wnd repair n-hg/genitT 0134

12051 Intmd wnd repair face/mmT 0134

12052 Intmd wnd repair face/mm CH T 0134

12053 Intmd wnd repair face/mm CH T 0134

12054 Intmd wnd repair face/mmT 0133

12055 Intmd wnd repair face/mmT 0134

12056 Intmd wnd repair face/mmT 0134

12057 Intmd wnd repair face/mmT 0134

13100 Repair of wound or lesionT 0135

13101 Repair of wound or lesionT 0135

13102 Repair wound/lesion add-on CH T 0134

13120 Repair of wound or lesionT 0134
13121 Repair of wound or lesion

T 0134

13122 Repair wound/lesion add-onT 0133

13131 Repair of wound or lesionT 0134

13132 Repair of wound or lesionT 0135

13133 Repair wound/lesion add-onT 0134

13150 Repair of wound or lesionT 0135

13151 Repair of wound or lesionT 0135

13152 Repair of wound or lesionT 0135

13153 Repair wound/lesion add-onT 0134

13160 Late closure of woundT 0137

14000 Skin tissue rearrangementT 0136

14001 Skin tissue rearrangementT 0136

14020 Skin tissue rearrangementT 0136

14021 Skin tissue rearrangementT 0136

14040 Skin tissue rearrangementT 0136

14041 Skin tissue rearrangementT 0136

14060 Skin tissue rearrangementT 0136

14061 Skin tissue rearrangementT 0136

14301 Skin tissue rearrangementT 0137

14302 Skin tissue rearrange add-onT 0137

14350 Skin tissue rearrangementT 0137

15002 Wound prep trk/arm/legT 0135

15003 Wound prep addl 100 cmT 0135

15004 Wound prep f/n/hf/g CH T 0134

15005 Wnd prep f/n/hf/g addl cmT 0135

15040 Harvest cultured skin graftT 0134

15050 Skin pinch graft CH T 0134

15100 Skin splt grft trnk/arm/legT 0137

15101 Skin splt grft t/a/l add-onT 0137

15110 Epidrm autogrft trnk/arm/legT 0135

15111 Epidrm autogrft t/a/l add-onT 0135

15115 Epidrm a-grft face/nck/hf/gT 0135

15116 Epidrm a-grft f/n/hf/g addl CH T 0134

15120 Skn splt a-grft fac/nck/hf/gT 0137

15121 Skn splt a-grft f/n/hf/g addT 0137

15130 Derm autograft trnk/arm/legT 0136

15131 Derm autograft t/a/l add-onT 0136

15135 Derm autograft face/nck/hf/gT 0136

15136 Derm autograft f/n/hf/g addT 0136

15150 Cult epiderm grft t/arm/legT 0135

15151 Cult epiderm grft t/a/l addlT 0135

15152 Cult epiderm graft t/a/l +%T 0135

15155 Cult epiderm graft f/n/hf/gT 0135

15156 Cult epidrm grft f/n/hfg addT 0135

15157 Cult epiderm grft f/n/hfg +%T 0135

15170 Acell graft trunk/arms/legsT 0135

15171 Acell graft t/arm/leg add-onT 0134

15175 Acellular graft f/n/hf/gT 0135

15176 Acell graft f/n/hf/g add-onT 0135

15200 Skin full graft trunkT 0136

15201 Skin full graft trunk add-onT 0136

15220 Skin full graft sclp/arm/legT 0136

15221 Skin full graft add-onT 0135

15240 Skin full grft face/genit/hfT 0136

15241 Skin full graft add-on CH T 0134
15260 Skin full graft een & lips

T 0136

15261 Skin full graft add-onT 0136

15300 Apply skinallogrft t/arm/lgT 0135

15301 Apply sknallogrft t/a/l addlT 0135

15320 Apply skin allogrft f/n/hf/gT 0135

15321 Aply sknallogrft f/n/hfg addT 0135

15330 Aply acell alogrft t/arm/legT 0135

15331 Aply acell grft t/a/l add-onT 0135

15335 Apply acell graft f/n/hf/gT 0135

15336 Aply acell grft f/n/hf/g addT 0135

15340 Apply cult skin substituteT 0134

15341 Apply cult skin sub add-onT 0134

15360 Apply cult derm sub t/a/lT 0134

15361 Aply cult derm sub t/a/l addT 0134

15365 Apply cult derm sub f/n/hf/gT 0134

15366 Apply cult derm f/hf/g addT 0134

15400 Apply skin xenograft t/a/lT 0135

15401 Apply skn xenogrft t/a/l addT 0135

15420 Apply skin xgraft f/n/hf/gT 0135

15421 Apply skn xgrft f/n/hf/g addT 0135

15430 Apply acellular xenograft CH T 0134

15431 Apply acellular xgraft addT 0135

15570 Form skin pedicle flapT 0137

15572 Form skin pedicle flapT 0137

15574 Form skin pedicle flapT 0137

15576 Form skin pedicle flapT 0137

15600 Skin graftT 0137

15610 Skin graftT 0137

15620 Skin graftT 0137

15630 Skin graftT 0137

15650 Transfer skin pedicle flapT 0137

15731 Forehead flap w/vasc pedicleT 0137

15732 Muscle-skin graft head/neckT 0137

15734 Muscle-skin graft trunkT 0137

15736 Muscle-skin graft armT 0137

15738 Muscle-skin graft legT 0137

15740 Island pedicle flap graftT 0136

15750 Neurovascular pedicle graftT 0137

15756 Free myo/skin flap microvascC

15757 Free skin flap microvascC

15758 Free fascial flap microvascC

15760 Composite skin graftT 0137

15770 Derma-fat-fascia graftT 0137

15775 Hair transplant punch graftsT 0133

15776 Hair transplant punch graftsT 0133

15780 Abrasion treatment of skinT 0022

15781 Abrasion treatment of skinT 0019

15782 Abrasion treatment of skinT 0019

15783 Abrasion treatment of skinT 0016

15786 Abrasion lesion singleT 0013

15787 Abrasion lesions add-onT 0013

15788 Chemical peel face epidermT 0013

15789 Chemical peel face dermalT 0015

15792 Chemical peel nonfacialT 0015

15793 Chemical peel nonfacialT 0013
15819 Plastic surgery neck

T 0134

15820 Revision of lower eyelidT 0137

15821 Revision of lower eyelidT 0137

15822 Revision of upper eyelidT 0137

15823 Revision of upper eyelidT 0137

15824 Removal of forehead wrinklesT 0137

15825 Removal of neck wrinklesT 0137

15826 Removal of brow wrinklesT 0137

15828 Removal of face wrinklesT 0137

15829 Removal of skin wrinklesT 0137

15830 Exc skin abdT 0022

15832 Excise excessive skin tissueT 0022

15833 Excise excessive skin tissueT 0022

15834 Excise excessive skin tissueT 0022

15835 Excise excessive skin tissueT 0022

15836 Excise excessive skin tissueT 0021

15837 Excise excessive skin tissueT 0021

15838 Excise excessive skin tissueT 0021

15839 Excise excessive skin tissueT 0021

15840 Graft for face nerve palsyT 0137

15841 Graft for face nerve palsyT 0137

15842 Flap for face nerve palsyT 0137

15845 Skin and muscle repair faceT 0137

15847 Exc skin abd add-onT 0022

15850 Removal of suturesT 0016

15851 Removal of suturesT 0016

15852 Dressing change not for burnX 0340

15860 Test for blood flow in graftX 0340

15876 Suction assisted lipectomyT 0137

15877 Suction assisted lipectomyT 0137

15878 Suction assisted lipectomyT 0137

15879 Suction assisted lipectomyT 0137

15920 Removal of tail bone ulcerT 0019

15922 Removal of tail bone ulcerT 0137

15931 Remove sacrum pressure soreT 0022

15933 Remove sacrum pressure soreT 0022

15934 Remove sacrum pressure soreT 0137

15935 Remove sacrum pressure soreT 0137

15936 Remove sacrum pressure soreT 0136

15937 Remove sacrum pressure soreT 0137

15940 Remove hip pressure soreT 0022

15941 Remove hip pressure soreT 0022

15944 Remove hip pressure soreT 0137

15945 Remove hip pressure soreT 0137

15946 Remove hip pressure soreT 0137

15950 Remove thigh pressure soreT 0022

15951 Remove thigh pressure soreT 0022

15952 Remove thigh pressure soreT 0136

15953 Remove thigh pressure soreT 0136

15956 Remove thigh pressure soreT 0136

15958 Remove thigh pressure soreT 0136

15999 Removal of pressure soreT 0019

16000 Initial treatment of burn(s)T 0013

16020 Dress/debrid p-thick burn sT 0015

16025 Dress/debrid p-thick burn mT 0015
16030 Dress/debrid p-thick burn l

T 0015

16035 Incision of burn scab initiT 0015

16036 Escharotomy addl incisionC

17000 Destruct premalg lesionT 0013

17003 Destruct premalg les 2-14T 0012

17004 Destroy premlg lesions 15+T 0016

17106 Destruction of skin lesionsT 0016

17107 Destruction of skin lesionsT 0016

17108 Destruction of skin lesionsT 0016

17110 Destruct b9 lesion 1-14T 0013

17111 Destruct lesion 15 or moreT 0015

17250 Chemical cautery tissueT 0015

17260 Destruction of skin lesionsT 0015

17261 Destruction of skin lesionsT 0015

17262 Destruction of skin lesionsT 0015

17263 Destruction of skin lesionsT 0015

17264 Destruction of skin lesionsT 0015

17266 Destruction of skin lesionsT 0016

17270 Destruction of skin lesionsT 0015

17271 Destruction of skin lesionsT 0015

17272 Destruction of skin lesionsT 0015

17273 Destruction of skin lesionsT 0016

17274 Destruction of skin lesionsT 0016

17276 Destruction of skin lesionsT 0016

17280 Destruction of skin lesionsT 0015

17281 Destruction of skin lesionsT 0016

17282 Destruction of skin lesionsT 0016

17283 Destruction of skin lesionsT 0016

17284 Destruction of skin lesionsT 0016

17286 Destruction of skin lesionsT 0016

17311 Mohs 1 stage h/n/hf/gT 0694

17312 Mohs addl stageT 0694

17313 Mohs 1 stage t/a/lT 0694

17314 Mohs addl stage t/a/lT 0694

17315 Mohs surg addl blockT 0694

17340 Cryotherapy of skinT 0013

17360 Skin peel therapyT 0013

17380 Hair removal by electrolysisT 0013

17999 Skin tissue procedureT 0012

19000 Drainage of breast lesionT 0004

19001 Drain breast lesion add-onT 0002

19020 Incision of breast lesionT 0008

19030 Injection for breast x-rayN

19100 Bx breast percut w/o imageT 0004

19101 Biopsy of breast openT 0028

19102 Bx breast percut w/imageT 0005

19103 Bx breast percut w/deviceT 0037

19105 Cryosurg ablate fa eachT 0029

19110 Nipple explorationT 0028

19112 Excise breast duct fistulaT 0028

19120 Removal of breast lesionT 0028

19125 Excision breast lesionT 0028

19126 Excision addl breast lesionT 0028

19260 Removal of chest wall lesionT 0021

19271 Revision of chest wallC
19272 Extensive chest wall surgery

C

19290 Place needle wire breastN

19291 Place needle wire breastN

19295 Place breast clip percut Q1 0340

19296 Place po breast cath for radT 0648

19297 Place breast cath for radT 0648

19298 Place breast rad tube/cathsT 0648

19300 Removal of breast tissueT 0028

19301 Partical mastectomyT 0028

19302 P-mastectomy w/ln removalT 0030

19303 Mast simple completeT 0029

19304 Mast subqT 0029

19305 Mast radicalC

19306 Mast rad urban typeC

19307 Mast mod radT 0030

19316 Suspension of breastT 0029

19318 Reduction of large breastT 0030

19324 Enlarge breastT 0030

19325 Enlarge breast with implantT 0648

19328 Removal of breast implantT 0029

19330 Removal of implant materialT 0029

19340 Immediate breast prosthesisT 0030

19342 Delayed breast prosthesisT 0648

19350 Breast reconstructionT 0028

19355 Correct inverted nipple(s)T 0029

19357 Breast reconstructionT 0648

19361 Breast reconstr w/lat flapC

19364 Breast reconstructionC

19366 Breast reconstructionT 0029

19367 Breast reconstructionC

19368 Breast reconstructionC

19369 Breast reconstructionC

19370 Surgery of breast capsuleT 0029

19371 Removal of breast capsuleT 0029

19380 Revise breast reconstructionT 0030

19396 Design custom breast implantT 0029

19499 Breast surgery procedureT 0028

20005 I&d abscess subfascialT 0020

20100 Explore wound neckT 0252

20101 Explore wound chestT 0137

20102 Explore wound abdomenT 0137

20103 Explore wound extremityT 0007

20150 Excise epiphyseal barT 0051

20200 Muscle biopsyT 0021

20205 Deep muscle biopsyT 0021

20206 Needle biopsy muscleT 0005

20220 Bone biopsy trocar/needleT 0020

20225 Bone biopsy trocar/needleT 0021

20240 Bone biopsy excisionalT 0022

20245 Bone biopsy excisionalT 0022

20250 Open bone biopsy CH T 0050

20251 Open bone biopsy CH T 0050

20500 Injection of sinus tractT 0252

20501 Inject sinus tract for x-rayN

20520 Removal of foreign bodyT 0019
20525 Removal of foreign body

T 0022

20526 Ther injection carp tunnelT 0204

20550 Inj tendon sheath/ligamentT 0204

20551 Inj tendon origin/insertionT 0204

20552 Inj trigger point 1/2 musclT 0204

20553 Inject trigger points =/> 3T 0204

20555 Place ndl musc/tis for rtT 0050

20600 Drain/inject joint/bursaT 0204

20605 Drain/inject joint/bursaT 0204

20610 Drain/inject joint/bursaT 0204

20612 Aspirate/inj ganglion cystT 0204

20615 Treatment of bone cystT 0004

20650 Insert and remove bone pin CH T 0050

20660 Apply rem fixation deviceT 0138

20661 Application of head braceC

20662 Application of pelvis braceT 0049

20663 Application of thigh brace CH T 0050

20664 Application of haloC

20665 Removal of fixation deviceX 0340

20670 Removal of support implantT 0021

20680 Removal of support implantT 0022

20690 Apply bone fixation deviceT 0050

20692 Apply bone fixation deviceT 0050

20693 Adjust bone fixation device CH T 0050

20694 Remove bone fixation deviceT 0049

20696 Comp multiplane ext fixationT 0050

20697 Comp ext fixate strut changeT 0139

20802 Replantation arm completeC

20805 Replant forearm completeC

20808 Replantation hand completeC

20816 Replantation digit completeC

20822 Replantation digit completeT 0054

20824 Replantation thumb completeC

20827 Replantation thumb completeC

20838 Replantation foot completeC

20900 Removal of bone for graftT 0050

20902 Removal of bone for graftT 0050

20910 Remove cartilage for graftT 0137

20912 Remove cartilage for graftT 0137

20920 Removal of fascia for graftT 0136

20922 Removal of fascia for graftT 0136

20924 Removal of tendon for graftT 0050

20926 Removal of tissue for graftT 0135

20930 Sp bone algrft morsel add-onC

20931 Sp bone algrft struct add-onC

20936 Sp bone agrft local add-onC

20937 Sp bone agrft morsel add-onC

20938 Sp bone agrft struct add-onC

20950 Fluid pressure muscleT 0006

20955 Fibula bone graft microvascC

20956 Iliac bone graft microvascC

20957 Mt bone graft microvascC

20962 Other bone graft microvascC

20969 Bone/skin graft microvascC

20970 Bone/skin graft iliac crestC
20972 Bone/skin graft metatarsal

T 0056

20973 Bone/skin graft great toeT 0056

20974 Electrical bone stimulationA

20975 Electrical bone stimulation N 

20979 Us bone stimulation X 0340

20982 Ablate bone tumor(s) perqT 0051

20985 Cptr-asst dir ms px N 

20999 Musculoskeletal surgeryT 0049

21010 Incision of jaw jointT 0254

21011 Exc face les sc < 2 cmT 0020

21012 Exc face les sbq 2+ cmT 0020

21013 Exc face tum deep < 2 cmT 0020

21014 Exc face tum deep 2+ cmT 0020

21015 Resect face tum < 2 cmT 0021

21016 Resect face tum + cmT 0022

21025 Excision of bone lower jawT 0256

21026 Excision of facial bone(s)T 0256

21029 Contour of face bone lesionT 0256

21030 Excise max/zygoma b9 tumorT 0254

21031 Remove exostosis mandibleT 0254

21032 Remove exostosis maxillaT 0254

21034 Excise max/zygoma mlg tumorT 0256

21040 Excise mandible lesionT 0254

21044 Removal of jaw bone lesionT 0256

21045 Extensive jaw surgeryC

21046 Remove mandible cyst complexT 0256

21047 Excise lwr jaw cyst w/repairT 0256

21048 Remove maxilla cyst complexT 0256

21049 Excis uppr jaw cyst w/repairT 0256

21050 Removal of jaw jointT 0256

21060 Remove jaw joint cartilageT 0256

21070 Remove coronoid processT 0256

21073 Mnpj of tmj w/anesthT 0252

21076 Prepare face/oral prosthesisT 0254

21077 Prepare face/oral prosthesisT 0256

21079 Prepare face/oral prosthesisT 0256

21080 Prepare face/oral prosthesisT 0256

21081 Prepare face/oral prosthesisT 0256

21082 Prepare face/oral prosthesisT 0256

21083 Prepare face/oral prosthesisT 0256

21084 Prepare face/oral prosthesisT 0256

21085 Prepare face/oral prosthesisT 0253

21086 Prepare face/oral prosthesisT 0256

21087 Prepare face/oral prosthesisT 0256

21088 Prepare face/oral prosthesisT 0256

21089 Prepare face/oral prosthesisT 0250

21100 Maxillofacial fixationT 0256

21110 Interdental fixationT 0252

21116 Injection jaw joint x-rayN

21120 Reconstruction of chinT 0254

21121 Reconstruction of chinT 0254

21122 Reconstruction of chinT 0254

21123 Reconstruction of chinT 0254

21125 Augmentation lower jaw boneT 0254

21127 Augmentation lower jaw boneT 0256
21137 Reduction of forehead

T 0254

21138 Reduction of foreheadT 0256

21139 Reduction of foreheadT 0256

21141 Reconstruct midface lefortC

21142 Reconstruct midface lefortC

21143 Reconstruct midface lefortC

21145 Reconstruct midface lefortC

21146 Reconstruct midface lefortC

21147 Reconstruct midface lefortC

21150 Reconstruct midface lefortT 0256

21151 Reconstruct midface lefortC

21154 Reconstruct midface lefortC

21155 Reconstruct midface lefortC

21159 Reconstruct midface lefortC

21160 Reconstruct midface lefortC

21172 Reconstruct orbit/foreheadT 0256

21175 Reconstruct orbit/foreheadT 0256

21179 Reconstruct entire foreheadC

21180 Reconstruct entire foreheadC

21181 Contour cranial bone lesionT 0254

21182 Reconstruct cranial boneC

21183 Reconstruct cranial boneC

21184 Reconstruct cranial boneC

21188 Reconstruction of midfaceC

21193 Reconst lwr jaw w/o graftT 0256

21194 Reconst lwr jaw w/graftC

21195 Reconst lwr jaw w/o fixationT 0256

21196 Reconst lwr jaw w/fixationC

21198 Reconstr lwr jaw segmentT 0256

21199 Reconstr lwr jaw w/advanceT 0256

21206 Reconstruct upper jaw boneT 0256

21208 Augmentation of facial bonesT 0256

21209 Reduction of facial bonesT 0256

21210 Face bone graftT 0256

21215 Lower jaw bone graftT 0256

21230 Rib cartilage graftT 0256

21235 Ear cartilage graftT 0254

21240 Reconstruction of jaw jointT 0256

21242 Reconstruction of jaw jointT 0256

21243 Reconstruction of jaw jointT 0256

21244 Reconstruction of lower jawT 0256

21245 Reconstruction of jawT 0256

21246 Reconstruction of jawT 0256

21247 Reconstruct lower jaw boneC

21248 Reconstruction of jawT 0256

21249 Reconstruction of jawT 0256

21255 Reconstruct lower jaw boneC

21256 Reconstruction of orbitT 0256

21260 Revise eye socketsT 0256

21261 Revise eye socketsT 0256

21263 Revise eye socketsT 0256

21267 Revise eye socketsT 0256

21268 Revise eye socketsC

21270 Augmentation cheek boneT 0256

21275 Revision orbitofacial bonesT 0256
21280 Revision of eyelid

T 0256

21282 Revision of eyelidT 0253

21295 Revision of jaw muscle/boneT 0252

21296 Revision of jaw muscle/boneT 0254

21299 Cranio/maxillofacial surgeryT 0250

21310 Treatment of nose fractureT 0250

21315 Treatment of nose fractureT 0253

21320 Treatment of nose fractureT 0253

21325 Treatment of nose fractureT 0254

21330 Treatment of nose fractureT 0254

21335 Treatment of nose fractureT 0254

21336 Treat nasal septal fractureT 0062

21337 Treat nasal septal fractureT 0253

21338 Treat nasoethmoid fractureT 0254

21339 Treat nasoethmoid fractureT 0254

21340 Treatment of nose fractureT 0256

21343 Treatment of sinus fractureC

21344 Treatment of sinus fractureC

21345 Treat nose/jaw fractureT 0254

21346 Treat nose/jaw fracture CHT 0254

21347 Treat nose/jaw fractureC

21348 Treat nose/jaw fractureC

21355 Treat cheek bone fractureT 0256

21356 Treat cheek bone fractureT 0254

21360 Treat cheek bone fractureT 0254

21365 Treat cheek bone fractureT 0256

21366 Treat cheek bone fractureC

21385 Treat eye socket fractureT 0256

21386 Treat eye socket fractureT 0256

21387 Treat eye socket fractureT 0256

21390 Treat eye socket fractureT 0256

21395 Treat eye socket fractureT 0256

21400 Treat eye socket fractureT 0252

21401 Treat eye socket fractureT 0253

21406 Treat eye socket fractureT 0256

21407 Treat eye socket fractureT 0256

21408 Treat eye socket fractureT 0256

21421 Treat mouth roof fractureT 0254

21422 Treat mouth roof fractureC

21423 Treat mouth roof fractureC

21431 Treat craniofacial fractureC

21432 Treat craniofacial fractureC

21433 Treat craniofacial fractureC

21435 Treat craniofacial fractureC

21436 Treat craniofacial fractureC

21440 Treat dental ridge fractureT 0254

21445 Treat dental ridge fractureT 0254

21450 Treat lower jaw fractureT 0251

21451 Treat lower jaw fractureT 0252

21452 Treat lower jaw fractureT 0253

21453 Treat lower jaw fractureT 0256

21454 Treat lower jaw fractureT 0254

21461 Treat lower jaw fractureT 0256

21462 Treat lower jaw fractureT 0256

21465 Treat lower jaw fractureT 0256
21470 Treat lower jaw fracture

T 0256

21480 Reset dislocated jawT 0250

21485 Reset dislocated jawT 0253

21490 Repair dislocated jawT 0256

21495 Treat hyoid bone fractureT 0253

21497 Interdental wiringT 0253

21499 Head surgery procedureT 0250

21501 Drain neck/chest lesionT 0008

21502 Drain chest lesionT 0049

21510 Drainage of bone lesionC

21550 Biopsy of neck/chestT 0021

21552 Exc neck les sc 3+ cmT 0022

21554 Exc neck tum deep 5+ cmT 0022

21555 Exc neck les sc < 3 cmT 0021

21556 Exc neck tum deep < 5 cmT 0022

21557 Resect neck tum < 5 cmT 0021

21558 Resect neck tum 5+ cmT 0022

21600 Partial removal of ribT 0050

21610 Partial removal of ribT 0050

21615 Removal of ribC

21616 Removal of rib and nervesC

21620 Partial removal of sternumC

21627 Sternal debridementC

21630 Extensive sternum surgeryC

21632 Extensive sternum surgeryC

21685 Hyoid myotomy & suspensionT 0252

21700 Revision of neck muscleT 0049

21705 Revision of neck muscle/ribC

21720 Revision of neck muscleT 0049

21725 Revision of neck muscleT 0006

21740 Reconstruction of sternumC

21742 Repair stern/nuss w/o scopeT 0051

21743 Repair sternum/nuss w/scopeT 0051

21750 Repair of sternum separationC

21800 Treatment of rib fractureT 0129

21805 Treatment of rib fractureT 0062

21810 Treatment of rib fracture(s)C

21820 Treat sternum fractureT 0129

21825 Treat sternum fractureC

21899 Neck/chest surgery procedureT 0250

21920 Biopsy soft tissue of backT 0020

21925 Biopsy soft tissue of backT 0022

21930 Exc back les sc < 3 cmT 0021

21931 Exc back les sc 3+ cmT 0022

21932 Exc back tum deep < 5 cmT 0021

21933 Exc back tum deep 5+ cmT 0022

21935 Resect back tum < 5 cmT 0021

21936 Resect back tum 5+ cmT 0022

22010 I&d p-spine c/t/cerv-thorC

22015 I&d p-spine l/s/lsC

22100 Remove part of neck vertebraT 0208

22101 Remove part thorax vertebraT 0208

22102 Remove part lumbar vertebraT 0208

22103 Remove extra spine segmentT 0208

22110 Remove part of neck vertebraC
22112 Remove part thorax vertebra

C

22114 Remove part lumbar vertebraC

22116 Remove extra spine segmentC

22206 Cut spine 3 col thorC

22207 Cut spine 3 col lumbC

22208 Cut spine 3 col addl segC

22210 Revision of neck spineC

22212 Revision of thorax spineC

22214 Revision of lumbar spineC

22216 Revise extra spine segmentC

22220 Revision of neck spineC

22222 Revision of thorax spineT 0208

22224 Revision of lumbar spineC

22226 Revise extra spine segmentC

22305 Treat spine process fractureT 0129

22310 Treat spine fractureT 0138

22315 Treat spine fractureT 0139

22318 Treat odontoid fx w/o graftC

22319 Treat odontoid fx w/graftC

22325 Treat spine fractureC

22326 Treat neck spine fractureC

22327 Treat thorax spine fractureC

22328 Treat each add spine fxC

22505 Manipulation of spineT 0045

22520 Percut vertebroplasty thorT 0050

22521 Percut vertebroplasty lumbT 0050

22522 Percut vertebroplasty addlT 0050

22523 Percut kyphoplasty thorT 0052

22524 Percut kyphoplasty lumbarT 0052

22525 Percut kyphoplasty add-onT 0052

22526 Idet single level

E

22527 Idet 1 or more levels

E

22532 Lat thorax spine fusionC

22533 Lat lumbar spine fusionC

22534 Lat thor/lumb addl segC

22548 Neck spine fusionC

22551 Neck spine fuse&remove addlC

22552 Addl neck spine fusionC

22554 Neck spine fusionC

22556 Thorax spine fusionC

22558 Lumbar spine fusionC

22585 Additional spinal fusionC

22590 Spine & skull spinal fusionC

22595 Neck spinal fusionC

22600 Neck spine fusionC

22610 Thorax spine fusionC

22612 Lumbar spine fusionT 0208

22614 Spine fusion extra segmentT 0208

22630 Lumbar spine fusionC

22632 Spine fusion extra segmentC

22800 Fusion of spineC

22802 Fusion of spineC

22804 Fusion of spineC

22808 Fusion of spineC

22810 Fusion of spineC
22812 Fusion of spine

C

22818 Kyphectomy 1-2 segmentsC

22819 Kyphectomy 3 or moreC

22830 Exploration of spinal fusionC

22840 Insert spine fixation deviceC

22841 Insert spine fixation deviceC

22842 Insert spine fixation deviceC

22843 Insert spine fixation deviceC

22844 Insert spine fixation deviceC

22845 Insert spine fixation deviceC

22846 Insert spine fixation deviceC

22847 Insert spine fixation deviceC

22848 Insert pelv fixation deviceC

22849 Reinsert spinal fixationC

22850 Remove spine fixation deviceC

22851 Apply spine prosth device CH T 0050

22852 Remove spine fixation deviceC

22855 Remove spine fixation deviceC

22856 Cerv artific diskectomyC

22857 Lumbar artif diskectomyC

22861 Revise cerv artific discC

22862 Revise lumbar artif discC

22864 Remove cerv artif discC

22865 Remove lumb artif discC

22899 Spine surgery procedure CH T 0050

22900 Exc back tum deep < 5 cmT 0022

22901 Exc back tum deep 5+ cmT 0022

22902 Exc abd les sc < 3 cmT 0021

22903 Exc abd les sc > 3 cmT 0022

22904 Resect abd tum < 5 cmT 0021

22905 Resect abd tum > 5 cmT 0022

22999 Abdomen surgery procedureT 0049

23000 Removal of calcium depositsT 0021

23020 Release shoulder joint CH T 0050

23030 Drain shoulder lesionT 0008

23031 Drain shoulder bursaT 0008

23035 Drain shoulder bone lesionT 0049

23040 Exploratory shoulder surgeryT 0050

23044 Exploratory shoulder surgeryT 0050

23065 Biopsy shoulder tissuesT 0020

23066 Biopsy shoulder tissuesT 0022

23071 Exc shoulder les sc > 3 cmT 0022

23073 Exc shoulder tum deep > 5 cmT 0022

23075 Exc shoulder les sc < 3 cmT 0021

23076 Exc shoulder tum deep < 5 cmT 0021

23077 Resect shoulder tum < 5 cmT 0021

23078 Resect shoulder tum > 5 cmT 0022

23100 Biopsy of shoulder jointT 0049

23101 Shoulder joint surgeryT 0050

23105 Remove shoulder joint liningT 0050

23106 Incision of collarbone jointT 0050

23107 Explore treat shoulder jointT 0050

23120 Partial removal collar boneT 0050

23125 Removal of collar boneT 0050

23130 Remove shoulder bone partT 0051
23140 Removal of bone lesion

T 0049

23145 Removal of bone lesionT 0050

23146 Removal of bone lesionT 0050

23150 Removal of humerus lesionT 0050

23155 Removal of humerus lesionT 0050

23156 Removal of humerus lesionT 0050

23170 Remove collar bone lesionT 0050

23172 Remove shoulder blade lesionT 0050

23174 Remove humerus lesionT 0050

23180 Remove collar bone lesionT 0050

23182 Remove shoulder blade lesionT 0050

23184 Remove humerus lesionT 0050

23190 Partial removal of scapulaT 0050

23195 Removal of head of humerusT 0050

23200 Resect clavicle tumorC

23210 Resect scapula tumorC

23220 Resect prox humerus tumorC

23330 Remove shoulder foreign bodyT 0020

23331 Remove shoulder foreign bodyT 0022

23332 Remove shoulder foreign bodyC

23350 Injection for shoulder x-rayN

23395 Muscle transfer shoulder/armT 0051

23397 Muscle transfersT 0052

23400 Fixation of shoulder bladeT 0050

23405 Incision of tendon & muscleT 0050

23406 Incise tendon(s) & muscle(s)T 0050

23410 Repair rotator cuff acuteT 0051

23412 Repair rotator cuff chronicT 0051

23415 Release of shoulder ligamentT 0051

23420 Repair of shoulderT 0051

23430 Repair biceps tendonT 0051

23440 Remove/transplant tendon CH T 0050

23450 Repair shoulder capsuleT 0052

23455 Repair shoulder capsuleT 0052

23460 Repair shoulder capsuleT 0052

23462 Repair shoulder capsuleT 0051

23465 Repair shoulder capsuleT 0052

23466 Repair shoulder capsuleT 0051

23470 Reconstruct shoulder jointT 0425

23472 Reconstruct shoulder jointC

23480 Revision of collar boneT 0051

23485 Revision of collar boneT 0052

23490 Reinforce clavicleT 0052

23491 Reinforce shoulder bonesT 0052

23500 Treat clavicle fractureT 0129

23505 Treat clavicle fractureT 0139

23515 Treat clavicle fractureT 0064

23520 Treat clavicle dislocationT 0138

23525 Treat clavicle dislocationT 0138

23530 Treat clavicle dislocationT 0063

23532 Treat clavicle dislocationT 0062

23540 Treat clavicle dislocationT 0129

23545 Treat clavicle dislocationT 0138

23550 Treat clavicle dislocationT 0063

23552 Treat clavicle dislocationT 0063
23570 Treat shoulder blade fx

T 0129

23575 Treat shoulder blade fxT 0138

23585 Treat scapula fractureT 0064

23600 Treat humerus fractureT 0129

23605 Treat humerus fractureT 0139

23615 Treat humerus fractureT 0064

23616 Treat humerus fractureT 0064

23620 Treat humerus fractureT 0129

23625 Treat humerus fractureT 0139

23630 Treat humerus fractureT 0064

23650 Treat shoulder dislocationT 0129

23655 Treat shoulder dislocationT 0045

23660 Treat shoulder dislocationT 0063

23665 Treat dislocation/fractureT 0138

23670 Treat dislocation/fractureT 0064

23675 Treat dislocation/fractureT 0129

23680 Treat dislocation/fractureT 0063

23700 Fixation of shoulderT 0045

23800 Fusion of shoulder jointT 0052

23802 Fusion of shoulder jointT 0052

23900 Amputation of arm & girdleC

23920 Amputation at shoulder jointC

23921 Amputation follow-up surgeryT 0136

23929 Shoulder surgery procedureT 0129

23930 Drainage of arm lesionT 0008

23931 Drainage of arm bursaT 0008

23935 Drain arm/elbow bone lesionT 0049

24000 Exploratory elbow surgeryT 0050

24006 Release elbow jointT 0050

24065 Biopsy arm/elbow soft tissueT 0021

24066 Biopsy arm/elbow soft tissueT 0021

24071 Exc arm/elbow les sc 3+ cmT 0022

24073 Ex arm/elbow tum deep > 5 cmT 0022

24075 Exc arm/elbow les sc < 3 cmT 0021

24076 Ex arm/elbow tum deep < 5 cmT 0021

24077 Resect arm/elbow tum < 5 cmT 0021

24079 Resect arm/elbow tum > 5 cmT 0022

24100 Biopsy elbow joint liningT 0049

24101 Explore/treat elbow jointT 0050

24102 Remove elbow joint liningT 0050

24105 Removal of elbow bursaT 0049

24110 Remove humerus lesionT 0049

24115 Remove/graft bone lesionT 0050

24116 Remove/graft bone lesionT 0050

24120 Remove elbow lesionT 0049

24125 Remove/graft bone lesionT 0050

24126 Remove/graft bone lesionT 0050

24130 Removal of head of radiusT 0050

24134 Removal of arm bone lesionT 0050

24136 Remove radius bone lesionT 0050

24138 Remove elbow bone lesionT 0050

24140 Partial removal of arm boneT 0050

24145 Partial removal of radiusT 0050

24147 Partial removal of elbowT 0050

24149 Radical resection of elbowT 0050
24150 Resect distal humerus tumor

T 0051

24152 Resect radius tumorT 0051

24155 Removal of elbow joint CH T 0050

24160 Remove elbow joint implantT 0050

24164 Remove radius head implantT 0050

24200 Removal of arm foreign bodyT 0019

24201 Removal of arm foreign bodyT 0021

24220 Injection for elbow x-rayN

24300 Manipulate elbow w/anesthT 0045

24301 Muscle/tendon transferT 0050

24305 Arm tendon lengtheningT 0050

24310 Revision of arm tendonT 0049

24320 Repair of arm tendon CH T 0050

24330 Revision of arm musclesT 0052

24331 Revision of arm musclesT 0051

24332 Tenolysis triceps CH T 0050

24340 Repair of biceps tendonT 0051

24341 Repair arm tendon/muscleT 0051

24342 Repair of ruptured tendonT 0051

24343 Repr elbow lat ligmnt w/tissT 0050

24344 Reconstruct elbow lat ligmntT 0052

24345 Repr elbw med ligmnt w/tissuT 0050

24346 Reconstruct elbow med ligmntT 0052

24357 Repair elbow percT 0050

24358 Repair elbow w/deb openT 0050

24359 Repair elbow deb/attch openT 0050

24360 Reconstruct elbow jointT 0047

24361 Reconstruct elbow jointT 0425

24362 Reconstruct elbow jointT 0048

24363 Replace elbow jointT 0425

24365 Reconstruct head of radiusT 0047

24366 Reconstruct head of radiusT 0425

24400 Revision of humerusT 0052

24410 Revision of humerusT 0051

24420 Revision of humerusT 0051

24430 Repair of humerusT 0052

24435 Repair humerus with graftT 0052

24470 Revision of elbow jointT 0051

24495 Decompression of forearmT 0050

24498 Reinforce humerusT 0052

24500 Treat humerus fractureT 0129

24505 Treat humerus fractureT 0129

24515 Treat humerus fractureT 0064

24516 Treat humerus fractureT 0064

24530 Treat humerus fractureT 0129

24535 Treat humerus fractureT 0138

24538 Treat humerus fractureT 0062

24545 Treat humerus fractureT 0064

24546 Treat humerus fractureT 0064

24560 Treat humerus fractureT 0129

24565 Treat humerus fractureT 0129

24566 Treat humerus fractureT 0062

24575 Treat humerus fractureT 0064

24576 Treat humerus fractureT 0129

24577 Treat humerus fractureT 0129
24579 Treat humerus fracture

T 0064

24582 Treat humerus fractureT 0062

24586 Treat elbow fractureT 0064

24587 Treat elbow fractureT 0064

24600 Treat elbow dislocationT 0129

24605 Treat elbow dislocationT 0045

24615 Treat elbow dislocationT 0064

24620 Treat elbow fractureT 0139

24635 Treat elbow fractureT 0064

24640 Treat elbow dislocationT 0129

24650 Treat radius fractureT 0129

24655 Treat radius fractureT 0138

24665 Treat radius fractureT 0063

24666 Treat radius fractureT 0064

24670 Treat ulnar fractureT 0129

24675 Treat ulnar fractureT 0129

24685 Treat ulnar fractureT 0063

24800 Fusion of elbow jointT 0051

24802 Fusion/graft of elbow jointT 0052

24900 Amputation of upper armC

24920 Amputation of upper armC

24925 Amputation follow-up surgeryT 0049

24930 Amputation follow-up surgeryC

24931 Amputate upper arm & implantC

24935 Revision of amputationT 0052

24940 Revision of upper armC

24999 Upper arm/elbow surgeryT 0129

25000 Incision of tendon sheathT 0049

25001 Incise flexor carpi radialisT 0049

25020 Decompress forearm 1 spaceT 0050

25023 Decompress forearm 1 spaceT 0050

25024 Decompress forearm 2 spacesT 0050

25025 Decompress forearm 2 spacesT 0050

25028 Drainage of forearm lesionT 0049

25031 Drainage of forearm bursaT 0049

25035 Treat forearm bone lesionT 0049

25040 Explore/treat wrist jointT 0050

25065 Biopsy forearm soft tissuesT 0020

25066 Biopsy forearm soft tissuesT 0022

25071 Exc forearm les sc > 3 cmT 0022

25073 Exc forearm tum deep 3+ cmT 0022

25075 Exc forearm les sc < 3 cmT 0021

25076 Exc forearm tum deep < 3 cmT 0021

25077 Resect forearm/wrist tum<3cmT 0021

25078 Resect forearm/wrist tum3+cmT 0022

25085 Incision of wrist capsuleT 0049

25100 Biopsy of wrist jointT 0049

25101 Explore/treat wrist jointT 0050

25105 Remove wrist joint liningT 0050

25107 Remove wrist joint cartilageT 0050

25109 Excise tendon forearm/wristT 0049

25110 Remove wrist tendon lesionT 0049

25111 Remove wrist tendon lesionT 0049

25112 Reremove wrist tendon lesionT 0049

25115 Remove wrist/forearm lesionT 0049
25116 Remove wrist/forearm lesion

T 0049

25118 Excise wrist tendon sheathT 0050

25119 Partial removal of ulnaT 0050

25120 Removal of forearm lesionT 0050

25125 Remove/graft forearm lesionT 0050

25126 Remove/graft forearm lesionT 0050

25130 Removal of wrist lesionT 0050

25135 Remove & graft wrist lesionT 0050

25136 Remove & graft wrist lesionT 0050

25145 Remove forearm bone lesionT 0050

25150 Partial removal of ulnaT 0050

25151 Partial removal of radiusT 0050

25170 Resect radius/ulnar tumor CH T 0050

25210 Removal of wrist boneT 0050

25215 Removal of wrist bonesT 0050

25230 Partial removal of radiusT 0050

25240 Partial removal of ulnaT 0050

25246 Injection for wrist x-rayN

25248 Remove forearm foreign bodyT 0049

25250 Removal of wrist prosthesisT 0050

25251 Removal of wrist prosthesisT 0050

25259 Manipulate wrist w/anesthesT 0139

25260 Repair forearm tendon/muscleT 0050

25263 Repair forearm tendon/muscleT 0050

25265 Repair forearm tendon/muscleT 0050

25270 Repair forearm tendon/muscleT 0050

25272 Repair forearm tendon/muscleT 0050

25274 Repair forearm tendon/muscleT 0050

25275 Repair forearm tendon sheathT 0050

25280 Revise wrist/forearm tendonT 0050

25290 Incise wrist/forearm tendonT 0050

25295 Release wrist/forearm tendonT 0049

25300 Fusion of tendons at wristT 0050

25301 Fusion of tendons at wristT 0050

25310 Transplant forearm tendon CH T 0050

25312 Transplant forearm tendonT 0051

25315 Revise palsy hand tendon(s) CH T 0050

25316 Revise palsy hand tendon(s)T 0052

25320 Repair/revise wrist jointT 0051

25332 Revise wrist jointT 0047

25335 Realignment of handT 0051

25337 Reconstruct ulna/radioulnarT 0051

25350 Revision of radiusT 0051

25355 Revision of radiusT 0051

25360 Revision of ulnaT 0051

25365 Revise radius & ulnaT 0052

25370 Revise radius or ulnaT 0051

25375 Revise radius & ulnaT 0051

25390 Shorten radius or ulnaT 0051

25391 Lengthen radius or ulnaT 0052

25392 Shorten radius & ulnaT 0050

25393 Lengthen radius & ulnaT 0051

25394 Repair carpal bone shortenT 0051

25400 Repair radius or ulnaT 0052

25405 Repair/graft radius or ulnaT 0052
25415 Repair radius & ulna

T 0052

25420 Repair/graft radius & ulnaT 0052

25425 Repair/graft radius or ulnaT 0052

25426 Repair/graft radius & ulnaT 0051

25430 Vasc graft into carpal boneT 0051

25431 Repair nonunion carpal boneT 0051

25440 Repair/graft wrist boneT 0052

25441 Reconstruct wrist jointT 0425

25442 Reconstruct wrist jointT 0425

25443 Reconstruct wrist jointT 0048

25444 Reconstruct wrist jointT 0048

25445 Reconstruct wrist jointT 0048

25446 Wrist replacementT 0425

25447 Repair wrist joint(s)T 0047

25449 Remove wrist joint implantT 0047

25450 Revision of wrist jointT 0051

25455 Revision of wrist jointT 0051

25490 Reinforce radiusT 0051

25491 Reinforce ulnaT 0051

25492 Reinforce radius and ulnaT 0051

25500 Treat fracture of radiusT 0129

25505 Treat fracture of radiusT 0138

25515 Treat fracture of radiusT 0063

25520 Treat fracture of radiusT 0138

25525 Treat fracture of radiusT 0063

25526 Treat fracture of radiusT 0063

25530 Treat fracture of ulnaT 0129

25535 Treat fracture of ulnaT 0129

25545 Treat fracture of ulnaT 0063

25560 Treat fracture radius & ulnaT 0129

25565 Treat fracture radius & ulnaT 0138

25574 Treat fracture radius & ulnaT 0064

25575 Treat fracture radius/ulnaT 0064

25600 Treat fracture radius/ulnaT 0129

25605 Treat fracture radius/ulnaT 0138

25606 Treat fx distal radialT 0062

25607 Treat fx rad extra-articulT 0064

25608 Treat fx rad intra-articulT 0064

25609 Treat fx radial 3+ fragT 0064

25622 Treat wrist bone fractureT 0129

25624 Treat wrist bone fractureT 0138

25628 Treat wrist bone fractureT 0063

25630 Treat wrist bone fractureT 0129

25635 Treat wrist bone fractureT 0129

25645 Treat wrist bone fractureT 0063

25650 Treat wrist bone fractureT 0129

25651 Pin ulnar styloid fractureT 0062

25652 Treat fracture ulnar styloidT 0063

25660 Treat wrist dislocationT 0129

25670 Treat wrist dislocationT 0062

25671 Pin radioulnar dislocationT 0062

25675 Treat wrist dislocationT 0129

25676 Treat wrist dislocationT 0062

25680 Treat wrist fractureT 0129

25685 Treat wrist fractureT 0062
25690 Treat wrist dislocation

T 0139

25695 Treat wrist dislocationT 0062

25800 Fusion of wrist jointT 0052

25805 Fusion/graft of wrist jointT 0052

25810 Fusion/graft of wrist jointT 0052

25820 Fusion of hand bonesT 0051

25825 Fuse hand bones with graftT 0052

25830 Fusion radioulnar jnt/ulnaT 0052

25900 Amputation of forearmC

25905 Amputation of forearmC

25907 Amputation follow-up surgeryT 0049

25909 Amputation follow-up surgeryT 0049

25915 Amputation of forearmC

25920 Amputate hand at wristC

25922 Amputate hand at wristT 0049

25924 Amputation follow-up surgeryC

25927 Amputation of handC

25929 Amputation follow-up surgeryT 0136

25931 Amputation follow-up surgeryT 0049

25999 Forearm or wrist surgeryT 0129

26010 Drainage of finger abscessT 0006

26011 Drainage of finger abscessT 0007

26020 Drain hand tendon sheathT 0053

26025 Drainage of palm bursaT 0053

26030 Drainage of palm bursa(s)T 0053

26034 Treat hand bone lesionT 0053

26035 Decompress fingers/handT 0053

26037 Decompress fingers/handT 0053

26040 Release palm contractureT 0053

26045 Release palm contractureT 0054

26055 Incise finger tendon sheathT 0053

26060 Incision of finger tendonT 0053

26070 Explore/treat hand jointT 0053

26075 Explore/treat finger jointT 0053

26080 Explore/treat finger jointT 0053

26100 Biopsy hand joint liningT 0053

26105 Biopsy finger joint liningT 0053

26110 Biopsy finger joint liningT 0053

26111 Exc hand les sc > 1.5 cmT 0022

26113 Exc hand tum deep > 1.5 cmT 0022

26115 Exc hand les sc < 1.5 cmT 0021

26116 Exc hand tum deep < 1.5 cmT 0021

26117 Exc hand tum ra < 3 cmT 0021

26118 Exc hand tum ra > 3 cmT 0022

26121 Release palm contractureT 0054

26123 Release palm contractureT 0054

26125 Release palm contractureT 0053

26130 Remove wrist joint liningT 0053

26135 Revise finger joint eachT 0054

26140 Revise finger joint eachT 0053

26145 Tendon excision palm/fingerT 0053

26160 Remove tendon sheath lesionT 0053

26170 Removal of palm tendon eachT 0053

26180 Removal of finger tendonT 0053

26185 Remove finger boneT 0053
26200 Remove hand bone lesion

T 0053

26205 Remove/graft bone lesionT 0054

26210 Removal of finger lesionT 0053

26215 Remove/graft finger lesionT 0053

26230 Partial removal of hand boneT 0053

26235 Partial removal finger boneT 0053

26236 Partial removal finger boneT 0053

26250 Extensive hand surgeryT 0053

26260 Resect prox finger tumorT 0053

26262 Resect distal finger tumorT 0053

26320 Removal of implant from handT 0021

26340 Manipulate finger w/anesthT 0138

26350 Repair finger/hand tendonT 0054

26352 Repair/graft hand tendonT 0054

26356 Repair finger/hand tendonT 0054

26357 Repair finger/hand tendonT 0054

26358 Repair/graft hand tendonT 0054

26370 Repair finger/hand tendonT 0054

26372 Repair/graft hand tendonT 0054

26373 Repair finger/hand tendonT 0054

26390 Revise hand/finger tendonT 0054

26392 Repair/graft hand tendonT 0054

26410 Repair hand tendonT 0053

26412 Repair/graft hand tendonT 0054

26415 Excision hand/finger tendonT 0054

26416 Graft hand or finger tendonT 0054

26418 Repair finger tendonT 0053

26420 Repair/graft finger tendonT 0054

26426 Repair finger/hand tendonT 0054

26428 Repair/graft finger tendonT 0054

26432 Repair finger tendonT 0053

26433 Repair finger tendonT 0053

26434 Repair/graft finger tendonT 0054

26437 Realignment of tendonsT 0053

26440 Release palm/finger tendonT 0053

26442 Release palm & finger tendonT 0054

26445 Release hand/finger tendonT 0053

26449 Release forearm/hand tendonT 0054

26450 Incision of palm tendonT 0053

26455 Incision of finger tendonT 0053

26460 Incise hand/finger tendonT 0053

26471 Fusion of finger tendonsT 0053

26474 Fusion of finger tendonsT 0053

26476 Tendon lengtheningT 0053

26477 Tendon shorteningT 0053

26478 Lengthening of hand tendonT 0053

26479 Shortening of hand tendonT 0053

26480 Transplant hand tendonT 0054

26483 Transplant/graft hand tendonT 0054

26485 Transplant palm tendonT 0054

26489 Transplant/graft palm tendonT 0054

26490 Revise thumb tendonT 0054

26492 Tendon transfer with graftT 0054

26494 Hand tendon/muscle transferT 0054

26496 Revise thumb tendonT 0054
26497 Finger tendon transfer

T 0054

26498 Finger tendon transferT 0054

26499 Revision of fingerT 0054

26500 Hand tendon reconstructionT 0053

26502 Hand tendon reconstructionT 0054

26508 Release thumb contractureT 0053

26510 Thumb tendon transferT 0054

26516 Fusion of knuckle jointT 0054

26517 Fusion of knuckle jointsT 0054

26518 Fusion of knuckle jointsT 0054

26520 Release knuckle contractureT 0053

26525 Release finger contractureT 0053

26530 Revise knuckle jointT 0047

26531 Revise knuckle with implantT 0048

26535 Revise finger jointT 0047

26536 Revise/implant finger jointT 0048

26540 Repair hand jointT 0053

26541 Repair hand joint with graftT 0054

26542 Repair hand joint with graftT 0053

26545 Reconstruct finger jointT 0054

26546 Repair nonunion handT 0054

26548 Reconstruct finger jointT 0054

26550 Construct thumb replacementT 0054

26551 Great toe-hand transferC

26553 Single transfer toe-handC

26554 Double transfer toe-handC

26555 Positional change of fingerT 0054

26556 Toe joint transferC

26560 Repair of web fingerT 0053

26561 Repair of web fingerT 0054

26562 Repair of web fingerT 0054

26565 Correct metacarpal flawT 0054

26567 Correct finger deformityT 0054

26568 Lengthen metacarpal/fingerT 0054

26580 Repair hand deformityT 0053

26587 Reconstruct extra fingerT 0053

26590 Repair finger deformityT 0053

26591 Repair muscles of handT 0054

26593 Release muscles of handT 0053

26596 Excision constricting tissueT 0053

26600 Treat metacarpal fractureT 0129

26605 Treat metacarpal fractureT 0129

26607 Treat metacarpal fractureT 0139

26608 Treat metacarpal fractureT 0062

26615 Treat metacarpal fractureT 0063

26641 Treat thumb dislocationT 0129

26645 Treat thumb fractureT 0138

26650 Treat thumb fractureT 0062

26665 Treat thumb fractureT 0063

26670 Treat hand dislocationT 0129

26675 Treat hand dislocationT 0129

26676 Pin hand dislocationT 0062

26685 Treat hand dislocationT 0062

26686 Treat hand dislocationT 0064

26700 Treat knuckle dislocationT 0129
26705 Treat knuckle dislocation

T 0129

26706 Pin knuckle dislocationT 0139

26715 Treat knuckle dislocationT 0062

26720 Treat finger fracture eachT 0129

26725 Treat finger fracture eachT 0129

26727 Treat finger fracture eachT 0062

26735 Treat finger fracture eachT 0062

26740 Treat finger fracture eachT 0129

26742 Treat finger fracture eachT 0129

26746 Treat finger fracture eachT 0062

26750 Treat finger fracture eachT 0129

26755 Treat finger fracture eachT 0129

26756 Pin finger fracture eachT 0062

26765 Treat finger fracture eachT 0062

26770 Treat finger dislocationT 0129

26775 Treat finger dislocationT 0045

26776 Pin finger dislocationT 0062

26785 Treat finger dislocationT 0062

26820 Thumb fusion with graftT 0054

26841 Fusion of thumbT 0054

26842 Thumb fusion with graftT 0054

26843 Fusion of hand jointT 0054

26844 Fusion/graft of hand jointT 0054

26850 Fusion of knuckleT 0054

26852 Fusion of knuckle with graftT 0054

26860 Fusion of finger jointT 0054

26861 Fusion of finger jnt add-onT 0054

26862 Fusion/graft of finger jointT 0054

26863 Fuse/graft added jointT 0054

26910 Amputate metacarpal boneT 0054

26951 Amputation of finger/thumbT 0053

26952 Amputation of finger/thumbT 0053

26989 Hand/finger surgeryT 0129

26990 Drainage of pelvis lesionT 0049

26991 Drainage of pelvis bursaT 0049

26992 Drainage of bone lesionC

27000 Incision of hip tendonT 0049

27001 Incision of hip tendonT 0050

27003 Incision of hip tendonT 0050

27005 Incision of hip tendonC

27006 Incision of hip tendonsT 0050

27025 Incision of hip/thigh fasciaC

27027 Buttock fasciotomy CH T 0050

27030 Drainage of hip jointC

27033 Exploration of hip jointT 0051

27035 Denervation of hip joint CH T 0050

27036 Excision of hip joint/muscleC

27040 Biopsy of soft tissuesT 0020

27041 Biopsy of soft tissuesT 0020

27043 Exc hip pelvis les sc > 3 cmT 0022

27045 Exc hip/pelv tum deep > 5 cmT 0022

27047 Exc hip/pelvis les sc < 3 cmT 0021

27048 Exc hip/pelv tum deep < 5 cmT 0021

27049 Resect hip/pelv tum < 5 cmT 0021

27050 Biopsy of sacroiliac jointT 0049
27052 Biopsy of hip joint

T 0049

27054 Removal of hip joint liningC

27057 Buttock fasciotomy w/dbrdmtT 0049

27059 Resect hip/pelv tum > 5 cmT 0022

27060 Removal of ischial bursaT 0049

27062 Remove femur lesion/bursaT 0049

27065 Remove hip bone les superT 0049

27066 Remove hip bone les deepT 0050

27067 Remove/graft hip bone lesionT 0050

27070 Part remove hip bone superC

27071 Part removal hip bone deepC

27075 Resect hip tumorC

27076 Resect hip tum incl acetabulC

27077 Resect hip tum w/innom boneC

27078 Rsect hip tum incl femurC

27080 Removal of tail boneT 0050

27086 Remove hip foreign bodyT 0020

27087 Remove hip foreign bodyT 0049

27090 Removal of hip prosthesisC

27091 Removal of hip prosthesisC

27093 Injection for hip x-rayN

27095 Injection for hip x-rayN

27096 Inject sacroiliac jointB

27097 Revision of hip tendonT 0050

27098 Transfer tendon to pelvisT 0050

27100 Transfer of abdominal muscleT 0051

27105 Transfer of spinal muscleT 0051

27110 Transfer of iliopsoas muscleT 0051

27111 Transfer of iliopsoas muscleT 0051

27120 Reconstruction of hip socketC

27122 Reconstruction of hip socketC

27125 Partial hip replacementC

27130 Total hip arthroplastyC

27132 Total hip arthroplastyC

27134 Revise hip joint replacementC

27137 Revise hip joint replacementC

27138 Revise hip joint replacementC

27140 Transplant femur ridgeC

27146 Incision of hip boneC

27147 Revision of hip boneC

27151 Incision of hip bonesC

27156 Revision of hip bonesC

27158 Revision of pelvisC

27161 Incision of neck of femurC

27165 Incision/fixation of femurC

27170 Repair/graft femur head/neckC

27175 Treat slipped epiphysisC

27176 Treat slipped epiphysisC

27177 Treat slipped epiphysisC

27178 Treat slipped epiphysisC

27179 Revise head/neck of femurT 0052

27181 Treat slipped epiphysisC

27185 Revision of femur epiphysisC

27187 Reinforce hip bonesC

27193 Treat pelvic ring fractureT 0129
27194 Treat pelvic ring fracture

T 0045

27200 Treat tail bone fractureT 0129

27202 Treat tail bone fractureT 0063

27215 Treat pelvic fracture(s)E

27216 Treat pelvic ring fractureE

27217 Treat pelvic ring fractureE

27218 Treat pelvic ring fractureE

27220 Treat hip socket fractureT 0129

27222 Treat hip socket fractureC

27226 Treat hip wall fractureC

27227 Treat hip fracture(s)C

27228 Treat hip fracture(s)C

27230 Treat thigh fractureT 0129

27232 Treat thigh fractureC

27235 Treat thigh fractureT 0050

27236 Treat thigh fractureC

27238 Treat thigh fractureT 0138

27240 Treat thigh fractureC

27244 Treat thigh fractureC

27245 Treat thigh fractureC

27246 Treat thigh fractureT 0138

27248 Treat thigh fractureC

27250 Treat hip dislocationT 0129

27252 Treat hip dislocationT 0045

27253 Treat hip dislocationC

27254 Treat hip dislocationC

27256 Treat hip dislocationT 0129

27257 Treat hip dislocationT 0045

27258 Treat hip dislocationC

27259 Treat hip dislocationC

27265 Treat hip dislocationT 0129

27266 Treat hip dislocationT 0045

27267 Cltx thigh fxT 0129

27268 Cltx thigh fx w/mnpjC

27269 Optx thigh fxC

27275 Manipulation of hip jointT 0045

27280 Fusion of sacroiliac jointC

27282 Fusion of pubic bonesC

27284 Fusion of hip jointC

27286 Fusion of hip jointC

27290 Amputation of leg at hipC

27295 Amputation of leg at hipC

27299 Pelvis/hip joint surgeryT 0129

27301 Drain thigh/knee lesionT 0008

27303 Drainage of bone lesionC

27305 Incise thigh tendon & fasciaT 0049

27306 Incision of thigh tendonT 0049

27307 Incision of thigh tendons CH T 0050

27310 Exploration of knee jointT 0050

27323 Biopsy thigh soft tissuesT 0020

27324 Biopsy thigh soft tissuesT 0022

27325 Neurectomy hamstringT 0220

27326 Neurectomy poplitealT 0220

27327 Exc thigh/knee les sc < 3 cmT 0022

27328 Exc thigh/knee tum deep <5cmT 0021
27329 Resect thigh/knee tum < 5 cm

T 0021

27330 Biopsy knee joint liningT 0050

27331 Explore/treat knee jointT 0050

27332 Removal of knee cartilageT 0050

27333 Removal of knee cartilageT 0050

27334 Remove knee joint liningT 0050

27335 Remove knee joint liningT 0050

27337 Exc thigh/knee les sc 3+ cmT 0022

27339 Exc thigh/knee tum deep 5+cmT 0022

27340 Removal of kneecap bursaT 0049

27345 Removal of knee cystT 0049

27347 Remove knee cystT 0049

27350 Removal of kneecapT 0050

27355 Remove femur lesionT 0050

27356 Remove femur lesion/graftT 0050

27357 Remove femur lesion/graftT 0050

27358 Remove femur lesion/fixationT 0050

27360 Partial removal leg bone(s)T 0050

27364 Resect thigh/knee tum 5+ cmT 0022

27365 Resect femur/knee tumorC

27370 Injection for knee x-rayN

27372 Removal of foreign bodyT 0022

27380 Repair of kneecap tendon CH T 0050

27381 Repair/graft kneecap tendon CH T 0050

27385 Repair of thigh muscle CH T 0050

27386 Repair/graft of thigh muscle CH T 0050

27390 Incision of thigh tendonT 0049

27391 Incision of thigh tendonsT 0049

27392 Incision of thigh tendons CH T 0050

27393 Lengthening of thigh tendonT 0050

27394 Lengthening of thigh tendonsT 0050

27395 Lengthening of thigh tendonsT 0051

27396 Transplant of thigh tendonT 0050

27397 Transplants of thigh tendonsT 0051

27400 Revise thigh muscles/tendonsT 0051

27403 Repair of knee cartilageT 0050

27405 Repair of knee ligamentT 0051

27407 Repair of knee ligamentT 0052

27409 Repair of knee ligamentsT 0052

27412 Autochondrocyte implant kneeT 0052

27415 Osteochondral knee allograftT 0052

27416 Osteochondral knee autograftT 0051

27418 Repair degenerated kneecapT 0051

27420 Revision of unstable kneecapT 0051

27422 Revision of unstable kneecapT 0051

27424 Revision/removal of kneecapT 0051

27425 Lat retinacular release openT 0050

27427 Reconstruction kneeT 0052

27428 Reconstruction kneeT 0052

27429 Reconstruction kneeT 0052

27430 Revision of thigh musclesT 0051

27435 Incision of knee joint CH T 0050

27437 Revise kneecapT 0047

27438 Revise kneecap with implantT 0048

27440 Revision of knee jointT 0047
27441 Revision of knee joint

T 0047

27442 Revision of knee jointT 0047

27443 Revision of knee jointT 0047

27445 Revision of knee jointC

27446 Revision of knee jointT 0425

27447 Total knee arthroplastyC

27448 Incision of thighC

27450 Incision of thighC

27454 Realignment of thigh boneC

27455 Realignment of kneeC

27457 Realignment of kneeC

27465 Shortening of thigh boneC

27466 Lengthening of thigh boneC

27468 Shorten/lengthen thighsC

27470 Repair of thighC

27472 Repair/graft of thighC

27475 Surgery to stop leg growthT 0050

27477 Surgery to stop leg growthC

27479 Surgery to stop leg growthT 0050

27485 Surgery to stop leg growthC

27486 Revise/replace knee jointC

27487 Revise/replace knee jointC

27488 Removal of knee prosthesisC

27495 Reinforce thighC

27496 Decompression of thigh/kneeT 0050

27497 Decompression of thigh/kneeT 0049

27498 Decompression of thigh/kneeT 0050

27499 Decompression of thigh/kneeT 0050

27500 Treatment of thigh fractureT 0138

27501 Treatment of thigh fractureT 0129

27502 Treatment of thigh fractureT 0139

27503 Treatment of thigh fractureT 0129

27506 Treatment of thigh fractureC

27507 Treatment of thigh fractureC

27508 Treatment of thigh fractureT 0129

27509 Treatment of thigh fractureT 0062

27510 Treatment of thigh fractureT 0138

27511 Treatment of thigh fractureC

27513 Treatment of thigh fractureC

27514 Treatment of thigh fractureC

27516 Treat thigh fx growth plateT 0129

27517 Treat thigh fx growth plateT 0129

27519 Treat thigh fx growth plateC

27520 Treat kneecap fractureT 0129

27524 Treat kneecap fractureT 0063

27530 Treat knee fractureT 0129

27532 Treat knee fractureT 0139

27535 Treat knee fractureC

27536 Treat knee fractureC

27538 Treat knee fracture(s)T 0129

27540 Treat knee fractureC

27550 Treat knee dislocationT 0129

27552 Treat knee dislocationT 0045

27556 Treat knee dislocationC

27557 Treat knee dislocationC
27558 Treat knee dislocation

C

27560 Treat kneecap dislocationT 0129

27562 Treat kneecap dislocationT 0045

27566 Treat kneecap dislocationT 0063

27570 Fixation of knee jointT 0045

27580 Fusion of kneeC

27590 Amputate leg at thighC

27591 Amputate leg at thighC

27592 Amputate leg at thighC

27594 Amputation follow-up surgeryT 0049

27596 Amputation follow-up surgeryC

27598 Amputate lower leg at kneeC

27599 Leg surgery procedureT 0129

27600 Decompression of lower legT 0049

27601 Decompression of lower legT 0049

27602 Decompression of lower leg CH T 0050

27603 Drain lower leg lesionT 0008

27604 Drain lower leg bursa CH T 0050

27605 Incision of achilles tendonT 0055

27606 Incision of achilles tendonT 0049

27607 Treat lower leg bone lesionT 0049

27610 Explore/treat ankle jointT 0050

27612 Exploration of ankle jointT 0050

27613 Biopsy lower leg soft tissueT 0020

27614 Biopsy lower leg soft tissueT 0022

27615 Resect leg/ankle tum < 5 cmT 0021

27616 Resect leg/ankle tum 5+ cmT 0022

27618 Exc leg/ankle tum < 3 cmT 0021

27619 Exc leg/ankle tum deep <5 cmT 0021

27620 Explore/treat ankle jointT 0050

27625 Remove ankle joint liningT 0050

27626 Remove ankle joint liningT 0050

27630 Removal of tendon lesionT 0049

27632 Exc leg/ankle les sc 3+ cmT 0022

27634 Exc leg/ankle tum deep 5+ cmT 0022

27635 Remove lower leg bone lesionT 0050

27637 Remove/graft leg bone lesionT 0050

27638 Remove/graft leg bone lesionT 0050

27640 Partial removal of tibia CH T 0050

27641 Partial removal of fibulaT 0050

27645 Resect tibia tumorC

27646 Resect fibula tumorC

27647 Resect talus/calcaneus tum CH T 0050

27648 Injection for ankle x-rayN

27650 Repair achilles tendonT 0051

27652 Repair/graft achilles tendonT 0052

27654 Repair of achilles tendonT 0051

27656 Repair leg fascia defectT 0049

27658 Repair of leg tendon eachT 0049

27659 Repair of leg tendon eachT 0049

27664 Repair of leg tendon eachT 0050

27665 Repair of leg tendon eachT 0050

27675 Repair lower leg tendonsT 0049

27676 Repair lower leg tendonsT 0050

27680 Release of lower leg tendonT 0050
27681 Release of lower leg tendons

T 0050

27685 Revision of lower leg tendonT 0050

27686 Revise lower leg tendonsT 0050

27687 Revision of calf tendonT 0050

27690 Revise lower leg tendonT 0051

27691 Revise lower leg tendonT 0051

27692 Revise additional leg tendonT 0051

27695 Repair of ankle ligamentT 0050

27696 Repair of ankle ligamentsT 0050

27698 Repair of ankle ligamentT 0050

27700 Revision of ankle jointT 0047

27702 Reconstruct ankle jointC

27703 Reconstruction ankle jointC

27704 Removal of ankle implantT 0049

27705 Incision of tibiaT 0051

27707 Incision of fibula CH T 0050

27709 Incision of tibia & fibulaT 0050

27712 Realignment of lower legC

27715 Revision of lower legC

27720 Repair of tibiaT 0063

27722 Repair/graft of tibiaT 0064

27724 Repair/graft of tibiaC

27725 Repair of lower legC

27726 Repair fibula nonunionT 0063

27727 Repair of lower legC

27730 Repair of tibia epiphysisT 0050

27732 Repair of fibula epiphysisT 0050

27734 Repair lower leg epiphysesT 0050

27740 Repair of leg epiphysesT 0050

27742 Repair of leg epiphysesT 0051

27745 Reinforce tibiaT 0052

27750 Treatment of tibia fractureT 0129

27752 Treatment of tibia fractureT 0139

27756 Treatment of tibia fractureT 0062

27758 Treatment of tibia fractureT 0063

27759 Treatment of tibia fractureT 0064

27760 Cltx medial ankle fxT 0129

27762 Cltx med ankle fx w/mnpjT 0139

27766 Optx medial ankle fxT 0063

27767 Cltx post ankle fxT 0129

27768 Cltx post ankle fx w/mnpjT 0129

27769 Optx post ankle fxT 0063

27780 Treatment of fibula fractureT 0129

27781 Treatment of fibula fractureT 0139

27784 Treatment of fibula fractureT 0063

27786 Treatment of ankle fractureT 0129

27788 Treatment of ankle fractureT 0129

27792 Treatment of ankle fractureT 0063

27808 Treatment of ankle fractureT 0129

27810 Treatment of ankle fractureT 0129

27814 Treatment of ankle fractureT 0063

27816 Treatment of ankle fractureT 0129

27818 Treatment of ankle fractureT 0138

27822 Treatment of ankle fractureT 0063

27823 Treatment of ankle fractureT 0064
27824 Treat lower leg fracture

T 0129

27825 Treat lower leg fractureT 0139

27826 Treat lower leg fractureT 0063

27827 Treat lower leg fractureT 0064

27828 Treat lower leg fractureT 0064

27829 Treat lower leg jointT 0063

27830 Treat lower leg dislocationT 0129

27831 Treat lower leg dislocationT 0139

27832 Treat lower leg dislocationT 0063

27840 Treat ankle dislocationT 0129

27842 Treat ankle dislocationT 0045

27846 Treat ankle dislocationT 0063

27848 Treat ankle dislocationT 0063

27860 Fixation of ankle jointT 0045

27870 Fusion of ankle joint openT 0052

27871 Fusion of tibiofibular jointT 0052

27880 Amputation of lower legC

27881 Amputation of lower legC

27882 Amputation of lower legC

27884 Amputation follow-up surgeryT 0049

27886 Amputation follow-up surgeryC

27888 Amputation of foot at ankleC

27889 Amputation of foot at ankleT 0050

27892 Decompression of legT 0050

27893 Decompression of legT 0050

27894 Decompression of legT 0050

27899 Leg/ankle surgery procedureT 0129

28001 Drainage of bursa of footT 0007

28002 Treatment of foot infectionT 0049

28003 Treatment of foot infectionT 0049

28005 Treat foot bone lesionT 0055

28008 Incision of foot fasciaT 0055

28010 Incision of toe tendonT 0055

28011 Incision of toe tendonsT 0055

28020 Exploration of foot jointT 0055

28022 Exploration of foot jointT 0055

28024 Exploration of toe jointT 0055

28035 Decompression of tibia nerveT 0220

28039 Exc foot/toe tum sc > 1.5 cmT 0022

28041 Exc foot/toe tum deep 1.5cm+T 0022

28043 Exc foot/toe tum sc < 1.5 cmT 0021

28045 Exc foot/toe tum deep <1.5cmT 0021

28046 Resect foot/toe tumor < 3 cmT 0021

28047 Resect foot/toe tumor > 3 cmT 0022

28050 Biopsy of foot joint liningT 0055

28052 Biopsy of foot joint liningT 0055

28054 Biopsy of toe joint liningT 0055

28055 Neurectomy footT 0220

28060 Partial removal foot fasciaT 0055

28062 Removal of foot fasciaT 0055

28070 Removal of foot joint liningT 0055

28072 Removal of foot joint liningT 0055

28080 Removal of foot lesionT 0055

28086 Excise foot tendon sheathT 0055

28088 Excise foot tendon sheathT 0055
28090 Removal of foot lesion

T 0055

28092 Removal of toe lesionsT 0055

28100 Removal of ankle/heel lesionT 0055

28102 Remove/graft foot lesionT 0056

28103 Remove/graft foot lesionT 0056

28104 Removal of foot lesionT 0055

28106 Remove/graft foot lesionT 0056

28107 Remove/graft foot lesionT 0056

28108 Removal of toe lesionsT 0055

28110 Part removal of metatarsalT 0055

28111 Part removal of metatarsalT 0055

28112 Part removal of metatarsalT 0055

28113 Part removal of metatarsalT 0055

28114 Removal of metatarsal headsT 0055

28116 Revision of footT 0055

28118 Removal of heel boneT 0055

28119 Removal of heel spurT 0055

28120 Part removal of ankle/heelT 0055

28122 Partial removal of foot boneT 0055

28124 Partial removal of toeT 0055

28126 Partial removal of toeT 0055

28130 Removal of ankle boneT 0055

28140 Removal of metatarsalT 0055

28150 Removal of toeT 0055

28153 Partial removal of toeT 0055

28160 Partial removal of toeT 0055

28171 Resect tarsal tumorT 0055

28173 Resect metatarsal tumorT 0055

28175 Resect phalanx of toe tumorT 0055

28190 Removal of foot foreign bodyT 0020

28192 Removal of foot foreign bodyT 0021

28193 Removal of foot foreign bodyT 0020

28200 Repair of foot tendonT 0055

28202 Repair/graft of foot tendonT 0055

28208 Repair of foot tendonT 0055

28210 Repair/graft of foot tendonT 0056

28220 Release of foot tendonT 0055

28222 Release of foot tendonsT 0055

28225 Release of foot tendonT 0055

28226 Release of foot tendonsT 0055

28230 Incision of foot tendon(s)T 0055

28232 Incision of toe tendonT 0055

28234 Incision of foot tendonT 0055

28238 Revision of foot tendonT 0056

28240 Release of big toeT 0055

28250 Revision of foot fasciaT 0055

28260 Release of midfoot jointT 0055

28261 Revision of foot tendonT 0055

28262 Revision of foot and ankleT 0055

28264 Release of midfoot jointT 0056

28270 Release of foot contractureT 0055

28272 Release of toe joint eachT 0055

28280 Fusion of toesT 0055

28285 Repair of hammertoeT 0055

28286 Repair of hammertoeT 0055
28288 Partial removal of foot bone

T 0055

28289 Repair hallux rigidusT 0055

28290 Correction of bunionT 0057

28292 Correction of bunionT 0057

28293 Correction of bunionT 0057

28294 Correction of bunionT 0057

28296 Correction of bunionT 0057

28297 Correction of bunionT 0057

28298 Correction of bunionT 0057

28299 Correction of bunionT 0057

28300 Incision of heel boneT 0056

28302 Incision of ankle boneT 0055

28304 Incision of midfoot bonesT 0056

28305 Incise/graft midfoot bonesT 0056

28306 Incision of metatarsalT 0055

28307 Incision of metatarsalT 0055

28308 Incision of metatarsalT 0055

28309 Incision of metatarsalsT 0056

28310 Revision of big toeT 0055

28312 Revision of toeT 0055

28313 Repair deformity of toeT 0055

28315 Removal of sesamoid boneT 0055

28320 Repair of foot bonesT 0056

28322 Repair of metatarsalsT 0056

28340 Resect enlarged toe tissueT 0055

28341 Resect enlarged toeT 0055

28344 Repair extra toe(s)T 0055

28345 Repair webbed toe(s)T 0055

28360 Reconstruct cleft footT 0056

28400 Treatment of heel fractureT 0129

28405 Treatment of heel fractureT 0139

28406 Treatment of heel fractureT 0062

28415 Treat heel fractureT 0064

28420 Treat/graft heel fractureT 0063

28430 Treatment of ankle fractureT 0129

28435 Treatment of ankle fractureT 0129

28436 Treatment of ankle fractureT 0062

28445 Treat ankle fractureT 0063

28446 Osteochondral talus autogrftT 0056

28450 Treat midfoot fracture eachT 0129

28455 Treat midfoot fracture eachT 0129

28456 Treat midfoot fractureT 0062

28465 Treat midfoot fracture eachT 0063

28470 Treat metatarsal fractureT 0129

28475 Treat metatarsal fractureT 0129

28476 Treat metatarsal fractureT 0062

28485 Treat metatarsal fractureT 0063

28490 Treat big toe fractureT 0129

28495 Treat big toe fractureT 0129

28496 Treat big toe fractureT 0062

28505 Treat big toe fractureT 0062

28510 Treatment of toe fractureT 0129

28515 Treatment of toe fractureT 0129

28525 Treat toe fractureT 0062

28530 Treat sesamoid bone fractureT 0129
28531 Treat sesamoid bone fracture

T 0062

28540 Treat foot dislocationT 0129

28545 Treat foot dislocationT 0062

28546 Treat foot dislocationT 0062

28555 Repair foot dislocationT 0063

28570 Treat foot dislocationT 0129

28575 Treat foot dislocationT 0139

28576 Treat foot dislocationT 0062

28585 Repair foot dislocationT 0062

28600 Treat foot dislocationT 0129

28605 Treat foot dislocationT 0129

28606 Treat foot dislocationT 0062

28615 Repair foot dislocationT 0063

28630 Treat toe dislocationT 0129

28635 Treat toe dislocationT 0045

28636 Treat toe dislocationT 0062

28645 Repair toe dislocationT 0062

28660 Treat toe dislocationT 0129

28665 Treat toe dislocationT 0045

28666 Treat toe dislocationT 0062

28675 Repair of toe dislocationT 0062

28705 Fusion of foot bonesT 0056

28715 Fusion of foot bonesT 0052

28725 Fusion of foot bonesT 0056

28730 Fusion of foot bonesT 0056

28735 Fusion of foot bonesT 0056

28737 Revision of foot bonesT 0056

28740 Fusion of foot bonesT 0056

28750 Fusion of big toe jointT 0056

28755 Fusion of big toe jointT 0055

28760 Fusion of big toe jointT 0056

28800 Amputation of midfootC

28805 Amputation thru metatarsalT 0055

28810 Amputation toe & metatarsalT 0055

28820 Amputation of toeT 0055

28825 Partial amputation of toeT 0055

28890 High energy eswt plantar fT 0050

28899 Foot/toes surgery procedureT 0129

29000 Application of body castS 0058

29010 Application of body castS 0426

29015 Application of body castS 0426

29020 Application of body castS 0058

29025 Application of body castS 0058

29035 Application of body castS 0426

29040 Application of body castS 0058

29044 Application of body castS 0426

29046 Application of body castS 0426

29049 Application of figure eightS 0058

29055 Application of shoulder castS 0426

29058 Application of shoulder castS 0058

29065 Application of long arm castS 0426

29075 Application of forearm castS 0426

29085 Apply hand/wrist castS 0058

29086 Apply finger castS 0058

29105 Apply long arm splintS 0058
29125 Apply forearm splint

S 0058

29126 Apply forearm splintS 0058

29130 Application of finger splintS 0058

29131 Application of finger splintS 0058

29200 Strapping of chestS 0058

29240 Strapping of shoulderS 0058

29260 Strapping of elbow or wristS 0058

29280 Strapping of hand or fingerS 0058

29305 Application of hip castS 0426

29325 Application of hip castsS 0426

29345 Application of long leg castS 0426

29355 Application of long leg castS 0426

29358 Apply long leg cast braceS 0426

29365 Application of long leg castS 0426

29405 Apply short leg castS 0426

29425 Apply short leg castS 0426

29435 Apply short leg castS 0426

29440 Addition of walker to castS 0058

29445 Apply rigid leg castS 0426

29450 Application of leg castS 0058

29505 Application long leg splintS 0058

29515 Application lower leg splintS 0058

29520 Strapping of hipS 0058

29530 Strapping of kneeS 0058

29540 Strapping of ankle and/or ftS 0058

29550 Strapping of toesS 0058

29580 Application of paste bootS 0058

29581 Apply multlay comprs lwr legS 0058

29590 Application of foot splintS 0058

29700 Removal/revision of castS 0058

29705 Removal/revision of castS 0058

29710 Removal/revision of castS 0426

29715 Removal/revision of castS 0058

29720 Repair of body castS 0058

29730 Windowing of castS 0058

29740 Wedging of castS 0058

29750 Wedging of clubfoot castS 0058

29799 Casting/strapping procedureS 0058

29800 Jaw arthroscopy/surgeryT 0041

29804 Jaw arthroscopy/surgeryT 0041

29805 Shoulder arthroscopy dxT 0041

29806 Shoulder arthroscopy/surgeryT 0042

29807 Shoulder arthroscopy/surgeryT 0042

29819 Shoulder arthroscopy/surgeryT 0042

29820 Shoulder arthroscopy/surgeryT 0042

29821 Shoulder arthroscopy/surgeryT 0042

29822 Shoulder arthroscopy/surgeryT 0041

29823 Shoulder arthroscopy/surgeryT 0042

29824 Shoulder arthroscopy/surgeryT 0041

29825 Shoulder arthroscopy/surgeryT 0042

29826 Shoulder arthroscopy/surgeryT 0042

29827 Arthroscop rotator cuff reprT 0042

29828 Arthroscopy biceps tenodesisT 0042

29830 Elbow arthroscopyT 0041

29834 Elbow arthroscopy/surgeryT 0041
29835 Elbow arthroscopy/surgery

T 0041

29836 Elbow arthroscopy/surgeryT 0041

29837 Elbow arthroscopy/surgeryT 0041

29838 Elbow arthroscopy/surgeryT 0041

29840 Wrist arthroscopyT 0041

29843 Wrist arthroscopy/surgeryT 0041

29844 Wrist arthroscopy/surgeryT 0041

29845 Wrist arthroscopy/surgeryT 0041

29846 Wrist arthroscopy/surgeryT 0041

29847 Wrist arthroscopy/surgeryT 0042

29848 Wrist endoscopy/surgeryT 0041

29850 Knee arthroscopy/surgeryT 0041

29851 Knee arthroscopy/surgeryT 0042

29855 Tibial arthroscopy/surgeryT 0042

29856 Tibial arthroscopy/surgeryT 0042

29860 Hip arthroscopy dxT 0042

29861 Hip arthro w/fb removalT 0042

29862 Hip arthr0 w/debridementT 0042

29863 Hip arthr0 w/synovectomyT 0042

29866 Autgrft implnt knee w/scopeT 0042

29867 Allgrft implnt knee w/scopeT 0042

29868 Meniscal trnspl knee w/scpeT 0042

29870 Knee arthroscopy dxT 0041

29871 Knee arthroscopy/drainageT 0041

29873 Knee arthroscopy/surgeryT 0041

29874 Knee arthroscopy/surgeryT 0041

29875 Knee arthroscopy/surgeryT 0041

29876 Knee arthroscopy/surgeryT 0041

29877 Knee arthroscopy/surgeryT 0041

29879 Knee arthroscopy/surgeryT 0041

29880 Knee arthroscopy/surgeryT 0041

29881 Knee arthroscopy/surgeryT 0041

29882 Knee arthroscopy/surgeryT 0041

29883 Knee arthroscopy/surgeryT 0041

29884 Knee arthroscopy/surgeryT 0041

29885 Knee arthroscopy/surgeryT 0042

29886 Knee arthroscopy/surgeryT 0041

29887 Knee arthroscopy/surgeryT 0041

29888 Knee arthroscopy/surgeryT 0052

29889 Knee arthroscopy/surgeryT 0052

29891 Ankle arthroscopy/surgeryT 0042

29892 Ankle arthroscopy/surgeryT 0052

29893 Scope plantar fasciotomyT 0055

29894 Ankle arthroscopy/surgeryT 0041

29895 Ankle arthroscopy/surgeryT 0041

29897 Ankle arthroscopy/surgeryT 0041

29898 Ankle arthroscopy/surgeryT 0041

29899 Ankle arthroscopy/surgeryT 0042

29900 Mcp joint arthroscopy dxT 0041

29901 Mcp joint arthroscopy surgT 0041

29902 Mcp joint arthroscopy surgT 0041

29904 Subtalar arthro w/fb rmvlT 0041

29905 Subtalar arthro w/excT 0041

29906 Subtalar arthro w/debT 0041

29907 Subtalar arthro w/fusionT 0042
29914 Hip arthro w/femoroplasty

T 0042

29915 Hip arthro acetabuloplastyT 0042

29916 Hip arthro w/labral repairT 0042

29999 Arthroscopy of jointT 0041

30000 Drainage of nose lesionT 0251

30020 Drainage of nose lesionT 0251

30100 Intranasal biopsyT 0252

30110 Removal of nose polyp(s)T 0253

30115 Removal of nose polyp(s)T 0253

30117 Removal of intranasal lesionT 0253

30118 Removal of intranasal lesionT 0254

30120 Revision of noseT 0254

30124 Removal of nose lesionT 0252

30125 Removal of nose lesionT 0256

30130 Excise inferior turbinateT 0253

30140 Resect inferior turbinateT 0254

30150 Partial removal of noseT 0256

30160 Removal of noseT 0256

30200 Injection treatment of noseT 0252

30210 Nasal sinus therapyT 0252

30220 Insert nasal septal buttonT 0252

30300 Remove nasal foreign bodyX 0340

30310 Remove nasal foreign bodyT 0253

30320 Remove nasal foreign bodyT 0253

30400 Reconstruction of noseT 0256

30410 Reconstruction of noseT 0256

30420 Reconstruction of noseT 0256

30430 Revision of noseT 0254

30435 Revision of noseT 0256

30450 Revision of noseT 0256

30460 Revision of noseT 0256

30462 Revision of noseT 0256

30465 Repair nasal stenosisT 0256

30520 Repair of nasal septumT 0254

30540 Repair nasal defectT 0256

30545 Repair nasal defectT 0256

30560 Release of nasal adhesionsT 0251

30580 Repair upper jaw fistulaT 0256

30600 Repair mouth/nose fistulaT 0256

30620 Intranasal reconstructionT 0256

30630 Repair nasal septum defectT 0254

30801 Ablate inf turbinate superfT 0252

30802 Ablate inf turbinate submucT 0253

30901 Control of nosebleedT 0250

30903 Control of nosebleedT 0250

30905 Control of nosebleedT 0250

30906 Repeat control of nosebleedT 0250

30915 Ligation nasal sinus arteryT 0092

30920 Ligation upper jaw arteryT 0092

30930 Ther fx nasal inf turbinateT 0253

30999 Nasal surgery procedureT 0250

31000 Irrigation maxillary sinusT 0251

31002 Irrigation sphenoid sinusT 0252

31020 Exploration maxillary sinusT 0254

31030 Exploration maxillary sinusT 0256
31032 Explore sinus remove polyps

T 0256

31040 Exploration behind upper jawT 0254

31050 Exploration sphenoid sinusT 0256

31051 Sphenoid sinus surgeryT 0256

31070 Exploration of frontal sinusT 0254

31075 Exploration of frontal sinusT 0256

31080 Removal of frontal sinusT 0256

31081 Removal of frontal sinusT 0256

31084 Removal of frontal sinusT 0256

31085 Removal of frontal sinusT 0256

31086 Removal of frontal sinusT 0256

31087 Removal of frontal sinusT 0256

31090 Exploration of sinusesT 0256

31200 Removal of ethmoid sinusT 0256

31201 Removal of ethmoid sinusT 0256

31205 Removal of ethmoid sinusT 0256

31225 Removal of upper jawC

31230 Removal of upper jawC

31231 Nasal endoscopy dxT 0072

31233 Nasal/sinus endoscopy dxT 0072

31235 Nasal/sinus endoscopy dxT 0074

31237 Nasal/sinus endoscopy surgT 0074

31238 Nasal/sinus endoscopy surgT 0074

31239 Nasal/sinus endoscopy surgT 0075

31240 Nasal/sinus endoscopy surgT 0074

31254 Revision of ethmoid sinusT 0075

31255 Removal of ethmoid sinusT 0075

31256 Exploration maxillary sinusT 0075

31267 Endoscopy maxillary sinusT 0075

31276 Sinus endoscopy surgicalT 0075

31287 Nasal/sinus endoscopy surgT 0075

31288 Nasal/sinus endoscopy surgT 0075

31290 Nasal/sinus endoscopy surgC

31291 Nasal/sinus endoscopy surgC

31292 Nasal/sinus endoscopy surgT 0075

31293 Nasal/sinus endoscopy surgT 0075

31294 Nasal/sinus endoscopy surgT 0075

31295 Sinus endo w/balloon dilT 0075

31296 Sinus endo w/balloon dilT 0075

31297 Sinus endo w/balloon dilT 0075

31299 Sinus surgery procedureT 0250

31300 Removal of larynx lesionT 0254

31320 Diagnostic incision larynxT 0256

31360 Removal of larynxC

31365 Removal of larynxC

31367 Partial removal of larynxC

31368 Partial removal of larynxC

31370 Partial removal of larynxC

31375 Partial removal of larynxC

31380 Partial removal of larynxC

31382 Partial removal of larynxC

31390 Removal of larynx & pharynxC

31395 Reconstruct larynx & pharynxC

31400 Revision of larynxT 0256

31420 Removal of epiglottisT 0256
31500 Insert emergency airway

S 0094

31502 Change of windpipe airwayS 0078

31505 Diagnostic laryngoscopyT 0071

31510 Laryngoscopy with biopsyT 0074

31511 Remove foreign body larynxT 0072

31512 Removal of larynx lesionT 0074

31513 Injection into vocal cordT 0072

31515 Laryngoscopy for aspirationT 0074

31520 Dx laryngoscopy newbornT 0072

31525 Dx laryngoscopy excl nbT 0074

31526 Dx laryngoscopy w/oper scopeT 0074

31527 Laryngoscopy for treatmentT 0075

31528 Laryngoscopy and dilationT 0074

31529 Laryngoscopy and dilationT 0074

31530 Laryngoscopy w/fb removalT 0074

31531 Laryngoscopy w/fb & op scopeT 0074

31535 Laryngoscopy w/biopsyT 0074

31536 Laryngoscopy w/bx & op scopeT 0074

31540 Laryngoscopy w/exc of tumorT 0074

31541 Larynscop w/tumr exc + scopeT 0074

31545 Remove vc lesion w/scopeT 0075

31546 Remove vc lesion scope/graftT 0075

31560 Laryngoscop w/arytenoidectomT 0075

31561 Larynscop remve cart + scopT 0075

31570 Laryngoscope w/vc injT 0074

31571 Laryngoscop w/vc inj + scopeT 0075

31575 Diagnostic laryngoscopyT 0072

31576 Laryngoscopy with biopsyT 0074

31577 Remove foreign body larynxT 0073

31578 Removal of larynx lesionT 0075

31579 Diagnostic laryngoscopyT 0073

31580 Revision of larynxT 0256

31582 Revision of larynxT 0256

31584 Treat larynx fractureC

31587 Revision of larynxC

31588 Revision of larynxT 0256

31590 Reinnervate larynxT 0256

31595 Larynx nerve surgeryT 0256

31599 Larynx surgery procedureT 0250

31600 Incision of windpipeT 0254

31601 Incision of windpipeT 0254

31603 Incision of windpipeT 0252

31605 Incision of windpipeT 0252

31610 Incision of windpipeT 0254

31611 Surgery/speech prosthesisT 0254

31612 Puncture/clear windpipeT 0254

31613 Repair windpipe openingT 0254

31614 Repair windpipe openingT 0256

31615 Visualization of windpipeT 0252

31620 Endobronchial us add-on N 

31622 Dx bronchoscope/washT 0076

31623 Dx bronchoscope/brushT 0076

31624 Dx bronchoscope/lavageT 0076

31625 Bronchoscopy w/biopsy(s)T 0076

31626 Bronchoscopy w/markers CHT 0415
31627 Navigational bronchoscopy N 

31628 Bronchoscopy/lung bx eachT 0076

31629 Bronchoscopy/needle bx eachT 0076

31630 Bronchoscopy dilate/fx reprT 0415

31631 Bronchoscopy dilate w/stentT 0415

31632 Bronchoscopy/lung bx addlT 0076

31633 Bronchoscopy/needle bx addlT 0076

31634 Bronch w/balloon occlusionT 0076

31635 Bronchoscopy w/fb removalT 0076

31636 Bronchoscopy bronch stentsT 0415

31637 Bronchoscopy stent add-onT 0076

31638 Bronchoscopy revise stentT 0415

31640 Bronchoscopy w/tumor exciseT 0415

31641 Bronchoscopy treat blockageT 0415

31643 Diag bronchoscope/catheterT 0076

31645 Bronchoscopy clear airwaysT 0076

31646 Bronchoscopy reclear airwayT 0076

31656 Bronchoscopy inj for x-rayT 0076

31715 Injection for bronchus x-rayN

31717 Bronchial brush biopsyT 0073

31720 Clearance of airwaysS 0077

31725 Clearance of airwaysC

31730 Intro windpipe wire/tubeT 0073

31750 Repair of windpipeT 0256

31755 Repair of windpipeT 0256

31760 Repair of windpipeC

31766 Reconstruction of windpipeC

31770 Repair/graft of bronchusC

31775 Reconstruct bronchusC

31780 Reconstruct windpipeC

31781 Reconstruct windpipeC

31785 Remove windpipe lesionT 0254

31786 Remove windpipe lesionC

31800 Repair of windpipe injuryC

31805 Repair of windpipe injuryC

31820 Closure of windpipe lesionT 0254

31825 Repair of windpipe defectT 0254

31830 Revise windpipe scarT 0254

31899 Airways surgical procedureT 0076

32035 Exploration of chestC

32036 Exploration of chestC

32095 Biopsy through chest wallC

32100 Exploration/biopsy of chestC

32110 Explore/repair chestC

32120 Re-exploration of chestC

32124 Explore chest free adhesionsC

32140 Removal of lung lesion(s)C

32141 Remove/treat lung lesionsC

32150 Removal of lung lesion(s)C

32151 Remove lung foreign bodyC

32160 Open chest heart massageC

32200 Drain open lung lesionC

32201 Drain percut lung lesionT 0070

32215 Treat chest liningC

32220 Release of lungC
32225 Partial release of lung

C

32310 Removal of chest liningC

32320 Free/remove chest liningC

32400 Needle biopsy chest liningT 0685

32402 Open biopsy chest liningC

32405 Biopsy lung or mediastinumT 0685

32420 Puncture/clear lungT 0070

32421 Thoracentesis for aspirationT 0070

32422 Thoracentesis w/tube insertT 0070

32440 Removal of lungC

32442 Sleeve pneumonectomyC

32445 Removal of lungC

32480 Partial removal of lungC

32482 BilobectomyC

32484 SegmentectomyC

32486 Sleeve lobectomyC

32488 Completion pneumonectomyC

32491 Lung volume reductionC

32500 Partial removal of lungC

32501 Repair bronchus add-onC

32503 Resect apical lung tumorC

32504 Resect apical lung tum/chestC

32540 Removal of lung lesionC

32550 Insert pleural cathT 0652

32551 Insertion of chest tubeT 0070

32552 Remove lung catheterS 0078

32553 Ins mark thor for rt perqX 0310

32560 Treat pleurodesis w/agentT 0070

32561 Lyse chest fibrin init dayT 0070

32562 Lyse chest fibrin subq dayT 0070

32601 Thoracoscopy diagnosticT 0069

32602 Thoracoscopy diagnosticT 0069

32603 Thoracoscopy diagnosticT 0069

32604 Thoracoscopy diagnosticT 0069

32605 Thoracoscopy diagnosticT 0069

32606 Thoracoscopy diagnosticT 0069

32650 Thoracoscopy surgicalC

32651 Thoracoscopy surgicalC

32652 Thoracoscopy surgicalC

32653 Thoracoscopy surgicalC

32654 Thoracoscopy surgicalC

32655 Thoracoscopy surgicalC

32656 Thoracoscopy surgicalC

32657 Thoracoscopy surgicalC

32658 Thoracoscopy surgicalC

32659 Thoracoscopy surgicalC

32660 Thoracoscopy surgicalC

32661 Thoracoscopy surgicalC

32662 Thoracoscopy surgicalC

32663 Thoracoscopy surgicalC

32664 Thoracoscopy surgicalC

32665 Thoracoscopy surgicalC

32800 Repair lung herniaC

32810 Close chest after drainageC

32815 Close bronchial fistulaC
32820 Reconstruct injured chest

C

32850 Donor pneumonectomyC

32851 Lung transplant singleC

32852 Lung transplant with bypassC

32853 Lung transplant doubleC

32854 Lung transplant with bypassC

32855 Prepare donor lung singleC

32856 Prepare donor lung doubleC

32900 Removal of rib(s)C

32905 Revise & repair chest wallC

32906 Revise & repair chest wallC

32940 Revision of lungC

32960 Therapeutic pneumothoraxT 0070

32997 Total lung lavageC

32998 Perq rf ablate tx pul tumorT 0423

32999 Chest surgery procedureT 0070

33010 Drainage of heart sacT 0070

33011 Repeat drainage of heart sacT 0070

33015 Incision of heart sacC

33020 Incision of heart sacC

33025 Incision of heart sacC

33030 Partial removal of heart sacC

33031 Partial removal of heart sacC

33050 Removal of heart sac lesionC

33120 Removal of heart lesionC

33130 Removal of heart lesionC

33140 Heart revascularize (tmr)C

33141 Heart tmr w/other procedureC

33202 Insert epicard eltrd openC

33203 Insert epicard eltrd endoC

33206 Insertion of heart pacemakerT 0089

33207 Insertion of heart pacemakerT 0089

33208 Insertion of heart pacemakerT 0655

33210 Insertion of heart electrodeT 0106

33211 Insertion of heart electrodeT 0106

33212 Insertion of pulse generatorT 0090

33213 Insertion of pulse generatorT 0654

33214 Upgrade of pacemaker systemT 0655

33215 Reposition pacing-defib leadT 0105

33216 Insert 1 electrode pm-defibT 0106

33217 Insert 2 electrode pm-defibT 0106

33218 Repair lead pace-defib oneT 0105

33220 Repair lead pace-defib dualT 0105

33222 Revise pocket pacemakerT 0136

33223 Revise pocket for defibT 0136

33224 Insert pacing lead & connect CHT 0655

33225 L ventric pacing lead add-on CH Q3 0108

33226 Reposition l ventric leadT 0105

33233 Removal of pacemaker systemT 0105

33234 Removal of pacemaker systemT 0105

33235 Removal pacemaker electrodeT 0105

33236 Remove electrode/thoracotomyC

33237 Remove electrode/thoracotomyC

33238 Remove electrode/thoracotomyC

33240 Insert pulse generator T 0107
33241 Remove pulse generator

T 0105

33243 Remove eltrd/thoracotomyC

33244 Remove eltrd transvenT 0105

33249 Eltrd/insert pace-defib CH Q3 0108

33250 Ablate heart dysrhythm focusC

33251 Ablate heart dysrhythm focusC

33254 Ablate atria lmtdC

33255 Ablate atria w/o bypass extC

33256 Ablate atria w/bypass extenC

33257 Ablate atria lmtd add-onC

33258 Ablate atria x10sv add-onC

33259 Ablate atria w/bypass add-onC

33261 Ablate heart dysrhythm focusC

33265 Ablate atria lmtd endoC

33266 Ablate atria x10sv endo

C

33282 Implant pat-active ht recordS 0680

33284 Remove pat-active ht recordT 0020

33300 Repair of heart woundC

33305 Repair of heart woundC

33310 Exploratory heart surgeryC

33315 Exploratory heart surgeryC

33320 Repair major blood vessel(s)C

33321 Repair major vesselC

33322 Repair major blood vessel(s)C

33330 Insert major vessel graftC

33332 Insert major vessel graftC

33335 Insert major vessel graftC

33400 Repair of aortic valveC

33401 Valvuloplasty openC

33403 Valvuloplasty w/cp bypassC

33404 Prepare heart-aorta conduitC

33405 Replacement of aortic valveC

33406 Replacement of aortic valveC

33410 Replacement of aortic valveC

33411 Replacement of aortic valveC

33412 Replacement of aortic valveC

33413 Replacement of aortic valveC

33414 Repair of aortic valveC

33415 Revision subvalvular tissueC

33416 Revise ventricle muscleC

33417 Repair of aortic valveC

33420 Revision of mitral valveC

33422 Revision of mitral valveC

33425 Repair of mitral valveC

33426 Repair of mitral valveC

33427 Repair of mitral valveC

33430 Replacement of mitral valveC

33460 Revision of tricuspid valveC

33463 Valvuloplasty tricuspidC

33464 Valvuloplasty tricuspidC

33465 Replace tricuspid valveC

33468 Revision of tricuspid valveC

33470 Revision of pulmonary valveC

33471 Valvotomy pulmonary valveC

33472 Revision of pulmonary valveC
33474 Revision of pulmonary valve

C

33475 Replacement pulmonary valveC

33476 Revision of heart chamberC

33478 Revision of heart chamberC

33496 Repair prosth valve clotC

33500 Repair heart vessel fistulaC

33501 Repair heart vessel fistulaC

33502 Coronary artery correctionC

33503 Coronary artery graftC

33504 Coronary artery graftC

33505 Repair artery w/tunnelC

33506 Repair artery translocationC

33507 Repair art intramuralC

33508 Endoscopic vein harvestN

33510 Cabg vein singleC

33511 Cabg vein twoC

33512 Cabg vein threeC

33513 Cabg vein fourC

33514 Cabg vein fiveC

33516 Cabg vein six or moreC

33517 Cabg artery-vein singleC

33518 Cabg artery-vein twoC

33519 Cabg artery-vein threeC

33521 Cabg artery-vein fourC

33522 Cabg artery-vein fiveC

33523 Cabg art-vein six or moreC

33530 Coronary artery bypass/reopC

33533 Cabg arterial singleC

33534 Cabg arterial twoC

33535 Cabg arterial threeC

33536 Cabg arterial four or moreC

33542 Removal of heart lesionC

33545 Repair of heart damageC

33548 Restore/remodel ventricleC

33572 Open coronary endarterectomyC

33600 Closure of valveC

33602 Closure of valveC

33606 Anastomosis/artery-aortaC

33608 Repair anomaly w/conduitC

33610 Repair by enlargementC

33611 Repair double ventricleC

33612 Repair double ventricleC

33615 Repair modified fontanC

33617 Repair single ventricleC

33619 Repair single ventricleC

33620 Apply r&l pulm art bandsC

33621 Transthor cath for stentC

33622 Redo compl cardiac anomalyC

33641 Repair heart septum defectC

33645 Revision of heart veinsC

33647 Repair heart septum defectsC

33660 Repair of heart defectsC

33665 Repair of heart defectsC

33670 Repair of heart chambersC

33675 Close mult vsd

C
33676 Close mult vsd w/resection

C

33677 Cl mult vsd w/rem pul band

C

33681 Repair heart septum defectC

33684 Repair heart septum defectC

33688 Repair heart septum defectC

33690 Reinforce pulmonary arteryC

33692 Repair of heart defectsC

33694 Repair of heart defectsC

33697 Repair of heart defectsC

33702 Repair of heart defectsC

33710 Repair of heart defectsC

33720 Repair of heart defectC

33722 Repair of heart defectC

33724 Repair venous anomaly

C

33726 Repair pul venous stenosis

C

33730 Repair heart-vein defect(s)C

33732 Repair heart-vein defectC

33735 Revision of heart chamberC

33736 Revision of heart chamberC

33737 Revision of heart chamberC

33750 Major vessel shuntC

33755 Major vessel shuntC

33762 Major vessel shuntC

33764 Major vessel shunt & graftC

33766 Major vessel shuntC

33767 Major vessel shuntC

33768 Cavopulmonary shuntingC

33770 Repair great vessels defectC

33771 Repair great vessels defectC

33774 Repair great vessels defectC

33775 Repair great vessels defectC

33776 Repair great vessels defectC

33777 Repair great vessels defectC

33778 Repair great vessels defectC

33779 Repair great vessels defectC

33780 Repair great vessels defectC

33781 Repair great vessels defectC

33782 Nikaidoh procC

33783 Nikaidoh proc w/ostia impltC

33786 Repair arterial trunkC

33788 Revision of pulmonary arteryC

33800 Aortic suspensionC

33802 Repair vessel defectC

33803 Repair vessel defectC

33813 Repair septal defectC

33814 Repair septal defectC

33820 Revise major vesselC

33822 Revise major vesselC

33824 Revise major vesselC

33840 Remove aorta constrictionC

33845 Remove aorta constrictionC

33851 Remove aorta constrictionC

33852 Repair septal defectC

33853 Repair septal defectC

33860 Ascending aortic graftC
33863 Ascending aortic graft

C

33864 Ascending aortic graftC

33870 Transverse aortic arch graftC

33875 Thoracic aortic graftC

33877 Thoracoabdominal graftC

33880 Endovasc taa repr incl subclC

33881 Endovasc taa repr w/o subclC

33883 Insert endovasc prosth taaC

33884 Endovasc prosth taa add-onC

33886 Endovasc prosth delayedC

33889 Artery transpose/endovas taaC

33891 Car-car bp grft/endovas taaC

33910 Remove lung artery emboliC

33915 Remove lung artery emboliC

33916 Surgery of great vesselC

33917 Repair pulmonary arteryC

33920 Repair pulmonary atresiaC

33922 Transect pulmonary arteryC

33924 Remove pulmonary shuntC

33925 Rpr pul art unifocal w/o cpbC

33926 Repr pul art unifocal w/cpbC

33930 Removal of donor heart/lungC

33933 Prepare donor heart/lungC

33935 Transplantation heart/lungC

33940 Removal of donor heartC

33944 Prepare donor heartC

33945 Transplantation of heartC

33960 External circulation assistC

33961 External circulation assistC

33967 Insert ia percut deviceC

33968 Remove aortic assist deviceC

33970 Aortic circulation assistC

33971 Aortic circulation assistC

33973 Insert balloon deviceC

33974 Remove intra-aortic balloonC

33975 Implant ventricular deviceC

33976 Implant ventricular deviceC

33977 Remove ventricular deviceC

33978 Remove ventricular deviceC

33979 Insert intracorporeal deviceC

33980 Remove intracorporeal deviceC

33981 Replace vad pump extC

33982 Replace vad intra w/o bpC

33983 Replace vad intra w/bpC

33999 Cardiac surgery procedureT 0070

34001 Removal of artery clotC

34051 Removal of artery clotC

34101 Removal of artery clotT 0088

34111 Removal of arm artery clotT 0088

34151 Removal of artery clotC

34201 Removal of artery clotT 0088

34203 Removal of leg artery clotT 0088

34401 Removal of vein clotC

34421 Removal of vein clotT 0088

34451 Removal of vein clotC
34471 Removal of vein clot

T 0088

34490 Removal of vein clotT 0088

34501 Repair valve femoral veinT 0088

34502 Reconstruct vena cavaC

34510 Transposition of vein valveT 0088

34520 Cross-over vein graftT 0088

34530 Leg vein fusionT 0088

34800 Endovas aaa repr w/sm tubeC

34802 Endovas aaa repr w/2-p partC

34803 Endovas aaa repr w/3-p partC

34804 Endovas aaa repr w/1-p partC

34805 Endovas aaa repr w/long tubeC

34806 Aneurysm press sensor add-onC

34808 Endovas iliac a device addonC

34812 Xpose for endoprosth femorlC

34813 Femoral endovas graft add-onC

34820 Xpose for endoprosth iliacC

34825 Endovasc extend prosth initC

34826 Endovasc exten prosth addlC

34830 Open aortic tube prosth reprC

34831 Open aortoiliac prosth reprC

34832 Open aortofemor prosth reprC

34833 Xpose for endoprosth iliacC

34834 Xpose endoprosth brachialC

34900 Endovasc iliac repr w/graftC

35001 Repair defect of arteryC

35002 Repair artery rupture neckC

35005 Repair defect of arteryC

35011 Repair defect of arteryT 0653

35013 Repair artery rupture armC

35021 Repair defect of arteryC

35022 Repair artery rupture chestC

35045 Repair defect of arm artery CHT 0093

35081 Repair defect of arteryC

35082 Repair artery rupture aortaC

35091 Repair defect of arteryC

35092 Repair artery rupture aortaC

35102 Repair defect of arteryC

35103 Repair artery rupture groinC

35111 Repair defect of arteryC

35112 Repair artery rupture spleenC

35121 Repair defect of arteryC

35122 Repair artery rupture bellyC

35131 Repair defect of arteryC

35132 Repair artery rupture groinC

35141 Repair defect of arteryC

35142 Repair artery rupture thighC

35151 Repair defect of arteryC

35152 Repair artery rupture kneeC

35180 Repair blood vessel lesionT 0093

35182 Repair blood vessel lesionC

35184 Repair blood vessel lesionT 0093

35188 Repair blood vessel lesionT 0088

35189 Repair blood vessel lesionC

35190 Repair blood vessel lesionT 0093
35201 Repair blood vessel lesion

T 0093

35206 Repair blood vessel lesionT 0093

35207 Repair blood vessel lesionT 0088

35211 Repair blood vessel lesionC

35216 Repair blood vessel lesionC

35221 Repair blood vessel lesionC

35226 Repair blood vessel lesionT 0020

35231 Repair blood vessel lesionT 0093

35236 Repair blood vessel lesionT 0093

35241 Repair blood vessel lesionC

35246 Repair blood vessel lesionC

35251 Repair blood vessel lesionC

35256 Repair blood vessel lesionT 0093

35261 Repair blood vessel lesionT 0653

35266 Repair blood vessel lesionT 0653

35271 Repair blood vessel lesionC

35276 Repair blood vessel lesionC

35281 Repair blood vessel lesionC

35286 Repair blood vessel lesionT 0653

35301 Rechanneling of arteryC

35302 Rechanneling of arteryC

35303 Rechanneling of arteryC

35304 Rechanneling of arteryC

35305 Rechanneling of arteryC

35306 Rechanneling of arteryC

35311 Rechanneling of arteryC

35321 Rechanneling of arteryT 0093

35331 Rechanneling of arteryC

35341 Rechanneling of arteryC

35351 Rechanneling of arteryC

35355 Rechanneling of arteryC

35361 Rechanneling of arteryC

35363 Rechanneling of arteryC

35371 Rechanneling of arteryC

35372 Rechanneling of arteryC

35390 Reoperation carotid add-onC

35400 AngioscopyC

35450 Repair arterial blockageC

35452 Repair arterial blockageC

35458 Repair arterial blockageT 0083

35460 Repair venous blockageT 0083

35471 Repair arterial blockageT 0083

35472 Repair arterial blockageT 0083

35475 Repair arterial blockageT 0083

35476 Repair venous blockageT 0083

35500 Harvest vein for bypassT 0103

35501 Artery bypass graftC

35506 Artery bypass graftC

35508 Artery bypass graftC

35509 Artery bypass graftC

35510 Artery bypass graftC

35511 Artery bypass graftC

35512 Artery bypass graftC

35515 Artery bypass graftC

35516 Artery bypass graftC
35518 Artery bypass graft

C

35521 Artery bypass graftC

35522 Artery bypass graft

C

35523 Artery bypass graft

C

35525 Artery bypass graft

C

35526 Artery bypass graftC

35531 Artery bypass graftC

35533 Artery bypass graftC

35535 Artery bypass graftC

35536 Artery bypass graftC

35537 Artery bypass graftC

35538 Artery bypass graftC

35539 Artery bypass graftC

35540 Artery bypass graftC

35548 Artery bypass graftC

35549 Artery bypass graftC

35551 Artery bypass graftC

35556 Artery bypass graftC

35558 Artery bypass graftC

35560 Artery bypass graftC

35563 Artery bypass graftC

35565 Artery bypass graftC

35566 Artery bypass graftC

35570 Artery bypass graftC

35571 Artery bypass graftC

35572 Harvest femoropopliteal veinN

35583 Vein bypass graftC

35585 Vein bypass graftC

35587 Vein bypass graftC

35600 Harvest art for cabg add-onC

35601 Artery bypass graftC

35606 Artery bypass graftC

35612 Artery bypass graftC

35616 Artery bypass graftC

35621 Artery bypass graftC

35623 Bypass graft not veinC

35626 Artery bypass graftC

35631 Artery bypass graftC

35632 Artery bypass graftC

35633 Artery bypass graftC

35634 Artery bypass graftC

35636 Artery bypass graftC

35637 Artery bypass graftC

35638 Artery bypass graftC

35642 Artery bypass graftC

35645 Artery bypass graftC

35646 Artery bypass graftC

35647 Artery bypass graftC

35650 Artery bypass graftC

35651 Artery bypass graftC

35654 Artery bypass graftC

35656 Artery bypass graftC

35661 Artery bypass graftC

35663 Artery bypass graftC

35665 Artery bypass graftC
35666 Artery bypass graft

C

35671 Artery bypass graftC

35681 Composite bypass graftC

35682 Composite bypass graftC

35683 Composite bypass graftC

35685 Bypass graft patency/patchT 0093

35686 Bypass graft/av fist patencyT 0093

35691 Arterial transpositionC

35693 Arterial transpositionC

35694 Arterial transpositionC

35695 Arterial transpositionC

35697 Reimplant artery eachC

35700 Reoperation bypass graftC

35701 Exploration carotid arteryC

35721 Exploration femoral arteryC

35741 Exploration popliteal arteryC

35761 Exploration of artery/veinT 0093

35800 Explore neck vesselsC

35820 Explore chest vesselsC

35840 Explore abdominal vesselsC

35860 Explore limb vesselsT 0093

35870 Repair vessel graft defectC

35875 Removal of clot in graftT 0088

35876 Removal of clot in graftT 0088

35879 Revise graft w/veinT 0088

35881 Revise graft w/veinT 0088

35883 Revise graft w/nonauto graft

T 0088

35884 Revise graft w/vein

T 0088

35901 Excision graft neckC

35903 Excision graft extremityT 0093

35905 Excision graft thoraxC

35907 Excision graft abdomenC

36000 Place needle in veinN

36002 Pseudoaneurysm injection trtS 0267

36005 Injection ext venographyN

36010 Place catheter in veinN

36011 Place catheter in veinN

36012 Place catheter in veinN

36013 Place catheter in arteryN

36014 Place catheter in arteryN

36015 Place catheter in arteryN

36100 Establish access to arteryN

36120 Establish access to arteryN

36140 Establish access to arteryN

36147 Access av dial grft for eval CHT 0668

36148 Access av dial grft for procN

36160 Establish access to aortaN

36200 Place catheter in aortaN

36215 Place catheter in arteryN

36216 Place catheter in arteryN

36217 Place catheter in arteryN

36218 Place catheter in arteryN

36245 Place catheter in arteryN

36246 Place catheter in arteryN

36247 Place catheter in arteryN
36248 Place catheter in artery

N

36260 Insertion of infusion pumpT 0623

36261 Revision of infusion pumpT 0105

36262 Removal of infusion pumpT 0105

36299 Vessel injection procedureN

36400 Bl draw < 3 yrs fem/jugularN

36405 Bl draw < 3 yrs scalp veinN

36406 Bl draw < 3 yrs other veinN

36410 Non-routine bl draw > 3 yrsN

36415 Routine venipunctureA

36416 Capillary blood drawN

36420 Vein access cutdown < 1 yr X 0035

36425 Vein access cutdown > 1 yr X 0035

36430 Blood transfusion serviceS 0110

36440 Bl push transfuse 2 yr or <S 0110

36450 Bl exchange/transfuse nbS 0110

36455 Bl exchange/transfuse non-nbS 0110

36460 Transfusion service fetalS 0110

36468 Injection(s) spider veinsT 0013

36469 Injection(s) spider veinsT 0013

36470 Injection therapy of veinT 0013

36471 Injection therapy of veinsT 0013

36475 Endovenous rf 1st veinT 0091

36476 Endovenous rf vein add-onT 0092

36478 Endovenous laser 1st veinT 0092

36479 Endovenous laser vein addonT 0092

36481 Insertion of catheter veinN

36500 Insertion of catheter veinN

36510 Insertion of catheter veinN

36511 Apheresis wbcS 0111

36512 Apheresis rbcS 0111

36513 Apheresis plateletsS 0111

36514 Apheresis plasmaS 0111

36515 Apheresis adsorp/reinfuseS 0112

36516 Apheresis selectiveS 0112

36522 PhotopheresisS 0112

36555 Insert non-tunnel cv cathT 0621

36556 Insert non-tunnel cv cathT 0621

36557 Insert tunneled cv cathT 0622

36558 Insert tunneled cv cathT 0622

36560 Insert tunneled cv cathT 0623

36561 Insert tunneled cv cathT 0623

36563 Insert tunneled cv cathT 0623

36565 Insert tunneled cv cathT 0623

36566 Insert tunneled cv cathT 0623

36568 Insert picc cathT 0621

36569 Insert picc cathT 0621

36570 Insert picvad cathT 0622

36571 Insert picvad cathT 0622

36575 Repair tunneled cv cathT 0121

36576 Repair tunneled cv cathT 0621

36578 Replace tunneled cv cathT 0622

36580 Replace cvad cathT 0621

36581 Replace tunneled cv cathT 0622

36582 Replace tunneled cv cathT 0623
36583 Replace tunneled cv cath

T 0623

36584 Replace picc cathT 0621

36585 Replace picvad cathT 0622

36589 Removal tunneled cv cathT 0121

36590 Removal tunneled cv cathT 0621

36591 Draw blood off venous device Q1 0624

36592 Collect blood from picc Q1 0624

36593 Declot vascular deviceT 0676

36595 Mech remov tunneled cv cathT 0622

36596 Mech remov tunneled cv cathT 0621

36597 Reposition venous catheterT 0621

36598 Inj w/fluor eval cv deviceT 0676

36600 Withdrawal of arterial blood Q3 0035

36620 Insertion catheter arteryN

36625 Insertion catheter arteryN

36640 Insertion catheter arteryT 0623

36660 Insertion catheter arteryC

36680 Insert needle bone cavityT 0002

36800 Insertion of cannulaT 0115

36810 Insertion of cannulaT 0115

36815 Insertion of cannulaT 0115

36818 Av fuse uppr arm cephalicT 0088

36819 Av fuse uppr arm basilicT 0088

36820 Av fusion/forearm veinT 0088

36821 Av fusion direct any siteT 0088

36822 Insertion of cannula(s)C

36823 Insertion of cannula(s)C

36825 Artery-vein autograftT 0088

36830 Artery-vein nonautograftT 0088

36831 Open thrombect av fistulaT 0088

36832 Av fistula revision openT 0088

36833 Av fistula revisionT 0088

36835 Artery to vein shuntT 0115

36838 Dist revas ligation hemoT 0088

36860 External cannula declottingT 0676

36861 Cannula declottingT 0115

36870 Percut thrombect av fistulaT 0653

37140 Revision of circulationC

37145 Revision of circulationC

37160 Revision of circulationC

37180 Revision of circulationC

37181 Splice spleen/kidney veinsC

37182 Insert hepatic shunt (tips)C

37183 Remove hepatic shunt (tips)T 0229

37184 Prim art mech thrombectomyT 0088

37185 Prim art m-thrombect add-onT 0088

37186 Sec art m-thrombect add-onT 0088

37187 Venous mech thrombectomyT 0088

37188 Venous m-thrombectomy add-onT 0088

37195 Thrombolytic therapy strokeT 0676

37200 Transcatheter biopsyT 0623

37201 Transcatheter therapy infuseT 0103

37202 Transcatheter therapy infuseT 0103

37203 Transcatheter retrievalT 0623

37204 Transcatheter occlusionT 0082
37205 Transcath iv stent percut

T 0229

37206 Transcath iv stent/perc addlT 0229

37207 Transcath iv stent openT 0229

37208 Transcath iv stent/open addlT 0229

37209 Change iv cath at thromb txT 0623

37210 Embolization uterine fibroidT 0229

37215 Transcath stent cca w/epsC

37216 Transcath stent cca w/o eps E 

37220 Iliac revascT 0083

37221 Iliac revasc w/stent CHT 0229

37222 Iliac revasc add-onT 0083

37223 Iliac revasc w/stent add-onT 0083

37224 Fem/popl revas w/tlaT 0083

37225 Fem/popl revas w/atherT 0229

37226 Fem/popl revasc w/stentT 0229

37227 Fem/popl revasc stnt & atherT 0319

37228 Tib/per revasc w/tlaT 0083

37229 Tib/per revasc w/atherT 0229

37230 Tib/per revasc w/stentT 0229

37231 Tib/per revasc stent & atherT 0319

37232 Tib/per revasc add-onT 0083

37233 Tibper revasc w/ather add-onT 0229

37234 Revsc opn/prq tib/pero stentT 0083

37235 Tib/per revasc stnt & atherT 0083

37250 Iv us first vessel add-on N 

37251 Iv us each add vessel add-on N 

37500 Endoscopy ligate perf veinsT 0091

37501 Vascular endoscopy procedureT 0092

37565 Ligation of neck veinT 0093

37600 Ligation of neck arteryT 0093

37605 Ligation of neck arteryT 0091

37606 Ligation of neck arteryT 0092

37607 Ligation of a-v fistulaT 0092

37609 Temporal artery procedureT 0021

37615 Ligation of neck arteryT 0092

37616 Ligation of chest arteryC

37617 Ligation of abdomen arteryC

37618 Ligation of extremity arteryC

37620 Revision of major veinT 0091

37650 Revision of major veinT 0092

37660 Revision of major veinC

37700 Revise leg veinT 0092

37718 Ligate/strip short leg veinT 0092

37722 Ligate/strip long leg veinT 0091

37735 Removal of leg veins/lesionT 0091

37760 Ligate leg veins radicalT 0092

37761 Ligate leg veins openT 0092

37765 Stab phleb veins xtr 10-20T 0092

37766 Phleb veins - extrem 20+T 0092

37780 Revision of leg veinT 0092

37785 Ligate/divide/excise veinT 0092

37788 Revascularization penisC

37790 Penile venous occlusionT 0181

37799 Vascular surgery procedureX 0624

38100 Removal of spleen totalC
38101 Removal of spleen partial

C

38102 Removal of spleen totalC

38115 Repair of ruptured spleenC

38120 Laparoscopy splenectomyT 0131

38129 Laparoscope proc spleenT 0130

38200 Injection for spleen x-rayN

38204 Bl donor search management N 

38205 Harvest allogenic stem cellsB

38206 Harvest auto stem cellsS 0111

38207 Cryopreserve stem cells S 0110

38208 Thaw preserved stem cells S 0110

38209 Wash harvest stem cells S 0110

38210 T-cell depletion of harvest S 0393

38211 Tumor cell deplete of harvst S 0393

38212 Rbc depletion of harvest S 0393

38213 Platelet deplete of harvest S 0393

38214 Volume deplete of harvest S 0393

38215 Harvest stem cell concentrte S 0393

38220 Bone marrow aspirationT 0003

38221 Bone marrow biopsyT 0003

38230 Bone marrow collectionS 0112

38240 Bone marrow/stem transplantS 0112

38241 Bone marrow/stem transplantS 0112

38242 Lymphocyte infuse transplantS 0111

38300 Drainage lymph node lesionT 0007

38305 Drainage lymph node lesionT 0008

38308 Incision of lymph channelsT 0113

38380 Thoracic duct procedureC

38381 Thoracic duct procedureC

38382 Thoracic duct procedureC

38500 Biopsy/removal lymph nodesT 0113

38505 Needle biopsy lymph nodesT 0005

38510 Biopsy/removal lymph nodesT 0113

38520 Biopsy/removal lymph nodesT 0113

38525 Biopsy/removal lymph nodesT 0113

38530 Biopsy/removal lymph nodesT 0113

38542 Explore deep node(s) neckT 0114

38550 Removal neck/armpit lesionT 0113

38555 Removal neck/armpit lesionT 0113

38562 Removal pelvic lymph nodesC

38564 Removal abdomen lymph nodesC

38570 Laparoscopy lymph node biopT 0131

38571 Laparoscopy lymphadenectomyT 0132

38572 Laparoscopy lymphadenectomyT 0131

38589 Laparoscope proc lymphaticT 0130

38700 Removal of lymph nodes neckT 0113

38720 Removal of lymph nodes neckT 0113

38724 Removal of lymph nodes neckC

38740 Remove armpit lymph nodesT 0114

38745 Remove armpit lymph nodesT 0114

38746 Remove thoracic lymph nodesC

38747 Remove abdominal lymph nodesC

38760 Remove groin lymph nodesT 0113

38765 Remove groin lymph nodesC

38770 Remove pelvis lymph nodesC
38780 Remove abdomen lymph nodes

C

38790 Inject for lymphatic x-rayN

38792 Identify sentinel node Q1 0392

38794 Access thoracic lymph ductN

38900 Io map of sent lymph nodeN

38999 Blood/lymph system procedureS 0110

39000 Exploration of chestC

39010 Exploration of chestC

39200 Removal chest lesionC

39220 Removal chest lesionC

39400 Visualization of chestT 0069

39499 Chest procedureC

39501 Repair diaphragm lacerationC

39503 Repair of diaphragm herniaC

39540 Repair of diaphragm herniaC

39541 Repair of diaphragm herniaC

39545 Revision of diaphragmC

39560 Resect diaphragm simpleC

39561 Resect diaphragm complexC

39599 Diaphragm surgery procedureC

40490 Biopsy of lipT 0251

40500 Partial excision of lipT 0253

40510 Partial excision of lipT 0254

40520 Partial excision of lipT 0253

40525 Reconstruct lip with flapT 0254

40527 Reconstruct lip with flapT 0254

40530 Partial removal of lipT 0254

40650 Repair lipT 0252

40652 Repair lipT 0252

40654 Repair lipT 0252

40700 Repair cleft lip/nasalT 0256

40701 Repair cleft lip/nasalT 0256

40702 Repair cleft lip/nasalT 0256

40720 Repair cleft lip/nasalT 0256

40761 Repair cleft lip/nasalT 0256

40799 Lip surgery procedureT 0250

40800 Drainage of mouth lesionT 0006

40801 Drainage of mouth lesionT 0252

40804 Removal foreign body mouthX 0340

40805 Removal foreign body mouthT 0252

40806 Incision of lip foldT 0251

40808 Biopsy of mouth lesionT 0251

40810 Excision of mouth lesionT 0253

40812 Excise/repair mouth lesionT 0253

40814 Excise/repair mouth lesionT 0253

40816 Excision of mouth lesionT 0254

40818 Excise oral mucosa for graftT 0251

40819 Excise lip or cheek foldT 0252

40820 Treatment of mouth lesionT 0253

40830 Repair mouth lacerationT 0251

40831 Repair mouth lacerationT 0252

40840 Reconstruction of mouthT 0254

40842 Reconstruction of mouthT 0254

40843 Reconstruction of mouthT 0254

40844 Reconstruction of mouthT 0256
40845 Reconstruction of mouth

T 0256

40899 Mouth surgery procedureT 0250

41000 Drainage of mouth lesionT 0253

41005 Drainage of mouth lesionT 0251

41006 Drainage of mouth lesionT 0254

41007 Drainage of mouth lesionT 0253

41008 Drainage of mouth lesionT 0253

41009 Drainage of mouth lesionT 0251

41010 Incision of tongue foldT 0252

41015 Drainage of mouth lesionT 0251

41016 Drainage of mouth lesionT 0252

41017 Drainage of mouth lesionT 0252

41018 Drainage of mouth lesionT 0252

41019 Place needles h&n for rtT 0254

41100 Biopsy of tongueT 0252

41105 Biopsy of tongueT 0253

41108 Biopsy of floor of mouthT 0019

41110 Excision of tongue lesionT 0253

41112 Excision of tongue lesionT 0253

41113 Excision of tongue lesionT 0253

41114 Excision of tongue lesionT 0254

41115 Excision of tongue foldT 0252

41116 Excision of mouth lesionT 0253

41120 Partial removal of tongueT 0254

41130 Partial removal of tongueC

41135 Tongue and neck surgeryC

41140 Removal of tongueC

41145 Tongue removal neck surgeryC

41150 Tongue mouth jaw surgeryC

41153 Tongue mouth neck surgeryC

41155 Tongue jaw & neck surgeryC

41250 Repair tongue lacerationT 0250

41251 Repair tongue lacerationT 0251

41252 Repair tongue lacerationT 0252

41500 Fixation of tongueT 0254

41510 Tongue to lip surgeryT 0253

41512 Tongue suspensionT 0252

41520 Reconstruction tongue foldT 0252

41530 Tongue base vol reductionT 0254

41599 Tongue and mouth surgeryT 0250

41800 Drainage of gum lesionT 0006

41805 Removal foreign body gumT 0254

41806 Removal foreign body jawboneT 0253

41820 Excision gum each quadrantT 0252

41821 Excision of gum flapT 0252

41822 Excision of gum lesionT 0253

41823 Excision of gum lesionT 0254

41825 Excision of gum lesionT 0253

41826 Excision of gum lesionT 0254

41827 Excision of gum lesionT 0254

41828 Excision of gum lesionT 0253

41830 Removal of gum tissueT 0253

41850 Treatment of gum lesionT 0253

41870 Gum graftT 0254

41872 Repair gumT 0253
41874 Repair tooth socket

T 0254

41899 Dental surgery procedureT 0250

42000 Drainage mouth roof lesionT 0251

42100 Biopsy roof of mouthT 0252

42104 Excision lesion mouth roofT 0253

42106 Excision lesion mouth roofT 0253

42107 Excision lesion mouth roofT 0254

42120 Remove palate/lesionT 0256

42140 Excision of uvulaT 0252

42145 Repair palate pharynx/uvulaT 0254

42160 Treatment mouth roof lesionT 0253

42180 Repair palateT 0251

42182 Repair palateT 0256

42200 Reconstruct cleft palateT 0256

42205 Reconstruct cleft palateT 0256

42210 Reconstruct cleft palateT 0256

42215 Reconstruct cleft palateT 0256

42220 Reconstruct cleft palateT 0256

42225 Reconstruct cleft palateT 0256

42226 Lengthening of palateT 0256

42227 Lengthening of palateT 0256

42235 Repair palateT 0253

42260 Repair nose to lip fistulaT 0254

42280 Preparation palate moldT 0251

42281 Insertion palate prosthesisT 0253

42299 Palate/uvula surgeryT 0250

42300 Drainage of salivary glandT 0253

42305 Drainage of salivary glandT 0253

42310 Drainage of salivary glandT 0251

42320 Drainage of salivary glandT 0251

42330 Removal of salivary stoneT 0253

42335 Removal of salivary stoneT 0253

42340 Removal of salivary stoneT 0253

42400 Biopsy of salivary glandT 0005

42405 Biopsy of salivary glandT 0254

42408 Excision of salivary cystT 0253

42409 Drainage of salivary cystT 0253

42410 Excise parotid gland/lesionT 0256

42415 Excise parotid gland/lesionT 0256

42420 Excise parotid gland/lesionT 0256

42425 Excise parotid gland/lesionT 0256

42426 Excise parotid gland/lesionC

42440 Excise submaxillary glandT 0256

42450 Excise sublingual glandT 0254

42500 Repair salivary ductT 0254

42505 Repair salivary ductT 0256

42507 Parotid duct diversionT 0256

42508 Parotid duct diversionT 0256

42509 Parotid duct diversionT 0256

42510 Parotid duct diversionT 0256

42550 Injection for salivary x-rayN

42600 Closure of salivary fistulaT 0253

42650 Dilation of salivary ductT 0252

42660 Dilation of salivary ductT 0251

42665 Ligation of salivary ductT 0254
42699 Salivary surgery procedure

T 0250

42700 Drainage of tonsil abscessT 0251

42720 Drainage of throat abscessT 0253

42725 Drainage of throat abscessT 0256

42800 Biopsy of throatT 0252

42802 Biopsy of throatT 0253

42804 Biopsy of upper nose/throatT 0253

42806 Biopsy of upper nose/throatT 0254

42808 Excise pharynx lesionT 0254

42809 Remove pharynx foreign bodyX 0340

42810 Excision of neck cystT 0254

42815 Excision of neck cystT 0256

42820 Remove tonsils and adenoidsT 0254

42821 Remove tonsils and adenoidsT 0254

42825 Removal of tonsilsT 0254

42826 Removal of tonsilsT 0254

42830 Removal of adenoidsT 0254

42831 Removal of adenoidsT 0254

42835 Removal of adenoidsT 0254

42836 Removal of adenoidsT 0254

42842 Extensive surgery of throatT 0254

42844 Extensive surgery of throatT 0256

42845 Extensive surgery of throatC

42860 Excision of tonsil tagsT 0254

42870 Excision of lingual tonsilT 0254

42890 Partial removal of pharynxT 0256

42892 Revision of pharyngeal wallsT 0256

42894 Revision of pharyngeal wallsC

42900 Repair throat woundT 0252

42950 Reconstruction of throatT 0254

42953 Repair throat esophagusC

42955 Surgical opening of throatT 0254

42960 Control throat bleedingT 0250

42961 Control throat bleedingC

42962 Control throat bleedingT 0256

42970 Control nose/throat bleedingT 0250

42971 Control nose/throat bleedingC

42972 Control nose/throat bleedingT 0253

42999 Throat surgery procedureT 0250

43020 Incision of esophagusT 0252

43030 Throat muscle surgeryT 0253

43045 Incision of esophagusC

43100 Excision of esophagus lesionC

43101 Excision of esophagus lesionC

43107 Removal of esophagusC

43108 Removal of esophagusC

43112 Removal of esophagusC

43113 Removal of esophagusC

43116 Partial removal of esophagusC

43117 Partial removal of esophagusC

43118 Partial removal of esophagusC

43121 Partial removal of esophagusC

43122 Partial removal of esophagusC

43123 Partial removal of esophagusC

43124 Removal of esophagusC
43130 Removal of esophagus pouch

T 0256

43135 Removal of esophagus pouchC

43200 Esophagus endoscopyT 0141

43201 Esoph scope w/submucous inj CHT 0419

43202 Esophagus endoscopy biopsyT 0141

43204 Esoph scope w/sclerosis injT 0141

43205 Esophagus endoscopy/ligation CHT 0419

43215 Esophagus endoscopy CHT 0419

43216 Esophagus endoscopy/lesionT 0422

43217 Esophagus endoscopy CHT 0419

43219 Esophagus endoscopyT 0384

43220 Esoph endoscopy dilation CHT 0419

43226 Esoph endoscopy dilation CHT 0419

43227 Esoph endoscopy repair CHT 0419

43228 Esoph endoscopy ablationT 0422

43231 Esoph endoscopy w/us exam CHT 0419

43232 Esoph endoscopy w/us fn bx CHT 0419

43234 Upper gi endoscopy examT 0141

43235 Uppr gi endoscopy diagnosisT 0141

43236 Uppr gi scope w/submuc injT 0141

43237 Endoscopic us exam esoph CHT 0419

43238 Uppr gi endoscopy w/us fn bx CHT 0419

43239 Upper gi endoscopy biopsyT 0141

43240 Esoph endoscope w/drain cyst CHT 0419

43241 Upper GI endoscopy with tubeT 0141

43242 Uppr gi endoscopy w/us fn bx CHT 0419

43243 Upper gi endoscopy & injectT 0141

43244 Upper GI endoscopy/ligation CHT 0419

43245 Uppr gi scope dilate strictr CHT 0419

43246 Place gastrostomy tube CHT 0419

43247 Operative upper GI endoscopyT 0141

43248 Uppr gi endoscopy/guide wireT 0141

43249 Esoph endoscopy dilation CHT 0419

43250 Upper GI endoscopy/tumor CHT 0419

43251 Operative upper GI endoscopy CHT 0419

43255 Operative upper GI endoscopy CHT 0419

43256 Uppr gi endoscopy w/stentT 0384

43257 Uppr gi scope w/thrml txmntT 0422

43258 Operative upper GI endoscopy CHT 0419

43259 Endoscopic ultrasound exam CHT 0419

43260 Endo cholangiopancreatographT 0151

43261 Endo cholangiopancreatographT 0151

43262 Endo cholangiopancreatographT 0151

43263 Endo cholangiopancreatographT 0151

43264 Endo cholangiopancreatographT 0151

43265 Endo cholangiopancreatographT 0151

43267 Endo cholangiopancreatographT 0151

43268 Endo cholangiopancreatographT 0384

43269 Endo cholangiopancreatographT 0384

43271 Endo cholangiopancreatographT 0151

43272 Endo cholangiopancreatographT 0151

43273 Endoscopic pancreatoscopyT 0151

43279 Lap myotomy hellerC

43280 Laparoscopy fundoplastyT 0132

43281 Lap paraesophag hern repairC
43282 Lap paraesoph her rpr w/mesh

C

43283 Lap esoph lengtheningC

43289 Laparoscope proc esophT 0130

43300 Repair of esophagusC

43305 Repair esophagus and fistulaC

43310 Repair of esophagusC

43312 Repair esophagus and fistulaC

43313 Esophagoplasty congenitalC

43314 Tracheo-esophagoplasty congC

43320 Fuse esophagus & stomachC

43325 Revise esophagus & stomachC

43327 Esoph fundoplasty lapC

43328 Esoph fundoplasty thorC

43330 Esophagomyotomy abdominalC

43331 Esophagomyotomy thoracicC

43332 Transab esoph hiat hern rprC

43333 Transab esoph hiat hern rprC

43334 Transthor diaphrag hern rprC

43335 Transthor diaphrag hern rprC

43336 Thorabd diaphr hern repairC

43337 Thorabd diaphr hern repairC

43338 Esoph lengtheningC

43340 Fuse esophagus & intestineC

43341 Fuse esophagus & intestineC

43350 Surgical opening esophagusC

43351 Surgical opening esophagusC

43352 Surgical opening esophagusC

43360 Gastrointestinal repairC

43361 Gastrointestinal repairC

43400 Ligate esophagus veinsC

43401 Esophagus surgery for veinsC

43405 Ligate/staple esophagusC

43410 Repair esophagus woundC

43415 Repair esophagus woundC

43420 Repair esophagus openingT 0254

43425 Repair esophagus openingC

43450 Dilate esophagusT 0140

43453 Dilate esophagusT 0140

43456 Dilate esophagusT 0140

43458 Dilate esophagus CH T 0419

43460 Pressure treatment esophagusC

43496 Free jejunum flap microvascC

43499 Esophagus surgery procedureT 0141

43500 Surgical opening of stomachC

43501 Surgical repair of stomachC

43502 Surgical repair of stomachC

43510 Surgical opening of stomach CH T 0141

43520 Incision of pyloric muscleC

43605 Biopsy of stomachC

43610 Excision of stomach lesionC

43611 Excision of stomach lesionC

43620 Removal of stomachC

43621 Removal of stomachC

43622 Removal of stomachC

43631 Removal of stomach partialC
43632 Removal of stomach partial

C

43633 Removal of stomach partialC

43634 Removal of stomach partialC

43635 Removal of stomach partialC

43640 Vagotomy & pylorus repairC

43641 Vagotomy & pylorus repairC

43644 Lap gastric bypass/roux-en-yC

43645 Lap gastr bypass incl smll iC

43647 Lap impl electrode antrumS 0061

43648 Lap revise/remv eltrd antrumT 0130

43651 Laparoscopy vagus nerveT 0132

43652 Laparoscopy vagus nerveT 0132

43653 Laparoscopy gastrostomyT 0131

43659 Laparoscope proc stomT 0130

43752 Nasal/orogastric w/stent Q3 0272

43753 Tx gastro intub w/aspX 0340

43754 Dx gastr intub w/asp specX 0340

43755 Dx gastr intub w/asp specsS 0097

43756 Dx duod intub w/asp specX 0272

43757 Dx duod intub w/asp specsX 0272

43760 Change gastrostomy tubeT 0676

43761 Reposition gastrostomy tubeT 0141

43770 Lap place gastr adj deviceC

43771 Lap revise gastr adj deviceC

43772 Lap rmvl gastr adj deviceC

43773 Lap replace gastr adj deviceC

43774 Lap rmvl gastr adj all partsC

43775 Lap sleeve gastrectomyE

43800 Reconstruction of pylorusC

43810 Fusion of stomach and bowelC

43820 Fusion of stomach and bowelC

43825 Fusion of stomach and bowelC

43830 Place gastrostomy tube CH T 0419

43831 Place gastrostomy tubeT 0141

43832 Place gastrostomy tubeC

43840 Repair of stomach lesionC

43842 V-band gastroplastyE

43843 Gastroplasty w/o v-bandC

43845 Gastroplasty duodenal switchC

43846 Gastric bypass for obesityC

43847 Gastric bypass incl small iC

43848 Revision gastroplastyC

43850 Revise stomach-bowel fusionC

43855 Revise stomach-bowel fusionC

43860 Revise stomach-bowel fusionC

43865 Revise stomach-bowel fusionC

43870 Repair stomach openingT 0422

43880 Repair stomach-bowel fistulaC

43881 Impl/redo electrd antrumC

43882 Revise/remove electrd antrumC

43886 Revise gastric port openT 0137

43887 Remove gastric port openT 0135

43888 Change gastric port openT 0137

43999 Stomach surgery procedureT 0141

44005 Freeing of bowel adhesionC
44010 Incision of small bowel

C

44015 Insert needle cath bowelC

44020 Explore small intestineC

44021 Decompress small bowelC

44025 Incision of large bowelC

44050 Reduce bowel obstructionC

44055 Correct malrotation of bowelC

44100 Biopsy of bowel CHT 0419

44110 Excise intestine lesion(s)C

44111 Excision of bowel lesion(s)C

44120 Removal of small intestineC

44121 Removal of small intestineC

44125 Removal of small intestineC

44126 Enterectomy w/o taper congC

44127 Enterectomy w/taper congC

44128 Enterectomy cong add-onC

44130 Bowel to bowel fusionC

44132 Enterectomy cadaver donorC

44133 Enterectomy live donorC

44135 Intestine transplnt cadaverC

44136 Intestine transplant liveC

44137 Remove intestinal allograftC

44139 Mobilization of colonC

44140 Partial removal of colonC

44141 Partial removal of colonC

44143 Partial removal of colonC

44144 Partial removal of colonC

44145 Partial removal of colonC

44146 Partial removal of colonC

44147 Partial removal of colonC

44150 Removal of colonC

44151 Removal of colon/ileostomyC

44155 Removal of colon/ileostomyC

44156 Removal of colon/ileostomyC

44157 Colectomy w/ileoanal anast

C

44158 Colectomy w/neo-rectum pouch

C

44160 Removal of colonC

44180 Lap enterolysisT 0131

44186 Lap jejunostomyT 0131

44187 Lap ileo/jejuno-stomyC

44188 Lap colostomyC

44202 Lap enterectomyC

44203 Lap resect s/intestine addlC

44204 Laparo partial colectomyC

44205 Lap colectomy part w/ileumC

44206 Lap part colectomy w/stomaT 0132

44207 L colectomy/coloproctostomyT 0132

44208 L colectomy/coloproctostomyT 0132

44210 Laparo total proctocolectomyC

44211 Lap colectomy w/proctectomyC

44212 Laparo total proctocolectomyC

44213 Lap mobil splenic fl add-onT 0130

44227 Lap close enterostomyC

44238 Laparoscope proc intestineT 0130

44300 Open bowel to skinC
44310 Ileostomy/jejunostomy

C

44312 Revision of ileostomyT 0137

44314 Revision of ileostomyC

44316 Devise bowel pouchC

44320 ColostomyC

44322 Colostomy with biopsiesC

44340 Revision of colostomyT 0137

44345 Revision of colostomyC

44346 Revision of colostomyC

44360 Small bowel endoscopyT 0142

44361 Small bowel endoscopy/biopsyT 0142

44363 Small bowel endoscopyT 0142

44364 Small bowel endoscopy CHT 0424

44365 Small bowel endoscopy CHT 0424

44366 Small bowel endoscopy CHT 0424

44369 Small bowel endoscopy CHT 0424

44370 Small bowel endoscopy/stentT 0384

44372 Small bowel endoscopy CHT 0424

44373 Small bowel endoscopy CHT 0424

44376 Small bowel endoscopyT 0142

44377 Small bowel endoscopy/biopsyT 0142

44378 Small bowel endoscopy CHT 0424

44379 S bowel endoscope w/stentT 0384

44380 Small bowel endoscopyT 0142

44382 Small bowel endoscopyT 0142

44383 Ileoscopy w/stentT 0384

44385 Endoscopy of bowel pouchT 0143

44386 Endoscopy bowel pouch/biopT 0143

44388 ColonoscopyT 0143

44389 Colonoscopy with biopsyT 0143

44390 Colonoscopy for foreign bodyT 0143

44391 Colonoscopy for bleedingT 0143

44392 Colonoscopy & polypectomyT 0143

44393 Colonoscopy lesion removalT 0143

44394 Colonoscopy w/snareT 0143

44397 Colonoscopy w/stentT 0384

44500 Intro gastrointestinal tubeT 0121

44602 Suture small intestineC

44603 Suture small intestineC

44604 Suture large intestineC

44605 Repair of bowel lesionC

44615 Intestinal stricturoplastyC

44620 Repair bowel openingC

44625 Repair bowel openingC

44626 Repair bowel openingC

44640 Repair bowel-skin fistulaC

44650 Repair bowel fistulaC

44660 Repair bowel-bladder fistulaC

44661 Repair bowel-bladder fistulaC

44680 Surgical revision intestineC

44700 Suspend bowel w/prosthesisC

44701 Intraop colon lavage add-onN

44715 Prepare donor intestineC

44720 Prep donor intestine/venousC

44721 Prep donor intestine/arteryC
44799 Unlisted procedure intestine

T 0153

44800 Excision of bowel pouchC

44820 Excision of mesentery lesionC

44850 Repair of mesenteryC

44899 Bowel surgery procedureC

44900 Drain app abscess openC

44901 Drain app abscess percutT 0037

44950 AppendectomyT 0153

44955 Appendectomy add-onT 0153

44960 AppendectomyC

44970 Laparoscopy appendectomyT 0131

44979 Laparoscope proc appT 0130

45000 Drainage of pelvic abscess CH T 0149

45005 Drainage of rectal abscess CH T 0149

45020 Drainage of rectal abscessT 0155

45100 Biopsy of rectumT 0149

45108 Removal of anorectal lesionT 0149

45110 Removal of rectumC

45111 Partial removal of rectumC

45112 Removal of rectumC

45113 Partial proctectomyC

45114 Partial removal of rectumC

45116 Partial removal of rectumC

45119 Remove rectum w/reservoirC

45120 Removal of rectumC

45121 Removal of rectum and colonC

45123 Partial proctectomyC

45126 Pelvic exenterationC

45130 Excision of rectal prolapseC

45135 Excision of rectal prolapseC

45136 Excise ileoanal reserviorC

45150 Excision of rectal strictureT 0149

45160 Excision of rectal lesionT 0149

45171 Exc rect tum transanal part CH T 0149

45172 Exc rect tum transanal fullT 0149

45190 Destruction rectal tumorT 0149

45300 Proctosigmoidoscopy dxT 0146

45303 Proctosigmoidoscopy dilateT 0147

45305 Proctosigmoidoscopy w/bxT 0147

45307 Proctosigmoidoscopy fbT 0428

45308 Proctosigmoidoscopy removalT 0147

45309 Proctosigmoidoscopy removalT 0147

45315 Proctosigmoidoscopy removalT 0147

45317 Proctosigmoidoscopy bleedT 0147

45320 Proctosigmoidoscopy ablateT 0428

45321 Proctosigmoidoscopy volvulT 0428

45327 Proctosigmoidoscopy w/stentT 0384

45330 Diagnostic sigmoidoscopyT 0146

45331 Sigmoidoscopy and biopsyT 0146

45332 Sigmoidoscopy w/fb removalT 0146

45333 Sigmoidoscopy & polypectomy CH T 0146

45334 Sigmoidoscopy for bleedingT 0147

45335 Sigmoidoscopy w/submuc injT 0146

45337 Sigmoidoscopy & decompressT 0146

45338 Sigmoidoscopy w/tumr remove CH T 0146
45339 Sigmoidoscopy w/ablate tum

rT 0147

45340 Sig w/balloon dilationT 0147

45341 Sigmoidoscopy w/ultrasound CH T 0146

45342 Sigmoidoscopy w/us guide bxT 0147

45345 Sigmoidoscopy w/stentT 0384

45355 Surgical colonoscopyT 0143

45378 Diagnostic colonoscopyT 0143

45379 Colonoscopy w/fb removalT 0143

45380 Colonoscopy and biopsyT 0143

45381 Colonoscopy submucous injT 0143

45382 Colonoscopy/control bleedingT 0143

45383 Lesion removal colonoscopyT 0143

45384 Lesion remove colonoscopyT 0143

45385 Lesion removal colonoscopyT 0143

45386 Colonoscopy dilate strictureT 0143

45387 Colonoscopy w/stentT 0384

45391 Colonoscopy w/endoscope usT 0143

45392 Colonoscopy w/endoscopic fnbT 0143

45395 Lap removal of rectumC

45397 Lap remove rectum w/pouchC

45400 Laparoscopic procC

45402 Lap proctopexy w/sig resectC

45499 Laparoscope proc rectumT 0130

45500 Repair of rectumT 0149

45505 Repair of rectumT 0150

45520 Treatment of rectal prolapseT 0013

45540 Correct rectal prolapseC

45541 Correct rectal prolapseT 0150

45550 Repair rectum/remove sigmoidC

45560 Repair of rectoceleT 0150

45562 Exploration/repair of rectumC

45563 Exploration/repair of rectumC

45800 Repair rect/bladder fistulaC

45805 Repair fistula w/colostomyC

45820 Repair rectourethral fistulaC

45825 Repair fistula w/colostomyC

45900 Reduction of rectal prolapseT 0148

45905 Dilation of anal sphincterT 0149

45910 Dilation of rectal narrowingT 0149

45915 Remove rectal obstructionT 0155

45990 Surg dx exam anorectalT 0149

45999 Rectum surgery procedureT 0148

46020 Placement of setonT 0149

46030 Removal of rectal markerT 0148

46040 Incision of rectal abscessT 0149

46045 Incision of rectal abscessT 0149

46050 Incision of anal abscess CHT 0148

46060 Incision of rectal abscessT 0149

46070 Incision of anal septumT 0155

46080 Incision of anal sphincterT 0149

46083 Incise external hemorrhoidT 0164

46200 Removal of anal fissureT 0149

46220 Excise anal ext tag/papillaT 0155

46221 Ligation of hemorrhoid(s)T 0148

46230 Removal of anal tagsT 0149
46250 Remove ext hem groups 2+

T 0149

46255 Remove int/ext hem 1 groupT 0149

46257 Remove in/ex hem grp & fissT 0149

46258 Remove in/ex hem grp w/fistuT 0149

46260 Remove in/ex hem groups 2+T 0149

46261 Remove in/ex hem grps & fissT 0149

46262 Remove in/ex hem grps w/fistT 0149

46270 Remove anal fist subqT 0149

46275 Remove anal fist interT 0149

46280 Remove anal fist complexT 0149

46285 Remove anal fist 2 stageT 0149

46288 Repair anal fistulaT 0149

46320 Removal of hemorrhoid clotT 0149

46500 Injection into hemorrhoid(s) CH T 0148

46505 Chemodenervation anal muscT 0149

46600 Diagnostic anoscopyX 0340

46604 Anoscopy and dilationT 0147

46606 Anoscopy and biopsyT 0146

46608 Anoscopy remove for body CH T 0146

46610 Anoscopy remove lesionT 0428

46611 AnoscopyT 0147

46612 Anoscopy remove lesionsT 0428

46614 Anoscopy control bleedingT 0146

46615 AnoscopyT 0428

46700 Repair of anal strictureT 0149

46705 Repair of anal strictureC

46706 Repr of anal fistula w/glueT 0150

46707 Repair anorectal fist w/plugT 0150

46710 Repr per/vag pouch sngl procC

46712 Repr per/vag pouch dbl procC

46715 Rep perf anoper fistuC

46716 Rep perf anoper/vestib fistuC

46730 Construction of absent anusC

46735 Construction of absent anusC

46740 Construction of absent anusC

46742 Repair of imperforated anusC

46744 Repair of cloacal anomalyC

46746 Repair of cloacal anomalyC

46748 Repair of cloacal anomalyC

46750 Repair of anal sphincterT 0150

46751 Repair of anal sphincterC

46753 Reconstruction of anusT 0149

46754 Removal of suture from anusT 0149

46760 Repair of anal sphincterT 0150

46761 Repair of anal sphincterT 0150

46762 Implant artificial sphincterT 0150

46900 Destruction anal lesion(s)T 0016

46910 Destruction anal lesion(s)T 0017

46916 Cryosurgery anal lesion(s)T 0015

46917 Laser surgery anal lesionsT 0017

46922 Excision of anal lesion(s)T 0017

46924 Destruction anal lesion(s)T 0017

46930 Destroy internal hemorrhoidsT 0148

46940 Treatment of anal fissureT 0149

46942 Treatment of anal fissureT 0148
46945 Remove by ligat int hem grp CH 

T 0149

46946 Remove by ligat int hem grps CH T 0149

46947 Hemorrhoidopexy by staplingT 0150

46999 Anus surgery procedureT 0148

47000 Needle biopsy of liverT 0685

47001 Needle biopsy liver add-onN

47010 Open drainage liver lesionC

47011 Percut drain liver lesionT 0037

47015 Inject/aspirate liver cystC

47100 Wedge biopsy of liverC

47120 Partial removal of liverC

47122 Extensive removal of liverC

47125 Partial removal of liverC

47130 Partial removal of liverC

47133 Removal of donor liverC

47135 Transplantation of liverC

47136 Transplantation of liverC

47140 Partial removal donor liverC

47141 Partial removal donor liverC

47142 Partial removal donor liverC

47143 Prep donor liver wholeC

47144 Prep donor liver 3-segmentC

47145 Prep donor liver lobe splitC

47146 Prep donor liver/venousC

47147 Prep donor liver/arterialC

47300 Surgery for liver lesionC

47350 Repair liver woundC

47360 Repair liver woundC

47361 Repair liver woundC

47362 Repair liver woundC

47370 Laparo ablate liver tumor rfT 0174

47371 Laparo ablate liver cryosurgT 0174

47379 Laparoscope procedure liverT 0130

47380 Open ablate liver tumor rfC

47381 Open ablate liver tumor cryoC

47382 Percut ablate liver rfT 0423

47399 Liver surgery procedureT 0004

47400 Incision of liver ductC

47420 Incision of bile ductC

47425 Incision of bile ductC

47460 Incise bile duct sphincterC

47480 Incision of gallbladderC

47490 Incision of gallbladderT 0152

47500 Injection for liver x-raysN

47505 Injection for liver x-raysN

47510 Insert catheter bile ductT 0152

47511 Insert bile duct drainT 0152

47525 Change bile duct catheterT 0427

47530 Revise/reinsert bile tubeT 0427

47550 Bile duct endoscopy add-onC

47552 Biliary endoscopy thru skinT 0152

47553 Biliary endoscopy thru skinT 0152

47554 Biliary endoscopy thru skinT 0152

47555 Biliary endoscopy thru skinT 0152

47556 Biliary endoscopy thru skinT 0152
47560 Laparoscopy w/cholangio

T 0130

47561 Laparo w/cholangio/biopsyT 0130

47562 Laparoscopic cholecystectomyT 0131

47563 Laparo cholecystectomy/graphT 0131

47564 Laparo cholecystectomy/explrT 0131

47570 Laparo cholecystoenterostomyC

47579 Laparoscope proc biliaryT 0130

47600 Removal of gallbladderC

47605 Removal of gallbladderC

47610 Removal of gallbladderC

47612 Removal of gallbladderC

47620 Removal of gallbladderC

47630 Remove bile duct stoneT 0152

47700 Exploration of bile ductsC

47701 Bile duct revisionC

47711 Excision of bile duct tumorC

47712 Excision of bile duct tumorC

47715 Excision of bile duct cystC

47720 Fuse gallbladder & bowelC

47721 Fuse upper gi structuresC

47740 Fuse gallbladder & bowelC

47741 Fuse gallbladder & bowelC

47760 Fuse bile ducts and bowelC

47765 Fuse liver ducts & bowelC

47780 Fuse bile ducts and bowelC

47785 Fuse bile ducts and bowelC

47800 Reconstruction of bile ductsC

47801 Placement bile duct supportC

47802 Fuse liver duct & intestineC

47900 Suture bile duct injuryC

47999 Bile tract surgery procedureT 0152

48000 Drainage of abdomenC

48001 Placement of drain pancreasC

48020 Removal of pancreatic stoneC

48100 Biopsy of pancreas openC

48102 Needle biopsy pancreasT 0685

48105 Resect/debride pancreasC

48120 Removal of pancreas lesionC

48140 Partial removal of pancreasC

48145 Partial removal of pancreasC

48146 PancreatectomyC

48148 Removal of pancreatic ductC

48150 Partial removal of pancreasC

48152 PancreatectomyC

48153 PancreatectomyC

48154 PancreatectomyC

48155 Removal of pancreasC

48160 Pancreas removal/transplantE

48400 Injection intraop add-onC

48500 Surgery of pancreatic cystC

48510 Drain pancreatic pseudocystC

48511 Drain pancreatic pseudocystT 0037

48520 Fuse pancreas cyst and bowelC

48540 Fuse pancreas cyst and bowelC

48545 PancreatorrhaphyC
48547 Duodenal exclusion

C

48548 Fuse pancreas and bowelC

48550 Donor pancreatectomyE

48551 Prep donor pancreasC

48552 Prep donor pancreas/venousC

48554 Transpl allograft pancreasC

48556 Removal allograft pancreasC

48999 Pancreas surgery procedureT 0004

49000 Exploration of abdomenC

49002 Reopening of abdomenC

49010 Exploration behind abdomenC

49020 Drain abdominal abscessC

49021 Drain abdominal abscessT 0037

49040 Drain open abdom abscessC

49041 Drain percut abdom abscessT 0037

49060 Drain open retrop abscessC

49061 Drain percut retroper abscT 0037

49062 Drain to peritoneal cavityC

49080 Puncture peritoneal cavityT 0070

49081 Removal of abdominal fluidT 0070

49180 Biopsy abdominal massT 0685

49203 Exc abd tum 5 cm or lessC

49204 Exc abd tum over 5 cmC

49205 Exc abd tum over 10 cmC

49215 Excise sacral spine tumorC

49220 Multiple surgery abdomenC

49250 Excision of umbilicusT 0153

49255 Removal of omentumC

49320 Diag laparo separate procT 0130

49321 Laparoscopy biopsyT 0130

49322 Laparoscopy aspirationT 0130

49323 Laparo drain lymphoceleT 0130

49324 Lap insert tunnel ip cath

T 0130

49325 Lap revision perm ip cath

T 0130

49326 Lap w/omentopexy add-on

T 0130

49327 Lap ins device for rt

T 0130

49329 Laparo proc abdm/per/omentT 0130

49400 Air injection into abdomenN

49402 Remove foreign body adbomenT 0153

49411 Ins mark abd/pel for rt perqX 0310

49412 Ins device for rt guide open C 

49418 Insert tun ip cath percT 0652

49419 Insert tun ip cath w/portT 0115

49421 Ins tun ip cath for dial opnT 0652

49422 Remove tunneled ip cathT 0105

49423 Exchange drainage catheterT 0427

49424 Assess cyst contrast injectN

49425 Insert abdomen-venous drainC

49426 Revise abdomen-venous shuntT 0153

49427 Injection abdominal shuntN

49428 Ligation of shuntC

49429 Removal of shuntT 0105

49435 Insert subq exten to ip cathT 0427

49436 Embedded ip cath exit-siteT 0427

49440 Place gastrostomy tube perc CHT 0419
49441 Place duod/jej tube perc CH

T 0419

49442 Place cecostomy tube perc CHT 0149

49446 Change g-tube to g-j perc CHT 0419

49450 Replace g/c tube percT 0121

49451 Replace duod/jej tube percT 0121

49452 Replace g-j tube percT 0121

49460 Fix g/colon tube w/deviceT 0121

49465 Fluoro exam of g/colon tube Q1 0277

49491 Rpr hern preemie reducT 0154

49492 Rpr ing hern premie blockedT 0154

49495 Rpr ing hernia baby reducT 0154

49496 Rpr ing hernia baby blockedT 0154

49500 Rpr ing hernia init reduceT 0154

49501 Rpr ing hernia init blockedT 0154

49505 Prp i/hern init reduc >5 y

r

T 0154

49507 Prp i/hern init block >5 y

r

T 0154

49520 Rerepair ing hernia reduceT 0154

49521 Rerepair ing hernia blockedT 0154

49525 Repair ing hernia slidingT 0154

49540 Repair lumbar herniaT 0154

49550 Rpr rem hernia init reduceT 0154

49553 Rpr fem hernia init blockedT 0154

49555 Rerepair fem hernia reduceT 0154

49557 Rerepair fem hernia blockedT 0154

49560 Rpr ventral hern init reducT 0154

49561 Rpr ventral hern init blockT 0154

49565 Rerepair ventrl hern reduceT 0154

49566 Rerepair ventrl hern blockT 0154

49568 Hernia repair w/meshT 0154

49570 Rpr epigastric hern reduceT 0154

49572 Rpr epigastric hern blockedT 0154

49580 Rpr umbil hern reduc < 5 yrT 0154

49582 Rpr umbil hern block < 5 yrT 0154

49585 Rpr umbil hern reduc > 5 yrT 0154

49587 Rpr umbil hern block > 5 yrT 0154

49590 Repair spigelian herniaT 0154

49600 Repair umbilical lesionT 0154

49605 Repair umbilical lesionC

49606 Repair umbilical lesionC

49610 Repair umbilical lesionC

49611 Repair umbilical lesionC

49650 Lap ing hernia repair initT 0131

49651 Lap ing hernia repair recurT 0131

49652 Lap vent/abd hernia repairT 0132

49653 Lap vent/abd hern proc compT 0132

49654 Lap inc hernia repairT 0132

49655 Lap inc hern repair compT 0132

49656 Lap inc hernia repair recurT 0132

49657 Lap inc hern recur compT 0132

49659 Laparo proc hernia repairT 0130

49900 Repair of abdominal wallC

49904 Omental flap extra-abdomC

49905 Omental flap intra-abdomC

49906 Free omental flap microvascC

49999 Abdomen surgery procedureT 0153
50010 Exploration of kidney

C

50020 Renal abscess open drainT 0162

50021 Renal abscess percut drainT 0037

50040 Drainage of kidneyC

50045 Exploration of kidneyC

50060 Removal of kidney stoneC

50065 Incision of kidneyC

50070 Incision of kidneyC

50075 Removal of kidney stoneC

50080 Removal of kidney stoneT 0429

50081 Removal of kidney stoneT 0429

50100 Revise kidney blood vesselsC

50120 Exploration of kidneyC

50125 Explore and drain kidneyC

50130 Removal of kidney stoneC

50135 Exploration of kidneyC

50200 Renal biopsy perqT 0685

50205 Renal biopsy openC

50220 Remove kidney openC

50225 Removal kidney open complexC

50230 Removal kidney open radicalC

50234 Removal of kidney & ureterC

50236 Removal of kidney & ureterC

50240 Partial removal of kidneyC

50250 Cryoablate renal mass openC

50280 Removal of kidney lesionC

50290 Removal of kidney lesionC

50300 Remove cadaver donor kidneyC

50320 Remove kidney living donorC

50323 Prep cadaver renal allograftC

50325 Prep donor renal graftC

50327 Prep renal graft/venousC

50328 Prep renal graft/arterialC

50329 Prep renal graft/ureteralC

50340 Removal of kidneyC

50360 Transplantation of kidneyC

50365 Transplantation of kidneyC

50370 Remove transplanted kidneyC

50380 Reimplantation of kidneyC

50382 Change ureter stent percutT 0162

50384 Remove ureter stent percutT 0161

50385 Change stent via transurethT 0162

50386 Remove stent via transurethT 0160

50387 Change ext/int ureter stentT 0427

50389 Remove renal tube w/fluoroT 0160

50390 Drainage of kidney lesionT 0685

50391 Instll rx agnt into rnal tubT 0126

50392 Insert kidney drainT 0161

50393 Insert ureteral tubeT 0162

50394 Injection for kidney x-rayN

50395 Create passage to kidneyT 0162

50396 Measure kidney pressureT 0164

50398 Change kidney tubeT 0427

50400 Revision of kidney/ureterC

50405 Revision of kidney/ureterC
50500 Repair of kidney wound

C

50520 Close kidney-skin fistulaC

50525 Repair renal-abdomen fistulaC

50526 Repair renal-abdomen fistulaC

50540 Revision of horseshoe kidneyC

50541 Laparo ablate renal cystT 0130

50542 Laparo ablate renal massT 0174

50543 Laparo partial nephrectomyT 0131

50544 Laparoscopy pyeloplasty CH T 0131

50545 Laparo radical nephrectomyC

50546 Laparoscopic nephrectomyC

50547 Laparo removal donor kidneyC

50548 Laparo remove w/ureterC

50549 Laparoscope proc renalT 0130

50551 Kidney endoscopyT 0160

50553 Kidney endoscopyT 0162

50555 Kidney endoscopy & biopsyT 0160

50557 Kidney endoscopy & treatmentT 0162

50561 Kidney endoscopy & treatmentT 0162

50562 Renal scope w/tumor resectT 0160

50570 Kidney endoscopyT 0160

50572 Kidney endoscopyT 0160

50574 Kidney endoscopy & biopsyT 0160

50575 Kidney endoscopyT 0163

50576 Kidney endoscopy & treatmentT 0161

50580 Kidney endoscopy & treatmentT 0161

50590 Fragmenting of kidney stoneT 0169

50592 Perc rf ablate renal tumorT 0423

50593 Perc cryo ablate renal tumT 0423

50600 Exploration of ureterC

50605 Insert ureteral supportC

50610 Removal of ureter stoneC

50620 Removal of ureter stoneC

50630 Removal of ureter stoneC

50650 Removal of ureterC

50660 Removal of ureterC

50684 Injection for ureter x-rayN

50686 Measure ureter pressureT 0126

50688 Change of ureter tube/stentT 0427

50690 Injection for ureter x-rayN

50700 Revision of ureterC

50715 Release of ureterC

50722 Release of ureterC

50725 Release/revise ureterC

50727 Revise ureterT 0165

50728 Revise ureterC

50740 Fusion of ureter & kidneyC

50750 Fusion of ureter & kidneyC

50760 Fusion of uretersC

50770 Splicing of uretersC

50780 Reimplant ureter in bladderC

50782 Reimplant ureter in bladderC

50783 Reimplant ureter in bladderC

50785 Reimplant ureter in bladderC

50800 Implant ureter in bowelC
50810 Fusion of ureter & bowel

C

50815 Urine shunt to intestineC

50820 Construct bowel bladderC

50825 Construct bowel bladderC

50830 Revise urine flowC

50840 Replace ureter by bowelC

50845 Appendico-vesicostomyC

50860 Transplant ureter to skinC

50900 Repair of ureterC

50920 Closure ureter/skin fistulaC

50930 Closure ureter/bowel fistulaC

50940 Release of ureterC

50945 Laparoscopy ureterolithotomyT 0131

50947 Laparo new ureter/bladderT 0131

50948 Laparo new ureter/bladderT 0131

50949 Laparoscope proc ureterT 0130

50951 Endoscopy of ureterT 0160

50953 Endoscopy of ureterT 0160

50955 Ureter endoscopy & biopsyT 0162

50957 Ureter endoscopy & treatmentT 0162

50961 Ureter endoscopy & treatmentT 0162

50970 Ureter endoscopyT 0160

50972 Ureter endoscopy & catheterT 0160

50974 Ureter endoscopy & biopsyT 0161

50976 Ureter endoscopy & treatmentT 0161

50980 Ureter endoscopy & treatmentT 0162

51020 Incise & treat bladderT 0162

51030 Incise & treat bladderT 0162

51040 Incise & drain bladderT 0162

51045 Incise bladder/drain ureterT 0160

51050 Removal of bladder stoneT 0162

51060 Removal of ureter stoneT 0163

51065 Remove ureter calculusT 0162

51080 Drainage of bladder abscessT 0008

51100 Drain bladder by needleT 0164

51101 Drain bladder by trocar/cathT 0126

51102 Drain bl w/cath insertionT 0165

51500 Removal of bladder cystT 0154

51520 Removal of bladder lesionT 0162

51525 Removal of bladder lesionC

51530 Removal of bladder lesionC

51535 Repair of ureter lesionT 0162

51550 Partial removal of bladderC

51555 Partial removal of bladderC

51565 Revise bladder & ureter(s)C

51570 Removal of bladderC

51575 Removal of bladder & nodesC

51580 Remove bladder/revise tractC

51585 Removal of bladder & nodesC

51590 Remove bladder/revise tractC

51595 Remove bladder/revise tractC

51596 Remove bladder/create pouchC

51597 Removal of pelvic structuresC

51600 Injection for bladder x-rayN

51605 Preparation for bladder xrayN
51610 Injection for bladder x-ray

N

51700 Irrigation of bladderT 0164

51701 Insert bladder catheterX 0340

51702 Insert temp bladder cathX 0340

51703 Insert bladder cath complexT 0126

51705 Change of bladder tubeT 0164

51710 Change of bladder tubeT 0121

51715 Endoscopic injection/implantT 0168

51720 Treatment of bladder lesionT 0156

51725 Simple cystometrogramT 0156

51726 Complex cystometrogramT 0156

51727 Cystometrogram w/upT 0156

51728 Cystometrogram w/vpT 0156

51729 Cystometrogram w/vp&upT 0156

51736 Urine flow measurementX 0340

51741 Electro-uroflowmetry firstT 0126

51784 Anal/urinary muscle studyT 0126

51785 Anal/urinary muscle studyT 0164

51792 Urinary reflex studyT 0126

51797 Intraabdominal pressure testT 0164

51798 Us urine capacity measureX 0340

51800 Revision of bladder/urethraC

51820 Revision of urinary tractC

51840 Attach bladder/urethraC

51841 Attach bladder/urethraC

51845 Repair bladder neckT 0202

51860 Repair of bladder woundT 0162

51865 Repair of bladder woundC

51880 Repair of bladder openingT 0162

51900 Repair bladder/vagina lesionC

51920 Close bladder-uterus fistulaC

51925 Hysterectomy/bladder repairC

51940 Correction of bladder defectC

51960 Revision of bladder & bowelC

51980 Construct bladder openingC

51990 Laparo urethral suspensionT 0131

51992 Laparo sling operationT 0131

51999 Laparoscope proc blaT 0130

52000 CystoscopyT 0160

52001 Cystoscopy removal of clotsT 0161

52005 Cystoscopy & ureter catheterT 0162

52007 Cystoscopy and biopsyT 0162

52010 Cystoscopy & duct catheterT 0160

52204 Cystoscopy w/biopsy(s)T 0162

52214 Cystoscopy and treatmentT 0162

52224 Cystoscopy and treatmentT 0162

52234 Cystoscopy and treatmentT 0162

52235 Cystoscopy and treatmentT 0162

52240 Cystoscopy and treatmentT 0162

52250 Cystoscopy and radiotracerT 0162

52260 Cystoscopy and treatmentT 0161

52265 Cystoscopy and treatmentT 0160

52270 Cystoscopy & revise urethraT 0161

52275 Cystoscopy & revise urethraT 0162

52276 Cystoscopy and treatmentT 0162
52277 Cystoscopy and treatment

T 0162

52281 Cystoscopy and treatmentT 0161

52282 Cystoscopy implant stentT 0163

52283 Cystoscopy and treatmentT 0162

52285 Cystoscopy and treatmentT 0161

52290 Cystoscopy and treatmentT 0162

52300 Cystoscopy and treatmentT 0162

52301 Cystoscopy and treatmentT 0162

52305 Cystoscopy and treatmentT 0162

52310 Cystoscopy and treatmentT 0161

52315 Cystoscopy and treatmentT 0162

52317 Remove bladder stoneT 0162

52318 Remove bladder stoneT 0162

52320 Cystoscopy and treatmentT 0162

52325 Cystoscopy stone removalT 0162

52327 Cystoscopy inject materialT 0163

52330 Cystoscopy and treatmentT 0162

52332 Cystoscopy and treatmentT 0162

52334 Create passage to kidneyT 0162

52341 Cysto w/ureter stricture txT 0162

52342 Cysto w/up stricture txT 0162

52343 Cysto w/renal stricture txT 0162

52344 Cysto/uretero stricture txT 0162

52345 Cysto/uretero w/up strictureT 0162

52346 Cystouretero w/renal strictT 0162

52351 Cystouretero & or pyeloscopeT 0162

52352 Cystouretero w/stone removeT 0162

52353 Cystouretero w/lithotripsyT 0163

52354 Cystouretero w/biopsyT 0162

52355 Cystouretero w/excise tumorT 0162

52400 Cystouretero w/congen reprT 0162

52402 Cystourethro cut ejacul ductT 0162

52450 Incision of prostateT 0162

52500 Revision of bladder neckT 0162

52601 Prostatectomy (TURP)T 0163

52630 Remove prostate regrowthT 0163

52640 Relieve bladder contractureT 0162

52647 Laser surgery of prostateT 0429

52648 Laser surgery of prostateT 0429

52649 Prostate laser enucleationT 0429

52700 Drainage of prostate abscessT 0162

53000 Incision of urethraT 0166

53010 Incision of urethraT 0166

53020 Incision of urethraT 0166

53025 Incision of urethraT 0166

53040 Drainage of urethra abscessT 0166

53060 Drainage of urethra abscessT 0166

53080 Drainage of urinary leakageT 0166

53085 Drainage of urinary leakageT 0166

53200 Biopsy of urethraT 0166

53210 Removal of urethraT 0168

53215 Removal of urethraT 0166

53220 Treatment of urethra lesionT 0168

53230 Removal of urethra lesionT 0168

53235 Removal of urethra lesionT 0166
53240 Surgery for urethra pouch

T 0168

53250 Removal of urethra glandT 0166

53260 Treatment of urethra lesionT 0166

53265 Treatment of urethra lesionT 0166

53270 Removal of urethra glandT 0166

53275 Repair of urethra defectT 0166

53400 Revise urethra stage 1T 0168

53405 Revise urethra stage 2T 0168

53410 Reconstruction of urethraT 0168

53415 Reconstruction of urethraC

53420 Reconstruct urethra stage 1T 0168

53425 Reconstruct urethra stage 2T 0168

53430 Reconstruction of urethraT 0168

53431 Reconstruct urethra/bladderT 0168

53440 Male sling procedureS 0385

53442 Remove/revise male slingT 0168

53444 Insert tandem cuffS 0385

53445 Insert uro/ves nck sphincterS 0386

53446 Remove uro sphincterT 0168

53447 Remove/replace ur sphincterS 0386

53448 Remov/replc ur sphinctr compC

53449 Repair uro sphincterT 0168

53450 Revision of urethraT 0168

53460 Revision of urethraT 0166

53500 Urethrlys transvag w/ scopeT 0168

53502 Repair of urethra injuryT 0166

53505 Repair of urethra injuryT 0168

53510 Repair of urethra injuryT 0166

53515 Repair of urethra injuryT 0168

53520 Repair of urethra defectT 0168

53600 Dilate urethra strictureT 0156

53601 Dilate urethra strictureT 0126

53605 Dilate urethra strictureT 0161

53620 Dilate urethra strictureT 0165

53621 Dilate urethra strictureT 0164

53660 Dilation of urethraT 0126

53661 Dilation of urethraT 0126

53665 Dilation of urethraT 0166

53850 Prostatic microwave thermotxT 0429

53852 Prostatic rf thermotxT 0429

53855 Insert prost urethral stentT 0164

53860 Transurethral rf treatmentT 0165

53899 Urology surgery procedureT 0126

54000 Slitting of prepuceT 0166

54001 Slitting of prepuceT 0166

54015 Drain penis lesionT 0008

54050 Destruction penis lesion(s)T 0013

54055 Destruction penis lesion(s)T 0017

54056 Cryosurgery penis lesion(s)T 0013

54057 Laser surg penis lesion(s)T 0017

54060 Excision of penis lesion(s)T 0017

54065 Destruction penis lesion(s)T 0017

54100 Biopsy of penisT 0021

54105 Biopsy of penisT 0022

54110 Treatment of penis lesionT 0181
54111 Treat penis lesion graft

T 0181

54112 Treat penis lesion graftT 0181

54115 Treatment of penis lesionT 0008

54120 Partial removal of penisT 0181

54125 Removal of penisC

54130 Remove penis & nodesC

54135 Remove penis & nodesC

54150 Circumcision w/regionl blockT 0183

54160 Circumcision neonateT 0183

54161 Circum 28 days or olderT 0183

54162 Lysis penil circumic lesionT 0183

54163 Repair of circumcisionT 0183

54164 Frenulotomy of penisT 0183

54200 Treatment of penis lesionT 0164

54205 Treatment of penis lesionT 0181

54220 Treatment of penis lesionT 0164

54230 Prepare penis studyN

54231 Dynamic cavernosometryT 0165

54235 Penile injection CHT 0164

54240 Penis studyT 0126

54250 Penis studyT 0164

54300 Revision of penisT 0181

54304 Revision of penisT 0181

54308 Reconstruction of urethraT 0181

54312 Reconstruction of urethraT 0181

54316 Reconstruction of urethraT 0181

54318 Reconstruction of urethraT 0181

54322 Reconstruction of urethraT 0181

54324 Reconstruction of urethraT 0181

54326 Reconstruction of urethraT 0181

54328 Revise penis/urethraT 0181

54332 Revise penis/urethraT 0181

54336 Revise penis/urethraT 0181

54340 Secondary urethral surgeryT 0181

54344 Secondary urethral surgeryT 0181

54348 Secondary urethral surgeryT 0181

54352 Reconstruct urethra/penisT 0181

54360 Penis plastic surgeryT 0181

54380 Repair penisT 0181

54385 Repair penisT 0181

54390 Repair penis and bladderC

54400 Insert semi-rigid prosthesisS 0385

54401 Insert self-contd prosthesisS 0386

54405 Insert multi-comp penis prosS 0386

54406 Remove muti-comp penis prosT 0181

54408 Repair multi-comp penis prosT 0181

54410 Remove/replace penis prosthS 0386

54411 Remov/replc penis pros compC

54415 Remove self-contd penis prosT 0181

54416 Remv/repl penis contain prosS 0386

54417 Remv/replc penis pros complC

54420 Revision of penisT 0181

54430 Revision of penisC

54435 Revision of penisT 0181

54440 Repair of penisT 0181
54450 Preputial stretching

T 0156

54500 Biopsy of testisT 0037

54505 Biopsy of testisT 0183

54512 Excise lesion testisT 0183

54520 Removal of testisT 0183

54522 Orchiectomy partialT 0183

54530 Removal of testisT 0154

54535 Extensive testis surgeryT 0181

54550 Exploration for testisT 0154

54560 Exploration for testisT 0183

54600 Reduce testis torsionT 0183

54620 Suspension of testisT 0183

54640 Suspension of testisT 0154

54650 Orchiopexy (Fowler-Stephens) CHT 0154

54660 Revision of testisT 0183

54670 Repair testis injuryT 0183

54680 Relocation of testis(es)T 0183

54690 Laparoscopy orchiectomyT 0131

54692 Laparoscopy orchiopexyT 0132

54699 Laparoscope proc testisT 0130

54700 Drainage of scrotumT 0183

54800 Biopsy of epididymisT 0004

54830 Remove epididymis lesionT 0183

54840 Remove epididymis lesionT 0183

54860 Removal of epididymisT 0183

54861 Removal of epididymisT 0183

54865 Explore epididymisT 0183

54900 Fusion of spermatic ductsT 0183

54901 Fusion of spermatic ductsT 0183

55000 Drainage of hydroceleT 0004

55040 Removal of hydroceleT 0154

55041 Removal of hydrocelesT 0154

55060 Repair of hydroceleT 0183

55100 Drainage of scrotum abscessT 0007

55110 Explore scrotumT 0183

55120 Removal of scrotum lesionT 0183

55150 Removal of scrotumT 0183

55175 Revision of scrotumT 0183

55180 Revision of scrotumT 0183

55200 Incision of sperm ductT 0183

55250 Removal of sperm duct(s)T 0183

55300 Prepare sperm duct x-rayN

55400 Repair of sperm ductT 0183

55450 Ligation of sperm ductT 0183

55500 Removal of hydroceleT 0183

55520 Removal of sperm cord lesionT 0183

55530 Revise spermatic cord veinsT 0183

55535 Revise spermatic cord veinsT 0154

55540 Revise hernia & sperm veinsT 0154

55550 Laparo ligate spermatic veinT 0131

55559 Laparo proc spermatic cordT 0130

55600 Incise sperm duct pouchT 0183

55605 Incise sperm duct pouchC

55650 Remove sperm duct pouchC

55680 Remove sperm pouch lesionT 0183
55700 Biopsy of prostate

T 0184

55705 Biopsy of prostateT 0184

55706 Prostate saturation samplingT 0184

55720 Drainage of prostate abscessT 0162

55725 Drainage of prostate abscessT 0162

55801 Removal of prostateC

55810 Extensive prostate surgeryC

55812 Extensive prostate surgeryC

55815 Extensive prostate surgeryC

55821 Removal of prostateC

55831 Removal of prostateC

55840 Extensive prostate surgeryC

55842 Extensive prostate surgeryC

55845 Extensive prostate surgeryC

55860 Surgical exposure prostateT 0165

55862 Extensive prostate surgeryC

55865 Extensive prostate surgeryC

55866 Laparo radical prostatectomyC

55870 ElectroejaculationT 0189

55873 Cryoablate prostateT 0674

55875 Transperi needle place pros Q3 0163

55876 Place rt device/marker pros X 0310

55899 Genital surgery procedureT 0126

55920 Place needles pelvic for rtT 0153

55970 Sex transformation m to fE

55980 Sex transformation f to mE

56405 I & D of vulva/perineumT 0188

56420 Drainage of gland abscessT 0188

56440 Surgery for vulva lesionT 0193

56441 Lysis of labial lesion(s)T 0193

56442 HymenotomyT 0193

56501 Destroy vulva lesions simT 0017

56515 Destroy vulva lesion/s complT 0017

56605 Biopsy of vulva/perineumT 0189

56606 Biopsy of vulva/perineumT 0188

56620 Partial removal of vulvaT 0193

56625 Complete removal of vulvaT 0193

56630 Extensive vulva surgeryC

56631 Extensive vulva surgeryC

56632 Extensive vulva surgeryC

56633 Extensive vulva surgeryC

56634 Extensive vulva surgeryC

56637 Extensive vulva surgeryC

56640 Extensive vulva surgeryC

56700 Partial removal of hymenT 0193

56740 Remove vagina gland lesionT 0193

56800 Repair of vaginaT 0193

56805 Repair clitorisT 0193

56810 Repair of perineumT 0193

56820 Exam of vulva w/scopeT 0188

56821 Exam/biopsy of vulva w/scopeT 0188

57000 Exploration of vaginaT 0193

57010 Drainage of pelvic abscessT 0193

57020 Drainage of pelvic fluidT 0192

57022 I & d vaginal hematoma ppT 0007
57023 I & d vag hematoma non-ob

T 0008

57061 Destroy vag lesions simpleT 0193

57065 Destroy vag lesions complexT 0193

57100 Biopsy of vaginaT 0192

57105 Biopsy of vaginaT 0193

57106 Remove vagina wall partialT 0193

57107 Remove vagina tissue partT 0195

57109 Vaginectomy partial w/nodesT 0195

57110 Remove vagina wall completeC

57111 Remove vagina tissue complC

57112 Vaginectomy w/nodes complC

57120 Closure of vaginaT 0195

57130 Remove vagina lesionT 0193

57135 Remove vagina lesionT 0193

57150 Treat vagina infectionT 0188

57155 Insert uteri tandems/ovoidsT 0192

57156 Ins vag brachytx deviceT 0189

57160 Insert pessary/other deviceT 0188

57170 Fitting of diaphragm/capT 0191

57180 Treat vaginal bleedingT 0188

57200 Repair of vaginaT 0193

57210 Repair vagina/perineumT 0193

57220 Revision of urethraT 0202

57230 Repair of urethral lesionT 0195

57240 Repair bladder & vaginaT 0195

57250 Repair rectum & vaginaT 0195

57260 Repair of vaginaT 0195

57265 Extensive repair of vaginaT 0202

57267 Insert mesh/pelvic flr addonT 0195

57268 Repair of bowel bulgeT 0195

57270 Repair of bowel pouchC

57280 Suspension of vaginaC

57282 Colpopexy extraperitonealT 0202

57283 Colpopexy intraperitonealT 0202

57284 Repair paravag defect openT 0202

57285 Repair paravag defect vagT 0202

57287 Revise/remove sling repairT 0195

57288 Repair bladder defectT 0202

57289 Repair bladder & vaginaT 0195

57291 Construction of vaginaT 0195

57292 Construct vagina with graftT 0195

57295 Revise vag graft via vaginaT 0193

57296 Revise vag graft open abdC

57300 Repair rectum-vagina fistulaT 0195

57305 Repair rectum-vagina fistulaC

57307 Fistula repair & colostomyC

57308 Fistula repair transperineC

57310 Repair urethrovaginal lesionT 0202

57311 Repair urethrovaginal lesionC

57320 Repair bladder-vagina lesionT 0195

57330 Repair bladder-vagina lesionT 0195

57335 Repair vaginaT 0195

57400 Dilation of vaginaT 0193

57410 Pelvic examinationT 0193

57415 Remove vaginal foreign bodyT 0193
57420 Exam of vagina w/scope

T 0189

57421 Exam/biopsy of vag w/scopeT 0189

57423 Repair paravag defect lap

T 0202

57425 Laparoscopy surg colpopexy CH T 0131

57426 Revise prosth vag graft lapT 0193

57452 Exam of cervix w/scopeT 0188

57454 Bx/curett of cervix w/scopeT 0189

57455 Biopsy of cervix w/scopeT 0189

57456 Endocerv curettage w/scopeT 0189

57460 Bx of cervix w/scope leepT 0193

57461 Conz of cervix w/scope leepT 0193

57500 Biopsy of cervixT 0192

57505 Endocervical curettageT 0192

57510 Cauterization of cervixT 0193

57511 Cryocautery of cervixT 0188

57513 Laser surgery of cervixT 0193

57520 Conization of cervixT 0193

57522 Conization of cervixT 0193

57530 Removal of cervixT 0195

57531 Removal of cervix radicalC

57540 Removal of residual cervixC

57545 Remove cervix/repair pelvisC

57550 Removal of residual cervixT 0195

57555 Remove cervix/repair vaginaT 0195

57556 Remove cervix repair bowelT 0202

57558 D&c of cervical stumpT 0193

57700 Revision of cervixT 0193

57720 Revision of cervixT 0193

57800 Dilation of cervical canalT 0193

58100 Biopsy of uterus liningT 0188

58110 Bx done w/colposcopy add-on N 

58120 Dilation and curettageT 0193

58140 Myomectomy abdom methodC

58145 Myomectomy vag methodT 0195

58146 Myomectomy abdom complexC

58150 Total hysterectomyC

58152 Total hysterectomyC

58180 Partial hysterectomyC

58200 Extensive hysterectomyC

58210 Extensive hysterectomyC

58240 Removal of pelvis contentsC

58260 Vaginal hysterectomy T 0195

58262 Vag hyst including t/o T 0195

58263 Vag hyst w/t/o & vag repair T 0195

58267 Vag hyst w/urinary repairC

58270 Vag hyst w/enterocele repair T 0195

58275 Hysterectomy/revise vaginaC

58280 Hysterectomy/revise vaginaC

58285 Extensive hysterectomyC

58290 Vag hyst complex T 0202

58291 Vag hyst incl t/o complex T 0202

58292 Vag hyst t/o & repair compl T 0202

58293 Vag hyst w/uro repair complC

58294 Vag hyst w/enterocele compl T 0202

58300 Insert intrauterine deviceE
58301 Remove intrauterine device

T 0188

58321 Artificial inseminationT 0189

58322 Artificial inseminationT 0189

58323 Sperm washingT 0189

58340 Catheter for hysterographyN

58345 Reopen fallopian tubeT 0193

58346 Insert heyman uteri capsuleT 0193

58350 Reopen fallopian tubeT 0195

58353 Endometr ablate thermalT 0195

58356 Endometrial cryoablationT 0202

58400 Suspension of uterusC

58410 Suspension of uterusC

58520 Repair of ruptured uterusC

58540 Revision of uterusC

58541 Lsh uterus 250 g or less

T 0132

58542 Lsh w/t/o ut 250 g or less

T 0132

58543 Lsh uterus above 250 g

T 0132

58544 Lsh w/t/o uterus above 250 g

T 0132

58545 Laparoscopic myomectomyT 0130

58546 Laparo-myomectomy complexT 0131

58548 Lap radical hystC

58550 Laparo-asst vag hysterectomyT 0132

58552 Laparo-vag hyst incl t/oT 0131

58553 Laparo-vag hyst complexT 0131

58554 Laparo-vag hyst w/t/o complT 0131

58555 Hysteroscopy dx sep procT 0190

58558 Hysteroscopy biopsyT 0190

58559 Hysteroscopy lysisT 0190

58560 Hysteroscopy resect septumT 0387

58561 Hysteroscopy remove myomaT 0387

58562 Hysteroscopy remove fbT 0190

58563 Hysteroscopy ablationT 0387

58565 Hysteroscopy sterilizationT 0202

58570 Tlh uterus 250 g or lessT 0131

58571 Tlh w/t/o 250 g or lessT 0131

58572 Tlh uterus over 250 gT 0131

58573 Tlh w/t/o uterus over 250 gT 0131

58578 Laparo proc uterusT 0130

58579 Hysteroscope procedureT 0190

58600 Division of fallopian tubeT 0195

58605 Division of fallopian tubeC

58611 Ligate oviduct(s) add-onC

58615 Occlude fallopian tube(s)T 0193

58660 Laparoscopy lysisT 0131

58661 Laparoscopy remove adnexaT 0131

58662 Laparoscopy excise lesionsT 0131

58670 Laparoscopy tubal cauteryT 0131

58671 Laparoscopy tubal blockT 0131

58672 Laparoscopy fimbrioplastyT 0131

58673 Laparoscopy salpingostomyT 0131

58679 Laparo proc oviduct-ovaryT 0130

58700 Removal of fallopian tubeC

58720 Removal of ovary/tube(s)C

58740 Adhesiolysis tube ovaryC

58750 Repair oviductC
58752 Revise ovarian tube(s)

C

58760 FimbrioplastyC

58770 Create new tubal openingT 0195

58800 Drainage of ovarian cyst(s)T 0193

58805 Drainage of ovarian cyst(s)T 0195

58820 Drain ovary abscess openT 0195

58822 Drain ovary abscess percutC

58823 Drain pelvic abscess percutT 0193

58825 Transposition ovary(s)C

58900 Biopsy of ovary(s)T 0193

58920 Partial removal of ovary(s)T 0195

58925 Removal of ovarian cyst(s)T 0195

58940 Removal of ovary(s)C

58943 Removal of ovary(s)C

58950 Resect ovarian malignancyC

58951 Resect ovarian malignancyC

58952 Resect ovarian malignancyC

58953 Tah rad dissect for debulkC

58954 Tah rad debulk/lymph removeC

58956 Bso omentectomy w/tahC

58957 Resect recurrent gyn malC

58958 Resect recur gyn mal w/ly

m

C

58960 Exploration of abdomenC

58970 Retrieval of oocyteT 0189

58974 Transfer of embryoT 0189

58976 Transfer of embryoT 0189

58999 Genital surgery procedureT 0191

59000 Amniocentesis diagnosticT 0189

59001 Amniocentesis therapeuticT 0192

59012 Fetal cord puncture prenatalT 0189

59015 Chorion biopsyT 0189

59020 Fetal contract stress testT 0188

59025 Fetal non-stress testT 0188

59030 Fetal scalp blood sampleT 0189

59050 Fetal monitor w/report M 

59051 Fetal monitor/interpret onlyB

59070 Transabdom amnioinfus w/usT 0188

59072 Umbilical cord occlud w/usT 0189

59074 Fetal fluid drainage w/usT 0189

59076 Fetal shunt placement w/usT 0189

59100 Remove uterus lesionT 0195

59120 Treat ectopic pregnancyC

59121 Treat ectopic pregnancyC

59130 Treat ectopic pregnancyC

59135 Treat ectopic pregnancyC

59136 Treat ectopic pregnancyC

59140 Treat ectopic pregnancyC

59150 Treat ectopic pregnancyT 0131

59151 Treat ectopic pregnancyT 0131

59160 D & c after deliveryT 0193

59200 Insert cervical dilatorT 0188

59300 Episiotomy or vaginal repairT 0193

59320 Revision of cervixT 0193

59325 Revision of cervixC

59350 Repair of uterusC
59400 Obstetrical care

B

59409 Obstetrical careT 0193

59410 Obstetrical careB

59412 Antepartum manipulationT 0193

59414 Deliver placentaT 0193

59425 Antepartum care onlyB

59426 Antepartum care onlyB

59430 Care after deliveryB

59510 Cesarean deliveryB

59514 Cesarean delivery onlyC

59515 Cesarean deliveryB

59525 Remove uterus after cesareanC

59610 Vbac deliveryB

59612 Vbac delivery onlyT 0193

59614 Vbac care after deliveryB

59618 Attempted vbac deliveryB

59620 Attempted vbac delivery onlyC

59622 Attempted vbac after careB

59812 Treatment of miscarriageT 0193

59820 Care of miscarriageT 0193

59821 Treatment of miscarriageT 0193

59830 Treat uterus infectionC

59840 AbortionT 0193

59841 AbortionT 0193

59850 AbortionC

59851 AbortionC

59852 AbortionC

59855 AbortionC

59856 AbortionC

59857 AbortionC

59866 Abortion (mpr)T 0189

59870 Evacuate mole of uterusT 0193

59871 Remove cerclage sutureT 0193

59897 Fetal invas px w/usT 0191

59898 Laparo proc ob care/deliverT 0130

59899 Maternity care procedureT 0191

60000 Drain thyroid/tongue cystT 0252

60100 Biopsy of thyroidT 0004

60200 Remove thyroid lesionT 0114

60210 Partial thyroid excisionT 0114

60212 Partial thyroid excisionT 0114

60220 Partial removal of thyroidT 0114

60225 Partial removal of thyroidT 0114

60240 Removal of thyroidT 0114

60252 Removal of thyroidT 0256

60254 Extensive thyroid surgeryC

60260 Repeat thyroid surgeryT 0256

60270 Removal of thyroidC

60271 Removal of thyroidT 0256

60280 Remove thyroid duct lesionT 0114

60281 Remove thyroid duct lesionT 0114

60300 Aspir/inj thyroid cystT 0004

60500 Explore parathyroid glandsT 0256

60502 Re-explore parathyroidsT 0256

60505 Explore parathyroid glandsC
60512 Autotransplant parathyroid

T 0022

60520 Removal of thymus glandT 0256

60521 Removal of thymus glandC

60522 Removal of thymus glandC

60540 Explore adrenal glandC

60545 Explore adrenal glandC

60600 Remove carotid body lesionC

60605 Remove carotid body lesionC

60650 Laparoscopy adrenalectomyC

60659 Laparo proc endocrineT 0130

60699 Endocrine surgery procedureT 0114

61000 Remove cranial cavity fluidT 0207

61001 Remove cranial cavity fluidT 0207

61020 Remove brain cavity fluidT 0207

61026 Injection into brain canalT 0207

61050 Remove brain canal fluidT 0207

61055 Injection into brain canalT 0207

61070 Brain canal shunt procedureT 0121

61105 Twist drill holeC

61107 Drill skull for implantationC

61108 Drill skull for drainageC

61120 Burr hole for punctureC

61140 Pierce skull for biopsyC

61150 Pierce skull for drainageC

61151 Pierce skull for drainageC

61154 Pierce skull & remove clotC

61156 Pierce skull for drainageC

61210 Pierce skull implant deviceC

61215 Insert brain-fluid deviceT 0224

61250 Pierce skull & exploreC

61253 Pierce skull & exploreC

61304 Open skull for explorationC

61305 Open skull for explorationC

61312 Open skull for drainageC

61313 Open skull for drainageC

61314 Open skull for drainageC

61315 Open skull for drainageC

61316 Implt cran bone flap to abdoC

61320 Open skull for drainageC

61321 Open skull for drainageC

61322 Decompressive craniotomyC

61323 Decompressive lobectomyC

61330 Decompress eye socketT 0256

61332 Explore/biopsy eye socketC

61333 Explore orbit/remove lesionC

61334 Explore orbit/remove objectT 0256

61340 Subtemporal decompressionC

61343 Incise skull (press relief)C

61345 Relieve cranial pressureC

61440 Incise skull for surgeryC

61450 Incise skull for surgeryC

61458 Incise skull for brain woundC

61460 Incise skull for surgeryC

61470 Incise skull for surgeryC

61480 Incise skull for surgeryC
61490 Incise skull for surgery

C

61500 Removal of skull lesionC

61501 Remove infected skull boneC

61510 Removal of brain lesionC

61512 Remove brain lining lesionC

61514 Removal of brain abscessC

61516 Removal of brain lesionC

61517 Implt brain chemotx add-onC

61518 Removal of brain lesionC

61519 Remove brain lining lesionC

61520 Removal of brain lesionC

61521 Removal of brain lesionC

61522 Removal of brain abscessC

61524 Removal of brain lesionC

61526 Removal of brain lesionC

61530 Removal of brain lesionC

61531 Implant brain electrodesC

61533 Implant brain electrodesC

61534 Removal of brain lesionC

61535 Remove brain electrodesC

61536 Removal of brain lesionC

61537 Removal of brain tissue

C

61538 Removal of brain tissueC

61539 Removal of brain tissueC

61540 Removal of brain tissue

C

61541 Incision of brain tissueC

61542 Removal of brain tissueC

61543 Removal of brain tissueC

61544 Remove & treat brain lesionC

61545 Excision of brain tumorC

61546 Removal of pituitary glandC

61548 Removal of pituitary glandC

61550 Release of skull seamsC

61552 Release of skull seamsC

61556 Incise skull/suturesC

61557 Incise skull/suturesC

61558 Excision of skull/suturesC

61559 Excision of skull/suturesC

61563 Excision of skull tumorC

61564 Excision of skull tumorC

61566 Removal of brain tissue

C

61567 Incision of brain tissue

C

61570 Remove foreign body brainC

61571 Incise skull for brain woundC

61575 Skull base/brainstem surgeryC

61576 Skull base/brainstem surgeryC

61580 Craniofacial approach skullC

61581 Craniofacial approach skullC

61582 Craniofacial approach skullC

61583 Craniofacial approach skullC

61584 Orbitocranial approach/skullC

61585 Orbitocranial approach/skullC

61586 Resect nasopharynx skullC

61590 Infratemporal approach/skullC

61591 Infratemporal approach/skullC
61592 Orbitocranial approach/skull

C

61595 Transtemporal approach/skullC

61596 Transcochlear approach/skullC

61597 Transcondylar approach/skullC

61598 Transpetrosal approach/skullC

61600 Resect/excise cranial lesionC

61601 Resect/excise cranial lesionC

61605 Resect/excise cranial lesionC

61606 Resect/excise cranial lesionC

61607 Resect/excise cranial lesionC

61608 Resect/excise cranial lesionC

61609 Transect artery sinusC

61610 Transect artery sinusC

61611 Transect artery sinusC

61612 Transect artery sinusC

61613 Remove aneurysm sinusC

61615 Resect/excise lesion skullC

61616 Resect/excise lesion skullC

61618 Repair duraC

61619 Repair duraC

61623 Endovasc tempory vessel occlT 0082

61624 Transcath occlusion cnsC

61626 Transcath occlusion non-cnsT 0082

61630 Intracranial angioplastyC

61635 Intracran angioplsty w/stentC

61640 Dilate ic vasospasm init E 

61641 Dilate ic vasospasm add-on E 

61642 Dilate ic vasospasm add-on E 

61680 Intracranial vessel surgeryC

61682 Intracranial vessel surgeryC

61684 Intracranial vessel surgeryC

61686 Intracranial vessel surgeryC

61690 Intracranial vessel surgeryC

61692 Intracranial vessel surgeryC

61697 Brain aneurysm repr complxC

61698 Brain aneurysm repr complxC

61700 Brain aneurysm repr simpleC

61702 Inner skull vessel surgeryC

61703 Clamp neck arteryC

61705 Revise circulation to headC

61708 Revise circulation to headC

61710 Revise circulation to headC

61711 Fusion of skull arteriesC

61720 Incise skull/brain surgeryT 0221

61735 Incise skull/brain surgeryC

61750 Incise skull/brain biopsyC

61751 Brain biopsy w/ct/mr guideC

61760 Implant brain electrodesC

61770 Incise skull for treatmentT 0221

61781 Scan proc cranial intraN

61782 Scan proc cranial extraN

61783 Scan proc spinalN

61790 Treat trigeminal nerveT 0220

61791 Treat trigeminal tractT 0203

61796 Srs cranial lesion simpleB
61797 Srs cran les simple addl

B

61798 Srs cranial lesion complexB

61799 Srs cran les complex addlB

61800 Apply srs headframe add-onB

61850 Implant neuroelectrodesC

61860 Implant neuroelectrodesC

61863 Implant neuroelectrodeC

61864 Implant neuroelectrde addlC

61867 Implant neuroelectrodeC

61868 Implant neuroelectrde addlC

61870 Implant neuroelectrodesC

61875 Implant neuroelectrodesC

61880 Revise/remove neuroelectrodeT 0687

61885 Insrt/redo neurostim 1 arrayS 0039

61886 Implant neurostim arrays S 0315

61888 Revise/remove neuroreceiverT 0688

62000 Treat skull fractureT 0254

62005 Treat skull fractureC

62010 Treatment of head injuryC

62100 Repair brain fluid leakageC

62115 Reduction of skull defectC

62116 Reduction of skull defectC

62117 Reduction of skull defectC

62120 Repair skull cavity lesionC

62121 Incise skull repairC

62140 Repair of skull defectC

62141 Repair of skull defectC

62142 Remove skull plate/flapC

62143 Replace skull plate/flapC

62145 Repair of skull & brainC

62146 Repair of skull with graftC

62147 Repair of skull with graftC

62148 Retr bone flap to fix skullC

62160 Neuroendoscopy add-on N 

62161 Dissect brain w/scopeC

62162 Remove colloid cyst w/scopeC

62163 Neuroendoscopy w/fb removalC

62164 Remove brain tumor w/scopeC

62165 Remove pituit tumor w/scopeC

62180 Establish brain cavity shuntC

62190 Establish brain cavity shuntC

62192 Establish brain cavity shuntC

62194 Replace/irrigate catheterT 0207

62200 Establish brain cavity shuntC

62201 Brain cavity shunt w/scopeC

62220 Establish brain cavity shuntC

62223 Establish brain cavity shuntC

62225 Replace/irrigate catheterT 0427

62230 Replace/revise brain shuntT 0224

62252 Csf shunt reprogramS 0691

62256 Remove brain cavity shuntC

62258 Replace brain cavity shuntC

62263 Epidural lysis mult sessions CH T 0203

62264 Epidural lysis on single dayT 0203

62267 Interdiscal perq aspir dxT 0004
62268 Drain spinal cord cyst

T 0207

62269 Needle biopsy spinal cordT 0685

62270 Spinal fluid tap diagnosticT 0206

62272 Drain cerebro spinal fluidT 0206

62273 Inject epidural patchT 0207

62280 Treat spinal cord lesionT 0207

62281 Treat spinal cord lesion CH T 0203

62282 Treat spinal canal lesion CH T 0203

62284 Injection for myelogramN

62287 Percutaneous diskectomyT 0221

62290 Inject for spine disk x-rayN

62291 Inject for spine disk x-rayN

62292 Injection into disk lesionT 0207

62294 Injection into spinal arteryT 0207

62310 Inject spine c/tT 0207

62311 Inject spine l/s (cd)T 0207

62318 Inject spine w/cath c/tT 0207

62319 Inject spine w/cath l/s (cd)T 0203

62350 Implant spinal canal cathT 0224

62351 Implant spinal canal cathT 0208

62355 Remove spinal canal catheterT 0203

62360 Insert spine infusion deviceT 0224

62361 Implant spine infusion pumpT 0227

62362 Implant spine infusion pumpT 0227

62365 Remove spine infusion deviceT 0221

62367 Analyze spine infusion pumpS 0691

62368 Analyze spine infusion pumpS 0691

63001 Removal of spinal laminaT 0208

63003 Removal of spinal laminaT 0208

63005 Removal of spinal laminaT 0208

63011 Removal of spinal laminaT 0208

63012 Removal of spinal laminaT 0208

63015 Removal of spinal laminaT 0208

63016 Removal of spinal laminaT 0208

63017 Removal of spinal laminaT 0208

63020 Neck spine disk surgeryT 0208

63030 Low back disk surgeryT 0208

63035 Spinal disk surgery add-onT 0208

63040 Laminotomy single cervicalT 0208

63042 Laminotomy single lumbarT 0208

63043 Laminotomy addl cervicalC

63044 Laminotomy addl lumbarC

63045 Removal of spinal laminaT 0208

63046 Removal of spinal laminaT 0208

63047 Removal of spinal laminaT 0208

63048 Remove spinal lamina add-onT 0208

63050 Cervical laminoplastyC

63051 C-laminoplasty w/graft/plateC

63055 Decompress spinal cordT 0208

63056 Decompress spinal cordT 0208

63057 Decompress spine cord add-onT 0208

63064 Decompress spinal cordT 0208

63066 Decompress spine cord add-onT 0208

63075 Neck spine disk surgeryT 0208

63076 Neck spine disk surgeryT 0208
63077 Spine disk surgery thorax

C

63078 Spine disk surgery thoraxC

63081 Removal of vertebral bodyC

63082 Remove vertebral body add-onC

63085 Removal of vertebral bodyC

63086 Remove vertebral body add-onC

63087 Removal of vertebral bodyC

63088 Remove vertebral body add-onC

63090 Removal of vertebral bodyC

63091 Remove vertebral body add-onC

63101 Removal of vertebral bodyC

63102 Removal of vertebral bodyC

63103 Remove vertebral body add-onC

63170 Incise spinal cord tract(s)C

63172 Drainage of spinal cystC

63173 Drainage of spinal cystC

63180 Revise spinal cord ligamentsC

63182 Revise spinal cord ligamentsC

63185 Incise spinal column/nervesC

63190 Incise spinal column/nervesC

63191 Incise spinal column/nervesC

63194 Incise spinal column & cordC

63195 Incise spinal column & cordC

63196 Incise spinal column & cordC

63197 Incise spinal column & cordC

63198 Incise spinal column & cordC

63199 Incise spinal column & cordC

63200 Release of spinal cordC

63250 Revise spinal cord vesselsC

63251 Revise spinal cord vesselsC

63252 Revise spinal cord vesselsC

63265 Excise intraspinal lesionC

63266 Excise intraspinal lesionC

63267 Excise intraspinal lesionC

63268 Excise intraspinal lesionC

63270 Excise intraspinal lesionC

63271 Excise intraspinal lesionC

63272 Excise intraspinal lesionC

63273 Excise intraspinal lesionC

63275 Biopsy/excise spinal tumorC

63276 Biopsy/excise spinal tumorC

63277 Biopsy/excise spinal tumorC

63278 Biopsy/excise spinal tumorC

63280 Biopsy/excise spinal tumorC

63281 Biopsy/excise spinal tumorC

63282 Biopsy/excise spinal tumorC

63283 Biopsy/excise spinal tumorC

63285 Biopsy/excise spinal tumorC

63286 Biopsy/excise spinal tumorC

63287 Biopsy/excise spinal tumorC

63290 Biopsy/excise spinal tumorC

63295 Repair of laminectomy defect

C

63300 Removal of vertebral bodyC

63301 Removal of vertebral bodyC

63302 Removal of vertebral bodyC
63303 Removal of vertebral body

C

63304 Removal of vertebral bodyC

63305 Removal of vertebral bodyC

63306 Removal of vertebral bodyC

63307 Removal of vertebral bodyC

63308 Remove vertebral body add-onC

63600 Remove spinal cord lesionT 0220

63610 Stimulation of spinal cordT 0220

63615 Remove lesion of spinal cordT 0220

63620 Srs spinal lesionB

63621 Srs spinal lesion addlB

63650 Implant neuroelectrodesS 0040

63655 Implant neuroelectrodesS 0061

63661 Remove spine eltrd perq arayT 0687

63662 Remove spine eltrd plateT 0687

63663 Revise spine eltrd perq aray CH T 0040

63664 Revise spine eltrd plate CH T 0040

63685 Insrt/redo spine n generator S 0039

63688 Revise/remove neuroreceiverT 0688

63700 Repair of spinal herniationC

63702 Repair of spinal herniationC

63704 Repair of spinal herniationC

63706 Repair of spinal herniationC

63707 Repair spinal fluid leakageC

63709 Repair spinal fluid leakageC

63710 Graft repair of spine defectC

63740 Install spinal shuntC

63741 Install spinal shuntT 0224

63744 Revision of spinal shuntT 0224

63746 Removal of spinal shuntT 0203

64400 N block inj trigeminalT 0204

64402 N block inj facialT 0204

64405 N block inj occipitalT 0206

64408 N block inj vagus CHT 0204

64410 N block inj phrenic CHT 0204

64412 N block inj spinal accessor CHT 0206

64413 N block inj cervical plexusT 0206

64415 N block inj brachial plexusT 0206

64416 N block cont infuse b plexT 0207

64417 N block inj axillaryT 0206

64418 N block inj suprascapularT 0206

64420 N block inj intercost sngT 0206

64421 N block inj intercost mltT 0207

64425 N block inj ilio-ing/hypogiT 0206

64430 N block inj pudendalT 0207

64435 N block inj paracervicalT 0206

64445 N block inj sciatic sngT 0207

64446 N blk inj sciatic cont infT 0207

64447 N block inj fem singleT 0206

64448 N block inj fem cont infT 0207

64449 N block inj lumbar plexusT 0207

64450 N block other peripheralT 0206

64455 N block inj plantar digitT 0204

64479 Inj foramen epidural c/tT 0207

64480 Inj foramen epidural add-onT 0206
64483 Inj foramen epidural l/s

T 0207

64484 Inj foramen epidural add-onT 0206

64490 Inj paravert f jnt c/t 1 levT 0207

64491 Inj paravert f jnt c/t 2 levT 0204

64492 Inj paravert f jnt c/t 3 levT 0204

64493 Inj paravert f jnt l/s 1 levT 0207

64494 Inj paravert f jnt l/s 2 levT 0204

64495 Inj paravert f jnt l/s 3 levT 0204

64505 N block spenopalatine ganglT 0204

64508 N block carotid sinus s/pT 0204

64510 N block stellate ganglionT 0207

64517 N block inj hypogas plxsT 0207

64520 N block lumbar/thoracicT 0207

64530 N block inj celiac pelusT 0207

64550 Apply neurostimulatorA

64553 Implant neuroelectrodesS 0040

64555 Implant neuroelectrodesS 0040

64560 Implant neuroelectrodesS 0040

64561 Implant neuroelectrodesS 0040

64565 Implant neuroelectrodesS 0040

64566 Neuroeltrd stim post tibialT 0204

64568 Inc for vagus n elect implS 0318

64569 Revise/repl vagus n eltrdT 0687

64570 Remove vagus n eltrdT 0221

64575 Implant neuroelectrodesS 0061

64577 Implant neuroelectrodesS 0061

64580 Implant neuroelectrodesS 0061

64581 Implant neuroelectrodesS 0061

64585 Revise/remove neuroelectrodeT 0687

64590 Insrt/redo pn/gastr stimul S 0039

64595 Revise/rmv pn/gastr stimulT 0688

64600 Injection treatment of nerveT 0203

64605 Injection treatment of nerveT 0220

64610 Injection treatment of nerveT 0220

64611 Chemodenerv saliv glandsT 0204

64612 Destroy nerve face muscleT 0204

64613 Destroy nerve neck muscleT 0206

64614 Destroy nerve extrem muscT 0206

64620 Injection treatment of nerve CHT 0203

64622 Destr paravertebrl nerve l/sT 0203

64623 Destr paravertebral n add-onT 0207

64626 Destr paravertebrl nerve c/t CHT 0203

64627 Destr paravertebral n add-onT 0204

64630 Injection treatment of nerveT 0207

64632 N block inj common digitT 0204

64640 Injection treatment of nerveT 0207

64650 Chemodenerv eccrine glandsT 0204

64653 Chemodenerv eccrine glandsT 0204

64680 Injection treatment of nerve CHT 0203

64681 Injection treatment of nerveT 0203

64702 Revise finger/toe nerveT 0220

64704 Revise hand/foot nerveT 0220

64708 Revise arm/leg nerveT 0220

64712 Revision of sciatic nerveT 0220

64713 Revision of arm nerve(s)T 0220
64714 Revise low back nerve(s)

T 0220

64716 Revision of cranial nerveT 0220

64718 Revise ulnar nerve at elbowT 0220

64719 Revise ulnar nerve at wristT 0220

64721 Carpal tunnel surgeryT 0220

64722 Relieve pressure on nerve(s)T 0220

64726 Release foot/toe nerveT 0220

64727 Internal nerve revisionT 0220

64732 Incision of brow nerveT 0220

64734 Incision of cheek nerveT 0220

64736 Incision of chin nerveT 0220

64738 Incision of jaw nerveT 0220

64740 Incision of tongue nerveT 0220

64742 Incision of facial nerveT 0220

64744 Incise nerve back of headT 0220

64746 Incise diaphragm nerveT 0220

64752 Incision of vagus nerveC

64755 Incision of stomach nervesC

64760 Incision of vagus nerveC

64761 Incision of pelvis nerveT 0220

64763 Incise hip/thigh nerveT 0220

64766 Incise hip/thigh nerveT 0221

64771 Sever cranial nerveT 0220

64772 Incision of spinal nerveT 0220

64774 Remove skin nerve lesionT 0220

64776 Remove digit nerve lesionT 0220

64778 Digit nerve surgery add-onT 0220

64782 Remove limb nerve lesionT 0220

64783 Limb nerve surgery add-onT 0220

64784 Remove nerve lesionT 0220

64786 Remove sciatic nerve lesionT 0221

64787 Implant nerve endT 0220

64788 Remove skin nerve lesionT 0220

64790 Removal of nerve lesionT 0220

64792 Removal of nerve lesionT 0221

64795 Biopsy of nerveT 0220

64802 Remove sympathetic nervesT 0220

64804 Remove sympathetic nervesT 0220

64809 Remove sympathetic nervesC

64818 Remove sympathetic nervesC

64820 Remove sympathetic nervesT 0220

64821 Remove sympathetic nervesT 0054

64822 Remove sympathetic nervesT 0054

64823 Remove sympathetic nervesT 0054

64831 Repair of digit nerveT 0221

64832 Repair nerve add-onT 0221

64834 Repair of hand or foot nerveT 0221

64835 Repair of hand or foot nerveT 0221

64836 Repair of hand or foot nerveT 0221

64837 Repair nerve add-onT 0221

64840 Repair of leg nerveT 0221

64856 Repair/transpose nerveT 0221

64857 Repair arm/leg nerveT 0221

64858 Repair sciatic nerveT 0221

64859 Nerve surgeryT 0221
64861 Repair of arm nerves

T 0221

64862 Repair of low back nervesT 0221

64864 Repair of facial nerveT 0221

64865 Repair of facial nerveT 0221

64866 Fusion of facial/other nerveC

64868 Fusion of facial/other nerveC

64870 Fusion of facial/other nerveT 0221

64872 Subsequent repair of nerveT 0221

64874 Repair & revise nerve add-onT 0221

64876 Repair nerve/shorten boneT 0221

64885 Nerve graft head or neckT 0221

64886 Nerve graft head or neckT 0221

64890 Nerve graft hand or footT 0221

64891 Nerve graft hand or footT 0221

64892 Nerve graft arm or legT 0221

64893 Nerve graft arm or legT 0221

64895 Nerve graft hand or footT 0221

64896 Nerve graft hand or footT 0221

64897 Nerve graft arm or legT 0221

64898 Nerve graft arm or legT 0221

64901 Nerve graft add-onT 0221

64902 Nerve graft add-onT 0221

64905 Nerve pedicle transferT 0221

64907 Nerve pedicle transferT 0221

64910 Nerve repair w/allograft

T 0221

64911 Neurorraphy w/vein autograft

T 0221

64999 Nervous system surgeryT 0204

65091 Revise eyeT 0242

65093 Revise eye with implantT 0242

65101 Removal of eyeT 0242

65103 Remove eye/insert implantT 0242

65105 Remove eye/attach implantT 0242

65110 Removal of eyeT 0242

65112 Remove eye/revise socketT 0242

65114 Remove eye/revise socketT 0242

65125 Revise ocular implantT 0241

65130 Insert ocular implantT 0241

65135 Insert ocular implantT 0241

65140 Attach ocular implantT 0242

65150 Revise ocular implantT 0241

65155 Reinsert ocular implantT 0242

65175 Removal of ocular implantT 0240

65205 Remove foreign body from eyeS 0698

65210 Remove foreign body from eyeS 0698

65220 Remove foreign body from eyeS 0698

65222 Remove foreign body from eyeS 0698

65235 Remove foreign body from eyeT 0233

65260 Remove foreign body from eyeT 0235

65265 Remove foreign body from eyeT 0237

65270 Repair of eye woundT 0240

65272 Repair of eye woundT 0234

65273 Repair of eye woundC

65275 Repair of eye woundT 0234

65280 Repair of eye woundT 0237

65285 Repair of eye woundT 0672
65286 Repair of eye wound

T 0255

65290 Repair of eye socket woundT 0243

65400 Removal of eye lesionT 0233

65410 Biopsy of corneaT 0233

65420 Removal of eye lesionT 0233

65426 Removal of eye lesionT 0234

65430 Corneal smearS 0698

65435 Curette/treat corneaT 0239

65436 Curette/treat corneaT 0233

65450 Treatment of corneal lesionS 0231

65600 Revision of corneaT 0240

65710 Corneal transplantT 0244

65730 Corneal transplantT 0244

65750 Corneal transplantT 0244

65755 Corneal transplantT 0244

65756 Corneal trnspl endothelialT 0244

65757 Prep corneal endo allograftN

65760 Revision of corneaE

65765 Revision of corneaE

65767 Corneal tissue transplantE

65770 Revise cornea with implantT 0293

65771 Radial keratotomyE

65772 Correction of astigmatismT 0233

65775 Correction of astigmatismT 0233

65778 Cover eye w/membrane CH Q2 0233

65779 Cover eye w/membrane suture CHT 0233

65780 Ocular reconst transplantT 0244

65781 Ocular reconst transplantT 0244

65782 Ocular reconst transplantT 0244

65800 Drainage of eyeT 0255

65805 Drainage of eye CHT 0234

65810 Drainage of eyeT 0234

65815 Drainage of eyeT 0234

65820 Relieve inner eye pressureT 0234

65850 Incision of eyeT 0234

65855 Laser surgery of eyeT 0247

65860 Incise inner eye adhesionsT 0247

65865 Incise inner eye adhesionsT 0233

65870 Incise inner eye adhesionsT 0234

65875 Incise inner eye adhesionsT 0234

65880 Incise inner eye adhesionsT 0233

65900 Remove eye lesionT 0232

65920 Remove implant of eyeT 0234

65930 Remove blood clot from eyeT 0234

66020 Injection treatment of eyeT 0233

66030 Injection treatment of eyeT 0233

66130 Remove eye lesionT 0234

66150 Glaucoma surgeryT 0234

66155 Glaucoma surgeryT 0234

66160 Glaucoma surgeryT 0234

66165 Glaucoma surgeryT 0234

66170 Glaucoma surgeryT 0234

66172 Incision of eyeT 0234

66174 Translum dil eye canalT 0673

66175 Trnslum dil eye canal w/stntT 0673
66180 Implant eye shunt

T 0673

66185 Revise eye shuntT 0234

66220 Repair eye lesionT 0672

66225 Repair/graft eye lesionT 0673

66250 Follow-up surgery of eyeT 0233

66500 Incision of irisT 0232

66505 Incision of irisT 0255

66600 Remove iris and lesionT 0234

66605 Removal of irisT 0234

66625 Removal of irisT 0255

66630 Removal of irisT 0234

66635 Removal of irisT 0234

66680 Repair iris & ciliary bodyT 0234

66682 Repair iris & ciliary bodyT 0234

66700 Destruction ciliary bodyT 0233

66710 Ciliary transsleral therapyT 0233

66711 Ciliary endoscopic ablationT 0233

66720 Destruction ciliary bodyT 0233

66740 Destruction ciliary bodyT 0234

66761 Revision of irisT 0247

66762 Revision of irisT 0247

66770 Removal of inner eye lesionT 0247

66820 Incision secondary cataractT 0255

66821 After cataract laser surgeryT 0247

66825 Reposition intraocular lensT 0234

66830 Removal of lens lesionT 0255

66840 Removal of lens materialT 0245

66850 Removal of lens materialT 0249

66852 Removal of lens materialT 0249

66920 Extraction of lensT 0249

66930 Extraction of lensT 0249

66940 Extraction of lensT 0245

66982 Cataract surgery complexT 0246

66983 Cataract surg w/iol 1 stageT 0246

66984 Cataract surg w/iol 1 stageT 0246

66985 Insert lens prosthesisT 0246

66986 Exchange lens prosthesisT 0246

66990 Ophthalmic endoscope add-onN

66999 Eye surgery procedureT 0232

67005 Partial removal of eye fluidT 0237

67010 Partial removal of eye fluidT 0672

67015 Release of eye fluidT 0672

67025 Replace eye fluidT 0672

67027 Implant eye drug systemT 0672

67028 Injection eye drugT 0238

67030 Incise inner eye strandsT 0237

67031 Laser surgery eye strandsT 0247

67036 Removal of inner eye fluidT 0672

67039 Laser treatment of retinaT 0672

67040 Laser treatment of retinaT 0672

67041 Vit for macular puckerT 0672

67042 Vit for macular holeT 0672

67043 Vit for membrane dissectT 0672

67101 Repair detached retinaT 0237

67105 Repair detached retinaT 0247
67107 Repair detached retina

T 0672

67108 Repair detached retinaT 0672

67110 Repair detached retinaT 0237

67112 Rerepair detached retinaT 0672

67113 Repair retinal detach cplxT 0672

67115 Release encircling materialT 0237

67120 Remove eye implant materialT 0237

67121 Remove eye implant materialT 0672

67141 Treatment of retinaT 0235

67145 Treatment of retinaT 0247

67208 Treatment of retinal lesionT 0235

67210 Treatment of retinal lesionT 0247

67218 Treatment of retinal lesionT 0237

67220 Treatment of choroid lesionT 0235

67221 Ocular photodynamic therT 0235

67225 Eye photodynamic ther add-onT 0235

67227 Treatment of retinal lesionT 0237

67228 Treatment of retinal lesionT 0247

67229 Tr retinal les preterm infT 0247

67250 Reinforce eye wallT 0240

67255 Reinforce/graft eye wallT 0237

67299 Eye surgery procedureT 0235

67311 Revise eye muscleT 0243

67312 Revise two eye musclesT 0243

67314 Revise eye muscleT 0243

67316 Revise two eye musclesT 0243

67318 Revise eye muscle(s)T 0243

67320 Revise eye muscle(s) add-onT 0243

67331 Eye surgery follow-up add-onT 0243

67332 Rerevise eye muscles add-onT 0243

67334 Revise eye muscle w/sutureT 0243

67335 Eye suture during surgeryT 0243

67340 Revise eye muscle add-onT 0243

67343 Release eye tissueT 0243

67345 Destroy nerve of eye muscleT 0238

67346 Biopsy eye muscle

T 0699

67399 Eye muscle surgery procedureT 0243

67400 Explore/biopsy eye socketT 0240

67405 Explore/drain eye socketT 0241

67412 Explore/treat eye socketT 0240

67413 Explore/treat eye socketT 0241

67414 Explr/decompress eye socketT 0242

67415 Aspiration orbital contentsT 0240

67420 Explore/treat eye socketT 0242

67430 Explore/treat eye socketT 0242

67440 Explore/drain eye socketT 0242

67445 Explr/decompress eye socketT 0242

67450 Explore/biopsy eye socketT 0242

67500 Inject/treat eye socketS 0231

67505 Inject/treat eye socketT 0238

67515 Inject/treat eye socketT 0238

67550 Insert eye socket implantT 0242

67560 Revise eye socket implantT 0241

67570 Decompress optic nerveT 0242

67599 Orbit surgery procedureT 0238
67700 Drainage of eyelid abscess

T 0238

67710 Incision of eyelidT 0239

67715 Incision of eyelid foldT 0240

67800 Remove eyelid lesionT 0238

67801 Remove eyelid lesionsT 0239

67805 Remove eyelid lesionsT 0238

67808 Remove eyelid lesion(s)T 0240

67810 Biopsy of eyelidT 0238

67820 Revise eyelashesS 0698

67825 Revise eyelashesT 0238

67830 Revise eyelashesT 0239

67835 Revise eyelashesT 0240

67840 Remove eyelid lesionT 0239

67850 Treat eyelid lesionT 0239

67875 Closure of eyelid by sutureT 0239

67880 Revision of eyelidT 0233

67882 Revision of eyelidT 0240

67900 Repair brow defectT 0241

67901 Repair eyelid defectT 0240

67902 Repair eyelid defectT 0241

67903 Repair eyelid defectT 0240

67904 Repair eyelid defectT 0240

67906 Repair eyelid defectT 0240

67908 Repair eyelid defectT 0240

67909 Revise eyelid defectT 0240

67911 Revise eyelid defectT 0240

67912 Correction eyelid w/implantT 0240

67914 Repair eyelid defectT 0240

67915 Repair eyelid defectT 0240

67916 Repair eyelid defectT 0240

67917 Repair eyelid defectT 0240

67921 Repair eyelid defectT 0240

67922 Repair eyelid defectT 0240

67923 Repair eyelid defectT 0240

67924 Repair eyelid defectT 0240

67930 Repair eyelid woundT 0240

67935 Repair eyelid woundT 0240

67938 Remove eyelid foreign bodyS 0231

67950 Revision of eyelidT 0240

67961 Revision of eyelidT 0240

67966 Revision of eyelidT 0240

67971 Reconstruction of eyelidT 0240

67973 Reconstruction of eyelidT 0241

67974 Reconstruction of eyelidT 0240

67975 Reconstruction of eyelidT 0240

67999 Revision of eyelidT 0238

68020 Incise/drain eyelid liningT 0238

68040 Treatment of eyelid lesionsS 0698

68100 Biopsy of eyelid lining CH T 0239

68110 Remove eyelid lining lesionT 0699

68115 Remove eyelid lining lesionT 0240

68130 Remove eyelid lining lesionT 0233

68135 Remove eyelid lining lesionT 0239

68200 Treat eyelid by injection CHS 0230

68320 Revise/graft eyelid liningT 0241
68325 Revise/graft eyelid lining

T 0241

68326 Revise/graft eyelid liningT 0240

68328 Revise/graft eyelid liningT 0241

68330 Revise eyelid liningT 0234

68335 Revise/graft eyelid liningT 0241

68340 Separate eyelid adhesionsT 0240

68360 Revise eyelid liningT 0234

68362 Revise eyelid liningT 0234

68371 Harvest eye tissue alograft CHT 0234

68399 Eyelid lining surgeryT 0238

68400 Incise/drain tear glandT 0238

68420 Incise/drain tear sacT 0240

68440 Incise tear duct openingT 0238

68500 Removal of tear glandT 0241

68505 Partial removal tear glandT 0241

68510 Biopsy of tear glandT 0240

68520 Removal of tear sacT 0241

68525 Biopsy of tear sacT 0240

68530 Clearance of tear ductT 0238

68540 Remove tear gland lesionT 0240

68550 Remove tear gland lesionT 0241

68700 Repair tear ductsT 0240

68705 Revise tear duct openingT 0238

68720 Create tear sac drainT 0241

68745 Create tear duct drainT 0241

68750 Create tear duct drainT 0241

68760 Close tear duct openingT 0238

68761 Close tear duct openingT 0238

68770 Close tear system fistulaT 0241

68801 Dilate tear duct openingS 0698

68810 Probe nasolacrimal ductT 0238

68811 Probe nasolacrimal ductT 0240

68815 Probe nasolacrimal ductT 0240

68816 Probe nl duct w/balloonT 0240

68840 Explore/irrigate tear ductsS 0231

68850 Injection for tear sac x-rayN

68899 Tear duct system surgeryT 0238

69000 Drain external ear lesionT 0006

69005 Drain external ear lesionT 0008

69020 Drain outer ear canal lesionT 0006

69090 Pierce earlobesE

69100 Biopsy of external earT 0251

69105 Biopsy of external ear canalT 0253

69110 Remove external ear partialT 0021

69120 Removal of external earT 0254

69140 Remove ear canal lesion(s)T 0254

69145 Remove ear canal lesion(s)T 0021

69150 Extensive ear canal surgeryT 0252

69155 Extensive ear/neck surgeryC

69200 Clear outer ear canalX 0340

69205 Clear outer ear canalT 0022

69210 Remove impacted ear waxX 0340

69220 Clean out mastoid cavityT 0013

69222 Clean out mastoid cavityT 0253

69300 Revise external earT 0254
69310 Rebuild outer ear canal

T 0256

69320 Rebuild outer ear canalT 0256

69399 Outer ear surgery procedureT 0250

69400 Inflate middle ear canalT 0251

69401 Inflate middle ear canalT 0251

69405 Catheterize middle ear canalT 0252

69420 Incision of eardrumT 0251

69421 Incision of eardrumT 0253

69424 Remove ventilating tubeT 0253

69433 Create eardrum openingT 0252

69436 Create eardrum openingT 0253

69440 Exploration of middle earT 0254

69450 Eardrum revisionT 0256

69501 MastoidectomyT 0256

69502 MastoidectomyT 0254

69505 Remove mastoid structuresT 0256

69511 Extensive mastoid surgeryT 0256

69530 Extensive mastoid surgeryT 0256

69535 Remove part of temporal boneC

69540 Remove ear lesionT 0253

69550 Remove ear lesionT 0256

69552 Remove ear lesionT 0256

69554 Remove ear lesionC

69601 Mastoid surgery revisionT 0256

69602 Mastoid surgery revisionT 0256

69603 Mastoid surgery revisionT 0256

69604 Mastoid surgery revisionT 0256

69605 Mastoid surgery revisionT 0256

69610 Repair of eardrumT 0254

69620 Repair of eardrumT 0254

69631 Repair eardrum structuresT 0256

69632 Rebuild eardrum structuresT 0256

69633 Rebuild eardrum structuresT 0256

69635 Repair eardrum structuresT 0256

69636 Rebuild eardrum structuresT 0256

69637 Rebuild eardrum structuresT 0256

69641 Revise middle ear & mastoidT 0256

69642 Revise middle ear & mastoidT 0256

69643 Revise middle ear & mastoidT 0256

69644 Revise middle ear & mastoidT 0256

69645 Revise middle ear & mastoidT 0256

69646 Revise middle ear & mastoidT 0256

69650 Release middle ear boneT 0254

69660 Revise middle ear boneT 0256

69661 Revise middle ear boneT 0256

69662 Revise middle ear boneT 0256

69666 Repair middle ear structuresT 0256

69667 Repair middle ear structuresT 0256

69670 Remove mastoid air cellsT 0256

69676 Remove middle ear nerveT 0256

69700 Close mastoid fistulaT 0256

69710 Implant/replace hearing aidE

69711 Remove/repair hearing aidT 0256

69714 Implant temple bone w/stimulT 0425

69715 Temple bne implnt w/stimulatT 0425
69717 Temple bone implant revision

T 0425

69718 Revise temple bone implantT 0425

69720 Release facial nerveT 0256

69725 Release facial nerveT 0256

69740 Repair facial nerveT 0256

69745 Repair facial nerveT 0256

69799 Middle ear surgery procedureT 0250

69801 Incise inner earT 0253

69802 Incise inner earT 0254

69805 Explore inner earT 0256

69806 Explore inner earT 0256

69820 Establish inner ear windowT 0256

69840 Revise inner ear windowT 0256

69905 Remove inner earT 0256

69910 Remove inner ear & mastoidT 0256

69915 Incise inner ear nerveT 0256

69930 Implant cochlear deviceT 0259

69949 Inner ear surgery procedureT 0250

69950 Incise inner ear nerveC

69955 Release facial nerveT 0256

69960 Release inner ear canalT 0256

69970 Remove inner ear lesionT 0256

69979 Temporal bone surgeryT 0250

69990 Microsurgery add-onN

70010 Contrast x-ray of brain Q2 0274

70015 Contrast x-ray of brain Q2 0274

70030 X-ray eye for foreign bodyX 0260

70100 X-ray exam of jawX 0260

70110 X-ray exam of jawX 0260

70120 X-ray exam of mastoidsX 0260

70130 X-ray exam of mastoidsX 0260

70134 X-ray exam of middle earX 0261

70140 X-ray exam of facial bonesX 0260

70150 X-ray exam of facial bonesX 0260

70160 X-ray exam of nasal bonesX 0260

70170 X-ray exam of tear duct Q2 0263

70190 X-ray exam of eye socketsX 0260

70200 X-ray exam of eye socketsX 0260

70210 X-ray exam of sinusesX 0260

70220 X-ray exam of sinusesX 0260

70240 X-ray exam pituitary saddleX 0260

70250 X-ray exam of skullX 0260

70260 X-ray exam of skullX 0261

70300 X-ray exam of teethX 0262

70310 X-ray exam of teethX 0262

70320 Full mouth x-ray of teethX 0262

70328 X-ray exam of jaw jointX 0260

70330 X-ray exam of jaw jointsX 0260

70332 X-ray exam of jaw joint Q2 0275

70336 Magnetic image jaw joint Q3 0336

70350 X-ray head for orthodontiaX 0260

70355 Panoramic x-ray of jawsX 0262

70360 X-ray exam of neckX 0260

70370 Throat x-ray & fluoroscopyX 0272

70371 Speech evaluation complexX 0272
70373 Contrast x-ray of larynx Q2 0263

70380 X-ray exam of salivary glandX 0260

70390 X-ray exam of salivary duct Q2 0263

70450 Ct head/brain w/o dye Q3 0332

70460 Ct head/brain w/dye Q3 0283

70470 Ct head/brain w/o & w/dy

e Q3 0333

70480 Ct orbit/ear/fossa w/o dye Q3 0332

70481 Ct orbit/ear/fossa w/dye Q3 0283

70482 Ct orbit/ear/fossa w/o&w/dy

e Q3 0333

70486 Ct maxillofacial w/o dye Q3 0332

70487 Ct maxillofacial w/dye Q3 0283

70488 Ct maxillofacial w/o & w/dy

e Q3 0333

70490 Ct soft tissue neck w/o dye Q3 0332

70491 Ct soft tissue neck w/dye Q3 0283

70492 Ct sft tsue nck w/o & w/dye Q3 0333

70496 Ct angiography head Q3 0662

70498 Ct angiography neck Q3 0662

70540 Mri orbit/face/neck w/o dye Q3 0336

70542 Mri orbit/face/neck w/dye Q3 0284

70543 Mri orbt/fac/nck w/o & w/dy

e Q3 0337

70544 Mr angiography head w/o dye Q3 0336

70545 Mr angiography head w/dye Q3 0284

70546 Mr angiograph head w/o&w/dy

e Q3 0337

70547 Mr angiography neck w/o dye Q3 0336

70548 Mr angiography neck w/dye Q3 0284

70549 Mr angiograph neck w/o&w/dy

e Q3 0337

70551 Mri brain w/o dye Q3 0336

70552 Mri brain w/dy

e Q3 0284

70553 Mri brain w/o & w/dy

e Q3 0337

70554 Fmri brain by tech Q3 0336

70555 Fmri brain by phys/psych

S 0336

70557 Mri brain w/o dyeS 0336

70558 Mri brain w/dyeS 0284

70559 Mri brain w/o & w/dyeS 0337

71010 Chest x-ray Q3 0260

71015 Chest x-ray Q3 0260

71020 Chest x-ray Q3 0260

71021 Chest x-rayX 0260

71022 Chest x-rayX 0260

71023 Chest x-ray and fluoroscopyX 0272

71030 Chest x-rayX 0260

71034 Chest x-ray and fluoroscopyX 0272

71035 Chest x-rayX 0260

71040 Contrast x-ray of bronchi Q2 0263

71060 Contrast x-ray of bronchi Q2 0263

71090 X-ray & pacemaker insertion N 

71100 X-ray exam of ribsX 0260

71101 X-ray exam of ribs/chestX 0260

71110 X-ray exam of ribsX 0260

71111 X-ray exam of ribs/chestX 0261

71120 X-ray exam of breastboneX 0260

71130 X-ray exam of breastboneX 0260

71250 Ct thorax w/o dye Q3 0332

71260 Ct thorax w/dye Q3 0283

71270 Ct thorax w/o & w/dy

e Q3 0333
71275 Ct angiography chest Q3 0662

71550 Mri chest w/o dye Q3 0336

71551 Mri chest w/dye Q3 0284

71552 Mri chest w/o & w/dy

e Q3 0337

71555 Mri angio chest w or w/o dyeB

72010 X-ray exam of spineX 0261

72020 X-ray exam of spineX 0260

72040 X-ray exam of neck spineX 0260

72050 X-ray exam of neck spineX 0261

72052 X-ray exam of neck spineX 0261

72069 X-ray exam of trunk spineX 0260

72070 X-ray exam of thoracic spineX 0260

72072 X-ray exam of thoracic spineX 0260

72074 X-ray exam of thoracic spineX 0260

72080 X-ray exam of trunk spineX 0260

72090 X-ray exam of trunk spineX 0261

72100 X-ray exam of lower spineX 0260

72110 X-ray exam of lower spineX 0261

72114 X-ray exam of lower spineX 0261

72120 X-ray exam of lower spineX 0260

72125 Ct neck spine w/o dye Q3 0332

72126 Ct neck spine w/dye Q3 0283

72127 Ct neck spine w/o & w/dy

e Q3 0333

72128 Ct chest spine w/o dye Q3 0332

72129 Ct chest spine w/dye Q3 0283

72130 Ct chest spine w/o & w/dy

e Q3 0333

72131 Ct lumbar spine w/o dye Q3 0332

72132 Ct lumbar spine w/dye Q3 0283

72133 Ct lumbar spine w/o & w/dy

e Q3 0333

72141 Mri neck spine w/o dye Q3 0336

72142 Mri neck spine w/dye Q3 0284

72146 Mri chest spine w/o dye Q3 0336

72147 Mri chest spine w/dye Q3 0284

72148 Mri lumbar spine w/o dye Q3 0336

72149 Mri lumbar spine w/dye Q3 0284

72156 Mri neck spine w/o & w/dy

e Q3 0337

72157 Mri chest spine w/o & w/dy

e Q3 0337

72158 Mri lumbar spine w/o & w/dy

e Q3 0337

72159 Mr angio spine w/o&w/dyeB

72170 X-ray exam of pelvisX 0260

72190 X-ray exam of pelvisX 0260

72191 Ct angiograph pelv w/o&w/dye Q3 0662

72192 Ct pelvis w/o dye Q3 0332

72193 Ct pelvis w/dye Q3 0283

72194 Ct pelvis w/o & w/dy

e Q3 0333

72195 Mri pelvis w/o dye Q3 0336

72196 Mri pelvis w/dye Q3 0284

72197 Mri pelvis w/o & w/dye Q3 0337

72198 Mr angio pelvis w/o & w/dy

e

B

72200 X-ray exam sacroiliac jointsX 0260

72202 X-ray exam sacroiliac jointsX 0260

72220 X-ray exam of tailboneX 0260

72240 Contrast x-ray of neck spine Q2 0274

72255 Contrast x-ray thorax spine Q2 0274

72265 Contrast x-ray lower spine Q2 0274
72270 Contrast x-ray spine Q2 0274

72275 Epidurography N 

72285 X-ray c/t spine disk Q2 0388

72291 Perq verte/sacroplsty fluor N 

72292 Perq verte/sacroplsty ct N 

72295 X-ray of lower spine disk Q2 0388

73000 X-ray exam of collar boneX 0260

73010 X-ray exam of shoulder bladeX 0260

73020 X-ray exam of shoulderX 0260

73030 X-ray exam of shoulderX 0260

73040 Contrast x-ray of shoulder Q2 0275

73050 X-ray exam of shouldersX 0260

73060 X-ray exam of humerusX 0260

73070 X-ray exam of elbowX 0260

73080 X-ray exam of elbowX 0260

73085 Contrast x-ray of elbow Q2 0275

73090 X-ray exam of forearmX 0260

73092 X-ray exam of arm infantX 0260

73100 X-ray exam of wristX 0260

73110 X-ray exam of wristX 0260

73115 Contrast x-ray of wrist Q2 0275

73120 X-ray exam of handX 0260

73130 X-ray exam of handX 0260

73140 X-ray exam of finger(s)X 0260

73200 Ct upper extremity w/o dye Q3 0332

73201 Ct upper extremity w/dye Q3 0283

73202 Ct uppr extremity w/o&w/dye Q3 0333

73206 Ct angio upr extrm w/o&w/dye Q3 0662

73218 Mri upper extremity w/o dye Q3 0336

73219 Mri upper extremity w/dye Q3 0284

73220 Mri uppr extremity w/o&w/dye Q3 0337

73221 Mri joint upr extrem w/o dye Q3 0336

73222 Mri joint upr extrem w/dye Q3 0284

73223 Mri joint upr extr w/o&w/dye Q3 0337

73225 Mr angio upr extr w/o&w/dyeB

73500 X-ray exam of hipX 0260

73510 X-ray exam of hipX 0260

73520 X-ray exam of hipsX 0260

73525 Contrast x-ray of hip Q2 0275

73530 X-ray exam of hip N 

73540 X-ray exam of pelvis & hipsX 0260

73542 X-ray exam sacroiliac joint Q2 0275

73550 X-ray exam of thighX 0260

73560 X-ray exam of knee 1 or 2X 0260

73562 X-ray exam of knee 3X 0260

73564 X-ray exam knee 4 or moreX 0260

73565 X-ray exam of kneesX 0260

73580 Contrast x-ray of knee joint Q2 0275

73590 X-ray exam of lower legX 0260

73592 X-ray exam of leg infantX 0260

73600 X-ray exam of ankleX 0260

73610 X-ray exam of ankleX 0260

73615 Contrast x-ray of ankle Q2 0275

73620 X-ray exam of footX 0260

73630 X-ray exam of footX 0260
73650 X-ray exam of heel

X 0260

73660 X-ray exam of toe(s)X 0260

73700 Ct lower extremity w/o dye Q3 0332

73701 Ct lower extremity w/dye Q3 0283

73702 Ct lwr extremity w/o&w/dye Q3 0333

73706 Ct angio lwr extr w/o&w/dye Q3 0662

73718 Mri lower extremity w/o dye Q3 0336

73719 Mri lower extremity w/dye Q3 0284

73720 Mri lwr extremity w/o&w/dye Q3 0337

73721 Mri jnt of lwr extre w/o dye Q3 0336

73722 Mri joint of lwr extr w/dye Q3 0284

73723 Mri joint lwr extr w/o&w/dye Q3 0337

73725 Mr ang lwr ext w or w/o dyeB

74000 X-ray exam of abdomenX 0260

74010 X-ray exam of abdomenX 0260

74020 X-ray exam of abdomenX 0260

74022 X-ray exam series abdomenX 0261

74150 Ct abdomen w/o dye Q3 0332

74160 Ct abdomen w/dye Q3 0283

74170 Ct abdomen w/o & w/dy

e Q3 0333

74175 Ct angio abdom w/o & w/dy

e Q3 0662

74176 Ct abd & pelvis w/o contrast CH Q3 0331

74177 Ct abdomen&pelvis w/contrast CH Q3 0334

74178 Ct abd&pelv 1+ section/regns CH Q3 0334

74181 Mri abdomen w/o dye Q3 0336

74182 Mri abdomen w/dye Q3 0284

74183 Mri abdomen w/o & w/dy

e Q3 0337

74185 Mri angio abdom w orw/o dy

e

B

74190 X-ray exam of peritoneum Q2 0263

74210 Contrst x-ray exam of throatS 0276

74220 Contrast x-ray esophagusS 0276

74230 Cine/vid x-ray throat/esophS 0276

74235 Remove esophagus obstruction N 

74240 X-ray exam upper gi tractS 0276

74241 X-ray exam upper gi tractS 0276

74245 X-ray exam upper gi tractS 0277

74246 Contrst x-ray uppr gi tractS 0276

74247 Contrst x-ray uppr gi tractS 0276

74249 Contrst x-ray uppr gi tractS 0277

74250 X-ray exam of small bowelS 0276

74251 X-ray exam of small bowelS 0277

74260 X-ray exam of small bowelS 0276

74261 Ct colonography dx Q3 0332

74262 Ct colonography dx w/dye Q3 0283

74263 Ct colonography screeningE

74270 Contrast x-ray exam of colonS 0276

74280 Contrast x-ray exam of colonS 0277

74283 Contrast x-ray exam of colonS 0276

74290 Contrast x-ray gallbladderS 0276

74291 Contrast x-rays gallbladderS 0276

74300 X-ray bile ducts/pancreas N 

74301 X-rays at surgery add-on N 

74305 X-ray bile ducts/pancreas Q2 0263

74320 Contrast x-ray of bile ducts Q2 0317

74327 X-ray bile stone removal N 
74328 X-ray bile duct endoscopy

N

74329 X-ray for pancreas endoscopyN

74330 X-ray bile/panc endoscopyN

74340 X-ray guide for GI tubeN

74355 X-ray guide intestinal tubeN

74360 X-ray guide gi dilationN

74363 X-ray bile duct dilationN

74400 Contrst x-ray urinary tractS 0278

74410 Contrst x-ray urinary tractS 0278

74415 Contrst x-ray urinary tractS 0278

74420 Contrst x-ray urinary tractS 0278

74425 Contrst x-ray urinary tract Q2 0278

74430 Contrast x-ray bladder Q2 0278

74440 X-ray male genital tract Q2 0278

74445 X-ray exam of penis Q2 0278

74450 X-ray urethra/bladder Q2 0278

74455 X-ray urethra/bladder Q2 0278

74470 X-ray exam of kidney lesion Q2 0263

74475 X-ray control cath insert Q2 0161

74480 X-ray control cath insert Q2 0161

74485 X-ray guide gu dilation Q2 0161

74710 X-ray measurement of pelvisX 0261

74740 X-ray female genital tract Q2 0263

74742 X-ray fallopian tube N 

74775 X-ray exam of perineumS 0278

75557 Cardiac mri for morph Q3 0336

75559 Cardiac mri w/stress img Q3 0336

75561 Cardiac mri for morph w/dye Q3 0337

75563 Card mri w/stress img & dye Q3 0337

75565 Card mri veloc flow mapping N 

75571 Ct hrt w/o dye w/ca testX 0340

75572 Ct hrt w/3d imageS 0383

75573 Ct hrt w/3d image congenS 0383

75574 Ct angio hrt w/3d imageS 0383

75600 Contrast x-ray exam of aorta Q2 0279

75605 Contrast x-ray exam of aorta Q2 0279

75625 Contrast x-ray exam of aorta Q2 0279

75630 X-ray aorta leg arteries Q2 0279

75635 Ct angio abdominal arteries Q2 0662

75650 Artery x-rays head & neck Q2 0280

75658 Artery x-rays arm Q2 0279

75660 Artery x-rays head & neck Q2 0280

75662 Artery x-rays head & neck Q2 0280

75665 Artery x-rays head & neck Q2 0279

75671 Artery x-rays head & neck Q2 0280

75676 Artery x-rays neck Q2 0279

75680 Artery x-rays neck Q2 0279

75685 Artery x-rays spine Q2 0279

75705 Artery x-rays spine Q2 0279

75710 Artery x-rays arm/leg Q2 0279

75716 Artery x-rays arms/legs Q2 0279

75722 Artery x-rays kidney Q2 0279

75724 Artery x-rays kidneys Q2 0279

75726 Artery x-rays abdomen Q2 0279

75731 Artery x-rays adrenal gland Q2 0279
75733 Artery x-rays adrenals Q2 0279

75736 Artery x-rays pelvis Q2 0279

75741 Artery x-rays lung Q2 0279

75743 Artery x-rays lungs Q2 0279

75746 Artery x-rays lung Q2 0668

75756 Artery x-rays chest Q2 0668

75774 Artery x-ray each vessel N 

75791 Av dialysis shunt imaging CH Q2 0668

75801 Lymph vessel x-ray arm/leg Q2 0317

75803 Lymph vessel x-ray arms/legs Q2 0317

75805 Lymph vessel x-ray trunk Q2 0317

75807 Lymph vessel x-ray trunk Q2 0317

75809 Nonvascular shunt x-ray Q2 0261

75810 Vein x-ray spleen/liver Q2 0279

75820 Vein x-ray arm/leg Q2 0668

75822 Vein x-ray arms/legs Q2 0668

75825 Vein x-ray trunk Q2 0279

75827 Vein x-ray chest Q2 0668

75831 Vein x-ray kidney Q2 0279

75833 Vein x-ray kidneys Q2 0279

75840 Vein x-ray adrenal gland Q2 0279

75842 Vein x-ray adrenal glands Q2 0279

75860 Vein x-ray neck Q2 0668

75870 Vein x-ray skull Q2 0668

75872 Vein x-ray skull Q2 0668

75880 Vein x-ray eye socket Q2 0668

75885 Vein x-ray liver Q2 0279

75887 Vein x-ray liver Q2 0668

75889 Vein x-ray liver Q2 0279

75891 Vein x-ray liver Q2 0279

75893 Venous sampling by catheter Q2 0279

75894 X-rays transcath therapyN

75896 X-rays transcath therapyN

75898 Follow-up angiography Q1 0261

75900 Intravascular cath exchangeC

75901 Remove cva device obstruct N 

75902 Remove cva lumen obstruct N 

75940 X-ray placement vein filter N 

75945 Intravascular us Q2 0267

75946 Intravascular us add-on N 

75952 Endovasc repair abdom aortaC

75953 Abdom aneurysm endovas rprC

75954 Iliac aneurysm endovas rprC

75956 Xray endovasc thor ao reprC

75957 Xray endovasc thor ao reprC

75958 Xray place prox ext thor aoC

75959 Xray place dist ext thor aoC

75960 Transcath iv stent rs&i N 

75961 Retrieval broken catheter N 

75962 Repair arterial blockage Q2 0083

75964 Repair artery blockage each N 

75966 Repair arterial blockage Q2 0083

75968 Repair artery blockage each N 

75970 Vascular biopsy N 

75978 Repair venous blockage Q2 0093
75980 Contrast xray exam bile duct N 

75982 Contrast xray exam bile duct N 

75984 Xray control catheter change N 

75989 Abscess drainage under x-rayN

76000 Fluoroscope examination Q1 0272

76001 Fluoroscope exam extensiveN

76010 X-ray nose to rectumX 0260

76080 X-ray exam of fistula Q2 0263

76098 X-ray exam breast specimen Q2 0317

76100 X-ray exam of body sectionX 0261

76101 Complex body section x-rayX 0263

76102 Complex body section x-raysX 0263

76120 Cine/video x-raysX 0272

76125 Cine/video x-rays add-on N 

76140 X-ray consultationE

76376 3d render w/o postprocess N 

76377 3d rendering w/postprocess N 

76380 CAT scan follow-up studyS 0282

76390 Mr spectroscopyE

76496 Fluoroscopic procedureX 0272

76497 Ct procedureS 0282

76498 Mri procedureS 0336

76499 Radiographic procedureX 0260

76506 Echo exam of headS 0265

76510 Ophth us b & quant aT 0232

76511 Ophth us quant a onlyS 0266

76512 Ophth us b w/non-quant aS 0266

76513 Echo exam of eye water bathS 0266

76514 Echo exam of eye thickness X 0035

76516 Echo exam of eyeS 0265

76519 Echo exam of eyeS 0266

76529 Echo exam of eyeS 0265

76536 Us exam of head and neckS 0266

76604 Us exam chest Q3 0265

76645 Us exam breast(s)S 0265

76700 Us exam abdom complete Q3 0266

76705 Echo exam of abdomen Q3 0266

76770 Us exam abdo back wall comp Q3 0266

76775 Us exam abdo back wall lim Q3 0266

76776 Us exam k transpl w/doppler Q3 0266

76800 Us exam spinal canalS 0266

76801 Ob us < 14 wks single fetusS 0266

76802 Ob us < 14 wks addl fetusS 0265

76805 Ob us >/= 14 wks sngl fetusS 0266

76810 Ob us >/= 14 wks addl fetusS 0266

76811 Ob us detailed sngl fetusS 0267

76812 Ob us detailed addl fetusS 0265

76813 Ob us nuchal meas 1 gest

S 0265

76814 Ob us nuchal meas add-on

S 0265

76815 Ob us limited fetus(s)S 0265

76816 Ob us follow-up per fetusS 0265

76817 Transvaginal us obstetricS 0265

76818 Fetal biophys profile w/nstS 0266

76819 Fetal biophys profil w/o nstS 0266

76820 Umbilical artery echoS 0265
76821 Middle cerebral artery echo

S 0265

76825 Echo exam of fetal heart CH S 0697

76826 Echo exam of fetal heart CH S 0697

76827 Echo exam of fetal heartS 0265

76828 Echo exam of fetal heartS 0265

76830 Transvaginal us non-obS 0266

76831 Echo exam uterus Q3 0267

76856 Us exam pelvic complete Q3 0266

76857 Us exam pelvic limited Q3 0265

76870 Us exam scrotum Q3 0266

76872 Us transrectalS 0266

76873 Echograp trans r pros studyS 0266

76881 Us xtr non-vasc completeS 0266

76882 Us xtr non-vasc lmtdS 0265

76885 Us exam infant hips dynamicS 0265

76886 Us exam infant hips staticS 0265

76930 Echo guide cardiocentesis N 

76932 Echo guide for heart biopsy N 

76936 Echo guide for artery repairS 0096

76937 Us guide vascular accessN

76940 Us guide tissue ablationN

76941 Echo guide for transfusion

N

76942 Echo guide for biopsy

N

76945 Echo guide villus sampling

N

76946 Echo guide for amniocentesis

N

76948 Echo guide ova aspiration

N

76950 Echo guidance radiotherapy

N

76965 Echo guidance radiotherapy

N

76970 Ultrasound exam follow-upS 0265

76975 GI endoscopic ultrasound Q2 0267

76977 Us bone density measureX 0340

76998 Us guide intraop N 

76999 Echo examination procedureS 0265

77001 Fluoroguide for vein device N 

77002 Needle localization by xray N 

77003 Fluoroguide for spine inject N 

77011 Ct scan for localization N 

77012 Ct scan for needle biopsy N 

77013 Ct guide for tissue ablation N 

77014 Ct scan for therapy guide N 

77021 Mr guidance for needle place N 

77022 Mri for tissue ablation N 

77031 Stereotact guide for brst bx N 

77032 Guidance for needle breast N 

77051 Computer dx mammogram add-on

A

77052 Comp screen mammogram add-on

A

77053 X-ray of mammary duct Q2 0263

77054 X-ray of mammary ducts Q2 0263

77055 Mammogram one breast

A

77056 Mammogram both breasts

A

77057 Mammogram screening

A

77058 Mri one breast

B

77059 Mri both breasts

B

77071 X-ray stress view X 0260

77072 X-rays for bone age X 0260
77073 X-rays bone length studies X 0260

77074 X-rays bone survey limited X 0261

77075 X-rays bone survey complete X 0261

77076 X-rays bone survey infant X 0261

77077 Joint survey single view X 0260

77078 Ct bone density axial

S 0288

77079 Ct bone density peripheral

S 0282

77080 Dxa bone density axial

S 0288

77081 Dxa bone density/peripheral

S 0665

77082 Dxa bone density vert fx X 0260

77083 Radiographic absorptiometry X 0261

77084 Magnetic image bone marrow S 0336

77261 Radiation therapy planningB

77262 Radiation therapy planningB

77263 Radiation therapy planningB

77280 Set radiation therapy fieldX 0304

77285 Set radiation therapy fieldX 0305

77290 Set radiation therapy fieldX 0305

77295 Set radiation therapy fieldX 0310

77299 Radiation therapy planningX 0304

77300 Radiation therapy dose planX 0304

77301 Radiotherapy dose plan imrtX 0310

77305 Teletx isodose plan simpleX 0304

77310 Teletx isodose plan intermedX 0304

77315 Teletx isodose plan complexX 0305

77321 Special teletx port planX 0305

77326 Brachytx isodose calc simpX 0304

77327 Brachytx isodose calc intermX 0305

77328 Brachytx isodose plan complX 0305

77331 Special radiation dosimetryX 0304

77332 Radiation treatment aid(s)X 0303

77333 Radiation treatment aid(s)X 0303

77334 Radiation treatment aid(s)X 0303

77336 Radiation physics consultX 0304

77338 Design mlc device for imrt CHX 0305

77370 Radiation physics consultX 0304

77371 Srs multisourceS 0127

77372 Srs linear basedB

77373 Sbrt deliveryB

77399 External radiation dosimetryX 0304

77401 Radiation treatment deliveryS 0300

77402 Radiation treatment deliveryS 0300

77403 Radiation treatment deliveryS 0300

77404 Radiation treatment deliveryS 0300

77406 Radiation treatment deliveryS 0300

77407 Radiation treatment deliveryS 0300

77408 Radiation treatment delivery CHS 0301

77409 Radiation treatment delivery CHS 0301

77411 Radiation treatment deliveryS 0301

77412 Radiation treatment deliveryS 0301

77413 Radiation treatment deliveryS 0301

77414 Radiation treatment deliveryS 0301

77416 Radiation treatment deliveryS 0301

77417 Radiology port film(s) N 

77418 Radiation tx delivery imrtS 0412
77421 Stereoscopic x-ray guidance

N

77422 Neutron beam tx simpleS 0301

77423 Neutron beam tx complexS 0301

77427 Radiation tx management x5B

77431 Radiation therapy managementB

77432 Stereotactic radiation trmtB

77435 Sbrt management N 

77470 Special radiation treatmentS 0299

77499 Radiation therapy managementB

77520 Proton trmt simple w/o compS 0664

77522 Proton trmt simple w/compS 0664

77523 Proton trmt intermediateS 0667

77525 Proton treatment complexS 0667

77600 Hyperthermia treatmentS 0299

77605 Hyperthermia treatmentS 0299

77610 Hyperthermia treatmentS 0299

77615 Hyperthermia treatmentS 0299

77620 Hyperthermia treatmentS 0299

77750 Infuse radioactive materialsS 0301

77761 Apply intrcav radiat simpleS 0312

77762 Apply intrcav radiat intermS 0312

77763 Apply intrcav radiat complS 0312

77776 Apply interstit radiat simplS 0312

77777 Apply interstit radiat interS 0312

77778 Apply interstit radiat compl Q3 0651

77785 Hdr brachytx 1 channelS 0313

77786 Hdr brachytx 2-12 channelS 0313

77787 Hdr brachytx over 12 chanS 0313

77789 Apply surface radiationS 0300

77790 Radiation handlingN

77799 Radium/radioisotope therapyS 0312

78000 Thyroid single uptakeS 0389

78001 Thyroid multiple uptakesS 0389

78003 Thyroid suppress/stimulS 0389

78006 Thyroid imaging with uptakeS 0391

78007 Thyroid image mult uptakesS 0391

78010 Thyroid imagingS 0390

78011 Thyroid imaging with flowS 0390

78015 Thyroid met imagingS 0406

78016 Thyroid met imaging/studiesS 0406

78018 Thyroid met imaging bodyS 0406

78020 Thyroid met uptake N 

78070 Parathyroid nuclear imagingS 0391

78075 Adrenal nuclear imaging CHS 0414

78099 Endocrine nuclear procedureS 0390

78102 Bone marrow imaging ltdS 0400

78103 Bone marrow imaging multS 0400

78104 Bone marrow imaging bodyS 0400

78110 Plasma volume singleS 0393

78111 Plasma volume multipleS 0393

78120 Red cell mass singleS 0393

78121 Red cell mass multipleS 0393

78122 Blood volumeS 0393

78130 Red cell survival studyS 0393

78135 Red cell survival kineticsS 0393
78140 Red cell sequestration

S 0393

78185 Spleen imagingS 0400

78190 Platelet survival kineticsS 0392

78191 Platelet survivalS 0392

78195 Lymph system imagingS 0400

78199 Blood/lymph nuclear examS 0400

78201 Liver imagingS 0394

78202 Liver imaging with flowS 0394

78205 Liver imaging (3D)S 0394

78206 Liver image (3d) with flowS 0394

78215 Liver and spleen imagingS 0394

78216 Liver & spleen image/flowS 0394

78220 Liver function studyS 0394

78223 Hepatobiliary imagingS 0394

78230 Salivary gland imagingS 0395

78231 Serial salivary imagingS 0395

78232 Salivary gland function examS 0395

78258 Esophageal motility studyS 0395

78261 Gastric mucosa imagingS 0395

78262 Gastroesophageal reflux examS 0395

78264 Gastric emptying studyS 0395

78267 Breath tst attain/anal c-14A

78268 Breath test analysis c-14A

78270 Vit B-12 absorption examS 0392

78271 Vit b-12 absrp exam int facS 0392

78272 Vit b-12 absorp combinedS 0392

78278 Acute GI blood loss imagingS 0395

78282 GI protein loss examS 0395

78290 Meckels divert examS 0395

78291 Leveen/shunt patency examS 0395

78299 GI nuclear procedureS 0395

78300 Bone imaging limited areaS 0396

78305 Bone imaging multiple areasS 0396

78306 Bone imaging whole bodyS 0396

78315 Bone imaging 3 phaseS 0396

78320 Bone imaging (3D)S 0396

78350 Bone mineral single photonE

78351 Bone mineral dual photonE

78399 Musculoskeletal nuclear examS 0396

78414 Non-imaging heart functionS 0398

78428 Cardiac shunt imagingS 0398

78445 Vascular flow imagingS 0397

78451 Ht muscle image spect singS 0377

78452 Ht muscle image spect multS 0377

78453 Ht muscle image planar singS 0377

78454 Ht musc image planar multS 0377

78456 Acute venous thrombus imageS 0397

78457 Venous thrombosis imagingS 0397

78458 Ven thrombosis images bilatS 0397

78459 Heart muscle imaging (PET)S 0307

78466 Heart infarct imageS 0398

78468 Heart infarct image (ef)S 0398

78469 Heart infarct image (3D)S 0398

78472 Gated heart planar singleS 0398

78473 Gated heart multipleS 0398
78481 Heart first pass single

S 0398

78483 Heart first pass multipleS 0398

78491 Heart image (pet) singleS 0307

78492 Heart image (pet) multipleS 0307

78494 Heart image spectS 0398

78496 Heart first pass add-on N 

78499 Cardiovascular nuclear examS 0398

78580 Lung perfusion imagingS 0401

78584 Lung V/Q image single breathS 0378

78585 Lung V/Q imagingS 0378

78586 Aerosol lung image singleS 0401

78587 Aerosol lung image multipleS 0401

78588 Perfusion lung imageS 0378

78591 Vent image 1 breath 1 projS 0401

78593 Vent image 1 proj gasS 0401

78594 Vent image mult proj gasS 0401

78596 Lung differential functionS 0378

78599 Respiratory nuclear examS 0401

78600 Brain image < 4 viewsS 0403

78601 Brain image w/flow < 4 viewsS 0402

78605 Brain image 4+ viewsS 0403

78606 Brain image w/flow 4 + viewsS 0402

78607 Brain imaging (3D)S 0402

78608 Brain imaging (PET)S 0308

78609 Brain imaging (PET)E

78610 Brain flow imaging onlyS 0403

78630 Cerebrospinal fluid scanS 0402

78635 CSF ventriculographyS 0402

78645 CSF shunt evaluationS 0403

78647 Cerebrospinal fluid scanS 0402

78650 CSF leakage imagingS 0402

78660 Nuclear exam of tear flowS 0403

78699 Nervous system nuclear examS 0403

78700 Kidney imaging morpholS 0404

78701 Kidney imaging with flowS 0404

78707 K flow/funct image w/o drugS 0404

78708 K flow/funct image w/drugS 0404

78709 K flow/funct image multipleS 0404

78710 Kidney imaging (3D)S 0404

78725 Kidney function studyS 0392

78730 Urinary bladder retentionS 0389

78740 Ureteral reflux studyS 0404

78761 Testicular imaging w/flowS 0404

78799 Genitourinary nuclear examS 0404

78800 Tumor imaging limited areaS 0406

78801 Tumor imaging mult areasS 0414

78802 Tumor imaging whole bodyS 0414

78803 Tumor imaging (3D)S 0414

78804 Tumor imaging whole bodyS 0408

78805 Abscess imaging ltd areaS 0414

78806 Abscess imaging whole bodyS 0414

78807 Nuclear localization/abscessS 0414

78808 Iv inj ra drug dx study Q1 0392

78811 Pet image ltd areaS 0308

78812 Pet image skull-thighS 0308
78813 Pet image full body

S 0308

78814 Pet image w/ct lmtdS 0308

78815 Pet image w/ct skull-thighS 0308

78816 Pet image w/ct full bodyS 0308

78999 Nuclear diagnostic examS 0389

79005 Nuclear rx oral adminS 0407

79101 Nuclear rx iv adminS 0407

79200 Nuclear rx intracav adminS 0413

79300 Nuclr rx interstit colloidS 0407

79403 Hematopoietic nuclear txS 0413

79440 Nuclear rx intra-articularS 0413

79445 Nuclear rx intra-arterialS 0407

79999 Nuclear medicine therapyS 0407

80047 Metabolic panel ionized caA

80048 Metabolic panel total caA

80050 General health panelE

80051 Electrolyte panelA

80053 Comprehen metabolic panelA

80055 Obstetric panelE

80061 Lipid panelA

80069 Renal function panelA

80074 Acute hepatitis panelA

80076 Hepatic function panelA

80100 Drug screen qualitate/multiE

80101 Drug screen singleE

80102 Drug confirmationA

80103 Drug analysis tissue prepN

80104 Drug scrn 1+ class nonchromoE

80150 Assay of amikacinA

80152 Assay of amitriptylineA

80154 Assay of benzodiazepinesA

80156 Assay carbamazepine totalA

80157 Assay carbamazepine freeA

80158 Assay of cyclosporineA

80160 Assay of desipramineA

80162 Assay of digoxinA

80164 Assay dipropylacetic acidA

80166 Assay of doxepinA

80168 Assay of ethosuximideA

80170 Assay of gentamicinA

80172 Assay of goldA

80173 Assay of haloperidolA

80174 Assay of imipramineA

80176 Assay of lidocaineA

80178 Assay of lithiumA

80182 Assay of nortriptylineA

80184 Assay of phenobarbitalA

80185 Assay of phenytoin totalA

80186 Assay of phenytoin freeA

80188 Assay of primidoneA

80190 Assay of procainamideA

80192 Assay of procainamideA

80194 Assay of quinidineA

80195 Assay of sirolimusA

80196 Assay of salicylateA
80197 Assay of tacrolimus

A

80198 Assay of theophyllineA

80200 Assay of tobramycinA

80201 Assay of topiramateA

80202 Assay of vancomycinA

80299 Quantitative assay drugA

80400 Acth stimulation panelA

80402 Acth stimulation panelA

80406 Acth stimulation panelA

80408 Aldosterone suppression evalA

80410 Calcitonin stimul panelA

80412 CRH stimulation panelA

80414 Testosterone responseA

80415 Estradiol response panelA

80416 Renin stimulation panelA

80417 Renin stimulation panelA

80418 Pituitary evaluation panelA

80420 Dexamethasone panelA

80422 Glucagon tolerance panelA

80424 Glucagon tolerance panelA

80426 Gonadotropin hormone panelA

80428 Growth hormone panelA

80430 Growth hormone panelA

80432 Insulin suppression panelA

80434 Insulin tolerance panelA

80435 Insulin tolerance panelA

80436 Metyrapone panelA

80438 TRH stimulation panelA

80439 TRH stimulation panelA

80440 TRH stimulation panelA

80500 Lab pathology consultation CHX 0342

80502 Lab pathology consultationX 0342

81000 Urinalysis nonauto w/scopeA

81001 Urinalysis auto w/scopeA

81002 Urinalysis nonauto w/o scopeA

81003 Urinalysis auto w/o scopeA

81005 UrinalysisA

81007 Urine screen for bacteriaA

81015 Microscopic exam of urineA

81020 Urinalysis glass testA

81025 Urine pregnancy testA

81050 Urinalysis volume measureA

81099 Urinalysis test procedureA

82000 Assay of blood acetaldehydeA

82003 Assay of acetaminophenA

82009 Test for acetone/ketonesA

82010 Acetone assayA

82013 Acetylcholinesterase assayA

82016 Acylcarnitines qualA

82017 Acylcarnitines quantA

82024 Assay of acthA

82030 Assay of adp & ampA

82040 Assay of serum albuminA

82042 Assay of urine albuminA

82043 Microalbumin quantitativeA
82044 Microalbumin semiquant

A

82045 Albumin ischemia modifiedA

82055 Assay of ethanolA

82075 Assay of breath ethanolA

82085 Assay of aldolaseA

82088 Assay of aldosteroneA

82101 Assay of urine alkaloidsA

82103 Alpha-1-antitrypsin totalA

82104 Alpha-1-antitrypsin phenoA

82105 Alpha-fetoprotein serumA

82106 Alpha-fetoprotein amnioticA

82107 Alpha-fetoprotein l3A

82108 Assay of aluminumA

82120 Amines vaginal fluid qualA

82127 Amino acid single qualA

82128 Amino acids mult qualA

82131 Amino acids single quantA

82135 Assay aminolevulinic acidA

82136 Amino acids quant 2-5A

82139 Amino acids quan 6 or moreA

82140 Assay of ammoniaA

82143 Amniotic fluid scanA

82145 Assay of amphetaminesA

82150 Assay of amylaseA

82154 Androstanediol glucuronideA

82157 Assay of androstenedioneA

82160 Assay of androsteroneA

82163 Assay of angiotensin IIA

82164 Angiotensin I enzyme testA

82172 Assay of apolipoproteinA

82175 Assay of arsenicA

82180 Assay of ascorbic acidA

82190 Atomic absorptionA

82205 Assay of barbituratesA

82232 Assay of beta-2 proteinA

82239 Bile acids totalA

82240 Bile acids cholylglycineA

82247 Bilirubin totalA

82248 Bilirubin directA

82252 Fecal bilirubin testA

82261 Assay of biotinidaseA

82270 Occult blood fecesA

82271 Occult blood other sourcesA

82272 Occult bld feces 1-3 testsA

82274 Assay test for blood fecalA

82286 Assay of bradykininA

82300 Assay of cadmiumA

82306 Vitamin d 25 hydroxyA

82308 Assay of calcitoninA

82310 Assay of calciumA

82330 Assay of calciumA

82331 Calcium infusion testA

82340 Assay of calcium in urineA

82355 Calculus analysis qualA

82360 Calculus assay quantA
82365 Calculus spectroscopy

A

82370 X-ray assay calculusA

82373 Assay c-d transfer measureA

82374 Assay blood carbon dioxideA

82375 Assay carboxyhb quantA

82376 Assay carboxyhb qualA

82378 Carcinoembryonic antigenA

82379 Assay of carnitineA

82380 Assay of caroteneA

82382 Assay urine catecholaminesA

82383 Assay blood catecholaminesA

82384 Assay three catecholaminesA

82387 Assay of cathepsin-dA

82390 Assay of ceruloplasminA

82397 Chemiluminescent assayA

82415 Assay of chloramphenicolA

82435 Assay of blood chlorideA

82436 Assay of urine chlorideA

82438 Assay other fluid chloridesA

82441 Test for chlorohydrocarbonsA

82465 Assay bld/serum cholesterolA

82480 Assay serum cholinesteraseA

82482 Assay rbc cholinesteraseA

82485 Assay chondroitin sulfateA

82486 Gas/liquid chromatographyA

82487 Paper chromatographyA

82488 Paper chromatographyA

82489 Thin layer chromatographyA

82491 Chromotography quant singA

82492 Chromotography quant multA

82495 Assay of chromiumA

82507 Assay of citrateA

82520 Assay of cocaineA

82523 Collagen crosslinksA

82525 Assay of copperA

82528 Assay of corticosteroneA

82530 Cortisol freeA

82533 Total cortisolA

82540 Assay of creatineA

82541 Column chromotography qualA

82542 Column chromotography quantA

82543 Column chromotograph/isotopeA

82544 Column chromotograph/isotopeA

82550 Assay of ck (cpk)A

82552 Assay of cpk in bloodA

82553 Creatine mb fractionA

82554 Creatine isoformsA

82565 Assay of creatinineA

82570 Assay of urine creatinineA

82575 Creatinine clearance testA

82585 Assay of cryofibrinogenA

82595 Assay of cryoglobulinA

82600 Assay of cyanideA

82607 Vitamin B-12A

82608 B-12 binding capacityA
82610 Cystatin c

A

82615 Test for urine cystinesA

82626 DehydroepiandrosteroneA

82627 DehydroepiandrosteroneA

82633 DesoxycorticosteroneA

82634 DeoxycortisolA

82638 Assay of dibucaine numberA

82646 Assay of dihydrocodeinoneA

82649 Assay of dihydromorphinoneA

82651 Assay of dihydrotestosteroneA

82652 Vit d 1 25-dihydroxyA

82654 Assay of dimethadioneA

82656 Pancreatic elastase fecal

A

82657 Enzyme cell activityA

82658 Enzyme cell activity raA

82664 Electrophoretic testA

82666 Assay of epiandrosteroneA

82668 Assay of erythropoietinA

82670 Assay of estradiolA

82671 Assay of estrogensA

82672 Assay of estrogenA

82677 Assay of estriolA

82679 Assay of estroneA

82690 Assay of ethchlorvynolA

82693 Assay of ethylene glycolA

82696 Assay of etiocholanoloneA

82705 Fats/lipids feces qualA

82710 Fats/lipids feces quantA

82715 Assay of fecal fatA

82725 Assay of blood fatty acidsA

82726 Long chain fatty acidsA

82728 Assay of ferritinA

82731 Assay of fetal fibronectinA

82735 Assay of fluorideA

82742 Assay of flurazepamA

82746 Blood folic acid serumA

82747 Assay of folic acid rbcA

82757 Assay of semen fructoseA

82759 Assay of rbc galactokinaseA

82760 Assay of galactoseA

82775 Assay galactose transferaseA

82776 Galactose transferase testA

82784 Assay iga/igd/igg/igm eachA

82785 Assay of igeA

82787 Igg 1 2 3 or 4 eachA

82800 Blood pHA

82803 Blood gases any combinationA

82805 Blood gases w/o2 saturationA

82810 Blood gases o2 sat onlyA

82820 Hemoglobin-oxygen affinityA

82930 Gastric analy w/ph ea specA

82938 Gastrin testA

82941 Assay of gastrinA

82943 Assay of glucagonA

82945 Glucose other fluidA
82946 Glucagon tolerance test

A

82947 Assay glucose blood quantA

82948 Reagent strip/blood glucoseA

82950 Glucose testA

82951 Glucose tolerance test (GTT)A

82952 GTT-added samplesA

82953 Glucose-tolbutamide testA

82955 Assay of g6pd enzymeA

82960 Test for G6PD enzymeA

82962 Glucose blood testA

82963 Assay of glucosidaseA

82965 Assay of gdh enzymeA

82975 Assay of glutamineA

82977 Assay of GGTA

82978 Assay of glutathioneA

82979 Assay rbc glutathioneA

82980 Assay of glutethimideA

82985 Glycated proteinA

83001 Gonadotropin (FSH)A

83002 Gonadotropin (LH)A

83003 Assay growth hormone (hgh)A

83008 Assay of guanosineA

83009 H pylori (c-13) blood

A

83010 Assay of haptoglobin quantA

83012 Assay of haptoglobinsA

83013 H pylori (c-13) breathA

83014 H pylori drug adminA

83015 Heavy metal screenA

83018 Quantitative screen metalsA

83020 Hemoglobin electrophoresisA

83021 Hemoglobin chromotographyA

83026 Hemoglobin copper sulfateA

83030 Fetal hemoglobin chemicalA

83033 Fetal hemoglobin assay qualA

83036 Glycosylated hemoglobin testA

83037 Glycosylated hb home deviceA

83045 Blood methemoglobin testA

83050 Blood methemoglobin assayA

83051 Assay of plasma hemoglobinA

83055 Blood sulfhemoglobin testA

83060 Blood sulfhemoglobin assayA

83065 Assay of hemoglobin heatA

83068 Hemoglobin stability screenA

83069 Assay of urine hemoglobinA

83070 Assay of hemosiderin qualA

83071 Assay of hemosiderin quantA

83080 Assay of b hexosaminidaseA

83088 Assay of histamineA

83090 Assay of homocystineA

83150 Assay of for hvaA

83491 Assay of corticosteroidsA

83497 Assay of 5-hiaaA

83498 Assay of progesteroneA

83499 Assay of progesteroneA

83500 Assay free hydroxyprolineA
83505 Assay total hydroxyproline

A

83516 Immunoassay nonantibodyA

83518 Immunoassay dipstickA

83519 Ria nonantibodyA

83520 Immunoassay quant nos nonabA

83525 Assay of insulinA

83527 Assay of insulinA

83528 Assay of intrinsic factorA

83540 Assay of ironA

83550 Iron binding testA

83570 Assay of idh enzymeA

83582 Assay of ketogenic steroidsA

83586 Assay 17- ketosteroidsA

83593 Fractionation ketosteroidsA

83605 Assay of lactic acidA

83615 Lactate (LD) (LDH) enzymeA

83625 Assay of ldh enzymesA

83630 Lactoferrin fecal (qual)

A

83631 Lactoferrin fecal (quant)

A

83632 Placental lactogenA

83633 Test urine for lactoseA

83634 Assay of urine for lactoseA

83655 Assay of leadA

83661 L/s ratio fetal lungA

83662 Foam stability fetal lungA

83663 Fluoro polarize fetal lungA

83664 Lamellar bdy fetal lungA

83670 Assay of lap enzymeA

83690 Assay of lipaseA

83695 Assay of lipoprotein(a)A

83698 Assay lipoprotein pla2A

83700 Lipopro bld electrophoreticA

83701 Lipoprotein bld hr fractionA

83704 Lipoprotein bld by nmrA

83718 Assay of lipoproteinA

83719 Assay of blood lipoproteinA

83721 Assay of blood lipoproteinA

83727 Assay of lrh hormoneA

83735 Assay of magnesiumA

83775 Assay of md enzymeA

83785 Assay of manganeseA

83788 Mass spectrometry qualA

83789 Mass spectrometry quantA

83805 Assay of meprobamateA

83825 Assay of mercuryA

83835 Assay of metanephrinesA

83840 Assay of methadoneA

83857 Assay of methemalbuminA

83858 Assay of methsuximideA

83861 Microfluid analy tearsA

83864 MucopolysaccharidesA

83866 Mucopolysaccharides screenA

83872 Assay synovial fluid mucinA

83873 Assay of csf proteinA

83874 Assay of myoglobinA
83876 Assay myeloperoxidase

A

83880 Natriuretic peptideA

83883 Assay nephelometry not specA

83885 Assay of nickelA

83887 Assay of nicotineA

83890 Molecule isolateA

83891 Molecule isolate nucleicA

83892 Molecular diagnosticsA

83893 Molecule dot/slot/blotA

83894 Molecule gel electrophorA

83896 Molecular diagnosticsA

83897 Molecule nucleic transferA

83898 Molecule nucleic ampli eachA

83900 Molecule nucleic ampli 2 seqA

83901 Molecule nucleic ampli addonA

83902 Molecular diagnosticsA

83903 Molecule mutation scanA

83904 Molecule mutation identifyA

83905 Molecule mutation identifyA

83906 Molecule mutation identifyA

83907 Lyse cells for nucleic extA

83908 Nucleic acid signal ampliA

83909 Nucleic acid high resoluteA

83912 Genetic examinationA

83913 Molecular rna stabilizationA

83914 Mutation ident ola/sbce/aspeA

83915 Assay of nucleotidaseA

83916 Oligoclonal bandsA

83918 Organic acids total quantA

83919 Organic acids qual eachA

83921 Organic acid single quantA

83925 Assay of opiatesA

83930 Assay of blood osmolalityA

83935 Assay of urine osmolalityA

83937 Assay of osteocalcinA

83945 Assay of oxalateA

83950 Oncoprotein her-2/neuA

83951 Oncoprotein dcpA

83970 Assay of parathormoneA

83986 Assay ph body fluid nosA

83987 Exhaled breath condensateA

83992 Assay for phencyclidineA

83993 Assay for calprotectin fecalA

84022 Assay of phenothiazineA

84030 Assay of blood pkuA

84035 Assay of phenylketonesA

84060 Assay acid phosphataseA

84061 Phosphatase forensic examA

84066 Assay prostate phosphataseA

84075 Assay alkaline phosphataseA

84078 Assay alkaline phosphataseA

84080 Assay alkaline phosphatasesA

84081 Amniotic fluid enzyme testA

84085 Assay of rbc pg6d enzymeA

84087 Assay phosphohexose enzymesA
84100 Assay of phosphorus

A

84105 Assay of urine phosphorusA

84106 Test for porphobilinogenA

84110 Assay of porphobilinogenA

84112 Placenta alpha micro ig c/vA

84119 Test urine for porphyrinsA

84120 Assay of urine porphyrinsA

84126 Assay of feces porphyrinsA

84127 Assay of feces porphyrinsA

84132 Assay of serum potassiumA

84133 Assay of urine potassiumA

84134 Assay of prealbuminA

84135 Assay of pregnanediolA

84138 Assay of pregnanetriolA

84140 Assay of pregnenoloneA

84143 Assay of 17-hydroxypregnenoA

84144 Assay of progesteroneA

84145 Procalcitonin (pct)A

84146 Assay of prolactinA

84150 Assay of prostaglandinA

84152 Assay of psa complexedA

84153 Assay of psa totalA

84154 Assay of psa freeA

84155 Assay of protein serumA

84156 Assay of protein urineA

84157 Assay of protein otherA

84160 Assay of protein any sourceA

84163 Pappa serum

A

84165 Protein e-phoresis serumA

84166 Protein e-phoresis/urine/csf

A

84181 Western blot testA

84182 Protein western blot testA

84202 Assay RBC protoporphyrinA

84203 Test RBC protoporphyrinA

84206 Assay of proinsulinA

84207 Assay of vitamin b-6A

84210 Assay of pyruvateA

84220 Assay of pyruvate kinaseA

84228 Assay of quinineA

84233 Assay of estrogenA

84234 Assay of progesteroneA

84235 Assay of endocrine hormoneA

84238 Assay nonendocrine receptorA

84244 Assay of reninA

84252 Assay of vitamin b-2A

84255 Assay of seleniumA

84260 Assay of serotoninA

84270 Assay of sex hormone globulA

84275 Assay of sialic acidA

84285 Assay of silicaA

84295 Assay of serum sodiumA

84300 Assay of urine sodiumA

84302 Assay of sweat sodiumA

84305 Assay of somatomedinA

84307 Assay of somatostatinA
84311 Spectrophotometry

A

84315 Body fluid specific gravityA

84375 Chromatogram assay sugarsA

84376 Sugars single qualA

84377 Sugars multiple qualA

84378 Sugars single quantA

84379 Sugars multiple quantA

84392 Assay of urine sulfateA

84402 Assay of testosteroneA

84403 Assay of total testosteroneA

84425 Assay of vitamin b-1A

84430 Assay of thiocyanateA

84431 Thromboxane urineA

84432 Assay of thyroglobulinA

84436 Assay of total thyroxineA

84437 Assay of neonatal thyroxineA

84439 Assay of free thyroxineA

84442 Assay of thyroid activityA

84443 Assay thyroid stim hormoneA

84445 Assay of tsiA

84446 Assay of vitamin eA

84449 Assay of transcortinA

84450 Transferase (AST) (SGOT)A

84460 Alanine amino (ALT) (SGPT)A

84466 Assay of transferrinA

84478 Assay of triglyceridesA

84479 Assay of thyroid (t3 or t4)A

84480 Assay triiodothyronine (t3)A

84481 Free assay (FT-3)A

84482 T3 reverseA

84484 Assay of troponin quantA

84485 Assay duodenal fluid trypsinA

84488 Test feces for trypsinA

84490 Assay of feces for trypsinA

84510 Assay of tyrosineA

84512 Assay of troponin qualA

84520 Assay of urea nitrogenA

84525 Urea nitrogen semi-quantA

84540 Assay of urine/urea-nA

84545 Urea-N clearance testA

84550 Assay of blood/uric acidA

84560 Assay of urine/uric acidA

84577 Assay of feces/urobilinogenA

84578 Test urine urobilinogenA

84580 Assay of urine urobilinogenA

84583 Assay of urine urobilinogenA

84585 Assay of urine vmaA

84586 Assay of vipA

84588 Assay of vasopressinA

84590 Assay of vitamin aA

84591 Assay of nos vitaminA

84597 Assay of vitamin kA

84600 Assay of volatilesA

84620 Xylose tolerance testA

84630 Assay of zincA
84681 Assay of c-peptide

A

84702 Chorionic gonadotropin testA

84703 Chorionic gonadotropin assayA

84704 Hcg free betachain testA

84830 Ovulation testsA

84999 Clinical chemistry testA

85002 Bleeding time testA

85004 Automated diff wbc countA

85007 Bl smear w/diff wbc countA

85008 Bl smear w/o diff wbc countA

85009 Manual diff wbc count b-coatA

85013 Spun microhematocritA

85014 HematocritA

85018 HemoglobinA

85025 Complete cbc w/auto diff wbcA

85027 Complete cbc automatedA

85032 Manual cell count eachA

85041 Automated rbc countA

85044 Manual reticulocyte countA

85045 Automated reticulocyte countA

85046 Reticyte/hgb concentrateA

85048 Automated leukocyte countA

85049 Automated platelet countA

85055 Reticulated platelet assayA

85060 Blood smear interpretationB

85097 Bone marrow interpretationX 0343

85130 Chromogenic substrate assayA

85170 Blood clot retractionA

85175 Blood clot lysis timeA

85210 Blood clot factor II testA

85220 Blood clot factor V testA

85230 Blood clot factor VII testA

85240 Blood clot factor VIII testA

85244 Blood clot factor VIII testA

85245 Blood clot factor VIII testA

85246 Blood clot factor VIII testA

85247 Blood clot factor VIII testA

85250 Blood clot factor IX testA

85260 Blood clot factor X testA

85270 Blood clot factor XI testA

85280 Blood clot factor XII testA

85290 Blood clot factor XIII testA

85291 Blood clot factor XIII testA

85292 Blood clot factor assayA

85293 Blood clot factor assayA

85300 Antithrombin III testA

85301 Antithrombin III testA

85302 Blood clot inhibitor antigenA

85303 Blood clot inhibitor testA

85305 Blood clot inhibitor assayA

85306 Blood clot inhibitor testA

85307 Assay activated protein cA

85335 Factor inhibitor testA

85337 ThrombomodulinA

85345 Coagulation timeA
85347 Coagulation tim

eA

85348 Coagulation timeA

85360 Euglobulin lysisA

85362 Fibrin degradation productsA

85366 Fibrinogen testA

85370 Fibrinogen testA

85378 Fibrin degrade semiquantA

85379 Fibrin degradation quantA

85380 Fibrin degradation vteA

85384 FibrinogenA

85385 FibrinogenA

85390 Fibrinolysins screenA

85396 Clotting assay whole blood

N

85397 Clotting funct activityA

85400 Fibrinolytic plasminA

85410 Fibrinolytic antiplasminA

85415 Fibrinolytic plasminogenA

85420 Fibrinolytic plasminogenA

85421 Fibrinolytic plasminogenA

85441 Heinz bodies directA

85445 Heinz bodies inducedA

85460 Hemoglobin fetalA

85461 Hemoglobin fetalA

85475 HemolysinA

85520 Heparin assayA

85525 Heparin neutralizationA

85530 Heparin-protamine toleranceA

85536 Iron stain peripheral bloodA

85540 Wbc alkaline phosphataseA

85547 RBC mechanical fragilityA

85549 MuramidaseA

85555 RBC osmotic fragilityA

85557 RBC osmotic fragilityA

85576 Blood platelet aggregationA

85597 Phospholipid pltlt neutralizA

85598 Hexagnal phosph pltlt neutrlA

85610 Prothrombin timeA

85611 Prothrombin testA

85612 Viper venom prothrombin timeA

85613 Russell viper venom dilutedA

85635 Reptilase testA

85651 Rbc sed rate nonautomatedA

85652 Rbc sed rate automatedA

85660 RBC sickle cell testA

85670 Thrombin time plasmaA

85675 Thrombin time titerA

85705 Thromboplastin inhibitionA

85730 Thromboplastin time partialA

85732 Thromboplastin time partialA

85810 Blood viscosity examinationA

85999 Hematology procedureA

86000 Agglutinins febrileA

86001 Allergen specific iggA

86003 Allergen specific IgEA

86005 Allergen specific IgEA
86021 WBC antibody identification

A

86022 Platelet antibodiesA

86023 Immunoglobulin assayA

86038 Antinuclear antibodiesA

86039 Antinuclear antibodies (ANA)A

86060 Antistreptolysin o titerA

86063 Antistreptolysin o screenA

86077 Physician blood bank service CHX 0342

86078 Physician blood bank serviceX 0343

86079 Physician blood bank service CHX 0342

86140 C-reactive proteinA

86141 C-reactive protein hsA

86146 Glycoprotein antibodyA

86147 Cardiolipin antibodyA

86148 Phospholipid antibodyA

86155 Chemotaxis assayA

86156 Cold agglutinin screenA

86157 Cold agglutinin titerA

86160 Complement antigenA

86161 Complement/function activityA

86162 Complement total (ch50)A

86171 Complement fixation eachA

86185 CounterimmunoelectrophoresisA

86200 Ccp antibodyA

86215 Deoxyribonuclease antibodyA

86225 DNA antibodyA

86226 Dna antibody single strandA

86235 Nuclear antigen antibodyA

86243 Fc receptorA

86255 Fluorescent antibody screenA

86256 Fluorescent antibody titerA

86277 Growth hormone antibodyA

86280 Hemagglutination inhibitionA

86294 Immunoassay tumor qualA

86300 Immunoassay tumor ca 15-3A

86301 Immunoassay tumor ca 19-9A

86304 Immunoassay tumor ca 125A

86305 Human epididymis protein 4A

86308 Heterophile antibodiesA

86309 Heterophile antibodiesA

86310 Heterophile antibodiesA

86316 Immunoassay tumor otherA

86317 Immunoassay infectious agentA

86318 Immunoassay infectious agentA

86320 Serum immunoelectrophoresisA

86325 Other immunoelectrophoresisA

86327 Immunoelectrophoresis assayA

86329 ImmunodiffusionA

86331 Immunodiffusion ouchterlonyA

86332 Immune complex assayA

86334 Immunofix e-phoresis serumA

86335 Immunfix e-phorsis/urine/csfA

86336 Inhibin AA

86337 Insulin antibodiesA

86340 Intrinsic factor antibodyA
86341 Islet cell antibody

A

86343 Leukocyte histamine releaseA

86344 Leukocyte phagocytosisA

86352 Cell function assay w/stimA

86353 Lymphocyte transformationA

86355 B cells total countA

86356 Mononuclear cell antigenA

86357 Nk cells total countA

86359 T cells total countA

86360 T cell absolute count/ratioA

86361 T cell absolute countA

86367 Stem cells total countA

86376 Microsomal antibodyA

86378 Migration inhibitory factorA

86382 Neutralization test viralA

86384 Nitroblue tetrazolium dy

e

A

86403 Particle agglutination testA

86406 Particle agglutination testA

86430 Rheumatoid factor testA

86431 Rheumatoid factor quantA

86480 Tb test cell immun measureA

86481 Tb ag response t-cell suspA

86485 Skin test candidaX 0341

86486 Skin test nos antigenX 0341

86490 Coccidioidomycosis skin testX 0341

86510 Histoplasmosis skin testX 0341

86580 TB intradermal testX 0341

86590 Streptokinase antibody

A

86592 Syphilis test non-trep qual

A

86593 Syphilis test non-trep quant

A

86602 Antinomyces antibody

A

86603 Adenovirus antibody

A

86606 Aspergillus antibody

A

86609 Bacterium antibody

A

86611 Bartonella antibody

A

86612 Blastomyces antibody

A

86615 Bordetella antibody

A

86617 Lyme disease antibody

A

86618 Lyme disease antibody

A

86619 Borrelia antibody

A

86622 Brucella antibody

A

86625 Campylobacter antibody

A

86628 Candida antibody

A

86631 Chlamydia antibody

A

86632 Chlamydia igm antibody

A

86635 Coccidioides antibody

A

86638 Q fever antibody

A

86641 Cryptococcus antibody

A

86644 CMV antibody

A

86645 Cmv antibody igm

A

86648 Diphtheria antibody

A

86651 Encephalitis antibody

A

86652 Encephalitis antibody

A

86653 Encephalitis antibody

A

86654 Encephalitis antibody

A
86658 Enterovirus antibody

A

86663 Epstein-barr antibody

A

86664 Epstein-barr antibody

A

86665 Epstein-barr antibody

A

86666 Ehrlichia antibody

A

86668 Francisella tularensis

A

86671 Fungus antibody

A

86674 Giardia lamblia antibody

A

86677 Helicobacter pylori

A

86682 Helminth antibody

A

86684 Hemophilus influenza

A

86687 Htlv-i antibody

A

86688 Htlv-ii antibody

A

86689 HTLV/HIV confirmatory test

A

86692 Hepatitis delta agent

A

86694 Herpes simplex test

A

86695 Herpes simplex test

A

86696 Herpes simplex type 2

A

86698 Histoplasma

A

86701 HIV-1

A

86702 HIV-2

A

86703 Hiv-1/hiv-2 single assay

A

86704 Hep b core antibody total

A

86705 Hep b core antibody igm

A

86706 Hep b surface antibody

A

86707 Hep be antibody

A

86708 Hep a antibody total

A

86709 Hep a antibody igm

A

86710 Influenza virus antibody

A

86713 Legionella antibody

A

86717 Leishmania antibody

A

86720 Leptospira antibody

A

86723 Listeria monocytogenes ab

A

86727 Lymph choriomeningitis ab

A

86729 Lympho venereum antibody

A

86732 Mucormycosis antibody

A

86735 Mumps antibody

A

86738 Mycoplasma antibody

A

86741 Neisseria meningitidis

A

86744 Nocardia antibody

A

86747 Parvovirus antibody

A

86750 Malaria antibody

A

86753 Protozoa antibody nos

A

86756 Respiratory virus antibody

A

86757 Rickettsia antibody

A

86759 Rotavirus antibody

A

86762 Rubella antibody

A

86765 Rubeola antibody

A

86768 Salmonella antibody

A

86771 Shigella antibody

A

86774 Tetanus antibody

A

86777 Toxoplasma antibody

A

86778 Toxoplasma antibody igm

A

86780 Treponema pallidum

A

86784 Trichinella antibody

A
86787 Varicella-zoster antibody

A

86788 West nile virus ab igm

A

86789 West nile virus antibody

A

86790 Virus antibody nos

A

86793 Yersinia antibody

A

86800 Thyroglobulin antibody

A

86803 Hepatitis c ab test

A

86804 Hep c ab test confirm

A

86805 Lymphocytotoxicity assay

A

86806 Lymphocytotoxicity assay

A

86807 Cytotoxic antibody screening

A

86808 Cytotoxic antibody screening

A

86812 Hla typing a b or c

A

86813 Hla typing a b or c

A

86816 Hla typing dr/dq

A

86817 Hla typing dr/dq

A

86821 Lymphocyte culture mixed

A

86822 Lymphocyte culture primed

A

86825 Hla x-math non-cytotoxic

A

86826 Hla x-match noncytotoxc addl

A

86849 Immunology procedure

A

86850 RBC antibody screenX 0345

86860 RBC antibody elutionX 0346

86870 RBC antibody identificationX 0346

86880 Coombs test directX 0409

86885 Coombs test indirect qualX 0409

86886 Coombs test indirect titerX 0409

86890 Autologous blood processX 0347

86891 Autologous blood op salvageX 0345

86900 Blood typing aboX 0409

86901 Blood typing rh (d)X 0409

86902 Blood type antigen donor eaX 0345

86904 Blood typing patient serumX 0345

86905 Blood typing rbc antigensX 0345

86906 Blood typing rh phenotypeX 0345

86910 Blood typing paternity testE

86911 Blood typing antigen systemE

86920 Compatibility test spinX 0345

86921 Compatibility test incubateX 0345

86922 Compatibility test antiglobX 0346

86923 Compatibility test electricX 0345

86927 Plasma fresh frozenX 0345

86930 Frozen blood prepX 0347

86931 Frozen blood thawX 0347

86932 Frozen blood freeze/thawX 0347

86940 Hemolysins/agglutinins autoA

86941 Hemolysins/agglutininsA

86945 Blood product/irradiationX 0345

86950 Leukacyte transfusionX 0345

86960 Vol reduction of blood/prodX 0345

86965 Pooling blood plateletsX 0346

86970 RBC pretreatmentX 0345

86971 RBC pretreatmentX 0345

86972 RBC pretreatmentX 0345

86975 Rbc pretreatment serumX 0346
86976 Rbc pretreatment serum

X 0345

86977 Rbc pretreatment serumX 0347

86978 Rbc pretreatment serumX 0346

86985 Split blood or productsX 0345

86999 Transfusion procedureX 0345

87001 Small animal inoculationA

87003 Small animal inoculationA

87015 Specimen concentrationA

87040 Blood culture for bacteriaA

87045 Feces culture bacteriaA

87046 Stool cultr bacteria eachA

87070 Culture bacteria otherA

87071 Culture bacteri aerobic othrA

87073 Culture bacteria anaerobicA

87075 Cultr bacteria except bloodA

87076 Culture anaerobe ident eachA

87077 Culture aerobic identifyA

87081 Culture screen onlyA

87084 Culture of specimen by kitA

87086 Urine culture/colony countA

87088 Urine bacteria cultureA

87101 Skin fungi cultureA

87102 Fungus isolation cultureA

87103 Blood fungus cultureA

87106 Fungi identification yeastA

87107 Fungi identification moldA

87109 MycoplasmaA

87110 Chlamydia cultureA

87116 Mycobacteria cultureA

87118 Mycobacteric identificationA

87140 Culture type immunofluorescA

87143 Culture typing glc/hplcA

87147 Culture type immunologicA

87149 Dna/rna direct probeA

87150 Dna/rna amplified probeA

87152 Culture type pulse field gelA

87153 Dna/rna sequencingA

87158 Culture typing added methodA

87164 Dark field examinationA

87166 Dark field examinationA

87168 Macroscopic exam arthropodA

87169 Macroscopic exam parasiteA

87172 Pinworm examA

87176 Tissue homogenization cultrA

87177 Ova and parasites smearsA

87181 Microbe susceptible diffuseA

87184 Microbe susceptible diskA

87185 Microbe susceptible enzymeA

87186 Microbe susceptible micA

87187 Microbe susceptible mlcA

87188 Microbe suscept macrobrothA

87190 Microbe suscept mycobacteriA

87197 Bactericidal level serumA

87205 Smear gram stainA

87206 Smear fluorescent/acid staiA
87207 Smear special stain

A

87209 Smear complex stainA

87210 Smear wet mount saline/inkA

87220 Tissue exam for fungiA

87230 Assay toxin or antitoxinA

87250 Virus inoculate eggs/animalA

87252 Virus inoculation tissueA

87253 Virus inoculate tissue addlA

87254 Virus inoculation shell viaA

87255 Genet virus isolate hsvA

87260 Adenovirus ag ifA

87265 Pertussis ag ifA

87267 Enterovirus antibody dfaA

87269 Giardia ag ifA

87270 Chlamydia trachomatis ag ifA

87271 Cytomegalovirus dfaA

87272 Cryptosporidium ag ifA

87273 Herpes simplex 2 ag ifA

87274 Herpes simplex 1 ag ifA

87275 Influenza b ag ifA

87276 Influenza a ag ifA

87277 Legionella micdadei ag ifA

87278 Legion pneumophilia ag ifA

87279 Parainfluenza ag ifA

87280 Respiratory syncytial ag ifA

87281 Pneumocystis carinii ag ifA

87283 Rubeola ag ifA

87285 Treponema pallidum ag ifA

87290 Varicella zoster ag ifA

87299 Antibody detection nos ifA

87300 Ag detection polyval ifA

87301 Adenovirus ag eiaA

87305 Aspergillus ag eiaA

87320 Chylmd trach ag eiaA

87324 Clostridium ag eiaA

87327 Cryptococcus neoform ag eiaA

87328 Cryptosporidium ag eiaA

87329 Giardia ag eiaA

87332 Cytomegalovirus ag eiaA

87335 E coli 0157 ag eiaA

87336 Entamoeb hist dispr ag eiaA

87337 Entamoeb hist group ag eiaA

87338 Hpylori stool eiaA

87339 H pylori ag eiaA

87340 Hepatitis b surface ag eiaA

87341 Hepatitis b surface ag eiaA

87350 Hepatitis be ag eiaA

87380 Hepatitis delta ag eiaA

87385 Histoplasma capsul ag eiaA

87390 Hiv-1 ag eiaA

87391 Hiv-2 ag eiaA

87400 Influenza a/b ag eiaA

87420 Resp syncytial ag eiaA

87425 Rotavirus ag eiaA

87427 Shiga-like toxin ag eiaA
87430 Strep a ag eia

A

87449 Ag detect nos eia multA

87450 Ag detect nos eia singleA

87451 Ag detect polyval eia multA

87470 Bartonella dna dir probeA

87471 Bartonella dna amp probeA

87472 Bartonella dna quantA

87475 Lyme dis dna dir probeA

87476 Lyme dis dna amp probeA

87477 Lyme dis dna quantA

87480 Candida dna dir probeA

87481 Candida dna amp probeA

87482 Candida dna quantA

87485 Chylmd pneum dna dir probeA

87486 Chylmd pneum dna amp probeA

87487 Chylmd pneum dna quantA

87490 Chylmd trach dna dir probeA

87491 Chylmd trach dna amp probeA

87492 Chylmd trach dna quantA

87493 C diff amplified probeA

87495 Cytomeg dna dir probeA

87496 Cytomeg dna amp probeA

87497 Cytomeg dna quantA

87498 Enterovirus dna amp probeA

87500 Vanomycin dna amp probeA

87501 Influenza dna amp prob 1+A

87502 Influenza dna amp probeA

87503 Influenza dna amp prob addlA

87510 Gardner vag dna dir probeA

87511 Gardner vag dna amp probeA

87512 Gardner vag dna quantA

87515 Hepatitis b dna dir probeA

87516 Hepatitis b dna amp probeA

87517 Hepatitis b dna quantA

87520 Hepatitis c rna dir probeA

87521 Hepatitis c rna amp probeA

87522 Hepatitis c rna quantA

87525 Hepatitis g dna dir probeA

87526 Hepatitis g dna amp probeA

87527 Hepatitis g dna quantA

87528 Hsv dna dir probeA

87529 Hsv dna amp probeA

87530 Hsv dna quantA

87531 Hhv-6 dna dir probeA

87532 Hhv-6 dna amp probeA

87533 Hhv-6 dna quantA

87534 Hiv-1 dna dir probeA

87535 Hiv-1 dna amp probeA

87536 Hiv-1 dna quantA

87537 Hiv-2 dna dir probeA

87538 Hiv-2 dna amp probeA

87539 Hiv-2 dna quantA

87540 Legion pneumo dna dir probA

87541 Legion pneumo dna amp probA

87542 Legion pneumo dna quantA
87550 Mycobacteria dna dir probe

A

87551 Mycobacteria dna amp probeA

87552 Mycobacteria dna quantA

87555 M.tuberculo dna dir probeA

87556 M.tuberculo dna amp probeA

87557 M.tuberculo dna quantA

87560 M.avium-intra dna dir probA

87561 M.avium-intra dna amp probA

87562 M.avium-intra dna quantA

87580 M.pneumon dna dir probeA

87581 M.pneumon dna amp probeA

87582 M.pneumon dna quantA

87590 N.gonorrhoeae dna dir probA

87591 N.gonorrhoeae dna amp probA

87592 N.gonorrhoeae dna quantA

87620 Hpv dna dir probeA

87621 Hpv dna amp probeA

87622 Hpv dna quantA

87640 Staph a dna amp probeA

87641 Mr-staph dna amp probeA

87650 Strep a dna dir probeA

87651 Strep a dna amp probeA

87652 Strep a dna quantA

87653 Strep b dna amp probeA

87660 Trichomonas vagin dir probeA

87797 Detect agent nos dna dirA

87798 Detect agent nos dna ampA

87799 Detect agent nos dna quantA

87800 Detect agnt mult dna direcA

87801 Detect agnt mult dna ampliA

87802 Strep b assay w/opticA

87803 Clostridium toxin a w/opticA

87804 Influenza assay w/opticA

87807 Rsv assay w/optic

A

87808 Trichomonas assay w/optic

A

87809 Adenovirus assay w/optic

A

87810 Chylmd trach assay w/opticA

87850 N. gonorrhoeae assay w/opticA

87880 Strep a assay w/opticA

87899 Agent nos assay w/opticA

87900 Phenotype infect agent drugA

87901 Genotype dna hiv reverse tA

87902 Genotype dna hepatitis cA

87903 Phenotype dna hiv w/cultureA

87904 Phenotype dna hiv w/clt addA

87905 Sialidase enzyme assayA

87906 Genotype dna hiv reverse tA

87999 Microbiology procedureA

88000 Autopsy (necropsy) grossE

88005 Autopsy (necropsy) grossE

88007 Autopsy (necropsy) grossE

88012 Autopsy (necropsy) grossE

88014 Autopsy (necropsy) grossE

88016 Autopsy (necropsy) grossE

88020 Autopsy (necropsy) completeE
88025 Autopsy (necropsy) complete

E

88027 Autopsy (necropsy) completeE

88028 Autopsy (necropsy) completeE

88029 Autopsy (necropsy) completeE

88036 Limited autopsyE

88037 Limited autopsyE

88040 Forensic autopsy (necropsy)E

88045 Coroners autopsy (necropsy)E

88099 Necropsy (autopsy) procedureE

88104 Cytopath fl nongyn smearsX 0433

88106 Cytopath fl nongyn filterX 0433

88107 Cytopath fl nongyn sm/fltr CHX 0433

88108 Cytopath concentrate techX 0433

88112 Cytopath cell enhance techX 0343

88120 Cytp urne 3-5 probes ea specX 0344

88121 Cytp urine 3-5 probes cmptrX 0344

88125 Forensic cytopathologyX 0433

88130 Sex chromatin identificationA

88140 Sex chromatin identificationA

88141 Cytopath c/v interpretN

88142 Cytopath c/v thin layerA

88143 Cytopath c/v thin layer redoA

88147 Cytopath c/v automatedA

88148 Cytopath c/v auto rescreenA

88150 Cytopath c/v manualA

88152 Cytopath c/v auto redoA

88153 Cytopath c/v redoA

88154 Cytopath c/v selectA

88155 Cytopath c/v index add-onA

88160 Cytopath smear other sourceX 0433

88161 Cytopath smear other sourceX 0433

88162 Cytopath smear other sourceX 0343

88164 Cytopath tbs c/v manualA

88165 Cytopath tbs c/v redoA

88166 Cytopath tbs c/v auto redoA

88167 Cytopath tbs c/v selectA

88172 Cytp dx eval fna 1st ea siteX 0433

88173 Cytopath eval fna reportX 0343

88174 Cytopath c/v auto in fluidA

88175 Cytopath c/v auto fluid redoA

88177 Cytp c/v auto thin lyr addlX 0342

88182 Cell marker studyX 0343

88184 Flowcytometry/ tc 1 markerX 0433

88185 Flowcytometry/tc add-onX 0433

88187 Flowcytometry/read 2-8X 0342

88188 Flowcytometry/read 9-15X 0343

88189 Flowcytometry/read 16 & >X 0343

88199 Cytopathology procedure

X 0342

88230 Tissue culture lymphocyteA

88233 Tissue culture skin/biopsyA

88235 Tissue culture placentaA

88237 Tissue culture bone marrowA

88239 Tissue culture tumorA

88240 Cell cryopreserve/storageA

88241 Frozen cell preparationA
88245 Chromosome analysis 20-25

A

88248 Chromosome analysis 50-100A

88249 Chromosome analysis 100A

88261 Chromosome analysis 5A

88262 Chromosome analysis 15-20A

88263 Chromosome analysis 45A

88264 Chromosome analysis 20-25A

88267 Chromosome analys placentaA

88269 Chromosome analys amnioticA

88271 Cytogenetics dna probeA

88272 Cytogenetics 3-5A

88273 Cytogenetics 10-30A

88274 Cytogenetics 25-99A

88275 Cytogenetics 100-300A

88280 Chromosome karyotype studyA

88283 Chromosome banding studyA

88285 Chromosome count additionalA

88289 Chromosome study additionalA

88291 Cyto/molecular reportM

88299 Cytogenetic studyX 0342

88300 Surgical path gross CHX 0342

88302 Tissue exam by pathologistX 0433

88304 Tissue exam by pathologistX 0343

88305 Tissue exam by pathologistX 0343

88307 Tissue exam by pathologistX 0344

88309 Tissue exam by pathologistX 0344

88311 Decalcify tissueX 0342

88312 Special stains group 1X 0433

88313 Special stains group 2X 0433

88314 Histochemical stains add-onX 0433

88318 Chemical histochemistryX 0433

88319 Enzyme histochemistryX 0343

88321 Microslide consultationX 0433

88323 Microslide consultationX 0343

88325 Comprehensive review of dataX 0344

88329 Path consult intropX 0433

88331 Path consult intraop 1 blocX 0343

88332 Path consult intraop addl CHX 0342

88333 Intraop cyto path consult 1X 0433

88334 Intraop cyto path consult 2X 0433

88342 ImmunohistochemistryX 0343

88346 Immunofluorescent studyX 0343

88347 Immunofluorescent studyX 0343

88348 Electron microscopyX 0661

88349 Scanning electron microscopyX 0661

88355 Analysis skeletal muscleX 0343

88356 Analysis nerveX 0344

88358 Analysis tumorX 0343

88360 Tumor immunohistochem/manualX 0343

88361 Tumor immunohistochem/computX 0344

88362 Nerve teasing preparationsX 0344

88363 Xm archive tissue molec analX 0342

88365 Insitu hybridization (fish)X 0344

88367 Insitu hybridization autoX 0343

88368 Insitu hybridization manualX 0344
88371 Protein western blot tissue

A

88372 Protein analysis w/probeA

88380 Microdissection laserN

88381 Microdissection manualN

88384 Eval molecular probes 11-50X 0433

88385 Eval molecul probes 51-250X 0343

88386 Eval molecul probes 251-500X 0344

88387 Tiss exam molecular studyN

88388 Tiss ex molecul study add-onN

88399 Surgical pathology procedureX 0342

88720 Bilirubin total transcutA

88738 Hgb quant transcutaneousA

88740 Transcutaneous carboxyhbA

88741 Transcutaneous methbA

88749 In vivo lab serviceA

89049 Chct for mal hyperthermiaX 0342

89050 Body fluid cell countA

89051 Body fluid cell countA

89055 Leukocyte assessment fecalA

89060 Exam synovial fluid crystalsA

89125 Specimen fat stainA

89160 Exam feces for meat fibersA

89190 Nasal smear for eosinophilsA

89220 Sputum specimen collection

X 0433

89230 Collect sweat for testX 0343

89240 Pathology lab procedure X 0342

89250 Cultr oocyte/embryo <4 day

s

X 0344

89251 Cultr oocyte/embryo <4 day

s

X 0344

89253 Embryo hatchingX 0344

89254 Oocyte identificationX 0344

89255 Prepare embryo for transferX 0344

89257 Sperm identificationX 0343

89258 Cryopreservation embryo(s)X 0344

89259 Cryopreservation sperm CHX 0433

89260 Sperm isolation simpleX 0343

89261 Sperm isolation complexX 0343

89264 Identify sperm tissueX 0344

89268 Insemination of oocytesX 0344

89272 Extended culture of oocytesX 0344

89280 Assist oocyte fertilizationX 0344

89281 Assist oocyte fertilizationX 0344

89290 Biopsy oocyte polar bodyX 0344

89291 Biopsy oocyte polar bodyX 0344

89300 Semen analysis w/huhnerA

89310 Semen analysis w/countA

89320 Semen anal vol/count/motA

89321 Semen anal sperm detectionA

89322 Semen anal strict criteriaA

89325 Sperm antibody testA

89329 Sperm evaluation testA

89330 Evaluation cervical mucusA

89331 Retrograde ejaculation analA

89335 Cryopreserve testicular tissX 0344

89342 Storage/year embryo(s)X 0344

89343 Storage/year sperm/semenX 0344
89344 Storage/year reprod tissue

X 0344

89346 Storage/year oocyte(s)X 0344

89352 Thawing cryopresrved embry

o

X 0344

89353 Thawing cryopresrved spermX 0344

89354 Thaw cryoprsvrd reprod tissX 0344

89356 Thawing cryopresrved oocyteX 0344

89398 Unlisted reprod med lab procX 0342

90281 Human ig imE

90283 Human ig ivE

90284 Human ig scE

90287 Botulinum antitoxinE

90288 Botulism ig ivE

90291 Cmv ig ivE

90296 Diphtheria antitoxinE

90371 Hep b ig imK 1630

90375 Rabies ig im/scK 9133

90376 Rabies ig heat treatedK 9134

90378 Rsv mab im 50mg CH N

90384 Rh ig full-dose imE

90385 Rh ig minidose imN

90386 Rh ig ivE

90389 Tetanus ig imE

90393 Vaccina ig imE

90396 Varicella-zoster ig imK 9135

90399 Immune globulinE

90460 Imadm any route 1st vac/toxB

90461 Inadm any route addl vac/toxB

90471 Immunization adminS 0436

90472 Immunization admin each addS 0436

90473 Immune admin oral/nasalS 0436

90474 Immune admin oral/nasal addlS 0436

90476 Adenovirus vaccine type 4 CH 

N

90477 Adenovirus vaccine type 7 E 

90581 Anthrax vaccine sc E 

90585 Bcg vaccine percutK 9137

90586 Bcg vaccine intravesicalB

90632 Hep a vaccine adult imN

90633 Hep a vacc ped/adol 2 doseN

90634 Hep a vacc ped/adol 3 doseN

90636 Hep a/hep b vacc adult imN

90644 Meningoccl hib vac 4 dose imE

90645 Hib vaccine hboc imN

90646 Hib vaccine prp-d imN

90647 Hib vaccine prp-omp imN

90648 Hib vaccine prp-t imN

90649 Hpv vaccine 4 valent imM

90650 Hpv vaccine 2 valent imM

90654 Flu vaccine no preserv, ID E 

90655 Flu vaccine no preserv 6-35m

L

90656 Flu vaccine no preserv 3 & >L

90657 Flu vaccine 3 yrs imL

90658 Flu vaccine 3 yrs & > im E 

90660 Flu vaccine nasalL

90661 Flu vacc cell cult prsv free E 

90662 Flu vacc prsv free inc antigL
90664 Flu vacc pandemic intranasal

E

90665 Lyme disease vaccine im

N

90666 Flu vac pandem prsrv free im

E

90667 Flu vac pandemic adjuvant im

E

90668 Flu vac pandemic splt im

E

90669 Pneumococcal vacc 7 val im L 

90670 Pneumococcal vacc 13 val im L 

90675 Rabies vaccine imK 9139

90676 Rabies vaccine idK 9140

90680 Rotovirus vacc 3 dose oral CH 

N

90681 Rotavirus vacc 2 dose oral

K 1239

90690 Typhoid vaccine oralN

90691 Typhoid vaccine im N 

90692 Typhoid vaccine h-p sc/idN

90693 Typhoid vaccine akd sc

B

90696 Dtap-ipv vacc 4-6 yr im

N

90698 Dtap-hib-ip vaccine im

N

90700 Dtap vaccine < 7 yrs imN

90701 Dtp vaccine imN

90702 Dt vaccine < 7 imN

90703 Tetanus vaccine imN

90704 Mumps vaccine scN

90705 Measles vaccine scN

90706 Rubella vaccine scN

90707 Mmr vaccine scN

90708 Measles-rubella vaccine sc

N

90710 Mmrv vaccine sc N 

90712 Oral poliovirus vaccineN

90713 Poliovirus ipv sc/imN

90714 Td vaccine no prsrv >/= 7 imN

90715 Tdap vaccine >7 imN

90716 Chicken pox vaccine scM

90717 Yellow fever vaccine scN

90718 Td vaccine > 7 imN

90719 Diphtheria vaccine imN

90720 Dtp/hib vaccine im

N

90721 Dtap/hib vaccine imN

90723 Dtap-hep b-ipv vaccine imE

90725 Cholera vaccine injectableE

90727 Plague vaccine im E 

90732 Pneumococcal vaccineL

90733 Meningococcal vaccine sc K 9143

90734 Meningococcal vaccine imK 9145

90735 Encephalitis vaccine sc

K 9144

90736 Zoster vacc sc M 

90738 Inactivated je vacc im M 

90740 Hepb vacc ill pat 3 dose imF

90743 Hep b vacc adol 2 dose imF

90744 Hepb vacc ped/adol 3 dose imF

90746 Hep b vaccine adult imF

90747 Hepb vacc ill pat 4 dose imF

90748 Hep b/hib vaccine imE

90749 Vaccine toxoidN

90801 Psy dx interview Q3 0323

90802 Intac psy dx interview Q3 0323
90804 Psytx office 20-30 min Q3 0322

90805 Psytx off 20-30 min w/e&m Q3 0322

90806 Psytx off 45-50 min Q3 0323

90807 Psytx off 45-50 min w/e&m Q3 0323

90808 Psytx office 75-80 min Q3 0323

90809 Psytx off 75-80 w/e&m Q3 0323

90810 Intac psytx off 20-30 min Q3 0322

90811 Intac psytx 20-30 w/e&m Q3 0322

90812 Intac psytx off 45-50 min Q3 0323

90813 Intac psytx 45-50 min w/e&m Q3 0323

90814 Intac psytx off 75-80 min Q3 0323

90815 Intac psytx 75-80 w/e&m Q3 0323

90816 Psytx hosp 20-30 minP

90817 Psytx hosp 20-30 min w/e&mP

90818 Psytx hosp 45-50 minP

90819 Psytx hosp 45-50 min w/e&mP

90821 Psytx hosp 75-80 minP

90822 Psytx hosp 75-80 min w/e&mP

90823 Intac psytx hosp 20-30 minP

90824 Intac psytx hsp 20-30 w/e&mP

90826 Intac psytx hosp 45-50 minP

90827 Intac psytx hsp 45-50 w/e&mP

90828 Intac psytx hosp 75-80 minP

90829 Intac psytx hsp 75-80 w/e&mP

90845 Psychoanalysis Q3 0323

90846 Family psytx w/o patient Q3 0324

90847 Family psytx w/patient Q3 0324

90849 Multiple family group psytx Q3 0325

90853 Group psychotherapy Q3 0325

90857 Intac group psytx Q3 0325

90862 Medication management Q3 0605

90865 Narcosynthesis Q3 0323

90867 Tcranial magn stim tx planS 0216

90868 Tcranial magn stim tx deliS 0216

90870 Electroconvulsive therapyS 0320

90875 Psychophysiological therapyE

90876 Psychophysiological therapyE

90880 Hypnotherapy Q3 0323

90882 Environmental manipulationE

90885 Psy evaluation of recordsN

90887 Consultation with familyN

90889 Preparation of reportN

90899 Psychiatric service/therapy Q3 0322

90901 Biofeedback train any methA

90911 Biofeedback peri/uro/rectal T 0126

90935 Hemodialysis one evaluationS 0170

90937 Hemodialysis repeated eval B 

90940 Hemodialysis access studyN

90945 Dialysis one evaluationV 0608

90947 Dialysis repeated evalB

90951 Esrd serv 4 visits p mo <2M

90952 Esrd serv 2-3 vsts p mo <2M

90953 Esrd serv 1 visit p mo <2M

90954 Esrd serv 4 vsts p mo 2-11M

90955 Esrd srv 2-3 vsts p mo 2-11M
90956 Esrd srv 1 visit p mo 2-11

M

90957 Esrd srv 4 vsts p mo 12-19M

90958 Esrd srv 2-3 vsts p mo 12-19M

90959 Esrd serv 1 vst p mo 12-19M

90960 Esrd srv 4 visits p mo 20+M

90961 Esrd srv 2-3 vsts p mo 20+M

90962 Esrd serv 1 visit p mo 20+M

90963 Esrd home pt serv p mo <2M

90964 Esrd home pt serv p mo 2-11M

90965 Esrd home pt serv p mo 12-19M

90966 Esrd home pt serv p mo 20+M

90967 Esrd home pt serv p day <2M

90968 Esrd home pt srv p day 2-11M

90969 Esrd home pt srv p day 12-19M

90970 Esrd home pt serv p day 20+M

90989 Dialysis training completeB

90993 Dialysis training incomplB

90997 Hemoperfusion B 

90999 Dialysis procedureB

91010 Esophagus motility studyX 0361

91013 Esophgl motil w/stim/perfusX 0361

91020 Gastric motility studiesX 0361

91022 Duodenal motility studyX 0361

91030 Acid perfusion of esophagusX 0361

91034 Gastroesophageal reflux testX 0361

91035 G-esoph reflx tst w/electrodX 0361

91037 Esoph imped function testX 0360

91038 Esoph imped funct test > 1hX 0361

91040 Esoph balloon distension tstX 0360

91065 Breath hydrogen testX 0360

91110 Gi tract capsule endoscopyT 0142

91111 Esophageal capsule endoscopy CHT 0419

91117 Colon motility 6 hr studyT 0156

91120 Rectal sensation testT 0126

91122 Anal pressure recordT 0156

91132 ElectrogastrographyX 0360

91133 Electrogastrography w/testX 0360

91299 Gastroenterology procedureX 0360

92002 Eye exam new patientV 0606

92004 Eye exam new patientV 0606

92012 Eye exam established patV 0605

92014 Eye exam & treatmentV 0605

92015 RefractionE

92018 New eye exam & treatmentT 0699

92019 Eye exam & treatmentT 0699

92020 Special eye evaluationS 0230

92025 Corneal topography CHS 0230

92060 Special eye evaluation CHS 0230

92065 Orthoptic/pleoptic training CHS 0230

92070 Fitting of contact lensN

92081 Visual field examination(s)S 0230

92082 Visual field examination(s) CHS 0230

92083 Visual field examination(s) CHS 0230

92100 Serial tonometry exam(s)N

92120 Tonography & eye evaluation CHS 0230
92130 Water provocation tonography

S 0230

92132 Cmptr ophth dx img ant segmtS 0230

92133 Cmptr ophth img optic nerveS 0230

92134 Cptr ophth dx img post segmtS 0230

92136 Ophthalmic biometry CHS 0230

92140 Glaucoma provocative testsS 0230

92225 Special eye exam initialS 0230

92226 Special eye exam subsequent CHS 0230

92227 Remote dx retinal imagingX 0035

92228 Remote retinal imaging mgmtX 0035

92230 Eye exam with photos CH S 0698

92235 Eye exam with photosS 0231

92240 Icg angiographyS 0231

92250 Eye exam with photos CHS 0230

92260 Ophthalmoscopy/dynamometryS 0230

92265 Eye muscle evaluation CHS 0230

92270 Electro-oculographyS 0230

92275 ElectroretinographyS 0231

92283 Color vision examinationS 0230

92284 Dark adaptation eye exam CHS 0230

92285 Eye photography CHS 0230

92286 Internal eye photography CH S 0698

92287 Internal eye photography CH S 0698

92310 Contact lens fittingE

92311 Contact lens fittingS 0698

92312 Contact lens fitting CHS 0230

92313 Contact lens fittingS 0230

92314 Prescription of contact lensE

92315 Prescription of contact lensS 0230

92316 Prescription of contact lensS 0698

92317 Prescription of contact lensS 0230

92325 Modification of contact lensS 0230

92326 Replacement of contact lens CHS 0230

92340 Fitting of spectaclesE

92341 Fitting of spectaclesE

92342 Fitting of spectaclesE

92352 Special spectacles fittingS 0698

92353 Special spectacles fittingS 0230

92354 Special spectacles fittingS 0230

92355 Special spectacles fittingS 0230

92358 Eye prosthesis serviceS 0230

92370 Repair & adjust spectaclesE

92371 Repair & adjust spectaclesS 0230

92499 Eye service or procedureS 0230

92502 Ear and throat examinationT 0251

92504 Ear microscopy examinationN

92506 Speech/hearing evaluationA

92507 Speech/hearing therapyA

92508 Speech/hearing therapyA

92511 NasopharyngoscopyT 0071

92512 Nasal function studiesX 0363

92516 Facial nerve function testX 0660

92520 Laryngeal function studiesX 0660

92526 Oral function therapyA

92531 Spontaneous nystagmus studyN
92532 Positional nystagmus test

N

92533 Caloric vestibular testN

92534 Optokinetic nystagmus testN

92540 Basic vestibular evaluationX 0660

92541 Spontaneous nystagmus testX 0363

92542 Positional nystagmus testX 0363

92543 Caloric vestibular testX 0660

92544 Optokinetic nystagmus testX 0363

92545 Oscillating tracking testX 0363

92546 Sinusoidal rotational testX 0660

92547 Supplemental electrical test N 

92548 PosturographyX 0660

92550 Tympanometry & reflex threshX 0364

92551 Pure tone hearing test airE

92552 Pure tone audiometry airX 0364

92553 Audiometry air & boneX 0365

92555 Speech threshold audiometryX 0364

92556 Speech audiometry completeX 0364

92557 Comprehensive hearing testX 0365

92559 Group audiometric testingE

92560 Bekesy audiometry screenE

92561 Bekesy audiometry diagnosis CHX 0365

92562 Loudness balance testX 0364

92563 Tone decay hearing testX 0364

92564 Sisi hearing testX 0364

92565 Stenger test pure toneX 0364

92567 TympanometryX 0364

92568 Acoustic refl threshold tstX 0364

92570 Acoustic immitance testing CHX 0365

92571 Filtered speech hearing testX 0364

92572 Staggered spondaic word testX 0366

92575 Sensorineural acuity testX 0364

92576 Synthetic sentence testX 0364

92577 Stenger test speechX 0366

92579 Visual audiometry (vra)X 0365

92582 Conditioning play audiometryX 0365

92583 Select picture audiometryX 0364

92584 ElectrocochleographyS 0216

92585 Auditor evoke potent compreS 0216

92586 Auditor evoke potent limitS 0218

92587 Evoked auditory testX 0363

92588 Evoked auditory testX 0363

92590 Hearing aid exam one earE

92591 Hearing aid exam both earsE

92592 Hearing aid check one earE

92593 Hearing aid check both earsE

92594 Electro hearng aid test oneE

92595 Electro hearng aid tst bothE

92596 Ear protector evaluationX 0364

92597 Oral speech device evalA

92601 Cochlear implt f/up exam < 7X 0366

92602 Reprogram cochlear implt < 7X 0366

92603 Cochlear implt f/up exam 7 >X 0366

92604 Reprogram cochlear implt 7 >X 0366

92605 Eval for nonspeech device rxA
92606 Non-speech device service

A

92607 Ex for speech device rx 1hrA

92608 Ex for speech device rx addlA

92609 Use of speech device serviceA

92610 Evaluate swallowing functionA

92611 Motion fluoroscopy/swallowA

92612 Endoscopy swallow tst (fees)A

92613 Endoscopy swallow tst (fees) B 

92614 Laryngoscopic sensory testA

92615 Eval laryngoscopy sense tstE

92616 Fees w/laryngeal sense testA

92617 Interprt fees/laryngeal testE

92620 Auditory function 60 minX 0365

92621 Auditory function + 15 minN

92625 Tinnitus assessmentX 0365

92626 Eval aud rehab statusX 0366

92627 Eval aud status rehab add-onN

92630 Aud rehab pre-ling hear lossE

92633 Aud rehab postling hear lossE

92640 Aud brainstem implt programg

X 0365

92700 Ent procedure/serviceX 0364

92950 Heart/lung resuscitation cprS 0094

92953 Temporary external pacing Q3 0094

92960 Cardioversion electric extS 0679

92961 Cardioversion electric intS 0679

92970 Cardioassist internalC

92971 Cardioassist externalC

92973 Percut coronary thrombectomyT 0088

92974 Cath place cardio brachytxT 0103

92975 Dissolve clot heart vesselC

92977 Dissolve clot heart vesselT 0676

92978 Intravasc us heart add-onN

92979 Intravasc us heart add-onN

92980 Insert intracoronary stentT 0104

92981 Insert intracoronary stentT 0104

92982 Coronary artery dilationT 0083

92984 Coronary artery dilationT 0083

92986 Revision of aortic valveT 0083

92987 Revision of mitral valveT 0083

92990 Revision of pulmonary valveT 0083

92992 Revision of heart chamberC

92993 Revision of heart chamberC

92995 Coronary atherectomyT 0082

92996 Coronary atherectomy add-onT 0082

92997 Pul art balloon repr percutT 0083

92998 Pul art balloon repr percutT 0083

93000 Electrocardiogram complete M 

93005 Electrocardiogram tracingS 0099

93010 Electrocardiogram reportB

93015 Cardiovascular stress testB

93016 Cardiovascular stress testB

93017 Cardiovascular stress testX 0100

93018 Cardiovascular stress testB

93024 Cardiac drug stress testX 0100

93025 Microvolt t-wave assessX 0100
93040 Rhythm ECG with report

B

93041 Rhythm ecg tracingX 0035

93042 Rhythm ecg reportB

93224 Ecg monit/reprt up to 48 hrsM

93225 Ecg monit/reprt up to 48 hrsS 0097

93226 Ecg monit/reprt up to 48 hrsS 0097

93227 Ecg monit/reprt up to 48 hrsM

93228 Remote 30 day ecg rev/reportM

93229 Remote 30 day ecg tech suppS 0209

93268 ECG record/reviewM

93270 Remote 30 day ecg rev/reportS 0097

93271 Ecg/monitoring and analysis S 0692

93272 Ecg/review interpret onlyM

93278 ECG/signal-averagedX 0035

93279 Pm device progr eval snglS 0690

93280 Pm device progr eval dualS 0690

93281 Pm device progr eval multiS 0690

93282 Icd device prog eval 1 snglS 0690

93283 Icd device progr eval dualS 0690

93284 Icd device progr eval multS 0690

93285 Ilr device eval progrS 0690

93286 Pre-op pm device evalN

93287 Pre-op icd device evalN

93288 Pm device eval in personS 0690

93289 Icd device interrogateS 0690

93290 Icm device eval X 0035

93291 Ilr device interrogateS 0690

93292 Wcd device interrogateS 0690

93293 Pm phone r-strip device evalS 0690

93294 Pm device interrogate remote M 

93295 Icd device interrogat remote M 

93296 Pm/icd remote tech servS 0690

93297 Icm device interrogat remote M 

93298 Ilr device interrogat remote M 

93299 Icm/ilr remote tech serv CHS 0690

93303 Echo transthoracicS 0270

93304 Echo transthoracicS 0269

93306 Tte w/doppler completeS 0269

93307 Tte w/o doppler completeS 0269

93308 Tte f-up or lmtdS 0697

93312 Echo transesophagealS 0270

93313 Echo transesophagealS 0269

93314 Echo transesophagealN

93315 Echo transesophageal CH S 0269

93316 Echo transesophagealS 0270

93317 Echo transesophagealN

93318 Echo transesophageal intraopS 0270

93320 Doppler echo exam heart N 

93321 Doppler echo exam heart N 

93325 Doppler color flow add-on N 

93350 Stress tte onlyS 0269

93351 Stress tte completeS 0270

93352 Admin ecg contrast agent M 

93451 Right heart cathT 0080

93452 Left hrt cath w/ventrclgrphyT 0080
93453 R&l hrt cath w/ventriclgrphy

T 0080

93454 Coronary artery angio s&iT 0080

93455 Coronary art/grft angio s&iT 0080

93456 R hrt coronary artery angioT 0080

93457 R hrt art/grft angioT 0080

93458 L hrt artery/ventricle angioT 0080

93459 L hrt art/grft angioT 0080

93460 R&l hrt art/ventricle angioT 0080

93461 R&l hrt art/ventricle angioT 0080

93462 L hrt cath trnsptl punctureT 0080

93463 Drug admin & hemodynmic measN

93464 Exercise w/hemodynamic measN

93503 Insert/place heart catheterT 0103

93505 Biopsy of heart liningT 0103

93530 Rt heart cath congenitalT 0080

93531 R & l heart cath congenitalT 0080

93532 R & l heart cath congenitalT 0080

93533 R & l heart cath congenitalT 0080

93561 Cardiac output measurementN

93562 Cardiac output measurementN

93563 Inject congenital card cathN

93564 Inject hrt congntl art/grftN

93565 Inject l ventr/atrial angioN

93566 Inject r ventr/atrial angioN

93567 Inject suprvlv aortographyN

93568 Inject pulm art hrt cathN

93571 Heart flow reserve measureN

93572 Heart flow reserve measureN

93580 Transcath closure of asdT 0434

93581 Transcath closure of vsdT 0434

93600 Bundle of His recordingS 0084

93602 Intra-atrial recordingS 0084

93603 Right ventricular recordingS 0084

93609 Map tachycardia add-on N 

93610 Intra-atrial pacingS 0084

93612 Intraventricular pacingS 0084

93613 Electrophys map 3d add-on N 

93615 Esophageal recordingS 0084

93616 Esophageal recordingS 0084

93618 Heart rhythm pacingS 0084

93619 Electrophysiology evaluation Q3 0085

93620 Electrophysiology evaluation Q3 0085

93621 Electrophysiology evaluation N 

93622 Electrophysiology evaluation N 

93623 Stimulation pacing heart N 

93624 Electrophysiologic studyT 0085

93631 Heart pacing mapping N 

93640 Evaluation heart device N 

93641 Electrophysiology evaluation N 

93642 Electrophysiology evaluationS 0084

93650 Ablate heart dysrhythm focus Q3 0085

93651 Ablate heart dysrhythm focus Q3 0086

93652 Ablate heart dysrhythm focus Q3 0086

93660 Tilt table evaluationS 0101

93662 Intracardiac ecg (ice) N 
93668 Peripheral vascular rehab

E

93701 Bioimpedance cv analysisS 0099

93720 Total body plethysmographyB

93721 Plethysmography tracing CHX 0367

93722 Plethysmography reportB

93724 Analyze pacemaker systemS 0690

93740 Temperature gradient studies CHX 0367

93745 Set-up cardiovert-defibrillS 0690

93750 Interrogation vad in personS 0692

93770 Measure venous pressureN

93784 Ambulatory BP monitoringE

93786 Ambulatory BP recordingS 0097

93788 Ambulatory BP analysisS 0097

93790 Review/report BP recording M 

93797 Cardiac rehabS 0095

93798 Cardiac rehab/monitorS 0095

93799 Cardiovascular procedureS 0097

93875 Extracranial studyS 0096

93880 Extracranial studyS 0267

93882 Extracranial studyS 0267

93886 Intracranial studyS 0267

93888 Intracranial studyS 0265

93890 Tcd vasoreactivity studyS 0266

93892 Tcd emboli detect w/o injS 0266

93893 Tcd emboli detect w/injS 0266

93922 Upr/l xtremity art 2 levelsS 0097

93923 Upr/lxtr art stdy 3+ lvlsS 0096

93924 Lwr xtr vasc stdy bilatS 0096

93925 Lower extremity studyS 0267

93926 Lower extremity studyS 0266

93930 Upper extremity studyS 0267

93931 Upper extremity studyS 0266

93965 Extremity studyS 0096

93970 Extremity studyS 0267

93971 Extremity studyS 0266

93975 Vascular studyS 0267

93976 Vascular studyS 0267

93978 Vascular studyS 0267

93979 Vascular studyS 0266

93980 Penile vascular studyS 0267

93981 Penile vascular studyS 0267

93982 Aneurysm pressure sens studyS 0097

93990 Doppler flow testingS 0266

94002 Vent mgmt inpat init day Q3 0079

94003 Vent mgmt inpat subq day Q3 0079

94004 Vent mgmt nf per dayB

94005 Home vent mgmt supervision M 

94010 Breathing capacity test CHX 0367

94011 Spirometry up to 2 yrs old CHX 0367

94012 Spirmtry w/brnchdil inf-2 yr CHX 0367

94013 Meas lung vol thru 2 yrsX 0369

94014 Patient recorded spirometryX 0367

94015 Patient recorded spirometryX 0367

94016 Review patient spirometryA

94060 Evaluation of wheezing S 0078
94070 Evaluation of wheezing

X 0369

94150 Vital capacity testX 0367

94200 Lung function test (MBC/MVV)X 0367

94240 Residual lung capacityX 0368

94250 Expired gas collectionX 0367

94260 Thoracic gas volume CHX 0367

94350 Lung nitrogen washout curve CHX 0367

94360 Measure airflow resistanceX 0367

94370 Breath airway closing volume CHX 0367

94375 Respiratory flow volume loop CHX 0367

94400 CO2 breathing response curveX 0367

94450 Hypoxia response curveX 0368

94452 Hast w/reportX 0368

94453 Hast w/oxygen titrate CHX 0367

94610 Surfactant admin thru tube S 0077

94620 Pulmonary stress test/simpleX 0368

94621 Pulm stress test/complexX 0369

94640 Airway inhalation treatmentS 0077

94642 Aerosol inhalation treatmentS 0078

94644 Cbt 1st hourX 0340

94645 Cbt each addl hourX 0340

94660 Pos airway pressure cpap Q3 0078

94662 Neg press ventilation cnp Q3 0079

94664 Evaluate pt use of inhalerS 0077

94667 Chest wall manipulationS 0077

94668 Chest wall manipulationS 0077

94680 Exhaled air analysis o2X 0368

94681 Exhaled air analysis o2/co2 CHX 0369

94690 Exhaled air analysisX 0367

94720 Monoxide diffusing capacityX 0368

94725 Membrane diffusion capacity CHX 0367

94750 Pulmonary compliance studyX 0367

94760 Measure blood oxygen levelN

94761 Measure blood oxygen levelN

94762 Measure blood oxygen level Q3 0097

94770 Exhaled carbon dioxide testX 0368

94772 Breath recording infantX 0369

94774 Ped home apnea rec compl B 

94775 Ped home apnea rec hk-up

S 0097

94776 Ped home apnea rec downld

S 0097

94777 Ped home apnea rec report B 

94799 Pulmonary service/procedureX 0367

95004 Percut allergy skin testsX 0381

95010 Percut allergy titrate testX 0381

95012 Exhaled nitric oxide measX 0367

95015 Id allergy titrate-drug/bugX 0381

95024 Id allergy test drug/bugX 0381

95027 Id allergy titrate-airborneX 0381

95028 Id allergy test-delayed typeX 0381

95044 Allergy patch testsX 0381

95052 Photo patch testX 0381

95056 Photosensitivity testsX 0370

95060 Eye allergy testsX 0370

95065 Nose allergy testX 0381

95070 Bronchial allergy testsX 0369
95071 Bronchial allergy tests CH

X 0368

95075 Ingestion challenge testX 0361

95115 Immunotherapy one injectionS 0436

95117 Immunotherapy injections S 0436

95120 Immunotherapy one injection E 

95125 Immunotherapy many antigens E 

95130 Immunotherapy insect venom E 

95131 Immunotherapy insect venoms E 

95132 Immunotherapy insect venoms E 

95133 Immunotherapy insect venoms E 

95134 Immunotherapy insect venoms E 

95144 Antigen therapy servicesS 0437

95145 Antigen therapy servicesS 0437

95146 Antigen therapy servicesS 0438

95147 Antigen therapy servicesS 0438

95148 Antigen therapy servicesS 0437

95149 Antigen therapy servicesS 0437

95165 Antigen therapy servicesS 0436

95170 Antigen therapy servicesS 0437

95180 Rapid desensitizationX 0370

95199 Allergy immunology servicesX 0381

95250 Glucose monitoring contV 0607

95251 Gluc monitor cont phys i&rB

95800 Slp stdy unattendedS 0213

95801 Slp stdy unatnd w/analS 0213

95803 Actigraphy testingS 0218

95805 Multiple sleep latency testS 0209

95806 Sleep study unatt&resp efftS 0213

95807 Sleep study attendedS 0209

95808 Polysomnography 1-3S 0209

95810 Polysomnography 4 or moreS 0209

95811 Polysomnography w/cpapS 0209

95812 Eeg 41-60 minutesS 0213

95813 Eeg over 1 hourS 0213

95816 Eeg awake and drowsyS 0213

95819 Eeg awake and asleepS 0213

95822 Eeg coma or sleep onlyS 0213

95824 Eeg cerebral death onlyS 0216

95827 Eeg all night recordingS 0213

95829 Surgery electrocorticogram N 

95830 Insert electrodes for EEGB

95831 Limb muscle testing manualA

95832 Hand muscle testing manualA

95833 Body muscle testing manualA

95834 Body muscle testing manualA

95851 Range of motion measurementsA

95852 Range of motion measurementsA

95857 Cholinesterase challengeS 0218

95860 Muscle test one limbS 0218

95861 Muscle test 2 limbsS 0218

95863 Muscle test 3 limbsS 0218

95864 Muscle test 4 limbsS 0218

95865 Muscle test larynxS 0218

95866 Muscle test hemidiaphragmS 0218

95867 Muscle test cran nerv unilatS 0218
95868 Muscle test cran nerve bilat

S 0218

95869 Muscle test thor paraspinalS 0215

95870 Muscle test nonparaspinalS 0215

95872 Muscle test one fiberS 0218

95873 Guide nerv destr elec stim N 

95874 Guide nerv destr needle emg N 

95875 Limb exercise testS 0218

95900 Motor nerve conduction testS 0215

95903 Motor nerve conduction testS 0215

95904 Sense nerve conduction testS 0215

95905 Motor/sens nrve conduct testS 0215

95920 Intraop nerve test add-on N 

95921 Autonomic nerv function testS 0218

95922 Autonomic nerv function testS 0218

95923 Autonomic nerv function testS 0218

95925 Somatosensory testingS 0216

95926 Somatosensory testingS 0216

95927 Somatosensory testingS 0216

95928 C motor evoked uppr limbsS 0218

95929 C motor evoked lwr limbsS 0218

95930 Visual evoked potential testS 0216

95933 Blink reflex testS 0215

95934 H-reflex testS 0215

95936 H-reflex testS 0215

95937 Neuromuscular junction testS 0218

95950 Ambulatory eeg monitoringS 0209

95951 EEG monitoring/videorecordS 0209

95953 EEG monitoring/computerS 0209

95954 EEG monitoring/giving drugsS 0218

95955 EEG during surgery N 

95956 Eeg monitor technol attendedS 0209

95957 EEG digital analysis N 

95958 EEG monitoring/function testS 0213

95961 Electrode stimulation brainS 0216

95962 Electrode stim brain add-onS 0216

95965 Meg spontaneous S 0067

95966 Meg evoked single S 0065

95967 Meg evoked each addl S 0065

95970 Analyze neurostim no progS 0218

95971 Analyze neurostim simpleS 0692

95972 Analyze neurostim complexS 0692

95973 Analyze neurostim complexS 0692

95974 Cranial neurostim complexS 0692

95975 Cranial neurostim complexS 0692

95978 Analyze neurostim brain/1hS 0692

95979 Analyz neurostim brain addonS 0692

95980 Io anal gast n-stim initN

95981 Io anal gast n-stim subsqS 0218

95982 Io ga n-stim subsq w/reprogS 0692

95990 Spin/brain pump refil & main

S 0439

95991 Spin/brain pump refil & main

S 0439

95992 Canalith repositioning procA

95999 Neurological procedureS 0215

96000 Motion analysis video/3dS 0216

96001 Motion test w/ft press measS 0216
96002 Dynamic surface emg

S 0218

96003 Dynamic fine wire emgS 0218

96004 Phys review of motion tests B 

96020 Functional brain mapping N 

96040 Genetic counseling 30 min B 

96101 Psycho testing by psych/phys Q3 0382

96102 Psycho testing by technician Q3 0382

96103 Psycho testing admin by comp Q3 0373

96105 Assessment of aphasiaA

96110 Developmental test lim Q3 0373

96111 Developmental test extend Q3 0373

96116 Neurobehavioral status exam Q3 0382

96118 Neuropsych tst by psych/phys Q3 0382

96119 Neuropsych testing by tec Q3 0382

96120 Neuropsych tst admin w/comp Q3 0382

96125 Cognitive test by hc pro A 

96150 Assess hlth/behave init Q3 0432

96151 Assess hlth/behave subseq Q3 0432

96152 Intervene hlth/behave indiv Q3 0432

96153 Intervene hlth/behave group Q3 0432

96154 Interv hlth/behav fam w/pt Q3 0432

96155 Interv hlth/behav fam no ptE

96360 Hydration iv infusion initS 0438

96361 Hydrate iv infusion add-onS 0436

96365 Ther/proph/diag iv inf initS 0439

96366 Ther/proph/diag iv inf addonS 0436

96367 Tx/proph/dg addl seq iv infS 0437

96368 Ther/diag concurrent infN

96369 Sc ther infusion up to 1 hrS 0439

96370 Sc ther infusion addl hrS 0437

96371 Sc ther infusion reset pumpS 0436

96372 Ther/proph/diag inj sc/imS 0436

96373 Ther/proph/diag inj iaS 0437

96374 Ther/proph/diag inj iv pushS 0437

96375 Tx/pro/dx inj new drug addonS 0437

96376 Tx/pro/dx inj same drug adonN

96379 Ther/prop/diag inj/inf procS 0436

96401 Chemo anti-neopl sq/imS 0437

96402 Chemo hormon antineopl sq/imS 0437

96405 Chemo intralesional up to 7S 0437

96406 Chemo intralesional over 7S 0439

96409 Chemo iv push sngl drug S 0439

96411 Chemo iv push addl drug S 0438

96413 Chemo iv infusion 1 hr S 0440

96415 Chemo iv infusion addl hrS 0437

96416 Chemo prolong infuse w/pumpS 0440

96417 Chemo iv infus each addl seqS 0438

96420 Chemo ia push tecniqueS 0438

96422 Chemo ia infusion up to 1 hrS 0440

96423 Chemo ia infuse each addl hr S 0438

96425 Chemotherapy infusion methodS 0440

96440 Chemotherapy intracavitaryS 0439

96446 Chemotx admn prtl cavityS 0439

96450 Chemotherapy into cnsS 0440

96521 Refill/maint portable pumpS 0439
96522 Refill/maint pump/resvr syst

S 0439

96523 Irrig drug delivery device Q1 0624

96542 Chemotherapy injectionS 0438

96549 Chemotherapy unspecifiedS 0436

96567 Photodynamic tx skinT 0015

96570 Photodynmc tx 30 min add-onT 0015

96571 Photodynamic tx addl 15 minT 0015

96900 Ultraviolet light therapyS 0001

96902 TrichogramN

96904 Whole body photographyN

96910 Photochemotherapy with UV-BS 0001

96912 Photochemotherapy with UV-AS 0001

96913 Photochemotherapy uv-a or bS 0683

96920 Laser tx skin < 250 sq cmT 0015

96921 Laser tx skin 250-500 sq cmT 0015

96922 Laser tx skin > 500 sq cmT 0015

96999 Dermatological procedureT 0012

97001 Pt evaluationA

97002 Pt re-evaluationA

97003 Ot evaluationA

97004 Ot re-evaluationA

97005 Athletic train evalE

97006 Athletic train reevalE

97010 Hot or cold packs therapyA

97012 Mechanical traction therapyA

97014 Electric stimulation therapyE

97016 Vasopneumatic device therapyA

97018 Paraffin bath therapyA

97022 Whirlpool therapyA

97024 Diathermy eg microwaveA

97026 Infrared therapyA

97028 Ultraviolet therapyA

97032 Electrical stimulationA

97033 Electric current therapyA

97034 Contrast bath therapyA

97035 Ultrasound therapyA

97036 HydrotherapyA

97039 Physical therapy treatmentA

97110 Therapeutic exercisesA

97112 Neuromuscular reeducationA

97113 Aquatic therapy/exercisesA

97116 Gait training therapyA

97124 Massage therapyA

97139 Physical medicine procedureA

97140 Manual therapyA

97150 Group therapeutic proceduresA

97530 Therapeutic activitiesA

97532 Cognitive skills developmentA

97533 Sensory integrationA

97535 Self care mngment trainingA

97537 Community/work reintegrationA

97542 Wheelchair mngment trainingA

97545 Work hardeningA

97546 Work hardening add-onA

97597 Rmvl devital tis 20 cm/<T 0015
97598 Rmvl devital tis addl 20 cm<

T 0015

97602 Wound(s) care non-selectiveT 0013

97605 Neg press wound tx < 50 cmT 0013

97606 Neg press wound tx > 50 cmT 0015

97750 Physical performance testA

97755 Assistive technology assessA

97760 Orthotic mgmt and trainingA

97761 Prosthetic trainingA

97762 C/o for orthotic/prosth useA

97799 Physical medicine procedureA

97802 Medical nutrition indiv inA

97803 Med nutrition indiv subseqA

97804 Medical nutrition groupA

97810 Acupunct w/o stimul 15 minE

97811 Acupunct w/o stimul addl 15mE

97813 Acupunct w/stimul 15 minE

97814 Acupunct w/stimul addl 15mE

98925 Osteopathic manipulationS 0060

98926 Osteopathic manipulationS 0060

98927 Osteopathic manipulationS 0060

98928 Osteopathic manipulationS 0060

98929 Osteopathic manipulationS 0060

98940 Chiropractic manipulationS 0060

98941 Chiropractic manipulationS 0060

98942 Chiropractic manipulationS 0060

98943 Chiropractic manipulationE

98960 Self-mgmt educ & train 1 ptE

98961 Self-mgmt educ/train 2-4 ptE

98962 Self-mgmt educ/train 5-8 ptE

98966 Hc pro phone call 5-10 minE

98967 Hc pro phone call 11-20 minE

98968 Hc pro phone call 21-30 minE

98969 Online service by hc proE

99000 Specimen handling E 

99001 Specimen handling E 

99002 Device handlingB

99024 Postop follow-up visitB

99026 In-hospital on call serviceE

99027 Out-of-hosp on call serviceE

99050 Medical services after hrsB

99051 Med serv eve/wkend/holidayB

99053 Med serv 10pm-8am 24 hr facB

99056 Med service out of officeB

99058 Office emergency careB

99060 Out of office emerg med servB

99070 Special suppliesB

99071 Patient education materialsB

99075 Medical testimonyE

99078 Group health educationN

99080 Special reports or formsB

99082 Unusual physician travelB

99090 Computer data analysisB

99091 Collect/review data from ptN

99100 Special anesthesia serviceB

99116 Anesthesia with hypothermiaB
99135 Special anesthesia procedure

B

99140 Emergency anesthesiaB

99143 Mod cs by same phys < 5 yrsN

99144 Mod cs by same phys 5 yrs +N

99145 Mod cs by same phys add-onN

99148 Mod cs diff phys < 5 yrsN

99149 Mod cs diff phys 5 yrs +N

99150 Mod cs diff phys add-onN

99170 Anogenital exam childT 0191

99172 Ocular function screenE

99173 Visual acuity screenE

99174 Ocular photoscreeningE

99175 Induction of vomitingN

99183 Hyperbaric oxygen therapyB

99190 Special pump servicesC

99191 Special pump servicesC

99192 Special pump servicesC

99195 PhlebotomyX 0624

99199 Special service/proc/reportB

99201 Office/outpatient visit newV 0604

99202 Office/outpatient visit newV 0605

99203 Office/outpatient visit newV 0606

99204 Office/outpatient visit newV 0607

99205 Office/outpatient visit new Q3 0608

99211 Office/outpatient visit estV 0604

99212 Office/outpatient visit estV 0605

99213 Office/outpatient visit estV 0605

99214 Office/outpatient visit estV 0606

99215 Office/outpatient visit est Q3 0607

99217 Observation care dischargeB

99218 Initial observation careB

99219 Initial observation careB

99220 Initial observation careB

99221 Initial hospital care B 

99222 Initial hospital care B 

99223 Initial hospital care B 

99224 Subsequent observation care B 

99225 Subsequent observation care B 

99226 Subsequent observation care B 

99231 Subsequent hospital care B 

99232 Subsequent hospital care B 

99233 Subsequent hospital care B 

99234 Observ/hosp same dateB

99235 Observ/hosp same dateB

99236 Observ/hosp same dateB

99238 Hospital discharge day B 

99239 Hospital discharge day B 

99241 Office consultationE

99242 Office consultationE

99243 Office consultationE

99244 Office consultationE

99245 Office consultationE

99251 Inpatient consultationE

99252 Inpatient consultationE

99253 Inpatient consultationE
99254 Inpatient consultation

E

99255 Inpatient consultationE

99281 Emergency dept visitV 0609

99282 Emergency dept visitV 0613

99283 Emergency dept visitV 0614

99284 Emergency dept visit Q3 0615

99285 Emergency dept visit Q3 0616

99288 Direct advanced life supportB

99291 Critical care first hour Q3 0617

99292 Critical care addl 30 minN

99304 Nursing facility care initB

99305 Nursing facility care initB

99306 Nursing facility care initB

99307 Nursing fac care subseqB

99308 Nursing fac care subseqB

99309 Nursing fac care subseqB

99310 Nursing fac care subseqB

99315 Nursing fac discharge dayB

99316 Nursing fac discharge dayB

99318 Annual nursing fac assessmntB

99324 Domicil/r-home visit new patB

99325 Domicil/r-home visit new patB

99326 Domicil/r-home visit new patB

99327 Domicil/r-home visit new patB

99328 Domicil/r-home visit new patB

99334 Domicil/r-home visit est patB

99335 Domicil/r-home visit est patB

99336 Domicil/r-home visit est patB

99337 Domicil/r-home visit est patB

99339 Domicil/r-home care supervisB

99340 Domicil/r-home care supervisB

99341 Home visit new patientB

99342 Home visit new patientB

99343 Home visit new patientB

99344 Home visit new patientB

99345 Home visit new patientB

99347 Home visit est patientB

99348 Home visit est patientB

99349 Home visit est patientB

99350 Home visit est patientB

99354 Prolonged service officeN

99355 Prolonged service officeN

99356 Prolonged service inpatientC

99357 Prolonged service inpatientC

99358 Prolong service w/o contactN

99359 Prolong serv w/o contact addN

99360 Physician standby servicesB

99363 Anticoag mgmt initB

99364 Anticoag mgmt subseqB

99366 Team conf w/pat by hc proN

99367 Team conf w/o pat by physN

99368 Team conf w/o pat by hc proN

99374 Home health care supervisionB

99375 Home health care supervisionE

99377 Hospice care supervisionB
99378 Hospice care supervision

E

99379 Nursing fac care supervisionB

99380 Nursing fac care supervisionB

99381 Init pm e/m new pat infE

99382 Init pm e/m new pat 1-4 yrsE

99383 Prev visit new age 5-11E

99384 Prev visit new age 12-17E

99385 Prev visit new age 18-39E

99386 Prev visit new age 40-64E

99387 Init pm e/m new pat 65+ yrsE

99391 Per pm reeval est pat infE

99392 Prev visit est age 1-4E

99393 Prev visit est age 5-11E

99394 Prev visit est age 12-17E

99395 Prev visit est age 18-39E

99396 Prev visit est age 40-64E

99397 Per pm reeval est pat 65+ yrE

99401 Preventive counseling indivE

99402 Preventive counseling indivE

99403 Preventive counseling indivE

99404 Preventive counseling indivE

99406 Behav chng smoking 3-10 minX 0031

99407 Behav chng smoking > 10 minX 0031

99408 Audit/dast 15-30 min E 

99409 Audit/dast over 30 minE

99411 Preventive counseling groupE

99412 Preventive counseling groupE

99420 Health risk assessment testE

99429 Unlisted preventive serviceE

99441 Phone e/m by phys 5-10 minE

99442 Phone e/m by phys 11-20 minE

99443 Phone e/m by phys 21-30 minE

99444 Online e/m by physE

99450 Basic life disability examE

99455 Work related disability examB

99456 Disability examinationB

99460 Init nb em per day hospV 0605

99461 Init nb em per day non-facM

99462 Sbsq nb em per day hospC

99463 Same day nb dischargeV 0605

99464 Attendance at deliveryN

99465 Nb resuscitationS 0094

99466 Ped crit care transportN

99467 Ped crit care transport addlN

99468 Neonate crit care initialC

99469 Neonate crit care subsqC

99471 Ped critical care initialC

99472 Ped critical care subsqC

99475 Ped crit care age 2-5 initC

99476 Ped crit care age 2-5 subsqC

99477 Init day hosp neonate careC

99478 Ic lbw inf < 1500 gm subsqC

99479 Ic lbw inf 1500-2500 g subsqC

99480 Ic inf pbw 2501-5000 g subsqC

99499 Unlisted e&m serviceB
99500 Home visit prenatal

E

99501 Home visit postnatalE

99502 Home visit nb careE

99503 Home visit resp therapyE

99504 Home visit mech ventilatorE

99505 Home visit stoma careE

99506 Home visit im injectionE

99507 Home visit cath maintainE

99509 Home visit day life activityE

99510 Home visit sing/m/fam counsE

99511 Home visit fecal/enema mgmtE

99512 Home visit for hemodialysisE

99600 Home visit nosE

99601 Home infusion/visit 2 hrs

E

99602 Home infusion each addtl hr

E

99605 Mtms by pharm np 15 min

E

99606 Mtms by pharm est 15 min

E

99607 Mtms by pharm addl 15 min

E

0001F Heart failure composite

E

0005F Osteoarthritis composite

E

0012F Cap bacterial assessE

0014F Comp preop assess cat surgE

0015F Melan follow-up completeE

0019T Extracorp shock wv tx ms nos A 

0030T Antiprothrombin antibodyA

0042T Ct perfusion w/contrast cbfN

0048T Implant ventricular device

C

0050T Removal circulation assist

C

0051T Implant total heart system

C

0052T Replace component heart syst

C

0053T Replace component heart syst

C

0054T Bone surgery using computer

N

0055T Bone surgery using computer

N

0058T Cryopreservation ovary tiss

X 0344

0059T Cryopreservation oocyte

X 0344

0071T U/s leiomyomata ablate <200S 0067

0072T U/s leiomyomata ablate >200S 0067

0073T Delivery comp imrtS 0412

0075T Perq stent/chest vert artC

0076T S&i stent/chest vert artC

0078T Endovasc aort repr w/deviceC

0079T Endovasc visc extnsn reprC

0080T Endovasc aort repr rad s&iC

0081T Endovasc visc extnsn s&iC

0085T Breath test heart rejectE

0092T Artific disc addlC

0095T Artific diskectomy addl C 

0098T Rev artific disc addlC

0099T Implant corneal ring CHT 0234

0100T Prosth retina receive&genT 0672

0101T Extracorp shockwv tx hi enrgT 0050

0102T Extracorp shockwv tx anesthT 0050

0103T HolotranscobalaminA

0106T Touch quant sensory test X 0341

0107T Vibrate quant sensory test X 0341
0108T Cool quant sensory test X 0341

0109T Heat quant sensory test X 0341

0110T Nos quant sensory testX 0341

0111T Rbc membranes fatty acidsA

0123T Scleral fistulizationT 0234

0124T Conjunctival drug placementT 0232

0126T Chd risk imt study Q1 0340

0141T Perq islet transplantE

0142T Open islet transplantE

0143T Laparoscopic islet transplntE

0155T Lap impl gast curve electrd

T 0130

0156T Lap remv gast curve electrd

T 0130

0157T Open impl gast curve electrd

C

0158T Open remv gast curve electrd

C

0159T Cad breast mri

N

0163T Lumb artif diskectomy addl

C

0164T Remove lumb artif disc addl

C

0165T Revise lumb artif disc addl

C

0166T Tcath vsd close w/o bypass

C

0167T Tcath vsd close w/bypass

C

0168T Rhinophototx light app bilat T 0251

0169T Place stereo cath brain

C

0171T Lumbar spine proces distract

T 0052

0172T Lumbar spine process addl

T 0052

0173T Iop monit io pressure

N

0174T Cad cxr with interp

N

0175T Cad cxr remote

N

0178T 64 lead ecg w/i&r B 

0179T 64 lead ecg w/tracing

X 0100

0180T 64 lead ecg w/i&r only B 

0181T Corneal hysteresis

S 0230

0182T Hdr elect brachytherapy

S 0313

0183T Wound ultrasound

T 0015

0184T Exc rectal tumor endoscopic

C

0185T Comptr probability analysis

N

0186T Suprachoroidal drug delivery

T 0237

0188T Videoconf crit care 74 min

M

0189T Videoconf crit care addl 30

M

0190T Place intraoc radiation src

T 0237

0191T Insert ant segment drain int

T 0673

0192T Insert ant segment drain ext

T 0673

0195T Arthrod presac interbody

C

0196T Arthrod presac interbody eac

C

0197T Intrafraction track motion

N

0198T Ocular blood flow measure

S 0230

0199T Physiologic tremor record

S 0215

0200T Perq sacral augmt unilat inj CH 

T 0050

0201T Perq sacral augmt bilat inj

T 0050

0202T Post vert arthrplst 1 lumbar

C

0205T Inirs each vessel add-on

N

0206T Remote algorithm analys ecg Q1 0340

0207T Clear eyelid gland w/heat

S 0230

0208T Audiometry air only

X 0035

0209T Audiometry air & bone

X 0035

0210T Speech audiometry threshold

X 0035
0211T Speech audiom thresh & recog

X 0035

0212T Compre audiometry evaluation CH

X 0365

0213T Njx paravert w/us cer/thor

T 0207

0214T Njx paravert w/us cer/thor

T 0204

0215T Njx paravert w/us cer/thor

T 0204

0216T Njx paravert w/us lumb/sac

T 0207

0217T Njx paravert w/us lumb/sac

T 0204

0218T Njx paravert w/us lumb/sac

T 0204

0219T Plmt post facet implt cerv

C

0220T Plmt post facet implt thor

C

0221T Plmt post facet implt lumb

T 0050

0222T Plmt post facet implt addl

T 0050

0223T Acoustic ecg w/i&r

S 0099

0224T Acoustic ecg 1+ analysis

S 0690

0225T Acoustic ecg analy & reprog

S 0690

0226T Anoscopy hra w/spec collect

X 0340

0227T Anoscopy hra w/biopsy

T 0146

0228T Njx tfrml eprl w/us cer/thor

T 0207

0229T Njx tfrml eprl w/us cer/thor

T 0206

0230T Njx tfrml eprl w/us lumb/sac

T 0207

0231T Njx tfrml eprl w/us lumb/sac

T 0206

0232T Njx platelet plasma

X 0340

0233T Skin glycation spectroscopy

A

0234T Trluml perip athrc renal art

T 0082

0235T Trluml perip athrc visceral

C

0236T Trluml perip athrc abd aorta

T 0082

0237T Trluml perip athrc brchiocph

T 0082

0238T Trluml perip athrc iliac art

T 0082

0239T Bioimpedance spectroscopy

S 0099

0240T Esoph motility 3d topography

X 0361

0241T Esoph motility w/stim/perf

X 0361

0242T Gi tract transit & pres meas

X 0361

0243T Intm msr bronchodil wheeze

S 0078

0244T Cont msr bronchodil wheeze

X 0369

0245T Opn tx rib fx 1-2 ribs

T 0062

0246T Opn tx rib fx 3-4 ribs

T 0062

0247T Opn tx rib fx 5-6 ribs

T 0062

0248T Opn tx rib fx 7+ ribs

T 0062

0249T Ligation hemorrhoid w/us

T 0155

0250T Insert bronchial valve

T 0415

0251T Remov bronchial valve addl

T 0076

0252T Bronchscpc rmvl bronch valve

T 0076

0253T Insert aqueous drain device

T 0234

0254T Evasc rpr iliac art bifur

C

0255T Evasc rpr iliac art bifr s&i

C

0256T Evasc aortic hrt valve

C

0257T Opn tthrc aortic hrt valve

C

0258T Aortic hrt valv w/o card by

pC

0259T Aortic hrt valve w/card by

pC

0260T Hypthrm bdy neonate 28d/<

N

0261T Hypthrm head neonate 28d/<

N

0500F Initial prenatal care visitE

0501F Prenatal flow sheetE

0502F Subsequent prenatal careE

0503F Postpartum care visitE
0505F Hemodialysis plan docd M 

0507F Periton dialysis plan docd M 

0509F Urine incon plan docd M 

0513F Elev bp plan of care docd M 

0514F Care plan hgb docd esa pt M 

0516F Anemia plan of care docd

E

0517F Glaucoma plan of care docd M 

0518F Fall plan of care docd M 

0519F Pland chemo docd b/4 txmnt

E

0520F Rad dos limts b/4 3d rad M 

0521F Plan of care 4 pain docd M 

0525F Initial visit for episode

E

0526F Subs visit for episode M 

0528F Rcmnd flw-up 10 yrs docd

E

0529F Intrvl 3+yrs pts clnscp docd M 

0535F Dyspnea mngmnt plan docd

E

0540F Gluco mngmnt plan docd M 

0545F Follow up care plan mdd docd

E

0575F HIV rna plan care docd M 

1000F Tobacco use assessedE

1002F Assess anginal symptom/level M 

1003F Level of activity assessE

1004F Clin symp vol ovrld assessE

1005F Asthma symptoms evaluate M 

1006F Osteoarthritis assess M 

1007F Anti-inflm/anlgsc otc assess M 

1008F Gi/renal risk assessE

1015F Copd symptoms assess

E

1018F Assess dyspnea not present

E

1019F Assess dyspnea present

E

1022F Pneumo imm status assess

E

1026F Co-morbid condition assess

E

1030F Influenza imm status assess

E

1034F Current tobacco smoker

E

1035F Smokeless tobacco user

E

1036F Tobacco non-user M 

1038F Persistent asthma M 

1039F Intermittent asthma M 

1040F Dsm-iv info mdd docd M 

1050F History of mole changes

E

1055F Visual funct status assess

E

1060F Doc perm/cont/parox atr fib

E

1061F Doc lack perm+cont+parox fib

E

1065F Ischm stroke symp lt3 hrsb/4

E

1066F Ischm stroke symp ge3 hrsb/4

E

1070F Alarm symp assessed-absent

E

1071F Alarm symp assessed-1+ prsnt

E

1090F Pres/absn urine incon assess M 

1091F Urine incon characterized M 

1100F Ptfalls assess-docd ge2+/y

r M 

1101F Pt falls assess-docd le1/y

r M 

1110F Pt lft inpt fac w/in 60 day

s M 

1111F Dschrg med/current med merge M 

1116F Auric/peri pain assessed M 

1118F GERD symps assessed 12 month

E
1119F Init eval for condition M 

1121F Subs eval for condition M 

1123F Acp discuss/dscn mkr docd M 

1124F Acp discuss-no dscnmkr docd M 

1125F Amnt pain noted pain prsnt M 

1126F Amnt pain noted none prsnt M 

1130F Bk pain + fxn assessed M 

1134F Epsd bk pain for =< 6 wks

E

1135F Epsd bk pain for > 6 wks

E

1136F Epsd bk pain for <= 12 wks

E

1137F Epsd bk pain for > 12 wks

E

1150F Doc pt rsk death w/in 1y

rE

1151F Doc no pt rsk death w/in 1y

rE

1152F Doc advncd dis comfort 1st

E

1153F Doc advncd dis cmfrt not 1st

E

1157F Advnc care plan in rcrd

E

1158F Advnc care plan tlk docd M 

1159F Med list docd in rcrd

E

1160F Rvw meds by rx/dr in rcrd

E

1170F Fxnl status assessed M 

1180F Thromboemb risk assessed

E

1200F Seizure type& frequ docd

E

1205F EPI etiol synd rvwd and docd

E

1220F Pt screened for depression

E

1400F Prkns diag rviewed

E

2000F Blood pressure measure M 

2001F Weight recordE

2002F Clin sign vol ovrld assessE

2004F Initial exam involved jointsE

2010F Vital signs recorded M 

2014F Mental status assess M 

2018F Hydration status assess

E

2019F Dilated macul exam done M 

2020F Dilated fundus eval done

E

2021F Dilat macul+ exam done M 

2022F Dil retina exam interp rev M 

2024F 7 field photo interp doc rev M 

2026F Eye image valid to dx rev M 

2027F Optic nerve head eval done M 

2028F Foot exam performed M 

2029F Complete phys skin exam done

E

2030F H2o stat docd normal

E

2031F H2o stat docd dehydrated

E

2035F Tymp memb motion examd M 

2040F Bk pn xm on init visit date M 

2044F Doc mntl tst b/4 bk trxmnt

E

2050F Wound char size etc docd E 

2060F Pt talk eval hlthwkr re mdd

E

3006F Cxr doc rev

E

3008F Body mass index docd

E

3011F Lipid panel doc rev

E

3014F Screen mammo doc rev M 

3015F Cerv cancer screen docd

E

3016F Pt scrnd unhlthy OH use M 

3017F Colorectal ca screen doc rev M 
3018F Pre-prxd rsk et al docd E 

3020F Lvf assess M 

3021F Lvef mod/sever deprs syst M 

3022F Lvef >=40% systolic M 

3023F Spirom doc rev M 

3025F Spirom fev/fvc<70% w/copd M 

3027F Spirom fev/fvc>=70%/w/o copd M 

3028F O2 saturation doc rev M 

3035F O2 saturation<=88% /pao<=55 E 

3037F O2 saturation> 88% /pao>55 E 

3038F Pulm fx w/in 12 mon b/4 surg M 

3040F Fev<40% predicted value E 

3042F Fev>=40% predicted value E 

3044F Hg a1c level lt 7.0% M 

3045F Hg a1c level 7.0-9.0% M 

3046F Hemoglobin a1c level > 9.0% M 

3048F Ldl-c <100 mg/dl M 

3049F Ldl-c 100-129 mg/dl M 

3050F Ldl-c >= 130 mg/dl M 

3060F Pos microalbuminuria rev M 

3061F Neg microalbuminuria rev M 

3062F Pos macroalbuminuria rev M 

3066F Nephropathy doc tx M 

3072F Low risk for retinopathy M 

3073F Pre-surg eye measures docd E 

3074F Syst bp lt 130 mm hg M 

3075F Syst bp ge 130 - 139mm hg M 

3077F Syst bp >= 140 mm hg M 

3078F Diast bp < 80 mm hg M 

3079F Diast bp 80-89 mm hg M 

3080F Diast bp >= 90 mm hg M 

3082F Kt/v <1.2 M 

3083F Kt/v > 1.2 <1.7 M 

3084F Kt/v ge 1.7 M 

3085F Suicide risk assessed M 

3088F Mdd mild E 

3089F Mdd moderate E 

3090F Mdd severe w/o psych E 

3091F Mdd severe w/psych E 

3092F Mdd in remission M 

3093F Doc new diag 1st/addl mdd E 

3095F Central dexa results docd M 

3096F Central dexa ordered M 

3100F Image test ref carot diam M 

3110F Pres/absn hmrhg/lesion docd M 

3111F Ct/mri brain done w/in 24hrs M 

3112F Ct/mri brain done >24 hrs M 

3120F 12-lead ecg performed M 

3130F Upper gi endoscopy performed E 

3132F Doc ref upper gi endoscopy E 

3140F Upper gi endo shows barrtts E 

3141F Upper gi endo not barrtts E 

3142F Barium swallow test ordered E 

3150F Forceps esoph biopsy done E 

3155F Cytogen test marrow b/4 tx M 
3160F Doc fe+ stores b/4 epo thx M 

3170F Flow cyto done b/4 tx M 

3200F Barium swallow test not req E 

3210F Grp a strep test performed M 

3215F Pt immunity to hep a docd M 

3216F Pt immunity to hep b docd M 

3218F Rna tstng hep c docd done M 

3220F Hep c quant rna tstng docd M 

3230F Note hring tst w/in 6 mon E 

3250F Nonprim loc anat bx site tum M 

3260F Pt cat/pn cat/hist grd docd M 

3265F Rna tstng hepc vir ord/docd M 

3266F Hepc gn tstng docd b/4txmnt M 

3268F Psa/t/glsc docd b/4 txmnt E 

3269F Bone scn b/4 txmnt/aftr Dx M 

3270F No bone scn b/4 txmnt/aftrDx M 

3271F Low risk prostate cancer M 

3272F Med risk prostate cancer M 

3273F High risk prostate cancer M 

3274F Prost Cncr rsk not lw/md/hgh M 

3278F Serum lvls CA/iPTH/lpd ord M 

3279F Hgb lvl >/= 13 g/dl M 

3280F Hgb lvl 11-12.9 g/dL M 

3281F Hgb lvl < 11 g/dl M 

3284F Iop down >15% of pre-svc lvl M 

3285F IOP down <15% of pre-svc lvl M 

3288F Fall risk assessment docd M 

3290F Pt=D(Rh)- and unsensitized E 

3291F Pt=d(rh)+ or sensitized E 

3292F Hiv tstng asked/docd/revwd E 

3293F Abo rh blood typing docd

E

3294F Grp b strep screening docd

E

3300F AJCC stage docd b/4 thxpy M 

3301F Cancer stage docd metast M 

3315F Er+ or pr+ breast cancer M 

3316F ER- or PR- breast cancer M 

3317F Path rpt malig cancer docd E 

3318F Path rpt malig cancer docd E 

3319F X-ray/ct/ultrsnd et al ord M 

3320F No xray/ct/ et al ordd M 

3321F AJCC cncr 0/IA melan docd M 

3322F Melanoma>ajcc stage 0 or ia M 

3323F Clin node stgng docdb/4 surg M 

3324F Mri ct scan ord rvwd rqstd

E

3325F Preop asses 4 cataract surg E 

3328F Prfrmnc docd 2 wks b/4 surg M 

3330F Imaging study ordered (bkp) E 

3331F Bk imaging tst not ordered E 

3340F Mammo assess inc xray docd M 

3341F Mammo assess negative docd M 

3342F Mammo assess bengn docd M 

3343F Mammo probably bengn docd M 

3344F Mammo assess susp docd M 

3345F Mammo assess hghlymalig doc M 

3350F Mammo bx proven malig docd M 
3351F Neg scrn dep symp by deptool

E

3352F No sig dep symp by dep tool

E

3353F Mild-mod dep symp by deptool

E

3354F Clin sig dep sym by dep tool

E

3370F AJCC brst cncr stage 0 docd M 

3372F Ajcc brst cncr stage 1 docd M 

3374F Ajcc brst cncr stage 1 docd M 

3376F AJCC brstcncr stage 2 docd M 

3378F AJCC brstcncr stage 3 docd M 

3380F AJCC brstcncr stage 4 docd M 

3382F AJCC cln cncr stage 0 docd M 

3384F AJCC cln cncr stage 1 docd M 

3386F AJCC cln cncr stage 2 docd M 

3388F AJCC cln cncr stage 3 docd M 

3390F AJCC cln cncr stage 4 docd M 

3450F Dyspnea scrnd no-mild dysp E 

3451F Dyspnea scrnd mod-high dysp E 

3452F Dyspnea not screened E 

3455F TB scrng done-interpd 6mon M 

3470F Ra disease activity low M 

3471F Ra disease activity mod M 

3472F Ra disease activity high M 

3475F Disease progn RA poor docd M 

3476F Disease progn RA good docd M 

3490F History aids-defining cond M 

3491F HIV unsure baby of HIV+moms E 

3492F History cd4+ cell count <350 M 

3493F No hist cd4+ cell count<350 M 

3494F CD4+cell count <200cells/mm3 M 

3495F Cd4+cell cnt 200-499 cells M 

3496F Cd4+ cell count + 500 cells M 

3497F CD4+ cell percentage <15% E 

3498F Cd4+ cell % >=15% (hiv) E 

3500F Cd4+cell cnt/% docd as done M 

3502F HIV rna vrl ld <lmts quantif M 

3503F HIV rna vrl ldnot<lmts quntf M 

3510F Doc tb scrng-rslts interpd E 

3511F Chlmyd/gonrh tsts docd done M 

3512F Syph scrng docd as done M 

3513F Hep B scrng docd as done E 

3514F Hep C scrng docd as done E 

3515F Pt has docd immun to hep C E 

3550F Low rsk thromboembolism E 

3551F Intrmed rsk thromboembolism E 

3552F Hgh risk for thromboembolism E 

3555F Pt inr measurement performed E 

3570F Rprt bone scint xref w xray M 

3572F Pt consid poss risk fx E 

3573F Pt not consid poss risk fx E 

3650F Eeg ordered rvwd reqstd E 

3700F Psych disorders assessed E 

3720F Cognit impairment assessed E 

4000F Tobacco use txmnt counseling M 

4001F Tobacco use txmnt pharmacol M 

4002F Statin therapy rx M 
4003F Pt ed write/oral pts w/ hf M 

4004F Pt tobacco screen rcvd tlk M 

4005F Pharm thx for op rxd M 

4006F Beta-blocker therapy rx M 

4009F Ace/arb inhibitor therapy rx M 

4011F Oral antiplatelet therapy rx M 

4012F Warfarin therapy rx M 

4014F Written discharge instr prvd E 

4015F Persist asthma medicine ctrl M 

4016F Anti-inflm/anlgsc agent rx E 

4017F Gi prophylaxis for nsaid rx E 

4018F Therapy exercise joint rx E 

4019F Doc recpt counsl vit d/calc+ E 

4025F Inhaled bronchodilator rx M 

4030F Oxygen therapy rx E 

4033F Pulmonary rehab rec E 

4035F Influenza imm rec E 

4037F Influenza imm order/admin M 

4040F Pneumoc vac/admin/rcvd M 

4041F Doc order cefazolin/cefurox M 

4042F Doc antibio not given M 

4043F Doc order given stop antibio M 

4044F Doc order given vte prophylx M 

4045F Empiric antibiotic rx M 

4046F Doc antibio given b/4 surg M 

4047F Doc antibio given b/4 surg M 

4048F Doc antibio given b/4 surg M 

4049F Doc order given stop antibio M 

4050F Ht care plan doc M 

4051F Referred for an AV fistula M 

4052F Hemodialysis via AV fistula E 

4053F Hemodialysis via AV graft E 

4054F Hemodialysis via catheter E 

4055F Pt rcvng periton dialysis E 

4056F Approp oral rehyd recommd E 

4058F Ped gastro ed given caregvr E 

4060F Psych svcs provided E 

4062F Pt referral psych docd E 

4063F Antidepres rxthxpy not rxd

E

4064F Antidepressant rx E 

4065F Antipsychotic rx E 

4066F ECT provided E 

4067F Pt referral for ect docd E 

4070F Dvt prophylx recvd day 2 M 

4073F Oral antiplat thx rx dischrg M 

4075F Anticoag thx rx at dischrg M 

4077F Doc t-pa admin considered E 

4079F Doc rehab svcs considered M 

4084F Aspirin recvd w/in 24 hrs M 

4090F Pt rcvng epo thxpy M 

4095F Pt not rcvng epo thxpy M 

4100F Biphos thxpy vein ord/recvd M 

4110F Int mam art used for cabg M 

4115F Beta blckr admin w/in 24 hrs M 

4120F Antibiot rxd/given M 
4124F Antibiot not rxd/given M 

4130F Topical prep rx aoe M 

4131F Syst antimicrobial thx rx M 

4132F No syst antimicrobial thx rx M 

4133F Antihist/decong rx/recom E 

4134F No antihist/decong rx/recom E 

4135F Systemic corticosteroids rx E 

4136F Syst corticosteroids not rx E 

4148F Hep A vac injxn admin/recvd M 

4149F Hep B vac injxn admin/recvd M 

4150F Pt recvng antivir txmnt hepc M 

4151F Pt not recvng antiv hep c M 

4153F Combo pegintf/rib rx M 

4155F Hep A vac series prev recvd E 

4157F Hep B vac series prev recvd E 

4158F Pt edu re alcoh drnkng done M 

4159F Contrcp talk b/4 antiv txmnt M 

4163F Pt couns 4 txmnt opt prost E 

4164F Adjv hrmnl thxpy rxd M 

4165F 3d-crt/imrt received M 

4167F Hd bed tilted 1st day vent E 

4168F Pt care icu&vent w/in 24hrs E 

4169F No pt care ICU/vent in 24hrs E 

4171F Pt rcvng esa thxpy M 

4172F Pt not rcvng esa thxpy M 

4174F Couns potent glauc impct E 

4175F Vis of >= 20/40 w/in 90 days M 

4176F Talk re uv light pt/crgvr E 

4177F Talk pt/crgvr re areds prev M 

4178F Antid glbln rcvd w/in 26wks E 

4179F Tamoxifen/AI prescribed M 

4180F Adjv thxpyrxd/rcvd colon ca M 

4181F Conformal radn thxpy rcvd E 

4182F No conformal radn thxpy E 

4185F Continuous ppi or h2ra rcvd E 

4186F No cont ppi or h2ra rcvd E 

4187F Anti rheum drugthxpyrxd/gvn M 

4188F Approp ACE/ARB tstng done E 

4189F Approp digoxin tstng done E 

4190F Approp diuretic tstng done E 

4191F Approp anticonvuls tstng E 

4192F Pt not rcvng glucoco thxpy M 

4193F Pt rcvng<10mg daily predniso M 

4194F Pt rcvng>10mg daily predniso M 

4195F Pt rcvng anti-rheum thxpy RA M 

4196F Ptnot rcvng anti-rhm thxpyRA M 

4200F External beam to prost only M 

4201F Extrnl beam other than prost M 

4210F ACE/ARB thxpy for >= 6 mons E 

4220F Digoxin thxpy for >= 6 mons E 

4221F Diuretic thxpy for >= 6 mons E 

4230F Anticonv thxpy for >= 6 mons E 

4240F Instr xrcz 4bk pn >12 weeks E 

4242F Sprvsd xrcz bk pn >12 weeks E 

4245F Pt instr nrml lifest M 
4248F Pt instr no bd rest>= 4 day

s M 

4250F Wrmng 4 surg normothermia M 

4255F Anesth 60+ min as docd M 

4256F Anesthe <60 min as docd M 

4260F Wound srfc culturetech used E 

4261F Tech other than surfc cultr E 

4265F Wet-dry dressings rx recmd E 

4266F No wet-dry drssings rx recmd E 

4267F Comprssion thxpy prescribed M 

4268F Pt ed re comp thxpy rcvd E 

4269F Appropos mthd offloading Rxd E 

4270F Pt rcvng anti r-viral thxpy M 

4271F Pt rcvng anti r-viral thxpy M 

4274F Flu immuno admind rcvd M 

4275F Hep b vac inj admin/rcvd E 

4276F Potent antivir thxpy Rxd M 

4279F PCP prophylaxis Rxd E 

4280F PCP prophylax Rxd 3mon low % M 

4290F Pt scrned for inj drug use M 

4293F Pt scrnd hgh-risk sex behav M 

4300F Pt rcvng warf thxpy E 

4301F Pt not rcvng warf thxpy E 

4305F Pt ed re ft care inspct rcvd E 

4306F Pt tlk psych & Rx opd addic E 

4320F Pt talk psychsoc&rx oh dpnd E 

4324F Pt queried prkns complic E 

4325F Med txmnt options rvwd w/pt E 

4326F Pt asked re symp auto dysfxn E 

4328F Pt asked re sleep disturb E 

4330F Cnslng epi spec sfty issues

E

4340F Cnslng chldbrng women epi

E

4400F Rehab thxpy options w/pt E 

5005F Pt counsld on exam for moles E 

5010F Macul result to phy mng dm M 

5015F Doc fx & test/txmnt for op M 

5020F Txmnts 2 main Dr by 1 mon E 

5050F Plan 2 main dr by 1 month M 

5060F Fndngs mammo 2pt w/in 3 days E 

5062F Mammo result com to pt 5 day E 

5100F Rsk fx ref w/n 24 hrs xray E 

5200F Eval appros surg thxpy epi

E

6005F Care level rationale doc E 

6010F Dysphag test done b/4 eating M 

6015F Dysphag test done b/4 eating M 

6020F Npo (nothing-mouth) ordered M 

6030F Max sterile barriers follwd M 

6040F Appro rad ds dvcs techs docd E 

6045F Radxps in end rprt4fluro pxd M 

6070F Pt asked/cnsld aed effects

E

6080F Pt/caregiver queried falls E 

6090F Pt/caregiver counsel safety E 

7010F Pt info into recall system M 

7020F Mammo assess cat in dbase E 

7025F Pt infosys alarm 4 nxt mammo M 

A0021 Outside state ambulance servE
A0080 Noninterest escort in non er

E

A0090 Interest escort in non erE

A0100 Nonemergency transport taxiE

A0110 Nonemergency transport busE

A0120 Noner transport mini-busE

A0130 Noner transport wheelch vanE

A0140 Nonemergency transport airE

A0160 Noner transport case workerE

A0170 Transport parking fees/tollsE

A0180 Noner transport lodgng recipE

A0190 Noner transport meals recipE

A0200 Noner transport lodgng escrtE

A0210 Noner transport meals escortE

A0225 Neonatal emergency transportE

A0380 Basic life support mileageE

A0382 Basic support routine supplsA

A0384 Bls defibrillation suppliesA

A0390 Advanced life support mileagE

A0392 Als defibrillation suppliesA

A0394 Als IV drug therapy suppliesA

A0396 Als esophageal intub supplsA

A0398 Als routine disposble supplsA

A0420 Ambulance waiting 1/2 hrA

A0422 Ambulance 02 life sustainingA

A0424 Extra ambulance attendantA

A0425 Ground mileageA

A0426 Als 1A

A0427 ALS1-emergencyA

A0428 blsA

A0429 BLS-emergencyA

A0430 Fixed wing air transportA

A0431 Rotary wing air transportA

A0432 PI volunteer ambulance coA

A0433 als 2A

A0434 Specialty care transportA

A0435 Fixed wing air mileageA

A0436 Rotary wing air mileageA

A0888 Noncovered ambulance mileageE

A0998 Ambulance response/treatmentE

A0999 Unlisted ambulance serviceA

A4206 1 CC sterile syringe&needleE

A4207 2 CC sterile syringe&needleE

A4208 3 CC sterile syringe&needleE

A4209 5+ CC sterile syringe&needleE

A4210 Nonneedle injection deviceE

A4211 Supp for self-adm injections E 

A4212 Non coring needle or styletB

A4213 20+ CC syringe onlyE

A4215 Sterile needleE

A4216 Sterile water/saline, 10 ml A

A4217 Sterile water/saline, 500 ml A

A4218 Sterile saline or water N 

A4220 Infusion pump refill kitN

A4221 Maint drug infus cath per wkY

A4222 Infusion supplies with pumpY
A4223 Infusion supplies w/o pump

E

A4230 Infus insulin pump non needl N 

A4231 Infusion insulin pump needle N 

A4232 Syringe w/needle insulin 3cc

E

A4233 Alkalin batt for glucose monY

A4234 J-cell batt for glucose monY

A4235 Lithium batt for glucose monY

A4236 Silvr oxide batt glucose monY

A4244 Alcohol or peroxide per pintE

A4245 Alcohol wipes per boxE

A4246 Betadine/phisohex solutionE

A4247 Betadine/iodine swabs/wipesE

A4248 Chlorhexidine antiseptN

A4250 Urine reagent strips/tabletsE

A4252 Blood ketone test or stripE

A4253 Blood glucose/reagent stripsY

A4255 Glucose monitor platformsY

A4256 Calibrator solution/chipsY

A4257 Replace Lensshield CartridgeY

A4258 Lancet device eachY

A4259 Lancets per boxY

A4261 Cervical cap contraceptiveE

A4262 Temporary tear duct plugN

A4263 Permanent tear duct plugN

A4264 Intratubal occlusion deviceE

A4265 ParaffinY

A4266 DiaphragmE

A4267 Male condomE

A4268 Female condomE

A4269 SpermicideE

A4270 Disposable endoscope sheath N 

A4280 Brst prsths adhsv attchmntA

A4281 Replacement breastpump tubeE

A4282 Replacement breastpump adptE

A4283 Replacement breastpump capE

A4284 Replcmnt breast pump shieldE

A4285 Replcmnt breast pump bottleE

A4286 Replcmnt breastpump lok ringE

A4290 Sacral nerve stim test leadB

A4300 Cath impl vasc access portalN

A4301 Implantable access syst percN

A4305 Drug delivery system >=50 MLN

A4306 Drug delivery system <=50 mlN

A4310 Insert tray w/o bag/cathA

A4311 Catheter w/o bag 2-way latexA

A4312 Cath w/o bag 2-way siliconeA

A4313 Catheter w/bag 3-wayA

A4314 Cath w/drainage 2-way latexA

A4315 Cath w/drainage 2-way silcneA

A4316 Cath w/drainage 3-wayA

A4320 Irrigation trayA

A4321 Cath therapeutic irrig agentA

A4322 Irrigation syringeA

A4326 Male external catheterA

A4327 Fem urinary collect dev cupA
A4328 Fem urinary collect pouch

A

A4330 Stool collection pouchA

A4331 Extension drainage tubingA

A4332 Lube sterile packetA

A4333 Urinary cath anchor deviceA

A4334 Urinary cath leg strapA

A4335 Incontinence supplyA

A4336 Urethral insertA

A4338 Indwelling catheter latexA

A4340 Indwelling catheter specialA

A4344 Cath indw foley 2 way silicnA

A4346 Cath indw foley 3 wayA

A4349 Disposable male external catA

A4351 Straight tip urine catheterA

A4352 Coude tip urinary catheterA

A4353 Intermittent urinary cathA

A4354 Cath insertion tray w/bagA

A4355 Bladder irrigation tubingA

A4356 Ext ureth clmp or compr dvcA

A4357 Bedside drainage bagA

A4358 Urinary leg or abdomen bagA

A4360 Disposable ext urethral devA

A4361 Ostomy face plateA

A4362 Solid skin barrierA

A4363 Ostomy clamp, replacementA

A4364 Adhesive, liquid or equalA

A4366 Ostomy vent

A

A4367 Ostomy beltA

A4368 Ostomy filterA

A4369 Skin barrier liquid per ozA

A4371 Skin barrier powder per ozA

A4372 Skin barrier solid 4x4 equivA

A4373 Skin barrier with flangeA

A4375 Drainable plastic pch w fcplA

A4376 Drainable rubber pch w fcpltA

A4377 Drainable plstic pch w/o fpA

A4378 Drainable rubber pch w/o fpA

A4379 Urinary plastic pouch w fcplA

A4380 Urinary rubber pouch w fcpltA

A4381 Urinary plastic pouch w/o fpA

A4382 Urinary hvy plstc pch w/o fpA

A4383 Urinary rubber pouch w/o fpA

A4384 Ostomy faceplt/silicone ringA

A4385 Ost skn barrier sld ext wearA

A4387 Ost clsd pouch w att st barrA

A4388 Drainable pch w ex wear barrA

A4389 Drainable pch w st wear barrA

A4390 Drainable pch ex wear convexA

A4391 Urinary pouch w ex wear barrA

A4392 Urinary pouch w st wear barrA

A4393 Urine pch w ex wear bar convA

A4394 Ostomy pouch liq deodorantA

A4395 Ostomy pouch solid deodorantA

A4396 Peristomal hernia supprt bltA

A4397 Irrigation supply sleeveA
A4398 Ostomy irrigation bag

A

A4399 Ostomy irrig cone/cath w brsA

A4400 Ostomy irrigation setA

A4402 Lubricant per ounceA

A4404 Ostomy ring eachA

A4405 Nonpectin based ostomy pasteA

A4406 Pectin based ostomy pasteA

A4407 Ext wear ost skn barr <=4sq"A

A4408 Ext wear ost skn barr >4sq"A

A4409 Ost skn barr convex <=4 sq iA

A4410 Ost skn barr extnd >4 sqA

A4411 Ost skn barr extnd =4sqA

A4412 Ost pouch drain high outputA

A4413 2 pc drainable ost pouchA

A4414 Ost sknbar w/o conv<=4 sq inA

A4415 Ost skn barr w/o conv >4 sqiA

A4416 Ost pch clsd w barrier/filtr

A

A4417 Ost pch w bar/bltinconv/fltr

A

A4418 Ost pch clsd w/o bar w filtr

A

A4419 Ost pch for bar w flange/flt

A

A4420 Ost pch clsd for bar w lk fl

A

A4421 Ostomy supply miscE

A4422 Ost pouch absorbent materialA

A4423 Ost pch for bar w lk fl/fltr

A

A4424 Ost pch drain w bar & filter

A

A4425 Ost pch drain for barrier fl

A

A4426 Ost pch drain 2 piece system

A

A4427 Ost pch drain/barr lk flng/f

A

A4428 Urine ost pouch w faucet/tap

A

A4429 Urine ost pouch w bltinconv

A

A4430 Ost urine pch w b/bltin conv

A

A4431 Ost pch urine w barrier/tapv

A

A4432 Os pch urine w bar/fange/tap

A

A4433 Urine ost pch bar w lock fln

A

A4434 Ost pch urine w lock flng/ft

A

A4450 Non-waterproof tapeA

A4452 Waterproof tapeA

A4455 Adhesive remover per ounceA

A4456 Adhesive remover, wipesA

A4458 Reusable enema bagE

A4461 Surgicl dress hold non-reuseA

A4463 Surgical dress holder reuseA

A4465 Non-elastic extremity binderN

A4466 Elastic garment/coveringE

A4470 Gravlee jet washerN

A4480 Vabra aspiratorN

A4481 Tracheostoma filterA

A4483 Moisture exchangerA

A4490 Above knee surgical stockingE

A4495 Thigh length surg stockingE

A4500 Below knee surgical stockingE

A4510 Full length surg stockingE

A4520 Incontinence garment anytypeE

A4550 Surgical traysB

A4554 Disposable underpadsE
A4556 Electrodes, pair

Y

A4557 Lead wires, pairY

A4558 Conductive gel or pasteY

A4559 Coupling gel or pasteY

A4561 Pessary rubber, any typeN

A4562 Pessary, non rubber,any typeN

A4565 SlingsN

A4566 Should sling/vest/abrestrainE

A4570 SplintE

A4575 Hyperbaric o2 chamber dispsE

A4580 Cast supplies (plaster)E

A4590 Special casting materialE

A4595 TENS suppl 2 lead per monthY

A4600 Sleeve, inter limb comp devY

A4601 Lith ion batt, non-pros use Y

A4604 Tubing with heating elementY

A4605 Trach suction cath close sysY

A4606 Oxygen probe used w oximeterA

A4608 Transtracheal oxygen cathY

A4611 Heavy duty batteryY

A4612 Battery cablesY

A4613 Battery charger Y 

A4614 Hand-held PEFR meter Y 

A4615 Cannula nasalY

A4616 Tubing (oxygen) per footY

A4617 Mouth pieceY

A4618 Breathing circuitsY

A4619 Face tentY

A4620 Variable concentration maskY

A4623 Tracheostomy inner cannulaA

A4624 Tracheal suction tubeY

A4625 Trach care kit for new trachA

A4626 Tracheostomy cleaning brushA

A4627 Spacer bag/reservoirE

A4628 Oropharyngeal suction cathY

A4629 Tracheostomy care kitA

A4630 Repl bat t.e.n.s. own by ptY

A4633 Uvl replacement bulbY

A4634 Replacement bulb th lightboxA

A4635 Underarm crutch padY

A4636 Handgrip for cane etcY

A4637 Repl tip cane/crutch/walkerY

A4638 Repl batt pulse gen sys

Y

A4639 Infrared ht sys replcmnt padY

A4640 Alternating pressure padY

A4641 Radiopharm dx agent nocN

A4642 In111 satumomabN

A4648 Implantable tissue marker

N

A4649 Surgical supplies

N

A4650 Implant radiation dosimeterN

A4651 Calibrated microcap tubeA

A4652 Microcapillary tube sealantA

A4653 PD catheter anchor beltA

A4657 Syringe w/wo needleN

A4660 Sphyg/bp app w cuff and stetN
A4663 Dialysis blood pressure cuff

N

A4670 Automatic bp monitor, dialE

A4671 Disposable cycler set

B

A4672 Drainage ext line, dialysis

B

A4673 Ext line w easy lock connect

B

A4674 Chem/antisept solution, 8oz

B

A4680 Activated carbon filter, eaN

A4690 Dialyzer, eachN

A4706 Bicarbonate conc sol per galN

A4707 Bicarbonate conc pow per pacN

A4708 Acetate conc sol per gallonN

A4709 Acid conc sol per gallonN

A4714 Treated water per gallonN

A4719 "Y set" tubingN

A4720 Dialysat sol fld vol > 249ccN

A4721 Dialysat sol fld vol > 999ccN

A4722 Dialys sol fld vol > 1999ccN

A4723 Dialys sol fld vol > 2999ccN

A4724 Dialys sol fld vol > 3999ccN

A4725 Dialys sol fld vol > 4999ccN

A4726 Dialys sol fld vol > 5999ccN

A4728 Dialysate solution, non-dex

B

A4730 Fistula cannulation set, eaN

A4736 Topical anesthetic, per gramN

A4737 Inj anesthetic per 10 mlN

A4740 Shunt accessoryN

A4750 Art or venous blood tubingN

A4755 Comb art/venous blood tubingN

A4760 Dialysate sol test kit, eachN

A4765 Dialysate conc pow per packN

A4766 Dialysate conc sol add 10 mlN

A4770 Blood collection tube/vacuumN

A4771 Serum clotting time tubeN

A4772 Blood glucose test stripsN

A4773 Occult blood test stripsN

A4774 Ammonia test stripsN

A4802 Protamine sulfate per 50 mgN

A4860 Disposable catheter tipsN

A4870 Plumb/elec wk hm hemo equipN

A4890 Repair/maint cont hemo equipN

A4911 Drain bag/bottleN

A4913 Misc dialysis supplies nocN

A4918 Venous pressure clampN

A4927 Non-sterile glovesN

A4928 Surgical maskN

A4929 Tourniquet for dialysis, eaN

A4930 Sterile, gloves per pairN

A4931 Reusable oral thermometerN

A4932 Reusable rectal thermometerE

A5051 Pouch clsd w barr attachedA

A5052 Clsd ostomy pouch w/o barrA

A5053 Clsd ostomy pouch faceplateA

A5054 Clsd ostomy pouch w/flangeA

A5055 Stoma capA

A5061 Pouch drainable w barrier atA
A5062 Drnble ostomy pouch w/o barr

A

A5063 Drain ostomy pouch w/flangeA

A5071 Urinary pouch w/barrierA

A5072 Urinary pouch w/o barrierA

A5073 Urinary pouch on barr w/flngA

A5081 Continent stoma plugA

A5082 Continent stoma catheterA

A5083 Stoma absorptive coverA

A5093 Ostomy accessory convex inseA

A5102 Bedside drain btl w/wo tubeA

A5105 Urinary suspensoryA

A5112 Urinary leg bagA

A5113 Latex leg strapA

A5114 Foam/fabric leg strapA

A5120 Skin barrier, wipe or swabA

A5121 Solid skin barrier 6x6A

A5122 Solid skin barrier 8x8A

A5126 Disk/foam pad +or- adhesiveA

A5131 Appliance cleanerA

A5200 Percutaneous catheter anchorA

A5500 Diab shoe for density insertY

A5501 Diabetic custom molded shoeY

A5503 Diabetic shoe w/roller/rockrY

A5504 Diabetic shoe with wedgeY

A5505 Diab shoe w/metatarsal barY

A5506 Diabetic shoe w/off set heelY

A5507 Modification diabetic shoeY

A5508 Diabetic deluxe shoeY

A5510 Compression form shoe insertE

A5512 Multi den insert direct form Y 

A5513 Multi den insert custom mold Y 

A6000 Wound warming wound coverE

A6010 Collagen based wound fillerA

A6011 Collagen gel/paste wound filA

A6021 Collagen dressing <=16 sq inA

A6022 Collagen drsg>16<=48 sq inA

A6023 Collagen dressing >48 sq inA

A6024 Collagen dsg wound fillerA

A6025 Silicone gel sheet, eachE

A6154 Wound pouch eachA

A6196 Alginate dressing <=16 sq inA

A6197 Alginate drsg >16 <=48 sq inA

A6198 alginate dressing > 48 sq inA

A6199 Alginate drsg wound fillerA

A6203 Composite drsg <= 16 sq inA

A6204 Composite drsg >16<=48 sq inA

A6205 Composite drsg > 48 sq inA

A6206 Contact layer <= 16 sq inA

A6207 Contact layer >16<= 48 sq inA

A6208 Contact layer > 48 sq inA

A6209 Foam drsg <=16 sq in w/o bdrA

A6210 Foam drg >16<=48 sq in w/o bA

A6211 Foam drg > 48 sq in w/o brdrA

A6212 Foam drg <=16 sq in w/borderA

A6213 Foam drg >16<=48 sq in w/bdrA
A6214 Foam drg > 48 sq in w/border

A

A6215 Foam dressing wound fillerA

A6216 Non-sterile gauze<=16 sq inA

A6217 Non-sterile gauze>16<=48 sqA

A6218 Non-sterile gauze > 48 sq inA

A6219 Gauze <= 16 sq in w/borderA

A6220 Gauze >16 <=48 sq in w/bordrA

A6221 Gauze > 48 sq in w/borderA

A6222 Gauze <=16 in no w/sal w/o bA

A6223 Gauze >16<=48 no w/sal w/o bA

A6224 Gauze > 48 in no w/sal w/o bA

A6228 Gauze <= 16 sq in water/salA

A6229 Gauze >16<=48 sq in watr/salA

A6230 Gauze > 48 sq in water/salneA

A6231 Hydrogel dsg<=16 sq inA

A6232 Hydrogel dsg>16<=48 sq inA

A6233 Hydrogel dressing >48 sq inA

A6234 Hydrocolld drg <=16 w/o bdrA

A6235 Hydrocolld drg >16<=48 w/o bA

A6236 Hydrocolld drg > 48 in w/o bA

A6237 Hydrocolld drg <=16 in w/bdrA

A6238 Hydrocolld drg >16<=48 w/bdrA

A6239 Hydrocolld drg > 48 in w/bdrA

A6240 Hydrocolld drg filler pasteA

A6241 Hydrocolloid drg filler dryA

A6242 Hydrogel drg <=16 in w/o bdrA

A6243 Hydrogel drg >16<=48 w/o bdrA

A6244 Hydrogel drg >48 in w/o bdrA

A6245 Hydrogel drg <= 16 in w/bdrA

A6246 Hydrogel drg >16<=48 in w/bA

A6247 Hydrogel drg > 48 sq in w/bA

A6248 Hydrogel drsg gel fillerA

A6250 Skin seal protect moisturizrA

A6251 Absorpt drg <=16 sq in w/o bA

A6252 Absorpt drg >16 <=48 w/o bdrA

A6253 Absorpt drg > 48 sq in w/o bA

A6254 Absorpt drg <=16 sq in w/bdrA

A6255 Absorpt drg >16<=48 in w/bdrA

A6256 Absorpt drg > 48 sq in w/bdrA

A6257 Transparent film <= 16 sq inA

A6258 Transparent film >16<=48 inA

A6259 Transparent film > 48 sq inA

A6260 Wound cleanser any type/sizeA

A6261 Wound filler gel/paste /ozA

A6262 Wound filler dry form / gramA

A6266 Impreg gauze no h20/sal/yardA

A6402 Sterile gauze <= 16 sq inA

A6403 Sterile gauze>16 <= 48 sq inA

A6404 Sterile gauze > 48 sq inA

A6407 Packing strips, non-impreg

A

A6410 Sterile eye padA

A6411 Non-sterile eye padA

A6412 Occlusive eye patchA

A6413 Adhesive bandage, first-aid E 

A6441 Pad band w>=3" <5"/yd

A
A6442 Conform band n/s w<3"/y

d

A

A6443 Conform band n/s w>=3"<5"/yd

A

A6444 Conform band n/s w>=5"/yd

A

A6445 Conform band s w <3"/yd

A

A6446 Conform band s w>=3" <5"/yd

A

A6447 Conform band s w >=5"/yd

A

A6448 Lt compres band <3"/yd

A

A6449 Lt compres band >=3" <5"/yd

A

A6450 Lt compres band >=5"/yd

A

A6451 Mod compres band w>=3"<5"/yd

A

A6452 High compres band w>=3"<5"yd

A

A6453 Self-adher band w <3"/yd

A

A6454 Self-adher band w>=3" <5"/yd

A

A6455 Self-adher band >=5"/yd

A

A6456 Zinc paste band w >=3"<5"/yd

A

A6457 Tubular dressing

A

A6501 Compres burngarment bodysuitA

A6502 Compres burngarment chinstrpA

A6503 Compres burngarment facehoodA

A6504 Cmprsburngarment glove-wristA

A6505 Cmprsburngarment glove-elbowA

A6506 Cmprsburngrmnt glove-axillaA

A6507 Cmprs burngarment foot-kneeA

A6508 Cmprs burngarment foot-thighA

A6509 Compres burn garment jacketA

A6510 Compres burn garment leotardA

A6511 Compres burn garment pantyA

A6512 Compres burn garment, nocA

A6513 Compress burn mask face/neckB

A6530 Compression stocking BK18-30E

A6531 Compression stocking BK30-40A

A6532 Compression stocking BK40-50A

A6533 Gc stocking thighlngth 18-30E

A6534 Gc stocking thighlngth 30-40E

A6535 Gc stocking thighlngth 40-50E

A6536 Gc stocking full lngth 18-30E

A6537 Gc stocking full lngth 30-40E

A6538 Gc stocking full lngth 40-50E

A6539 Gc stocking waistlngth 18-30E

A6540 Gc stocking waistlngth 30-40E

A6541 Gc stocking waistlngth 40-50E

A6544 Gc stocking garter beltE

A6545 Grad comp non-elastic BKA

A6549 G compression stockingE

A6550 Neg pres wound ther drsg set

Y

A7000 Disposable canister for pumpY

A7001 Nondisposable pump canisterY

A7002 Tubing used w suction pumpY

A7003 Nebulizer administration setY

A7004 Disposable nebulizer sml volY

A7005 Nondisposable nebulizer setY

A7006 Filtered nebulizer admin setY

A7007 Lg vol nebulizer disposableY

A7008 Disposable nebulizer prefillY

A7009 Nebulizer reservoir bottleY
A7010 Disposable corrugated tubing

Y

A7011 Nondispos corrugated tubingY

A7012 Nebulizer water collec devicY

A7013 Disposable compressor filterY

A7014 Compressor nondispos filterY

A7015 Aerosol mask used w nebulizeY

A7016 Nebulizer dome & mouthpieceY

A7017 Nebulizer not used w oxygenY

A7018 Water distilled w/nebulizerY

A7020 Interface, cough stim deviceY

A7025 Replace chest compress vestY

A7026 Replace chst cmprss sys hoseY

A7027 Combination oral/nasal maskY

A7028 Repl oral cushion combo maskY

A7029 Repl nasal pillow comb maskY

A7030 CPAP full face maskY

A7031 Replacement facemask interfaY

A7032 Replacement nasal cushionY

A7033 Replacement nasal pillowsY

A7034 Nasal application deviceY

A7035 Pos airway press headgearY

A7036 Pos airway press chinstrapY

A7037 Pos airway pressure tubingY

A7038 Pos airway pressure filterY

A7039 Filter, non disposable w papY

A7040 One way chest drain valveA

A7041 Water seal drain containerA

A7042 Implanted pleural catheterN

A7043 Vacuum drainagebottle/tubingA

A7044 PAP oral interfaceY

A7045 Repl exhalation port for PAPY

A7046 Repl water chamber, PAP dev

Y

A7501 Tracheostoma valve w diaphraA

A7502 Replacement diaphragm/fplateA

A7503 HMES filter holder or capA

A7504 Tracheostoma HMES filterA

A7505 HMES or trach valve housingA

A7506 HMES/trachvalve adhesivediskA

A7507 Integrated filter & holderA

A7508 Housing & Integrated AdhesivA

A7509 Heat & moisture exchange sy

s

A

A7520 Trach/laryn tube non-cuffed

A

A7521 Trach/laryn tube cuffed

A

A7522 Trach/laryn tube stainless

A

A7523 Tracheostomy shower protect

A

A7524 Tracheostoma stent/stud/bttn

A

A7525 Tracheostomy mask

A

A7526 Tracheostomy tube collar

A

A7527 Trach/laryn tube plug/stopA

A8000 Soft protect helmet prefab Y 

A8001 Hard protect helmet prefab Y 

A8002 Soft protect helmet custom Y 

A8003 Hard protect helmet custom Y 

A8004 Repl soft interface, helmet Y 

A9150 Misc/exper non-prescript druB
A9152 Single vitamin nos

E

A9153 Multi-vitamin nosE

A9155 Artificial saliva B 

A9180 Lice treatment, topicalE

A9270 Non-covered item or serviceE

A9273 Hot/cold h2obot/cap/col/wrap Y 

A9274 Ext amb insulin delivery sy

s

E

A9275 Disp home glucose monitor 

E

A9276 Disposable sensor, CGM sys

E

A9277 External transmitter, CGM

E

A9278 External receiver, CGM sys

E

A9279 Monitoring feature/deviceNOC

E

A9280 Alert device, noc

E

A9281 Reaching/grabbing device

E

A9282 Wig any type

E

A9283 Foot press off load supp dev

E

A9284 Non-electronic spirometerN

A9300 Exercise equipmentE

A9500 Tc99m sestamibi

N

A9501 Technetium TC-99m teboroxime

N

A9502 Tc99m tetrofosmin

N

A9503 Tc99m medronateN

A9504 Tc99m apcitideN

A9505 TL201 thalliumN

A9507 In111 capromabN

A9508 I131 iodobenguate, dxN

A9509 Iodine I-123 sod iodide milN

A9510 Tc99m disofenin N 

A9512 Tc99m pertechnetateN

A9516 Iodine I-123 sod iodide mic

N

A9517 I131 iodide cap, rx K 1064

A9521 Tc99m exametazimeN

A9524 I131 serum albumin, dxN

A9526 Nitrogen N-13 ammoniaN

A9527 Iodine I-125 sodium iodide

U 2632

A9528 Iodine I-131 iodide cap, dxN

A9529 I131 iodide sol, dx N 

A9530 I131 iodide sol, rx K 1150

A9531 I131 max 100uCi N 

A9532 I125 serum albumin, dx N 

A9536 Tc99m depreotide N 

A9537 Tc99m mebrofeninN

A9538 Tc99m pyrophosphate

N

A9539 Tc99m pentetate N 

A9540 Tc99m MAA

N

A9541 Tc99m sulfur colloidN

A9542 In111 ibritumomab, dx N 

A9543 Y90 ibritumomab, rx K 1643

A9544 I131 tositumomab, dx N 

A9545 I131 tositumomab, rx K 1645

A9546 Co57/58 N 

A9547 In111 oxyquinoline N 

A9548 In111 pentetate N 

A9550 Tc99m gluceptate N 

A9551 Tc99m succimer N 
A9552 F18 fdg N 

A9553 Cr51 chromate N 

A9554 I125 iothalamate, dx N 

A9555 Rb82 rubidium N 

A9556 Ga67 gallium N 

A9557 Tc99m bicisate N 

A9558 Xe133 xenon 10mci N 

A9559 Co57 cyano

N

A9560 Tc99m labeled rbc

N

A9561 Tc99m oxidronate N 

A9562 Tc99m mertiatide N 

A9563 P32 Na phosphate K 1675

A9564 P32 chromic phosphate K 1676

A9566 Tc99m fanolesomab N 

A9567 Technetium TC-99m aerosol

N

A9568 Technetium tc99m arcitumomab

N

A9569 Technetium TC-99m auto WBC

N

A9570 Indium In-111 auto WBC

N

A9571 Indium IN-111 auto platelet

N

A9572 Indium In-111 pentetreotide

N

A9576 Inj prohance multipack

N

A9577 Inj multihance

N

A9578 Inj multihance multipack

N

A9579 Gad-base MR contrast NOS,1ml N

A9580 Sodium fluoride F-18N

A9581 Gadoxetate disodium injN

A9582 Iodine I-123 iobenguane CHN

A9583 Gadofosveset trisodium inj CHN

A9600 Sr89 strontium K 0701

A9604 Sm 153 lexidronam

K 1295

A9698 Non-rad contrast materialNOCN

A9699 Radiopharm rx agent nocN

A9700 Echocardiography ContrastB

A9900 Supply/accessory/service Y 

A9901 Delivery/set up/dispensingA

A9999 DME supply or accessory, nosY

B4034 Enter feed supkit syr by dayY

B4035 Enteral feed supp pump per dY

B4036 Enteral feed sup kit grav byY

B4081 Enteral ng tubing w/ styletY

B4082 Enteral ng tubing w/o styletY

B4083 Enteral stomach tube levineY

B4087 Gastro/jejuno tube, stdA

B4088 Gastro/jejuno tube, low-proA

B4100 Food thickener oralE

B4102 EF adult fluids and electroY

B4103 EF ped fluid and electrolyteY

B4104 Additive for enteral formulaE

B4149 EF blenderized foodsY

B4150 EF complet w/intact nutrient

Y

B4152 EF calorie dense>/=1.5Kcal

Y

B4153 EF hydrolyzed/amino acids

Y

B4154 EF spec metabolic noninherit

Y

B4155 EF incomplete/modular

Y

B4157 EF special metabolic inheritY
B4158 EF ped complete intact nut

Y

B4159 EF ped complete soy basedY

B4160 EF ped caloric dense>/=0.7kcY

B4161 EF ped hydrolyzed/amino acidY

B4162 EF ped specmetabolic inheritY

B4164 Parenteral 50% dextrose solu

Y

B4168 Parenteral sol amino acid 3.

Y

B4172 Parenteral sol amino acid 5.

Y

B4176 Parenteral sol amino acid 7-

Y

B4178 Parenteral sol amino acid >

Y

B4180 Parenteral sol carb > 50%

Y

B4185 Parenteral sol 10 gm lipidsB

B4189 Parenteral sol amino acid & Y 

B4193 Parenteral sol 52-73 gm prot Y 

B4197 Parenteral sol 74-100 gm pro Y 

B4199 Parenteral sol > 100gm prote Y 

B4216 Parenteral nutrition additiv Y 

B4220 Parenteral supply kit premix Y 

B4222 Parenteral supply kit homemi Y 

B4224 Parenteral administration ki Y 

B5000 Parenteral sol renal-amirosy Y 

B5100 Parenteral sol hepatic-fream Y 

B5200 Parenteral sol stres-brnch c Y 

B9000 Enter infusion pump w/o alrm Y 

B9002 Enteral infusion pump w/ ala Y 

B9004 Parenteral infus pump portab Y 

B9006 Parenteral infus pump statio Y 

B9998 Enteral supp not otherwise c Y 

B9999 Parenteral supp not othrws c Y 

C1300 HYPERBARIC OxygenS 0659

C1713 Anchor/screw bn/bn,tis/bnN

C1714 Cath, trans atherectomy, dirN

C1715 Brachytherapy needleN

C1716 Brachytx, non-str, Gold-198

U 1716

C1717 Brachytx, non-str,HDR Ir-192

U 1717

C1719 Brachytx, NS, Non-HDRIr-192

U 1719

C1721 AICD, dual chamberN

C1722 AICD, single chamberN

C1724 Cath, trans atherec,rotationN

C1725 Cath, translumin non-laserN

C1726 Cath, bal dil, non-vascularN

C1727 Cath, bal tis dis, non-vasN

C1728 Cath, brachytx seed admN

C1729 Cath, drainageN

C1730 Cath, EP, 19 or few electN

C1731 Cath, EP, 20 or more elecN

C1732 Cath, EP, diag/abl, 3D/vectN

C1733 Cath, EP, othr than cool-tipN

C1749 Endo, colon, retro imagingH 1749

C1750 Cath, hemodialysis,long-termN

C1751 Cath, inf, per/cent/midlineN

C1752 Cath,hemodialysis,short-termN

C1753 Cath, intravas ultrasoundN

C1754 Catheter, intradiscalN

C1755 Catheter, intraspinalN
C1756 Cath, pacing, transesoph

N

C1757 Cath, thrombectomy/embolectN

C1758 Catheter, ureteralN

C1759 Cath, intra echocardiographyN

C1760 Closure dev, vascN

C1762 Conn tiss, human(inc fascia)N

C1763 Conn tiss, non-humanN

C1764 Event recorder, cardiacN

C1765 Adhesion barrierN

C1766 Intro/sheath,strble,non-peelN

C1767 Generator, neuro non-rechargN

C1768 Graft, vascularN

C1769 Guide wireN

C1770 Imaging coil, MR, insertableN

C1771 Rep dev, urinary, w/slingN

C1772 Infusion pump, programmableN

C1773 Ret dev, insertableN

C1776 Joint device (implantable)N

C1777 Lead, AICD, endo single coilN

C1778 Lead, neurostimulatorN

C1779 Lead, pmkr, transvenous VDDN

C1780 Lens, intraocular (new tech)N

C1781 Mesh (implantable)N

C1782 MorcellatorN

C1783 Ocular imp, aqueous drain deN

C1784 Ocular dev, intraop, det retN

C1785 Pmkr, dual, rate-respN

C1786 Pmkr, single, rate-respN

C1787 Patient progr, neurostimN

C1788 Port, indwelling, impN

C1789 Prosthesis, breast, impN

C1813 Prosthesis, penile, inflatabN

C1814 Retinal tamp, silicone oilN

C1815 Pros, urinary sph, impN

C1816 Receiver/transmitter, neuroN

C1817 Septal defect imp sysN

C1818 Integrated keratoprosthesisN

C1819 Tissue localization-excisionN

C1820 Generator neuro rechg bat sy N 

C1821 Interspinous implant N 

C1874 Stent, coated/cov w/del sysN

C1875 Stent, coated/cov w/o del syN

C1876 Stent, non-coa/non-cov w/delN

C1877 Stent, non-coat/cov w/o delN

C1878 Matrl for vocal cordN

C1879 Tissue marker, implantableN

C1880 Vena cava filterN

C1881 Dialysis access systemN

C1882 AICD, other than sing/dualN

C1883 Adapt/ext, pacing/neuro leadN

C1884 Embolization Protect systN

C1885 Cath, translumin angio laserN

C1887 Catheter, guidingN

C1888 Endovas non-cardiac abl cathN

C1891 Infusion pump,non-prog, permN
C1892 Intro/sheath,fixed,peel-away

N

C1893 Intro/sheath, fixed,non-peelN

C1894 Intro/sheath, non-laserN

C1895 Lead, AICD, endo dual coilN

C1896 Lead, AICD, non sing/dualN

C1897 Lead, neurostim test kitN

C1898 Lead, pmkr, other than transN

C1899 Lead, pmkr/AICD combinationN

C1900 Lead, coronary venousN

C2614 Probe, perc lumb discN

C2615 Sealant, pulmonary, liquidN

C2616 Brachytx, non-str,Yttrium-90

U 2616

C2617 Stent, non-cor, tem w/o delN

C2618 Probe, cryoablationN

C2619 Pmkr, dual, non rate-respN

C2620 Pmkr, single, non rate-respN

C2621 Pmkr, other than sing/dualN

C2622 Prosthesis, penile, non-infN

C2625 Stent, non-cor, tem w/del syN

C2626 Infusion pump, non-prog,tempN

C2627 Cath, suprapubic/cystoscopicN

C2628 Catheter, occlusionN

C2629 Intro/sheath, laserN

C2630 Cath, EP, cool-tipN

C2631 Rep dev, urinary, w/o slingN

C2634 Brachytx, non-str, HA, I-125

U 2634

C2635 Brachytx, non-str, HA, P-103

U 2635

C2636 Brachy linear, non-str,P-103

U 2636

C2637 Brachy,non-str,Ytterbium-169 B 

C2638 Brachytx, stranded, I-125U 2638

C2639 Brachytx, non-stranded,I-125U 2639

C2640 Brachytx, stranded, P-103U 2640

C2641 Brachytx, non-stranded,P-103U 2641

C2642 Brachytx, stranded, C-131U 2642

C2643 Brachytx, non-stranded,C-131U 2643

C2698 Brachytx, stranded, NOSU 2698

C2699 Brachytx, non-stranded, NOSU 2699

C8900 MRA w/cont, abd Q3 0284

C8901 MRA w/o cont, abd Q3 0336

C8902 MRA w/o fol w/cont, abd Q3 0337

C8903 MRI w/cont, breast, uni Q3 0284

C8904 MRI w/o cont, breast, uni Q3 0336

C8905 MRI w/o fol w/cont, brst, un Q3 0337

C8906 MRI w/cont, breast, bi Q3 0284

C8907 MRI w/o cont, breast, bi Q3 0336

C8908 MRI w/o fol w/cont, breast, Q3 0337

C8909 MRA w/cont, chest Q3 0284

C8910 MRA w/o cont, chest Q3 0336

C8911 MRA w/o fol w/cont, chest Q3 0337

C8912 MRA w/cont, lwr ext Q3 0284

C8913 MRA w/o cont, lwr ext Q3 0336

C8914 MRA w/o fol w/cont, lwr ext Q3 0337

C8918 MRA w/cont, pelvis Q3 0284

C8919 MRA w/o cont, pelvis Q3 0336

C8920 MRA w/o fol w/cont, pelvis Q3 0337
C8921 TTE w or w/o fol w/cont, com

S 0128

C8922 TTE w or w/o fol w/cont, f/uS 0128

C8923 2D TTE w or w/o fol w/con,coS 0128

C8924 2D TTE w or w/o fol w/con,fuS 0128

C8925 2D TEE w or w/o fol w/con,inS 0128

C8926 TEE w or w/o fol w/cont,congS 0128

C8927 TEE w or w/o fol w/cont, monS 0128

C8928 TTE w or w/o fol w/con,stresS 0128

C8929 TTE w or wo fol wcon,DopplerS 0128

C8930 TTE w or w/o contr, cont ECGS 0128

C8931 MRA, w/dye, spinal canal Q3 0284

C8932 MRA, w/o dye, spinal canal Q3 0336

C8933 MRA, w/o&w/dye, spinal canal Q3 0337

C8934 MRA, w/dye, upper extremity Q3 0284

C8935 MRA, w/o dye, upper extr Q3 0336

C8936 MRA, w/o&w/dye, upper extr Q3 0337

C8957 Prolonged IV inf, req pumpS 0440

C9113 Inj pantoprazole sodium, viaN

C9121 Injection, argatrobanK 9121

C9248 Inj, clevidipine butyrate

K 9248

C9250 Artiss fibrin sealant CH

K 9250

C9254 Injection, lacosamide

K 9254

C9257 Bevacizumab injection

K 1281

C9270 Gammaplex IVIG

G 9270

C9272 Inj, denosumab

G 9272

C9273 Sipuleucel-T, per infusion

G 9273

C9274 Crotalidae Poly Immune Fab

G 9274

C9275 Hexaminolevulinate HCl

G 9275

C9276 Cabazitaxel injection

G 9276

C9277 Lumizyme, 1 mg

G 9277

C9279 Injection, ibuprofen

G 9279

C9280 Injection, eribulin mesylate

G 9280

C9281 Injection, pegloticase 

G 9281

C9282 Injection, ceftaroline fosamil 

G 9282

C9352 Neuragen nerve guide, per cm N 

C9353 Neurawrap nerve protector,cm N 

C9354 Veritas collagen matrix, cm2 N 

C9355 Neuromatrix nerve cuff, cm N 

C9356 TenoGlide tendon prot, cm2 N 

C9358 SurgiMend, fetal

K 9358

C9359 Implnt,bon void filler-putty N 

C9360 SurgiMend, neonatal CH

K 9360

C9361 NeuroMend nerve wrap CH N 

C9362 Implnt,bon void filler-strip CH N 

C9363 Integra Meshed Bil Wound Mat CH

K 9363

C9364 Porcine implant, Permacol CH N 

C9367 Endoform Dermal Template

G 9367

C9399 Unclassified drugs or biologA

C9716 Radiofrequency energy to anuT 0150

C9724 EPS gast cardia plicT 0422

C9725 Place endorectal appT 0148

C9726 Rxt breast appl place/removT 0028

C9727 Insert palate implants T 0252

C9728 Place device/marker, non pro X 0310

C9729 Percut lumbar lami

T 0208
C9800 Dermal filler inj px/suppl T 0135

C9898 Inpnt stay radiolabeled item

N

C9899 Inpt implant pros dev,no cov

A

D0120 Periodic oral evaluationE

D0140 Limit oral eval problm focusE

D0145 Oral evaluation, pt < 3yrs E 

D0150 Comprehensve oral evaluationS 0330

D0160 Extensv oral eval prob focusE

D0170 Re-eval,est pt,problem focusE

D0180 Comp periodontal evaluationE

D0210 Intraor complete film seriesE

D0220 Intraoral periapical first fE

D0230 Intraoral periapical ea addE

D0240 Intraoral occlusal filmS 0330

D0250 Extraoral first filmS 0330

D0260 Extraoral ea additional filmS 0330

D0270 Dental bitewing single filmS 0330

D0272 Dental bitewings two filmsS 0330

D0273 Bitewings - three films E 

D0274 Dental bitewings four filmsS 0330

D0277 Vert bitewings-sev to eightS 0330

D0290 Dental film skull/facial bonE

D0310 Dental saliographyE

D0320 Dental tmj arthrogram incl iE

D0321 Dental other tmj filmsE

D0322 Dental tomographic surveyE

D0330 Dental panoramic filmE

D0340 Dental cephalometric filmE

D0350 Oral/facial photo imagesE

D0360 Cone beam ct

E

D0362 Cone beam, two dimensional

E

D0363 Cone beam, three dimensional

E

D0415 Collection of microorganismsE

D0416 Viral cultureB

D0417 Collect & prep saliva sampleE

D0418 Analysis of saliva sampleE

D0421 Gen tst suscept oral diseaseB

D0425 Caries susceptibility testE

D0431 Diag tst detect mucos abnormB

D0460 Pulp vitality testS 0330

D0470 Diagnostic castsE

D0472 Gross exam, prep & reportB

D0473 Micro exam, prep & reportB

D0474 Micro w exam of surg marginsB

D0475 Decalcification procedureB

D0476 Spec stains for microorganisB

D0477 Spec stains not for microorgB

D0478 Immunohistochemical stainsB

D0479 Tissue in-situ hybridizationB

D0480 Cytopath smear prep & reportB

D0481 Electron microscopy diagnostB

D0482 Direct immunofluorescenceB

D0483 Indirect immunofluorescenceB

D0484 Consult slides prep elsewherB

D0485 Consult inc prep of slidesB
D0486 Access of transep cytol samp E 

D0502 Other oral pathology proceduB

D0999 Unspecified diagnostic proceB

D1110 Dental prophylaxis adultE

D1120 Dental prophylaxis childE

D1203 Topical app fluoride childE

D1204 Topical app fluoride adultE

D1206 Topical fluoride varnishE

D1310 Nutri counsel-control cariesE

D1320 Tobacco counselingE

D1330 Oral hygiene instructionE

D1351 Dental sealant per toothE

D1352 Prev resin rest, perm toothE

D1510 Space maintainer fxd unilatS 0330

D1515 Fixed bilat space maintainerS 0330

D1520 Remove unilat space maintainS 0330

D1525 Remove bilat space maintainS 0330

D1550 Recement space maintainerS 0330

D1555 Remove fix space maintainerE

D2140 Amalgam one surface permanenE

D2150 Amalgam two surfaces permaneE

D2160 Amalgam three surfaces permaE

D2161 Amalgam 4 or > surfaces permE

D2330 Resin one surface-anteriorE

D2331 Resin two surfaces-anteriorE

D2332 Resin three surfaces-anterioE

D2335 Resin 4/> surf or w incis anE

D2390 Ant resin-based cmpst crownE

D2391 Post 1 srfc resinbased cmpstE

D2392 Post 2 srfc resinbased cmpstE

D2393 Post 3 srfc resinbased cmpstE

D2394 Post >=4srfc resinbase cmpstE

D2410 Dental gold foil one surfaceE

D2420 Dental gold foil two surfaceE

D2430 Dental gold foil three surfaE

D2510 Dental inlay metalic 1 surfE

D2520 Dental inlay metallic 2 surfE

D2530 Dental inlay metl 3/more surE

D2542 Dental onlay metallic 2 surfE

D2543 Dental onlay metallic 3 surfE

D2544 Dental onlay metl 4/more surE

D2610 Inlay porcelain/ceramic 1 suE

D2620 Inlay porcelain/ceramic 2 suE

D2630 Dental onlay porc 3/more surE

D2642 Dental onlay porcelin 2 surfE

D2643 Dental onlay porcelin 3 surfE

D2644 Dental onlay porc 4/more surE

D2650 Inlay composite/resin one suE

D2651 Inlay composite/resin two suE

D2652 Dental inlay resin 3/mre surE

D2662 Dental onlay resin 2 surfaceE

D2663 Dental onlay resin 3 surfaceE

D2664 Dental onlay resin 4/mre surE

D2710 Crown resin-based indirectE

D2712 Crown 3/4 resin-based composE
D2720 Crown resin w/ high noble m

eE

D2721 Crown resin w/ base metalE

D2722 Crown resin w/ noble metalE

D2740 Crown porcelain/ceramic subsE

D2750 Crown porcelain w/ h noble mE

D2751 Crown porcelain fused base mE

D2752 Crown porcelain w/ noble metE

D2780 Crown 3/4 cast hi noble metE

D2781 Crown 3/4 cast base metalE

D2782 Crown 3/4 cast noble metalE

D2783 Crown 3/4 porcelain/ceramicE

D2790 Crown full cast high noble mE

D2791 Crown full cast base metalE

D2792 Crown full cast noble metalE

D2794 Crown-titaniumE

D2799 Provisional crownE

D2910 Recement inlay onlay or partE

D2915 Recement cast or prefab postE

D2920 Dental recement crownE

D2930 Prefab stnlss steel crwn priE

D2931 Prefab stnlss steel crown peE

D2932 Prefabricated resin crownE

D2933 Prefab stainless steel crownE

D2934 Prefab steel crown primaryE

D2940 Protective restorationE

D2950 Core build-up incl any pinsE

D2951 Tooth pin retentionE

D2952 Post and core cast + crownE

D2953 Each addtnl cast postE

D2954 Prefab post/core + crownE

D2955 Post removalE

D2957 Each addtnl prefab postE

D2960 Laminate labial veneerE

D2961 Lab labial veneer resinE

D2962 Lab labial veneer porcelainE

D2970 Temp crown (fractured tooth) E 

D2971 Add proc construct new crownE

D2975 CopingE

D2980 Crown repairE

D2999 Dental unspec restorative prS 0330

D3110 Pulp cap directE

D3120 Pulp cap indirectE

D3220 Therapeutic pulpotomyE

D3221 Gross pulpal debridementE

D3222 Part pulp for apexogenesisE

D3230 Pulpal therapy anterior primE

D3240 Pulpal therapy posterior priE

D3310 End thxpy, anterior toothE

D3320 End thxpy, bicuspid toothE

D3330 End thxpy, molarE

D3331 Non-surg tx root canal obsE

D3332 Incomplete endodontic txE

D3333 Internal root repairE

D3346 Retreat root canal anteriorE

D3347 Retreat root canal bicuspidE
D3348 Retreat root canal molar

E

D3351 Apexification/recalc initialE

D3352 Apexification/recalc interimE

D3353 Apexification/recalc finalE

D3354 Pulpal regeneration E

D3410 Apicoect/perirad surg anterE

D3421 Root surgery bicuspidE

D3425 Root surgery molarE

D3426 Root surgery ea add rootE

D3430 Retrograde fillingE

D3450 Root amputationE

D3460 Endodontic endosseous implanS 0330

D3470 Intentional replantationE

D3910 Isolation- tooth w rubb damE

D3920 Tooth splittingE

D3950 Canal prep/fitting of dowelE

D3999 Endodontic procedureS 0330

D4210 Gingivectomy/plasty per quadE

D4211 Gingivectomy/plasty per tootE

D4230 Ana crown exp 4 or> per quadE

D4231 Ana crown exp 1-3 per quadE

D4240 Gingival flap proc w/ planinE

D4241 Gngvl flap w rootplan 1-3 thE

D4245 Apically positioned flapE

D4249 Crown lengthen hard tissueE

D4260 Osseous surgery per quadrantS 0330

D4261 Osseous surgl-3teethperquadE

D4263 Bone replce graft first siteS 0330

D4264 Bone replce graft each addS 0330

D4265 Bio mtrls to aid soft/os regE

D4266 Guided tiss regen resorbleE

D4267 Guided tiss regen nonresorbE

D4268 Surgical revision procedureS 0330

D4270 Pedicle soft tissue graft prS 0330

D4271 Free soft tissue graft procS 0330

D4273 Subepithelial tissue graftS 0330

D4274 Distal/proximal wedge procE

D4275 Soft tissue allograftE

D4276 Con tissue w dble ped graftE

D4320 Provision splnt intracoronalE

D4321 Provisional splint extracoroE

D4341 Periodontal scaling & rootE

D4342 Periodontal scaling 1-3teethE

D4355 Full mouth debridementS 0330

D4381 Localized delivery antimicroS 0330

D4910 Periodontal maint proceduresE

D4920 Unscheduled dressing changeE

D4999 Unspecified periodontal procE

D5110 Dentures complete maxillaryE

D5120 Dentures complete mandibleE

D5130 Dentures immediat maxillaryE

D5140 Dentures immediat mandibleE

D5211 Dentures maxill part resinE

D5212 Dentures mand part resinE

D5213 Dentures maxill part metalE
D5214 Dentures mandibl part metal

E

D5225 Maxillary part denture flexE

D5226 Mandibular part denture flexE

D5281 Removable partial dentureE

D5410 Dentures adjust cmplt maxilE

D5411 Dentures adjust cmplt mandE

D5421 Dentures adjust part maxillE

D5422 Dentures adjust part mandblE

D5510 Dentur repr broken compl basE

D5520 Replace denture teeth compltE

D5610 Dentures repair resin baseE

D5620 Rep part denture cast frameE

D5630 Rep partial denture claspE

D5640 Replace part denture teethE

D5650 Add tooth to partial dentureE

D5660 Add clasp to partial dentureE

D5670 Replc tth&acrlc on mtl frmwkE

D5671 Replc tth&acrlc mandibularE

D5710 Dentures rebase cmplt maxilE

D5711 Dentures rebase cmplt mandE

D5720 Dentures rebase part maxillE

D5721 Dentures rebase part mandblE

D5730 Denture reln cmplt maxil chE

D5731 Denture reln cmplt mand chrE

D5740 Denture reln part maxil chrE

D5741 Denture reln part mand chrE

D5750 Denture reln cmplt max labE

D5751 Denture reln cmplt mand labE

D5760 Denture reln part maxil labE

D5761 Denture reln part mand labE

D5810 Denture interm cmplt maxillE

D5811 Denture interm cmplt mandblE

D5820 Denture interm part maxillE

D5821 Denture interm part mandblE

D5850 Denture tiss conditn maxillE

D5851 Denture tiss condtin mandblE

D5860 Overdenture completeE

D5861 Overdenture partialE

D5862 Precision attachmentE

D5867 Replacement of precision attE

D5875 Prosthesis modificationE

D5899 Removable prosthodontic procE

D5911 Facial moulage sectionalS 0330

D5912 Facial moulage completeS 0330

D5913 Nasal prosthesisE

D5914 Auricular prosthesisE

D5915 Orbital prosthesisE

D5916 Ocular prosthesisE

D5919 Facial prosthesisE

D5922 Nasal septal prosthesisE

D5923 Ocular prosthesis interimE

D5924 Cranial prosthesisE

D5925 Facial augmentation implantE

D5926 Replacement nasal prosthesisE

D5927 Auricular replacementE
D5928 Orbital replacement

E

D5929 Facial replacementE

D5931 Surgical obturatorE

D5932 Postsurgical obturatorE

D5933 Refitting of obturatorE

D5934 Mandibular flange prosthesisE

D5935 Mandibular denture prosthE

D5936 Temp obturator prosthesisE

D5937 Trismus applianceE

D5951 Feeding aidE

D5952 Pediatric speech aidE

D5953 Adult speech aidE

D5954 Superimposed prosthesisE

D5955 Palatal lift prosthesisE

D5958 Intraoral con def inter pltE

D5959 Intraoral con def mod palatE

D5960 Modify speech aid prosthesisE

D5982 Surgical stentE

D5983 Radiation applicatorS 0330

D5984 Radiation shieldS 0330

D5985 Radiation cone locatorS 0330

D5986 Fluoride applicatorE

D5987 Commissure splintS 0330

D5988 Surgical splintE

D5991 Topical medicament carrierE

D5992 Adjust max prost appliance E

D5993 Main/clean max prosthesis E

D5999 Maxillofacial prosthesisE

D6010 Odontics endosteal implantE

D6012 Endosteal implantE

D6040 Odontics eposteal implantE

D6050 Odontics transosteal implntE

D6053 Implnt/abtmnt spprt remv dntE

D6054 Implnt/abtmnt spprt remvprtlE

D6055 Implant connecting barE

D6056 Prefabricated abutmentE

D6057 Custom abutmentE

D6058 Abutment supported crownE

D6059 Abutment supported mtl crownE

D6060 Abutment supported mtl crownE

D6061 Abutment supported mtl crownE

D6062 Abutment supported mtl crownE

D6063 Abutment supported mtl crownE

D6064 Abutment supported mtl crownE

D6065 Implant supported crownE

D6066 Implant supported mtl crownE

D6067 Implant supported mtl crownE

D6068 Abutment supported retainerE

D6069 Abutment supported retainerE

D6070 Abutment supported retainerE

D6071 Abutment supported retainerE

D6072 Abutment supported retainerE

D6073 Abutment supported retainerE

D6074 Abutment supported retainerE

D6075 Implant supported retainerE
D6076 Implant supported retainer

E

D6077 Implant supported retainerE

D6078 Implnt/abut suprtd fixd dentE

D6079 Implnt/abut suprtd fixd dentE

D6080 Implant maintenanceE

D6090 Repair implantE

D6091 Repl semi/precision attachE

D6092 Recement supp crownE

D6093 Recement supp part dentureE

D6094 Abut support crown titaniumE

D6095 Odontics repr abutmentE

D6100 Removal of implantE

D6190 Radio/surgical implant indexE

D6194 Abut support retainer titaniE

D6199 Implant procedureE

D6205 Pontic-indirect resin basedE

D6210 Prosthodont high noble metalE

D6211 Bridge base metal castE

D6212 Bridge noble metal castE

D6214 Pontic titaniumE

D6240 Bridge porcelain high nobleE

D6241 Bridge porcelain base metalE

D6242 Bridge porcelain nobel metalE

D6245 Bridge porcelain/ceramicE

D6250 Bridge resin w/high nobleE

D6251 Bridge resin base metalE

D6252 Bridge resin w/noble metalE

D6253 Provisional ponticE

D6254 Interim pontic E

D6545 Dental retainr cast metlE

D6548 Porcelain/ceramic retainerE

D6600 Porcelain/ceramic inlay 2srfE

D6601 Porc/ceram inlay >= 3 surfacE

D6602 Cst hgh nble mtl inlay 2 srfE

D6603 Cst hgh nble mtl inlay >=3srE

D6604 Cst bse mtl inlay 2 surfacesE

D6605 Cst bse mtl inlay >= 3 surfaE

D6606 Cast noble metal inlay 2 surE

D6607 Cst noble mtl inlay >=3 surfE

D6608 Onlay porc/crmc 2 surfacesE

D6609 Onlay porc/crmc >=3 surfacesE

D6610 Onlay cst hgh nbl mtl 2 srfcE

D6611 Onlay cst hgh nbl mtl >=3srfE

D6612 Onlay cst base mtl 2 surfaceE

D6613 Onlay cst base mtl >=3 surfaE

D6614 Onlay cst nbl mtl 2 surfacesE

D6615 Onlay cst nbl mtl >=3 surfacE

D6624 Inlay titaniumE

D6634 Onlay titaniumE

D6710 Crown-indirect resin basedE

D6720 Retain crown resin w hi nbleE

D6721 Crown resin w/base metalE

D6722 Crown resin w/noble metalE

D6740 Crown porcelain/ceramicE

D6750 Crown porcelain high nobleE
D6751 Crown porcelain base metal

E

D6752 Crown porcelain noble metalE

D6780 Crown 3/4 high noble metalE

D6781 Crown 3/4 cast based metalE

D6782 Crown 3/4 cast noble metalE

D6783 Crown 3/4 porcelain/ceramicE

D6790 Crown full high noble metalE

D6791 Crown full base metal castE

D6792 Crown full noble metal castE

D6793 Provisional retainer crownE

D6794 Crown titaniumE

D6795 Interim retainer crown E

D6920 Dental connector barS 0330

D6930 Dental recement bridgeE

D6940 Stress breakerE

D6950 Precision attachmentE

D6970 Post & core plus retainerE

D6972 Prefab post & core plus retaE

D6973 Core build up for retainerE

D6975 Coping metalE

D6976 Each addtnl cast postE

D6977 Each addtl prefab postE

D6980 Bridge repairE

D6985 Pediatric partial denture fxE

D6999 Fixed prosthodontic procE

D7111 Extraction coronal remnantsS 0330

D7140 Extraction erupted tooth/exrS 0330

D7210 Rem imp tooth w mucoper flpS 0330

D7220 Impact tooth remov soft tissS 0330

D7230 Impact tooth remov part bonyS 0330

D7240 Impact tooth remov comp bonyS 0330

D7241 Impact tooth rem bony w/compS 0330

D7250 Tooth root removalS 0330

D7251 CoronectomyE

D7260 Oral antral fistula closureS 0330

D7261 Primary closure sinus perfS 0330

D7270 Tooth reimplantationE

D7272 Tooth transplantationE

D7280 Exposure impact tooth orthodE

D7282 Mobilize erupted/malpos tootE

D7283 Place device impacted toothB

D7285 Biopsy of oral tissue hardE

D7286 Biopsy of oral tissue softE

D7287 Exfoliative cytolog collectE

D7288 Brush biopsyB

D7290 Repositioning of teethE

D7291 Transseptal fiberotomyS 0330

D7292 Screw retained plateE

D7293 Temp anchorage dev w flapE

D7294 Temp anchorage dev w/o flapE

D7295 Bone harvest,auto graft proc E

D7310 Alveoplasty w/ extractionE

D7311 Alveoloplasty w/extract 1-3E

D7320 Alveoplasty w/o extractionE

D7321 Alveoloplasty not w/extractsB
D7340 Vestibuloplasty ridge extens

E

D7350 Vestibuloplasty exten graftE

D7410 Rad exc lesion up to 1.25 cmE

D7411 Excision benign lesion>1.25cE

D7412 Excision benign lesion complE

D7413 Excision malig lesion<=1.25cE

D7414 Excision malig lesion>1.25cmE

D7415 Excision malig les complicatE

D7440 Malig tumor exc to 1.25 cmE

D7441 Malig tumor > 1.25 cmE

D7450 Rem odontogen cyst to 1.25cmE

D7451 Rem odontogen cyst > 1.25 cmE

D7460 Rem nonodonto cyst to 1.25cmE

D7461 Rem nonodonto cyst > 1.25 cmE

D7465 Lesion destructionE

D7471 Rem exostosis any siteE

D7472 Removal of torus palatinusE

D7473 Remove torus mandibularisE

D7485 Surg reduct osseoustuberositE

D7490 Maxilla or mandible resectioE

D7510 I&d absc intraoral soft tissE

D7511 Incision/drain abscess intraB

D7520 I&d abscess extraoralE

D7521 Incision/drain abscess extraB

D7530 Removal fb skin/areolar tissE

D7540 Removal of fb reactionE

D7550 Removal of sloughed off boneE

D7560 Maxillary sinusotomyE

D7610 Maxilla open reduct simpleE

D7620 Clsd reduct simpl maxilla fxE

D7630 Open red simpl mandible fxE

D7640 Clsd red simpl mandible fxE

D7650 Open red simp malar/zygom fxE

D7660 Clsd red simp malar/zygom fxE

D7670 Closd rductn splint alveolusE

D7671 Alveolus open reductionE

D7680 Reduct simple facial bone fxE

D7710 Maxilla open reduct compoundE

D7720 Clsd reduct compd maxilla fxE

D7730 Open reduct compd mandble fxE

D7740 Clsd reduct compd mandble fxE

D7750 Open red comp malar/zygma fxE

D7760 Clsd red comp malar/zygma fxE

D7770 Open reduc compd alveolus fxE

D7771 Alveolus clsd reduc stblz teE

D7780 Reduct compnd facial bone fxE

D7810 Tmj open reduct-dislocationE

D7820 Closed tmp manipulationE

D7830 Tmj manipulation under anestE

D7840 Removal of tmj condyleE

D7850 Tmj meniscectomyE

D7852 Tmj repair of joint discE

D7854 Tmj excisn of joint membraneE

D7856 Tmj cutting of a muscleE

D7858 Tmj reconstructionE
D7860 Tmj cutting into joint

E

D7865 Tmj reshaping componentsE

D7870 Tmj aspiration joint fluidE

D7871 Lysis + lavage w cathetersE

D7872 Tmj diagnostic arthroscopyE

D7873 Tmj arthroscopy lysis adhesnE

D7874 Tmj arthroscopy disc repositE

D7875 Tmj arthroscopy synovectomyE

D7876 Tmj arthroscopy discectomyE

D7877 Tmj arthroscopy debridementE

D7880 Occlusal orthotic applianceE

D7899 Tmj unspecified therapyE

D7910 Dent sutur recent wnd to 5cmE

D7911 Dental suture wound to 5 cmE

D7912 Suture complicate wnd > 5 cmE

D7920 Dental skin graftE

D7940 Reshaping bone orthognathicS 0330

D7941 Bone cutting ramus closedE

D7943 Cutting ramus open w/graftE

D7944 Bone cutting segmentedE

D7945 Bone cutting body mandibleE

D7946 Reconstruction maxilla totalE

D7947 Reconstruct maxilla segmentE

D7948 Reconstruct midface no graftE

D7949 Reconstruct midface w/graftE

D7950 Mandible graftE

D7951 Sinus aug w bone/bone supE

D7953 Bone replacement graftE

D7955 Repair maxillofacial defectsE

D7960 Frenulectomy/frenectomyE

D7963 FrenuloplastyE

D7970 Excision hyperplastic tissueE

D7971 Excision pericoronal gingivaE

D7972 Surg redct fibrous tuberositE

D7980 SialolithotomyE

D7981 Excision of salivary glandE

D7982 SialodochoplastyE

D7983 Closure of salivary fistulaE

D7990 Emergency tracheotomyE

D7991 Dental coronoidectomyE

D7995 Synthetic graft facial bonesE

D7996 Implant mandible for augmentE

D7997 Appliance removalE

D7998 Intraoral place of fix devE

D7999 Oral surgery procedureE

D8010 Limited dental tx primaryE

D8020 Limited dental tx transitionE

D8030 Limited dental tx adolescentE

D8040 Limited dental tx adultE

D8050 Intercep dental tx primaryE

D8060 Intercep dental tx transitnE

D8070 Compre dental tx transitionE

D8080 Compre dental tx adolescentE

D8090 Compre dental tx adultE

D8210 Orthodontic rem appliance txE
D8220 Fixed appliance therapy habt

E

D8660 Preorthodontic tx visitE

D8670 Periodic orthodontc tx visitE

D8680 Orthodontic retentionE

D8690 Orthodontic treatmentE

D8691 Repair ortho applianceE

D8692 Replacement retainerE

D8693 Rebond/cement/repair retainE

D8999 Orthodontic procedureE

D9110 Tx dental pain minor procN

D9120 Fix partial denture sectionE

D9210 Dent anesthesia w/o surgeryE

D9211 Regional block anesthesiaE

D9212 Trigeminal block anesthesiaE

D9215 Local anesthesiaE

D9220 General anesthesiaE

D9221 General anesthesia ea ad 15mE

D9230 AnalgesiaN

D9241 Intravenous sedationE

D9242 IV sedation ea ad 30 mE

D9248 Sedation (non-iv)N

D9310 Dental consultationE

D9410 Dental house callE

D9420 Hospital/ASC callE

D9430 Office visit during hoursE

D9440 Office visit after hoursE

D9450 Case presentation tx planE

D9610 Dent therapeutic drug injectE

D9612 Thera par drugs 2 or > adminE

D9630 Other drugs/medicamentsS 0330

D9910 Dent appl desensitizing medE

D9911 Appl desensitizing resinE

D9920 Behavior managementE

D9930 Treatment of complicationsS 0330

D9940 Dental occlusal guardS 0330

D9941 Fabrication athletic guardE

D9942 Repair/reline occlusal guardE

D9950 Occlusion analysisS 0330

D9951 Limited occlusal adjustmentS 0330

D9952 Complete occlusal adjustmentS 0330

D9970 Enamel microabrasionE

D9971 Odontoplasty 1-2 teethE

D9972 Extrnl bleaching per archE

D9973 Extrnl bleaching per toothE

D9974 Intrnl bleaching per toothE

D9999 Adjunctive procedureE

E0100 Cane adjust/fixed with tipY

E0105 Cane adjust/fixed quad/3 proY

E0110 Crutch forearm pairY

E0111 Crutch forearm eachY

E0112 Crutch underarm pair woodY

E0113 Crutch underarm each woodY

E0114 Crutch underarm pair no woodY

E0116 Crutch underarm each no woodY

E0117 Underarm springassist crutchY
E0118 Crutch substitute

E

E0130 Walker rigid adjust/fixed htY

E0135 Walker folding adjust/fixedY

E0140 Walker w trunk support

Y

E0141 Rigid wheeled walker adj/fixY

E0143 Walker folding wheeled w/o sY

E0144 Enclosed walker w rear seatY

E0147 Walker variable wheel resistY

E0148 Heavyduty walker no wheelsY

E0149 Heavy duty wheeled walkerY

E0153 Forearm crutch platform attaY

E0154 Walker platform attachmentY

E0155 Walker wheel attachment,pairY

E0156 Walker seat attachmentY

E0157 Walker crutch attachmentY

E0158 Walker leg extenders set of4Y

E0159 Brake for wheeled walkerY

E0160 Sitz type bath or equipmentY

E0161 Sitz bath/equipment w/faucetY

E0162 Sitz bath chairY

E0163 Commode chair with fixed armY

E0165 Commode chair with detacharmY

E0167 Commode chair pail or panY

E0168 Heavyduty/wide commode chairY

E0170 Commode chair electricY

E0171 Commode chair non-electricY

E0172 Seat lift mechanism toiletE

E0175 Commode chair foot restY

E0181 Press pad alternating w/ pumY

E0182 Replace pump, alt press padY

E0184 Dry pressure mattressY

E0185 Gel pressure mattress padY

E0186 Air pressure mattressY

E0187 Water pressure mattressY

E0188 Synthetic sheepskin padY

E0189 Lambswool sheepskin padY

E0190 Positioning cushion

E

E0191 Protector heel or elbowY

E0193 Powered air flotation bedY

E0194 Air fluidized bedY

E0196 Gel pressure mattressY

E0197 Air pressure pad for mattresY

E0198 Water pressure pad for mattrY

E0199 Dry pressure pad for mattresY

E0200 Heat lamp without standY

E0202 Phototherapy light w/ photomY

E0203 Therapeutic lightbox tabletp E 

E0205 Heat lamp with standY

E0210 Electric heat pad standardY

E0215 Electric heat pad moistY

E0217 Water circ heat pad w pumpY

E0218 Water circ cold pad w pumpY

E0221 Infrared heating pad systemY

E0225 Hydrocollator unitY

E0231 Wound warming deviceE
E0232 Warming card for NW

T

E

E0235 Paraffin bath unit portableY

E0236 Pump for water circulating pY

E0239 Hydrocollator unit portableY

E0240 Bath/shower chair

E

E0241 Bath tub wall railE

E0242 Bath tub rail floorE

E0243 Toilet railE

E0244 Toilet seat raisedE

E0245 Tub stool or benchE

E0246 Transfer tub rail attachmentE

E0247 Trans bench w/wo comm open

E

E0248 HDtrans bench w/wo comm open

E

E0249 Pad water circulating heat uY

E0250 Hosp bed fixed ht w/ mattresY

E0251 Hosp bed fixd ht w/o mattresY

E0255 Hospital bed var ht w/ mattrY

E0256 Hospital bed var ht w/o mattY

E0260 Hosp bed semi-electr w/ mattY

E0261 Hosp bed semi-electr w/o matY

E0265 Hosp bed total electr w/ matY

E0266 Hosp bed total elec w/o mattY

E0270 Hospital bed institutional tE

E0271 Mattress innerspringY

E0272 Mattress foam rubberY

E0273 Bed boardE

E0274 Over-bed tableE

E0275 Bed pan standardY

E0276 Bed pan fractureY

E0277 Powered pres-redu air mattrsY

E0280 Bed cradleY

E0290 Hosp bed fx ht w/o rails w/mY

E0291 Hosp bed fx ht w/o rail w/oY

E0292 Hosp bed var ht w/o rail w/oY

E0293 Hosp bed var ht w/o rail w/Y

E0294 Hosp bed semi-elect w/ mattrY

E0295 Hosp bed semi-elect w/o mattY

E0296 Hosp bed total elect w/ mattY

E0297 Hosp bed total elect w/o matY

E0300 Enclosed ped crib hosp grade

Y

E0301 HD hosp bed, 350-600 lbs

Y

E0302 Ex hd hosp bed > 600 lbs

Y

E0303 Hosp bed hvy dty xtra wide

Y

E0304 Hosp bed xtra hvy dty x wide

Y

E0305 Rails bed side half length

Y

E0310 Rails bed side full length

Y

E0315 Bed accessory brd/tbl/supprtE

E0316 Bed safety enclosureY

E0325 Urinal male jug-typeY

E0326 Urinal female jug-typeY

E0328 Ped hospital bed, manualY

E0329 Ped hospital bed semi/electY

E0350 Control unit bowel systemE

E0352 Disposable pack w/bowel systE

E0370 Air elevator for heelE
E0371 Nonpower mattress overlay

Y

E0372 Powered air mattress overlayY

E0373 Nonpowered pressure mattressY

E0424 Stationary compressed gas 02Y

E0425 Gas system stationary compreE

E0430 Oxygen system gas portableE

E0431 Portable gaseous 02Y

E0433 Portable liquid oxygen sy

s

Y

E0434 Portable liquid 02Y

E0435 Oxygen system liquid portablE

E0439 Stationary liquid 02Y

E0440 Oxygen system liquid stationE

E0441 Stationary O2 contents, gasY

E0442 Stationary O2 contents, liqY

E0443 Portable 02 contents, gasY

E0444 Portable 02 contents, liquidY

E0445 Oximeter non-invasiveN

E0446 Topical Ox Deliver sys, nosE

E0450 Vol control vent invasiv intY

E0455 Oxygen tent excl croup/ped tY

E0457 Chest shellY

E0459 Chest wrapY

E0460 Neg press vent portabl/statnY

E0461 Vol control vent noninv intY

E0462 Rocking bed w/ or w/o side rY

E0463 Press supp vent invasive intY

E0464 Press supp vent noninv intY

E0470 RAD w/o backup non-inv intfc

Y

E0471 RAD w/backup non inv intrfc

Y

E0472 RAD w backup invasive intrfc

Y

E0480 Percussor elect/pneum home mY

E0481 Intrpulmnry percuss vent sy

s

E

E0482 Cough stimulating deviceY

E0483 Chest compression gen systemY

E0484 Non-elec oscillatory pep dvcY

E0485 Oral device/appliance prefabY

E0486 Oral device/appliance cusfabY

E0487 Electronic spirometer N

E0500 Ippb all typesY

E0550 Humidif extens supple w ippbY

E0555 Humidifier for use w/ regulaY

E0560 Humidifier supplemental w/ iY

E0561 Humidifier nonheated w PAP

Y

E0562 Humidifier heated used w PAP

Y

E0565 Compressor air power sourceY

E0570 Nebulizer with compressionY

E0571 Aerosol compressor for svnebY

E0572 Aerosol compressor adjust prY

E0574 Ultrasonic generator w svnebY

E0575 Nebulizer ultrasonicY

E0580 Nebulizer for use w/ regulatY

E0585 Nebulizer w/ compressor & heY

E0600 Suction pump portab hom modlY

E0601 Cont airway pressure deviceY

E0602 Manual breast pumpY
E0603 Electric breast pump

N

E0604 Hosp grade elec breast pumpA

E0605 Vaporizer room typeY

E0606 Drainage board posturalY

E0607 Blood glucose monitor homeY

E0610 Pacemaker monitr audible/visY

E0615 Pacemaker monitr digital/visY

E0616 Cardiac event recorderN

E0617 Automatic ext defibrillatorY

E0618 Apnea monitorY

E0619 Apnea monitor w recorderY

E0620 Cap bld skin piercing laserY

E0621 Patient lift sling or seatY

E0625 Patient lift bathroom or toiE

E0627 Seat lift incorp lift-chairY

E0628 Seat lift for pt furn-electrY

E0629 Seat lift for pt furn-non-elY

E0630 Patient lift hydraulicY

E0635 Patient lift electricY

E0636 PT support & positioning sy

s

Y

E0637 Combination sit to stand sys

E

E0638 Standing frame sy

sE

E0639 Moveable patient lift systemE

E0640 Fixed patient lift systemE

E0641 Multi-position stnd fram sysE

E0642 Dynamic standing frameE

E0650 Pneuma compresor non-segmentY

E0651 Pneum compressor segmentalY

E0652 Pneum compres w/cal pressureY

E0655 Pneumatic appliance half armY

E0656 Segmental pneumatic trunkY

E0657 Segmental pneumatic chestY

E0660 Pneumatic appliance full legY

E0665 Pneumatic appliance full armY

E0666 Pneumatic appliance half legY

E0667 Seg pneumatic appl full legY

E0668 Seg pneumatic appl full armY

E0669 Seg pneumatic appli half legY

E0671 Pressure pneum appl full legY

E0672 Pressure pneum appl full armY

E0673 Pressure pneum appl half legY

E0675 Pneumatic compression device

Y

E0676 Inter limb compress dev NOS

Y

E0691 Uvl pnl 2 sq ft or lessY

E0692 Uvl sys panel 4 ftY

E0693 Uvl sys panel 6 ftY

E0694 Uvl md cabinet sys 6 ftY

E0700 Safety equipmentE

E0705 Transfer deviceB

E0710 Restraints any typeE

E0720 Tens two leadY

E0730 Tens four leadY

E0731 Conductive garment for tens/Y

E0740 Incontinence treatment systmY

E0744 Neuromuscular stim for scoliY
E0745 Neuromuscular stim for shock

Y

E0746 Electromyograph biofeedbackN

E0747 Elec osteogen stim not spineY

E0748 Elec osteogen stim spinalY

E0749 Elec osteogen stim implantedN

E0755 Electronic salivary reflex sE

E0760 Osteogen ultrasound stimltorY

E0761 Nontherm electromgntc deviceE

E0762 Trans elec jt stim dev sysB

E0764 Functional neuromuscularstimY

E0765 Nerve stimulator for tx n&vY

E0769 Electric wound treatment devB

E0770 Functional electric stim NOS

Y

E0776 Iv poleY

E0779 Amb infusion pump mechanicalY

E0780 Mech amb infusion pump <8hrsY

E0781 External ambulatory infus puY

E0782 Non-programble infusion pumpN

E0783 Programmable infusion pumpN

E0784 Ext amb infusn pump insulinY

E0785 Replacement impl pump cathetN

E0786 Implantable pump replacementN

E0791 Parenteral infusion pump staY

E0830 Ambulatory traction deviceN

E0840 Tract frame attach headboardY

E0849 Cervical pneum trac equipY

E0850 Traction stand free standingY

E0855 Cervical traction equipmentY

E0856 Cervic collar w air bladderY

E0860 Tract equip cervical tractY

E0870 Tract frame attach footboardY

E0880 Trac stand free stand extremY

E0890 Traction frame attach pelvicY

E0900 Trac stand free stand pelvicY

E0910 Trapeze bar attached to bedY

E0911 HD trapeze bar attach to bedY

E0912 HD trapeze bar free standingY

E0920 Fracture frame attached to bY

E0930 Fracture frame free standingY

E0935 Cont pas motion exercise devY

E0936 CPM device, other than kneeE

E0940 Trapeze bar free standingY

E0941 Gravity assisted traction deY

E0942 Cervical head harness/halterY

E0944 Pelvic belt/harness/bootY

E0945 Belt/harness extremityY

E0946 Fracture frame dual w crossY

E0947 Fracture frame attachmnts peY

E0948 Fracture frame attachmnts ceY

E0950 TrayY

E0951 Loop heelY

E0952 Toe loop/holder, eachY

E0955 Cushioned headrest

Y

E0956 W/c lateral trunk/hip suppor

Y

E0957 W/c medial thigh support

Y
E0958 Whlchr att- conv 1 arm drive

Y

E0959 Amputee adapterB

E0960 W/c shoulder harness/straps

Y

E0961 Wheelchair brake extensionB

E0966 Wheelchair head rest extensiB

E0967 Manual wc hand rim w projectY

E0968 Wheelchair commode seatY

E0969 Wheelchair narrowing deviceY

E0970 Wheelchair no. 2 footplates E 

E0971 Wheelchair anti-tipping deviB

E0973 W/Ch access det adj armrestB

E0974 W/Ch access anti-rollbackB

E0978 W/C acc,saf belt pelv strapB

E0980 Wheelchair safety vestY

E0981 Seat upholstery, replacement

Y

E0982 Back upholstery, replacement

Y

E0983 Add pwr joystick

Y

E0984 Add pwr tiller

Y

E0985 W/c seat lift mechanism

Y

E0986 Man w/c push-rim pow assist

Y

E0990 Wheelchair elevating leg resB

E0992 Wheelchair solid seat insertB

E0994 Wheelchair arm restY

E0995 Wheelchair calf restB

E1002 Pwr seat tilt

Y

E1003 Pwr seat recline

Y

E1004 Pwr seat recline mech

Y

E1005 Pwr seat recline pwr

Y

E1006 Pwr seat combo w/o shear

Y

E1007 Pwr seat combo w/shear

Y

E1008 Pwr seat combo pwr shear

Y

E1009 Add mech leg elevation

Y

E1010 Add pwr leg elevation

Y

E1011 Ped wc modify width adjustmY

E1014 Reclining back add ped w/cY

E1015 Shock absorber for man w/cY

E1016 Shock absorber for power w/cY

E1017 HD shck absrbr for hd man wcY

E1018 HD shck absrber for hd powwcY

E1020 Residual limb support systemY

E1028 W/c manual swingaway

Y

E1029 W/c vent tray fixed

Y

E1030 W/c vent tray gimbaled

Y

E1031 Rollabout chair with castersY

E1035 Patient transfer system <300Y

E1036 Patient transfer system >300Y

E1037 Transport chair, ped sizeY

E1038 Transport chair pt wt<=300lbY

E1039 Transport chair pt wt >300lbY

E1050 Whelchr fxd full length arms

Y

E1060 Wheelchair detachable arms

Y

E1070 Wheelchair detachable foot r

Y

E1083 Hemi-wheelchair fixed arms

Y

E1084 Hemi-wheelchair detachable a

Y

E1085 Hemi-wheelchair fixed arms E 
E1086 Hemi-wheelchair detachable a E 

E1087 Wheelchair lightwt fixed arm

Y

E1088 Wheelchair lightweight det a

Y

E1089 Wheelchair lightwt fixed arm E 

E1090 Wheelchair lightweight det a E 

E1092 Wheelchair wide w/ leg rests

Y

E1093 Wheelchair wide w/ foot rest

Y

E1100 Whchr s-recl fxd arm leg res

Y

E1110 Wheelchair semi-recl detach

Y

E1130 Whlchr stand fxd arm ft rest E 

E1140 Wheelchair standard detach a E 

E1150 Wheelchair standard w/ leg rY

E1160 Wheelchair fixed armsY

E1161 Manual adult wc w tiltinspacY

E1170 Whlchr ampu fxd arm leg restY

E1171 Wheelchair amputee w/o leg rY

E1172 Wheelchair amputee detach arY

E1180 Wheelchair amputee w/ foot rY

E1190 Wheelchair amputee w/ leg reY

E1195 Wheelchair amputee heavy dutY

E1200 Wheelchair amputee fixed armY

E1220 Whlchr special size/constrcY

E1221 Wheelchair spec size w footY

E1222 Wheelchair spec size w/ legY

E1223 Wheelchair spec size w footY

E1224 Wheelchair spec size w/ legY

E1225 Manual semi-reclining backY

E1226 Manual fully reclining backB

E1227 Wheelchair spec sz spec ht aY

E1228 Wheelchair spec sz spec ht bY

E1229 Pediatric wheelchair NOSY

E1230 Power operated vehicleY

E1231 Rigid ped w/c tilt-in-spaceY

E1232 Folding ped wc tilt-in-spaceY

E1233 Rig ped wc tltnspc w/o seatY

E1234 Fld ped wc tltnspc w/o seatY

E1235 Rigid ped wc adjustableY

E1236 Folding ped wc adjustableY

E1237 Rgd ped wc adjstabl w/o seatY

E1238 Fld ped wc adjstabl w/o seatY

E1239 Ped power wheelchair NOS Y 

E1240 Whchr litwt det arm leg rest

Y

E1250 Wheelchair lightwt fixed arm E 

E1260 Wheelchair lightwt foot rest E 

E1270 Wheelchair lightweight leg r

Y

E1280 Whchr h-duty det arm leg res

Y

E1285 Wheelchair heavy duty fixed E 

E1290 Wheelchair hvy duty detach a E 

E1295 Wheelchair heavy duty fixed

Y

E1296 Wheelchair special seat heigY

E1297 Wheelchair special seat deptY

E1298 Wheelchair spec seat depth/wY

E1300 Whirlpool portableE

E1310 Whirlpool non-portableY

E1353 Oxygen supplies regulatorY
E1354 Wheeled cart, port cyl/conc

Y

E1355 Oxygen supplies stand/rackY

E1356 Batt pack/cart, port concY

E1357 Battery charger, port concY

E1358 DC power adapter, port concY

E1372 Oxy suppl heater for nebulizY

E1390 Oxygen concentratorY

E1391 Oxygen concentrator, dual

Y

E1392 Portable oxygen concentrator

Y

E1399 Durable medical equipment mi

Y

E1405 O2/water vapor enrich w/heatY

E1406 O2/water vapor enrich w/o heY

E1500 CentrifugeA

E1510 Kidney dialysate delivry sysA

E1520 Heparin infusion pumpA

E1530 Replacement air bubble detecA

E1540 Replacement pressure alarmA

E1550 Bath conductivity meterA

E1560 Replace blood leak detectorA

E1570 Adjustable chair for esrd ptA

E1575 Transducer protect/fld barA

E1580 Unipuncture control systemA

E1590 Hemodialysis machineA

E1592 Auto interm peritoneal dialyA

E1594 Cycler dialysis machineA

E1600 Deli/install chrg hemo equipA

E1610 Reverse osmosis h2o puri sysA

E1615 Deionizer H2O puri systemA

E1620 Replacement blood pumpA

E1625 Water softening systemA

E1630 Reciprocating peritoneal diaA

E1632 Wearable artificial kidneyA

E1634 Peritoneal dialysis clamp

B

E1635 Compact travel hemodialyzerA

E1636 Sorbent cartridges per 10A

E1637 Hemostats for dialysis, eachA

E1639 Dialysis scaleA

E1699 Dialysis equipment nocA

E1700 Jaw motion rehab systemY

E1701 Repl cushions for jaw motionY

E1702 Repl measr scales jaw motionY

E1800 Adjust elbow ext/flex deviceY

E1801 SPS elbow deviceY

E1802 Adjst forearm pro/sup deviceY

E1805 Adjust wrist ext/flex deviceY

E1806 SPS wrist deviceY

E1810 Adjust knee ext/flex deviceY

E1811 SPS knee deviceY

E1812 Knee ext/flex w act res ctrlY

E1815 Adjust ankle ext/flex deviceY

E1816 SPS ankle deviceY

E1818 SPS forearm deviceY

E1820 Soft interface materialY

E1821 Replacement interface SPSDY

E1825 Adjust finger ext/flex devcY
E1830 Adjust toe ext/flex device

Y

E1831 Static str toe dev ext/flexY

E1840 Adj shoulder ext/flex deviceY

E1841 Static str shldr dev rom adjY

E1902 AAC non-electronic board

Y

E2000 Gastric suction pump hme mdlY

E2100 Bld glucose monitor w voiceY

E2101 Bld glucose monitor w lanceY

E2120 Pulse gen sys tx endolymp fl

Y

E2201 Man w/ch acc seat w>=20"<24"

Y

E2202 Seat width 24-27 in

Y

E2203 Frame depth less than 22 in

Y

E2204 Frame depth 22 to 25 in

Y

E2205 Manual wc accessory, handrimY

E2206 Complete wheel lock assemblyY

E2207 Crutch and cane holderY

E2208 Cylinder tank carrierY

E2209 Arm trough eachY

E2210 Wheelchair bearingsY

E2211 Pneumatic propulsion tireY

E2212 Pneumatic prop tire tubeY

E2213 Pneumatic prop tire insertY

E2214 Pneumatic caster tire eachY

E2215 Pneumatic caster tire tubeY

E2216 Foam filled propulsion tireY

E2217 Foam filled caster tire eachY

E2218 Foam propulsion tire eachY

E2219 Foam caster tire any size eaY

E2220 Solid propulsion tire eachY

E2221 Solid caster tire eachY

E2222 Solid caster integrated whlY

E2224 Propulsion whl excludes tireY

E2225 Caster wheel excludes tireY

E2226 Caster fork replacement onlyY

E2227 Gear reduction drive wheelY

E2228 Mwc acc, wheelchair brakeY

E2230 Manual standing systemE

E2231 Solid seat support baseY

E2291 Planar back for ped size wcY

E2292 Planar seat for ped size wcY

E2293 Contour back for ped size wcY

E2294 Contour seat for ped size wcY

E2295 Ped dynamic seating frameY

E2300 Pwr seat elevation sys

Y

E2301 Pwr standing

Y

E2310 Electro connect btw control

Y

E2311 Electro connect btw 2 sys

Y

E2312 Mini-prop remote joystick

Y

E2313 PWC harness, expand control

Y

E2321 Hand interface joystick

Y

E2322 Mult mech switches

Y

E2323 Special joystick handle

Y

E2324 Chin cup interface

Y

E2325 Sip and puff interface

Y

E2326 Breath tube kit

Y
E2327 Head control interface mech

Y

E2328 Head/extremity control inter

Y

E2329 Head control nonproportional

Y

E2330 Head control proximity switc

Y

E2331 Attendant control

Y

E2340 W/c wdth 20-23 in seat frame

Y

E2341 W/c wdth 24-27 in seat frame

Y

E2342 W/c dpth 20-21 in seat frame

Y

E2343 W/c dpth 22-25 in seat frame

Y

E2351 Electronic SGD interface

Y

E2360 22nf nonsealed leadacid

Y

E2361 22nf sealed leadacid battery

Y

E2362 Gr24 nonsealed leadacid

Y

E2363 Gr24 sealed leadacid battery

Y

E2364 U1nonsealed leadacid battery

Y

E2365 U1 sealed leadacid battery

Y

E2366 Battery charger, single mode

Y

E2367 Battery charger, dual mode

Y

E2368 Power wc motor replacementY

E2369 Pwr wc gear box replacementY

E2370 Pwr wc motor/gear box comboY

E2371 Gr27 sealed leadacid batteryY

E2372 Gr27 non-sealed leadacidY

E2373 Hand/chin ctrl spec joystickY

E2374 Hand/chin ctrl std joystickY

E2375 Non-expandable controllerY

E2376 Expandable controller, replY

E2377 Expandable controller, initlY

E2381 Pneum drive wheel tireY

E2382 Tube, pneum wheel drive tireY

E2383 Insert, pneum wheel drive Y

E2384 Pneumatic caster tireY

E2385 Tube, pneumatic caster tireY

E2386 Foam filled drive wheel tireY

E2387 Foam filled caster tireY

E2388 Foam drive wheel tireY

E2389 Foam caster tireY

E2390 Solid drive wheel tireY

E2391 Solid caster tireY

E2392 Solid caster tire, integrateY

E2394 Drive wheel excludes tireY

E2395 Caster wheel excludes tireY

E2396 Caster forkY

E2397 Pwc acc, lith-based batteryY

E2402 Neg press wound therapy pump

Y

E2500 SGD digitized pre-rec <=8min

Y

E2502 SGD prerec msg >8min <=20min

Y

E2504 SGD prerec msg>20min <=40min

Y

E2506 SGD prerec msg > 40 min

Y

E2508 SGD spelling phys contact

Y

E2510 SGD w multi methods msg/accs

Y

E2511 SGD sftwre prgrm for PC/PDA

Y

E2512 SGD accessory, mounting sys

Y

E2599 SGD accessory noc

Y

E2601 Gen w/c cushion wdth < 22 inY
E2602 Gen w/c cushion wdth >=22 in

Y

E2603 Skin protect wc cus wd <22inY

E2604 Skin protect wc cus wd>=22inY

E2605 Position wc cush wdth <22 inY

E2606 Position wc cush wdth>=22 inY

E2607 Skin pro/pos wc cus wd <22inY

E2608 Skin pro/pos wc cus wd>=22inY

E2609 Custom fabricate w/c cushionY

E2610 Powered w/c cushionB

E2611 Gen use back cush wdth <22inY

E2612 Gen use back cush wdth>=22inY

E2613 Position back cush wd <22inY

E2614 Position back cush wd>=22inY

E2615 Pos back post/lat wdth <22inY

E2616 Pos back post/lat wdth>=22inY

E2617 Custom fab w/c back cushionY

E2619 Replace cover w/c seat cushY

E2620 WC planar back cush wd <22inY

E2621 WC planar back cush wd>=22inY

E2622 Adj skin pro w/c cus wd<22inY

E2623 Adj skin pro wc cus wd>=22inY

E2624 Adj skin pro/pos cus<22inY

E2625 Adj skin pro/pos wc cus>=22Y

E8000 Posterior gait trainerE

E8001 Upright gait trainerE

E8002 Anterior gait trainerE

G0008 Admin influenza virus vac S 0350

G0009 Admin pneumococcal vaccine S 0350

G0010 Admin hepatitis b vaccineS 0436

G0027 Semen analysisA

G0101 CA screen;pelvic/breast examV 0604

G0102 Prostate ca screening; dreN

G0103 PSA screening A

G0104 CA screen;flexi sigmoidscopeS 0159

G0105 Colorectal scrn; hi risk indT 0158

G0106 Colon CA screen;barium enemaS 0157

G0108 Diab manage trn per indivA

G0109 Diab manage trn ind/groupA

G0117 Glaucoma scrn hgh risk direcS 0698

G0118 Glaucoma scrn hgh risk direcS 0230

G0120 Colon ca scrn; barium enemaS 0157

G0121 Colon ca scrn not hi rsk indT 0158

G0122 Colon ca scrn; barium enemaE

G0123 Screen cerv/vag thin layerA

G0124 Screen c/v thin layer by MD B 

G0127 Trim nail(s)T 0012

G0128 CORF skilled nursing serviceB

G0129 Partial hosp prog serviceP

G0130 Single energy x-ray studyX 0260

G0141 Scr c/v cyto,autosys and md B 

G0143 Scr c/v cyto,thinlayer,rescrA

G0144 Scr c/v cyto,thinlayer,rescrA

G0145 Scr c/v cyto,thinlayer,rescrA

G0147 Scr c/v cyto, automated sysA

G0148 Scr c/v cyto, autosys, rescrA
G0151 HHCP-serv of pt,ea 15 min

B

G0152 HHCP-serv of ot,ea 15 minB

G0153 HHCP-svs of s/l path,ea 15mnB

G0154 HHCP-svs of rn,ea 15 minB

G0155 HHCP-svs of csw,ea 15 minB

G0156 HHCP-svs of aide,ea 15 minB

G0157 HHC PT assistant ea 15 B

G0158 HHC OT assistant ea 15B

G0159 HHC PT maint ea 15 minB

G0160 HHC Occup Therapy ea 15B

G0161 HHC SLP ea 15 minB

G0162 HHC RN E&M plan svs, 15 minB

G0163 HHC LPN/RN obs/asses ea 15B

G0164 HHC lis nurse train ea 15B

G0166 Extrnl counterpulse, per txT 0678

G0168 Wound closure by adhesive B 

G0173 Linear acc stereo radsur comS 0067

G0175 OPPS Service,sched team confV 0607

G0176 OPPS/PHP;activity therapyP

G0177 OPPS/PHP; train & educ serv N 

G0179 MD recertification HHA PT M 

G0180 MD certification HHA patient M 

G0181 Home health care supervision M 

G0182 Hospice care supervision M 

G0186 Dstry eye lesn,fdr vssl techT 0235

G0202 ScreeningmammographydigitalA

G0204 DiagnosticmammographydigitalA

G0206 DiagnosticmammographydigitalA

G0219 PET img wholbod melano noncoE

G0235 PET not otherwise specifiedE

G0237 Therapeutic procd strg endurS 0077

G0238 Oth resp proc, indivS 0077

G0239 Oth resp proc, groupS 0077

G0245 Initial foot exam pt lopsV 0604

G0246 Followup eval of foot pt lopV 0605

G0247 Routine footcare pt w lopsT 0013

G0248 Demonstrate use home inr monV 0607

G0249 Provide INR test mater/equipV 0607

G0250 MD INR test revie inter mgmtM

G0251 Linear acc based stero radioS 0065

G0252 PET imaging initial dxE

G0255 Current percep threshold tstE

G0257 Unsched dialysis ESRD pt hosS 0170

G0259 Inject for sacroiliac jointN

G0260 Inj for sacroiliac jt anesthT 0207

G0268 Removal of impacted wax md N 

G0269 Occlusive device in vein artN

G0270 MNT subs tx for change dxA

G0271 Group MNT 2 or more 30 minsA

G0275 Renal angio, cardiac cathN

G0278 Iliac art angio,cardiac cathN

G0281 Elec stim unattend for pressA

G0282 Elect stim wound care not pdE

G0283 Elec stim other than woundA

G0288 Recon, CTA for surg planN
G0289 Arthro, loose body + chondro

N

G0290 Drug-eluting stents, singleT 0656

G0291 Drug-eluting stents,each addT 0656

G0293 Non-cov surg proc,clin trial X 0340

G0294 Non-cov proc, clinical trial X 0340

G0295 Electromagnetic therapy oncE

G0302 Pre-op service LVRS completeS 0209

G0303 Pre-op service LVRS 10-15dosS 0209

G0304 Pre-op service LVRS 1-9 dosS 0213

G0305 Post op service LVRS min 6S 0213

G0306 CBC/diffwbc w/o plateletA

G0307 CBC without plateletA

G0328 Fecal blood scrn immunoassayA

G0329 Electromagntic tx for ulcersA

G0333 Dispense fee initial 30 dayM

G0337 Hospice evaluation preelectiB

G0339 Robot lin-radsurg com, firstS 0067

G0340 Robt lin-radsurg fractx 2-5S 0066

G0341 Percutaneous islet celltransC

G0342 Laparoscopy islet cell transC

G0343 Laparotomy islet cell transpC

G0364 Bone marrow aspirate &biopsy X 0340

G0365 Vessel mapping hemo accessS 0267

G0372 MD service required for PMDM

G0378 Hospital observation per hr 

N

G0379 Direct refer hospital observ Q3 0604

G0380 Lev 1 hosp type B ED visit V 0626

G0381 Lev 2 hosp type B ED visit V 0627

G0382 Lev 3 hosp type B ED visit V 0628

G0383 Lev 4 hosp type B ED visit V 0629

G0384 Lev 5 hosp type B ED visit Q3 0630

G0389 Ultrasound exam AAA screenS 0266

G0390 Trauma Respons w/hosp criti

S 0618

G0396 Alcohol/subs interv 15-30mn S 0432

G0397 Alcohol/subs interv >30 min S 0432

G0398 Home sleep test/type 2 Porta S 0213

G0399 Home sleep test/type 3 Porta S 0213

G0400 Home sleep test/type 4 Porta S 0213

G0402 Initial preventive exam

V 0606

G0403 EKG for initial prevent exam

M

G0404 EKG tracing for initial prev 

S 0099

G0405 EKG interpret & report preve B 

G0406 Telhealth inpt consult 15min

C

G0407 Telheath inpt consult 25min

C

G0408 Telhealth inpt consult 35min

C

G0409 CORF related serv 15 mins ea

M

G0410 Grp psych partial hosp 45-50

P

G0411 Inter active grp psych parti

P

G0412 Open tx iliac spine uni/bil

C

G0413 Pelvic ring fracture uni/bil T 0050

G0414 Pelvic ring fx treat int fix

C

G0415 Open tx post pelvic fxcture

C

G0416 Sat biopsy prostate 1-20 spc

X 0661

G0417 Sat biopsy prostate 21-40 CH

S 1505

G0418 Sat biopsy prostate 41-60 CH

S 1506
G0419 Sat biopsy prostate: >60 CH

S 1508

G0420 Ed svc CKD ind per sessionA

G0421 Ed svc CKD grp per sessionA

G0422 Intens cardiac rehab w/exercS 0095

G0423 Intens cardiac rehab no exerS 0095

G0424 Pulmonary rehab w exerS 0102

G0425 Inpt telehealth consult 30mC

G0426 Inpt telehealth consult 50mC

G0427 Inpt telehealth con 70/>mC

G0428 Collagen Meniscus ImplantE

G0429 Dermal filler injection(s) B 

G0431 drug screen multiple class

A

G0432 EIA HIV-1/HIV-2 screen

A

G0433 ELISA HIV-1/HIV-2 screen

A

G0434 Drug screen multi drug class

A

G0435 Oral HIV-1/HIV-2 screen

A

G0436 Tobacco-use counsel 3-10 min

X 0031

G0437 Tobacco-use counsel>10min

X 0031

G0438 PPPS, initial visit

A

G0439 PPPS, subseq visit

A

G0440 Skin/dermal subs init 25or< B 

G0441 Skin/dermal subs each addition B 

G3001 Admin + supply, tositumomabS 0442

G8126 Pt treat w/antidepress12wksM

G8127 Pt not treat w/antidepres12wM

G8128 Pt inelig for antidepres medM

G8395 LVEF>=40% doc normal or mild M 

G8396 LVEF not performed M 

G8397 Dil macula/fundus exam/w doc M 

G8398 Dil macular/fundus not perfo M 

G8399 Pt w/DXA document or order M 

G8400 Pt w/DXA no document or orde M 

G8401 Pt inelig osteo screen measu M 

G8404 Low extemity neur exam docum M 

G8405 Low extemity neur not perfor M 

G8406 Pt inelig lower extrem neuro M 

G8410 Eval on foot documented M 

G8415 Eval on foot not performed M 

G8416 Pt inelig footwear evaluatio M 

G8417 Calc BMI abv up param f/u M 

G8418 Calc BMI blw low param f/u M 

G8419 Calc BMI out nrm param nof/u M 

G8420 Calc BMI norm parameters M 

G8421 BMI not calculated M 

G8422 Pt inelig BMI calculation M 

G8427 Doc cur meds by prov M 

G8428 Cur meds not document M 

G8430 Pt inelig med check M 

G8431 Pos clin depres scrn f/u doc M 

G8432 Clin depression screen not d M 

G8433 Pt inelig; scrn clin dep M 

G8440 Pain assess f/u pln document M 

G8441 No document of pain assess M 

G8442 Pt inelig pain assessment M 

G8447 Pt vis doc use EHR cer ATCB M 
G8448 Pt vis doc w/PQRI qual EHR M 

G8450 Beta-bloc rx pt w/abn lvef M 

G8451 Pt w/abn lvef inelig b-bloc M 

G8452 Pt w/abn lvef b-bloc no rx M 

G8458 Pt inelig geno no antvir tx M 

G8459 Doc pt rec antivir treat M 

G8460 Pt inelig RNA no antvir tx M 

G8461 Pt rec antivir treat hep c M 

G8462 Pt inelig couns no antvir tx M 

G8463 Pt rec antiviral treat doc M 

G8464 Pt inelig; lo to no dter rsk M 

G8465 High risk recurrence pro ca M 

G8468 ACE/ARB rx pt w/abn lvef M 

G8469 Pt w/abn lvef inelig ACE/ARB M 

G8470 Pt w/ normal lvef M 

G8471 LVEF not performed/doc M 

G8472 ACE/ARB no rx pt w/abn lvef M 

G8473 ACE/ARB thxpy rx'd M 

G8474 ACE/ARB not rx'd; doc reas M 

G8475 ACE/ARB thxpy not rx'd M 

G8476 BP sys <130 and dias <80 M 

G8477 BP sys>=130 and/or dias >=80 M 

G8478 BP not performed/doc M 

G8482 Flu immunize order/admin M 

G8483 Flu imm no ord/admin doc rea M 

G8484 Flu immunize no order/admin M 

G8485 Report, Diabetes measures M 

G8486 Report, Prev Care Measures M 

G8487 Report CKD Measures M 

G8489 CAD measures grp M 

G8490 RA measures grp M 

G8491 HIV/AIDS measures grp M 

G8492 Periop Care measures grp M 

G8493 Back pain measures grp M 

G8494 DM meas qual act perform M 

G8495 CKD meas qual act perform M 

G8496 Prev Care MG qual act perfrm M 

G8497 CABG meas qual act perform M 

G8498 CAD meas qual act perform M 

G8499 RA meas qual act perform M 

G8500 HIV meas qual act perform M 

G8501 Perio meas qual act perform M 

G8502 Back Pain MG qual act perfrm M 

G8506 Pt rec ACE/ARB M 

G8508 Pt inelig; pain asses no f/u M 

G8509 Pain assess no f/u pln doc M 

G8510 Pt inelig neg scrn depres M 

G8511 Clin depres scrn no f/u doc M 

G8524 Patch closure conv CEA M 

G8525 No patch closure CEA M 

G8526 No patch closure conv CEA M 

G8530 Auto AV fistula recd M 

G8531 Pt inelig; auto AV fistula M 

G8532 No auto AV fistula; no reas M 

G8534 Doc elder mal scrn f/u plan M 
G8535 Pt inelig no eld mal scrn M 

G8536 No doc elder mal scrn M 

G8537 Pt inelig eldmal scrn no f/u M 

G8538 Eld mal scrn no f/u pln M 

G8539 Cur funct assess & care pln M 

G8540 Pt inelig funct assess M 

G8541 No doc cur funct assess M 

G8542 Pt inelig func asses no pln M 

G8543 Cur funct asses; no care pln M 

G8544 CABG measures grp M 

G8545 HepC measures grp M 

G8546 CAP measures grp M 

G8547 IVD measures grp M 

G8548 HF measures grp M 

G8549 HepC MG qual act perform M 

G8550 CAP MG qual act perform M 

G8551 HF MG qual act perform M 

G8552 IVD MG qual act perform M 

G8553 1 Rx via qualified eRx sys M 

G8556 Ref to doc otolog eval M 

G8557 Pt inelig ref otolog eval M 

G8558 No ref to doc otolog eval M 

G8559 Pt ref doc oto eval M 

G8560 Pt hx act drain prev 90 days M 

G8561 Pt inelig for ref oto eval M 

G8562 Pt no hx act drain 90 d M 

G8563 Pt no ref oto reas no spec M 

G8564 Pt ref oto eval M 

G8565 Ver doc hear loss M 

G8566 Pt inelig ref oto eval M 

G8567 Pt no doc hear loss M 

G8568 Pt no ref otolo no spec M 

G8569 Prol intubation req M 

G8570 No prol intub req M 

G8571 Ster wd ifx 30 d postop M 

G8572 No ster wd ifx M 

G8573 Stk/CVA CABG M 

G8574 No strk/CVA CABG M 

G8575 Postop ren insuf M 

G8576 No postop ren insuf M 

G8577 Reop req bld grft oth M 

G8578 No reop req bld grft oth M 

G8579 Antplt med disch M 

G8580 Antplt med contraind M 

G8581 no antplt med disch M 

G8582 Bblock disch M 

G8583 Bblock contraind M 

G8584 No bblock disch M 

G8585 Antilipid treat disch M 

G8586 Antlip disch contra M 

G8587 No antlipid treat disch M 

G8588 Sys BP <140 M 

G8589 Sys BP >= 140 M 

G8590 Dia BP < 90 M 

G8591 Dia BP >= 90 M 
G8592 No BP measure M 

G8593 Lipid pn results M 

G8594 No lipid prof perf M 

G8595 Ldl < 100 M 

G8596 No LDL perf M 

G8597 Ldl >= 100 M 

G8598 Asp therp used M 

G8599 No asp therp used M 

G8600 tPA initi w/in 3 hrs M 

G8601 No elig tPA init w/in 3 hrs M 

G8602 No tPA init w/in 3 hrs M 

G8603 Spok lang comp score M 

G8604 No high score spok lang M 

G8605 No spok lang comp score M 

G8606 Attention score M 

G8607 No high score attention M 

G8608 No attention score M 

G8609 Memory score M 

G8610 No high score memory M 

G8611 No memory score M 

G8612 Moto speech score M 

G8613 No high score moto speech M 

G8614 No moto speech score M 

G8615 Reading score M 

G8616 No high score reading M 

G8617 No reading score M 

G8618 Spok lang exp score M 

G8619 No high score spok lang exp M 

G8620 No spok lang exp score M 

G8621 Writing score M 

G8622 No high score writing M 

G8623 No writing score M 

G8624 Swallowing score M 

G8625 No high score swallowing M 

G8626 No swallowing score M 

G8627 Surg proc w/in 30 days M 

G8628 No surg proc w/in 30 days M 

G8629 Doc antibio order b/4 surg M 

G8630 Doc antibio given b/4 surg M 

G8631 Pt no elg 4 order antbi give M 

G8632 Doc no antibi order b/4 surg M 

G8633 Pharm ther osteo rx M 

G8634 Pt no elg phar ther osteo M 

G8635 No pharm ther osteo rx M 

G8636 Flu immun admin/prev rec M 

G8637 Pt no elg receiv flu immun M 

G8638 Flu immun no admin/prev rec M 

G8639 Flu immun admin or prev rec M 

G8640 Pt no elg rec flu immun M 

G8641 Flu immun not admin/pre rec M 

G8642 Hrdshp rural w/o internet M 

G8643 Hrdshp w/o suff pharm w/eRx M 

G8644 EP no prescribe priv M 

G8645 Asthma measures grp M 

G8646 Asthma MG qual act perform M 
G8647 Fun stat score knee >= 0 M 

G8648 Fun stat score knee < 0 M 

G8649 Fun stat score knee pt noelg M 

G8650 Fun stat score knee not done M 

G8651 Fun stat score hip >= 0 M 

G8652 Fun stat score hip < 0 M 

G8653 Fun stat score hip pt no elg M 

G8654 Fun stat score hip not done M 

G8655 Fun stat score LE >= 0 M 

G8656 Fun stat score LE < 0 M 

G8657 Fun stat score LE pt no elg M 

G8658 Fun stat score LE not done M 

G8659 Fun stat score LS >= 0 M 

G8660 Fun stat score LS < 0 M 

G8661 Fun stat score LS pt no elg M 

G8662 Fun stat score LS not done M 

G8663 Fun stat score shdl >=0 M 

G8664 Fun stat score shdl < 0 M 

G8665 Fun stat score shdl pt no elg M 

G8666 Fun stat score shdl not done M 

G8667 Fun stat score UE >=0 M 

G8668 Fun stat score UE < 0 M 

G8669 Fun stat score UE pt no elg M 

G8670 Fun stat score UE not done M 

G8671 Fun stat score neck/TS >=0 M 

G8672 Fun stat score neck/TS < 0 M 

G8673 Fun stat scor nek/TS pt no elg M 

G8674 Fun stat scor nek/TS not don M 

G8675 BP Syst >= 140 mmHg M 

G8676 BP Diast >= 90 mmHg M 

G8677 BP Syst < 130 mmHg M 

G8678 BP Syst >=130 - 139 mmHg M 

G8679 BP Diast < 80 mmHg M 

G8680 BP Diast 80-89 mmHg M 

G8681 Pt hosp w/HF M 

G8682 LVG test perf M 

G8683 Pt not elig for LVF test M 

G8684 Pt not hosp w/HF M 

G8685 LVF test not perf M 

G8686 Toba smkr curr or 2 hand exp M 

G8687 No tob smkr cur no 2 hnd exp M 

G8688 Smkls tob cur; no 2 hnd exp M 

G8689 Toba use not assess M 

G8690 Curr toba smkr or 2 hand exp M 

G8691 No cur tob smkr no 2 hnd exp M 

G8692 Curr smkls tob; no 2 hnd exp M 

G8693 Tobacco no assess M 

G9001 MCCD, initial rateB

G9002 MCCD,maintenance rateB

G9003 MCCD, risk adj hi, initialB

G9004 MCCD, risk adj lo, initialB

G9005 MCCD, risk adj, maintenanceB

G9006 MCCD, Home monitoringB

G9007 MCCD, sch team confB

G9008 Mccd,phys coor-care ovrsghtB
G9009 MCCD, risk adj, level 3

B

G9010 MCCD, risk adj, level 4B

G9011 MCCD, risk adj, level 5B

G9012 Other Specified Case MgmtB

G9013 ESRD demo bundle level IE

G9014 ESRD demo bundle-level IIE

G9016 Demo-smoking cessation counE

G9017 Amantadine HCL 100mg oralA

G9018 Zanamivir,inhalation pwd 10mA

G9019 Oseltamivir phosphate 75mgA

G9020 Rimantadine HCL 100mg oralA

G9033 Amantadine HCL oral brandA

G9034 Zanamivir, inh pwdr, brandA

G9035 Oseltamivir phosp, brandA

G9036 Rimantadine HCL, brandA

G9041 Low vision rehab occupationa A 

G9042 Low vision rehab orient/mobi A 

G9043 Low vision lowvision therapi A 

G9044 Low vision rehabilate teache A 

G9050 Oncology work-up evaluation E 

G9051 Oncology tx decision-mgmt E 

G9052 Onc surveillance for disease E 

G9053 Onc expectant management pt E 

G9054 Onc supervision palliative E 

G9055 Onc visit unspecified NOS E 

G9056 Onc prac mgmt adheres guide E 

G9057 Onc pract mgmt differs trial E 

G9058 Onc prac mgmt disagree w/gui E 

G9059 Onc prac mgmt pt opt alterna E 

G9060 Onc prac mgmt dif pt comorb E 

G9061 Onc prac cond noadd by guide E 

G9062 Onc prac guide differs nos E 

G9063 Onc dx nsclc stgI no progres M 

G9064 Onc dx nsclc stg2 no progres M 

G9065 Onc dx nsclc stg3A no progre M 

G9066 Onc dx nsclc stg3B-4 metasta M 

G9067 Onc dx nsclc dx unknown nos M 

G9068 Onc dx sclc/nsclc limited M 

G9069 Onc dx sclc/nsclc ext at dx M 

G9070 Onc dx sclc/nsclc ext unknwn M 

G9071 Onc dx brst stg1-2B HR,nopro M 

G9072 Onc dx brst stg1-2 noprogres M 

G9073 Onc dx brst stg3-HR, no pro M 

G9074 Onc dx brst stg3-noprogress M 

G9075 Onc dx brst metastic/ recur M 

G9077 Onc dx prostate T1no progres M 

G9078 Onc dx prostate T2no progres M 

G9079 Onc dx prostate T3b-T4noprog M 

G9080 Onc dx prostate w/rise PSA M 

G9083 Onc dx prostate unknwn nos M 

G9084 Onc dx colon t1-3,n1-2,no pr M 

G9085 Onc dx colon T4, N0 w/o prog M 

G9086 Onc dx colon T1-4 no dx prog M 

G9087 Onc dx colon metas evid dx M 

G9088 Onc dx colon metas noevid dx M 
G9089 Onc dx colon extent unknown M 

G9090 Onc dx rectal T1-2 no progr M 

G9091 Onc dx rectal T3 N0 no prog M 

G9092 Onc dx rectal T1-3,N1-2noprg M 

G9093 Onc dx rectal T4,N,M0 no prg M 

G9094 Onc dx rectal M1 w/mets prog M 

G9095 Onc dx rectal extent unknwn M 

G9096 Onc dx esophag T1-T3 noprog M 

G9097 Onc dx esophageal T4 no prog M 

G9098 Onc dx esophageal mets recur M 

G9099 Onc dx esophageal unknown M 

G9100 Onc dx gastric no recurrence M 

G9101 Onc dx gastric p R1-R2noprog M 

G9102 Onc dx gastric unresectable M 

G9103 Onc dx gastric recurrent M 

G9104 Onc dx gastric unknown NOS M 

G9105 Onc dx pancreatc p R0 res no M 

G9106 Onc dx pancreatc p R1/R2 no M 

G9107 Onc dx pancreatic unresectab M 

G9108 Onc dx pancreatic unknwn NOS M 

G9109 Onc dx head/neck T1-T2no prg M 

G9110 Onc dx head/neck T3-4 noprog M 

G9111 Onc dx head/neck M1 mets rec M 

G9112 Onc dx head/neck ext unknown M 

G9113 Onc dx ovarian stg1A-B no pr M 

G9114 Onc dx ovarian stg1A-B or 2 M 

G9115 Onc dx ovarian stg3/4 noprog M 

G9116 Onc dx ovarian recurrence M 

G9117 Onc dx ovarian unknown NOS M 

G9123 Onc dx CML chronic phase M 

G9124 Onc dx CML acceler phase M 

G9125 Onc dx CML blast phase M 

G9126 Onc dx CML remission M 

G9128 Onc dx multi myeloma stage I M 

G9129 Onc dx mult myeloma stg2 hig M 

G9130 Onc dx multi myeloma unknown M 

G9131 Onc dx brst unknown NOS M 

G9132 Onc dx prostate mets no cast M 

G9133 Onc dx prostate clinical met M 

G9134 Onc NHLstg 1-2 no relap no M 

G9135 Onc dx NHL stg 3-4 not relap M 

G9136 Onc dx NHL trans to lg Bcell M 

G9137 Onc dx NHL relapse/refractor M 

G9138 Onc dx NHL stg unknown M 

G9139 Onc dx CML dx status unknown M 

G9140 Frontier extended stay demo A 

G9141 Influenza A H1N1,admin w couS 0350

G9142 Influenza A H1N1, vaccineE

G9143 Warfarin respon genetic test A 

G9147 Outpt IV insulin tx any meaE

J0120 Tetracyclin injection N 

J0129 Abatacept injection K 9230

J0130 Abciximab injectionK 1605

J0132 Acetylcysteine injectionK 1272

J0133 Acyclovir injection N 
J0135 Adalimumab injection

K 1083

J0150 Injection adenosine 6 MG N 

J0152 Adenosine injectionK 0917

J0171 Adrenalin epinephrine inject

N

J0180 Agalsidase beta injectionK 9208

J0190 Inj biperiden lactate/5 mg

E

J0200 Alatrofloxacin mesylateN

J0205 Alglucerase injectionK 0900

J0207 AmifostineK 7000

J0210 Methyldopate hcl injectionK 2210

J0215 Alefacept K 1633

J0220 Alglucosidase alfa injection K 9234

J0256 Alpha 1 proteinase inhibitorK 0901

J0270 Alprostadil for injectionB

J0275 Alprostadil urethral supposB

J0278 Amikacin sulfate injection N 

J0280 Aminophyllin 250 MG injN

J0282 Amiodarone HClN

J0285 Amphotericin B N 

J0287 Amphotericin b lipid complexK 9024

J0288 Ampho b cholesteryl sulfateK 0735

J0289 Amphotericin b liposome injK 0736

J0290 Ampicillin 500 MG injN

J0295 Ampicillin sodium per 1.5 gmN

J0300 Amobarbital 125 MG inj CH K 1341

J0330 Succinycholine chloride injN

J0348 Anidulafungin injectionK 1349

J0350 Injection anistreplase 30 u E 

J0360 Hydralazine hcl injectionN

J0364 Apomorphine hydrochloride

N

J0365 Aprotonin, 10,000 kiu

N

J0380 Inj metaraminol bitartrate N 

J0390 Chloroquine injectionN

J0395 Arbutamine hcl injection E 

J0400 Aripiprazole injection N 

J0456 AzithromycinN

J0461 Atropine sulfate injection

N

J0470 Dimecaprol injection

N

J0475 Baclofen 10 MG injectionK 9032

J0476 Baclofen intrathecal trial K 1631

J0480 Basiliximab K 1683

J0500 Dicyclomine injectionN

J0515 Inj benztropine mesylate CH N

J0520 Bethanechol chloride injectN

J0558 PenG benzathine/procaine inj

N

J0561 Penicillin g benzathine inj

N

J0583 Bivalirudin K 3041

J0585 Injection,onabotulinumtoxinAK 0902

J0586 AbobotulinumtoxinAK 1289

J0587 Inj, rimabotulinumtoxinBK 9018

J0592 Buprenorphine hydrochlorideN

J0594 Busulfan injection

K 1178

J0595 Butorphanol tartrate 1 mg

N

J0597 C-1 esterase, berinert

G 9269

J0598 C-1 esterase, cinryze CH

K 9251
J0600 Edetate calcium disodium inj

K 1274

J0610 Calcium gluconate injectionN

J0620 Calcium glycer & lact/10 MLN

J0630 Calcitonin salmon injection CHN

J0636 Inj calcitriol per 0.1 mcgN

J0637 Caspofungin acetateK 9019

J0638 Canakinumab injection

K 1311

J0640 Leucovorin calcium injectionN

J0641 Levoleucovorin injection CH

K 1236

J0670 Inj mepivacaine HCL/10 mlN

J0690 Cefazolin sodium injectionN

J0692 Cefepime HCl for injectionN

J0694 Cefoxitin sodium injectionN

J0696 Ceftriaxone sodium injectionN

J0697 Sterile cefuroxime injectionN

J0698 Cefotaxime sodium injectionN

J0702 Betamethasone acet&sod phospN

J0706 Caffeine citrate injection N 

J0710 Cephapirin sodium injectionN

J0713 Inj ceftazidime per 500 mgN

J0715 Ceftizoxime sodium / 500 MGN

J0718 Certolizumab pegol inj CH 

K 9249

J0720 Chloramphenicol sodium injecN

J0725 Chorionic gonadotropin/1000uN

J0735 Clonidine hydrochloride CH N

J0740 Cidofovir injectionK 9033

J0743 Cilastatin sodium injectionN

J0744 Ciprofloxacin ivN

J0745 Inj codeine phosphate /30 MGN

J0760 Colchicine injectionN

J0770 Colistimethate sodium injN

J0775 Collagenase, clost hist injG 1340

J0780 Prochlorperazine injectionN

J0795 Corticorelin ovine triflutal K 1684

J0800 Corticotropin injectionK 1280

J0833 Cosyntropin injection NOSK 0835

J0834 Cosyntropin cortrosyn inj CH

N

J0850 Cytomegalovirus imm IV /vialK 0903

J0878 Daptomycin injection

K 9124

J0881 Darbepoetin alfa, non-esrd K 1685

J0882 Darbepoetin alfa, esrd useA

J0885 Epoetin alfa, non-esrd K 1686

J0886 Epoetin alfa 1000 units ESRDA

J0894 Decitabine injection K 9231

J0895 Deferoxamine mesylate inj N 

J0900 Testosterone enanthate injN

J0945 Brompheniramine maleate inj CH N

J1000 Depo-estradiol cypionate injN

J1020 Methylprednisolone 20 MG injN

J1030 Methylprednisolone 40 MG injN

J1040 Methylprednisolone 80 MG injN

J1051 Medroxyprogesterone injN

J1055 Medrxyprogester acetate injE

J1056 MA/EC contraceptiveinjectionE

J1060 Testosterone cypionate 1 MLN
J1070 Testosterone cypionat 100 MG

N

J1080 Testosterone cypionat 200 MGN

J1094 Inj dexamethasone acetateN

J1100 Dexamethasone sodium phosN

J1110 Inj dihydroergotamine mesyltN

J1120 Acetazolamid sodium injectioN

J1160 Digoxin injectionN

J1162 Digoxin immune fab (ovine) K 1687

J1165 Phenytoin sodium injectionN

J1170 Hydromorphone injectionN

J1180 Dyphylline injectionN

J1190 Dexrazoxane HCl injectionK 0726

J1200 Diphenhydramine hcl injectioN

J1205 Chlorothiazide sodium inj K 0747

J1212 Dimethyl sulfoxide 50% 50 ML K 1221

J1230 Methadone injectionN

J1240 Dimenhydrinate injectionN

J1245 Dipyridamole injectionN

J1250 Inj dobutamine HCL/250 mgN

J1260 Dolasetron mesylate

N

J1265 Dopamine injection N 

J1267 Doripenem injection N 

J1270 Injection, doxercalciferolN

J1290 Ecallantide injectionG 9263

J1300 Eculizumab injection

K 9236

J1320 Amitriptyline injectionN

J1324 Enfuvirtide injectionN

J1325 Epoprostenol injection

N

J1327 Eptifibatide injectionK 1607

J1330 Ergonovine maleate injection N 

J1335 Ertapenem injection

N

J1364 Erythro lactobionate /500 MGN

J1380 Estradiol valerate 10 MG injN

J1410 Inj estrogen conjugate 25 MGK 9038

J1430 Ethanolamine oleate 100 mg K 1688

J1435 Injection estrone per 1 MG

E

J1436 Etidronate disodium inj

N

J1438 Etanercept injectionK 1608

J1440 Filgrastim 300 mcg injectionK 0728

J1441 Filgrastim 480 mcg injectionK 7049

J1450 FluconazoleN

J1451 Fomepizole, 15 mg K 1689

J1452 Intraocular Fomivirsen na

E

J1453 Fosaprepitant injection K 9242

J1455 Foscarnet sodium injection CH K 1359

J1457 Gallium nitrate injection CH N

J1458 Galsulfase injection K 9224

J1459 Inj IVIG privigen 500 mg K 1214

J1460 Gamma globulin 1 CC inj K 3043

J1559 Hizentra injection K 1312

J1560 Gamma globulin > 10 CC inj K 0933

J1561 Gamunex injection K 0948

J1562 Vivaglobin, inj K 1275

J1566 Immune globulin, powderK 2731

J1568 Octagam injection

K 0943
J1569 Gammagard liquid injection

K 0944

J1570 Ganciclovir sodium injection CH 

K 1343

J1571 Hepagam b im injection

K 0946

J1572 Flebogamma injection

K 0947

J1573 Hepagam b intravenous, inj

K 1138

J1580 Garamycin gentamicin injN

J1590 Gatifloxacin injectionN

J1595 Injection glatiramer acetate K 1015

J1599 Ivig non-lyophilized, NOSN

J1600 Gold sodium thiomaleate injN

J1610 Glucagon hydrochloride/1 MGK 9042

J1620 Gonadorelin hydroch/ 100 mcg CH K 1344

J1626 Granisetron hcl injection

N

J1630 Haloperidol injectionN

J1631 Haloperidol decanoate injN

J1640 Hemin, 1 mg K 1690

J1642 Inj heparin sodium per 10 uN

J1644 Inj heparin sodium per 1000uN

J1645 Dalteparin sodiumN

J1650 Inj enoxaparin sodiumN

J1652 Fondaparinux sodiumN

J1655 Tinzaparin sodium injection

N

J1670 Tetanus immune globulin injK 1670

J1675 Histrelin acetateB

J1680 Human fibrinogen conc inj CH

K 1290

J1700 Hydrocortisone acetate injN

J1710 Hydrocortisone sodium ph injN

J1720 Hydrocortisone sodium succ iN

J1730 Diazoxide injection CH N

J1740 Ibandronate sodium injectionK 9229

J1742 Ibutilide fumarate injectionK 9044

J1743 Idursulfase injectionK 9232

J1745 Infliximab injectionK 7043

J1750 Inj iron dextranK 1237

J1756 Iron sucrose injection CH 

N

J1786 Imuglucerase injectionK 1327

J1790 Droperidol injectionN

J1800 Propranolol injectionN

J1810 Droperidol/fentanyl injE

J1815 Insulin injectionN

J1817 Insulin for insulin pump useN

J1826 Interferon Beta-1A inj

E

J1830 Interferon beta-1b / .25 MGK 0910

J1835 Itraconazole injection CH K 1355

J1840 Kanamycin sulfate 500 MG injN

J1850 Kanamycin sulfate 75 MG injN

J1885 Ketorolac tromethamine injN

J1890 Cephalothin sodium injectionN

J1930 Lanreotide injection

K 9237

J1931 Laronidase injectionK 9209

J1940 Furosemide injectionN

J1945 Lepirudin K 1693

J1950 Leuprolide acetate /3.75 MGK 0800

J1953 Levetiracetam injection

N

J1955 Inj levocarnitine per 1 gmB
J1956 Levofloxacin injection

N

J1960 Levorphanol tartrate injN

J1980 Hyoscyamine sulfate injN

J1990 Chlordiazepoxide injection

N

J2001 Lidocaine injection

N

J2010 Lincomycin injectionN

J2020 Linezolid injectionK 9001

J2060 Lorazepam injectionN

J2150 Mannitol injectionN

J2170 Mecasermin injection

K 1308

J2175 Meperidine hydrochl /100 MGN

J2180 Meperidine/promethazine injN

J2185 Meropenem

N

J2210 Methylergonovin maleate injN

J2248 Micafungin sodium injection K 9227

J2250 Inj midazolam hydrochlorideN

J2260 Inj milrinone lactate / 5 MGN

J2270 Morphine sulfate injectionN

J2271 Morphine so4 injection 100mgN

J2275 Morphine sulfate injectionN

J2278 Ziconotide injection K 1694

J2280 Inj, moxifloxacin 100 mgN

J2300 Inj nalbuphine hydrochlorideN

J2310 Inj naloxone hydrochlorideN

J2315 Naltrexone, depot form K 0759

J2320 Nandrolone decanoate 50 MG CH 

N

J2323 Natalizumab injection K 9126

J2325 Nesiritide injection K 1695

J2353 Octreotide injection, depotK 1207

J2354 Octreotide inj, non-depot N 

J2355 Oprelvekin injectionK 7011

J2357 Omalizumab injectionK 9300

J2358 Olanzapine long-acting injK 1331

J2360 Orphenadrine injectionN

J2370 Phenylephrine hcl injectionN

J2400 Chloroprocaine hcl injectionN

J2405 Ondansetron hcl injection

N

J2410 Oxymorphone hcl injectionN

J2425 Palifermin injection K 1696

J2426 Paliperidone palmitate inj CH K 9255

J2430 Pamidronate disodium /30 MG

N

J2440 Papaverin hcl injectionN

J2460 Oxytetracycline injection

E

J2469 Palonosetron hclK 9210

J2501 ParicalcitolN

J2503 Pegaptanib sodium injection

K 1697

J2504 Pegademase bovine, 25 iu K 1739

J2505 Injection, pegfilgrastim 6mg

K 9119

J2510 Penicillin g procaine inj CH 

N

J2513 Pentastarch 10% solution

K 1222

J2515 Pentobarbital sodium inj

N

J2540 Penicillin g potassium inj

N

J2543 Piperacillin/tazobactamN

J2545 Pentamidine non-comp unitB

J2550 Promethazine hcl injectionN
J2560 Phenobarbital sodium inj

N

J2562 Plerixafor injection CH

K 9252

J2590 Oxytocin injectionN

J2597 Inj desmopressin acetate CH

K 1356

J2650 Prednisolone acetate injN

J2670 Totazoline hcl injectionN

J2675 Inj progesterone per 50 MGN

J2680 Fluphenazine decanoate 25 MGN

J2690 Procainamide hcl injectionN

J2700 Oxacillin sodium injeciton CHN

J2710 Neostigmine methylslfte injN

J2720 Inj protamine sulfate/10 MGN

J2724 Protein c concentrateK 1139

J2725 Inj protirelin per 250 mcg CHK 1357

J2730 Pralidoxime chloride inj K 1023

J2760 Phentolaine mesylate inj CH K 1358

J2765 Metoclopramide hcl injectionN

J2770 Quinupristin/dalfopristinK 2770

J2778 Ranibizumab injectionK 9233

J2780 Ranitidine hydrochloride injN

J2783 Rasburicase

K 0738

J2785 Regadenoson injection

K 9244

J2788 Rho d immune globulin 50 mcgK 9023

J2790 Rho d immune globulin injK 0884

J2791 Rhophylac injectionK 0945

J2792 Rho(D) immune globulin h, sdK 1609

J2793 Rilonacept injectionK 1291

J2794 Risperidone, long acting

K 9125

J2795 Ropivacaine HCl injectionN

J2796 Romiplostim injection

K 9245

J2800 Methocarbamol injectionN

J2805 Sincalide injection CH N

J2810 Inj theophylline per 40 MGN

J2820 Sargramostim injectionK 0731

J2850 Inj secretin synthetic human K 1700

J2910 Aurothioglucose injeciton

N

J2916 Na ferric gluconate complexN

J2920 Methylprednisolone injectionN

J2930 Methylprednisolone injectionN

J2940 Somatrem injection CH 

E

J2941 Somatropin injectionK 7034

J2950 Promazine hcl injectionN

J2993 Reteplase injectionK 9005

J2995 Inj streptokinase /250000 IUK 1226

J2997 Alteplase recombinantK 7048

J3000 Streptomycin injectionN

J3010 Fentanyl citrate injecitonN

J3030 Sumatriptan succinate / 6 MGN

J3070 Pentazocine injectionN

J3095 Telavancin injectionG 9258

J3101 Tenecteplase injection

K 9002

J3105 Terbutaline sulfate injN

J3110 Teriparatide injectionB

J3120 Testosterone enanthate injN

J3130 Testosterone enanthate injN
J3140 Testosterone suspension inj

N

J3150 Testosteron propionate injN

J3230 Chlorpromazine hcl injectionN

J3240 Thyrotropin injectionK 9108

J3243 Tigecycline injectionK 9228

J3246 Tirofiban HClK 7041

J3250 Trimethobenzamide hcl injN

J3260 Tobramycin sulfate injectionN

J3262 Tocilizumab injectionG 9264

J3265 Injection torsemide 10 mg/mlN

J3280 Thiethylperazine maleate injN

J3285 Treprostinil injection K 1701

J3300 Triamcinolone A inj PRS-free K 1253

J3301 Triamcinolone acet inj NOS

N

J3302 Triamcinolone diacetate injN

J3303 Triamcinolone hexacetonl injN

J3305 Inj trimetrexate glucoronate CH E

J3310 Perphenazine injecitonK 1304

J3315 Triptorelin pamoateK 9122

J3320 Spectinomycn di-hcl injE

J3350 Urea injectionK 1306

J3355 Urofollitropin, 75 iu K 1741

J3357 Ustekinumab injectionG 9261

J3360 Diazepam injectionN

J3364 Urokinase 5000 IU injection

N

J3365 Urokinase 250,000 IU injK 7036

J3370 Vancomycin hcl injectionN

J3385 Velaglucerase alfaG 9271

J3396 Verteporfin injectionK 1203

J3400 Triflupromazine hcl inj

E

J3410 Hydroxyzine hcl injectionN

J3411 Thiamine hcl 100 mg

N

J3415 Pyridoxine hcl 100 mg

N

J3420 Vitamin b12 injectionN

J3430 Vitamin k phytonadione injN

J3465 Injection, voriconazoleK 1052

J3470 Hyaluronidase injection

N

J3471 Ovine, up to 999 USP units

N

J3472 Ovine, 1000 USP units

N

J3473 Hyaluronidase recombinant

N

J3475 Inj magnesium sulfateN

J3480 Inj potassium chlorideN

J3485 ZidovudineN

J3486 Ziprasidone mesylate

N

J3487 Zoledronic acidK 9115

J3488 Reclast injection

K 0951

J3490 Drugs unclassified injectionN

J3520 Edetate disodium per 150 mgE

J3530 Nasal vaccine inhalationN

J3535 Metered dose inhaler drugE

J3570 Laetrile amygdalin vit B17E

J3590 Unclassified biologicsN

J7030 Normal saline solution infusN

J7040 Normal saline solution infusN

J7042 5% dextrose/normal salineN
J7050 Normal saline solution infus

N

J7060 5% dextrose/waterN

J7070 D5w infusionN

J7100 Dextran 40 infusionN

J7110 Dextran 75 infusionN

J7120 Ringers lactate infusionN

J7130 Hypertonic saline solutionN

J7184 Wilate injectionG 9267

J7185 Xyntha injK 1268

J7186 Antihemophilic viii/vwf comp K 1213

J7187 Humate-P, inj K 1704

J7189 Factor viia K 1705

J7190 Factor viiiK 0925

J7191 Factor VIII (porcine)K 1279

J7192 Factor viii recombinant NOSK 0927

J7193 Factor IX non-recombinantK 0931

J7194 Factor ix complexK 0928

J7195 Factor IX recombinantK 0932

J7196 Antithrombin recombinantK 1332

J7197 Antithrombin iii injection

K 1263

J7198 Anti-inhibitorK 0929

J7199 Hemophilia clot factor nocB

J7300 Intraut copper contraceptiveE

J7302 Levonorgestrel iu contraceptE

J7303 Contraceptive vaginal ringE

J7304 Contraceptive hormone patchE

J7306 Levonorgestrel implant sysE

J7307 Etonogestrel implant systemE

J7308 Aminolevulinic acid hcl topK 7308

J7309 Methyl aminolevulinate, topK 1338

J7310 Ganciclovir long act implantK 0913

J7311 Fluocinolone acetonide implt

K 9225

J7312 Dexamethasone intra implant CH

K 9256

J7321 Hyalgan/supartz inj per doseK 0873

J7323 Euflexxa inj per doseK 0875

J7324 Orthovisc inj per doseK 0877

J7325 Synvisc or Synvisc-OneK 0874

J7330 Cultured chondrocytes implntB

J7335 Capsaicin 8% patchG 9268

J7500 Azathioprine oral 50mgN

J7501 Azathioprine parenteralK 0887

J7502 Cyclosporine oral 100 mg

N

J7504 Lymphocyte immune globulinK 0890

J7505 Monoclonal antibodiesK 7038

J7506 Prednisone oralN

J7507 Tacrolimus oral per 1 MGN

J7509 Methylprednisolone oralN

J7510 Prednisolone oral per 5 mgN

J7511 Antithymocyte globuln rabbitK 9104

J7513 Daclizumab, parenteralK 1612

J7515 Cyclosporine oral 25 mg

N

J7516 Cyclosporin parenteral 250mg

N

J7517 Mycophenolate mofetil oral

N

J7518 Mycophenolic acid N 

J7520 Sirolimus, oral N 
J7525 Tacrolimus injection

K 9006

J7599 Immunosuppressive drug nocN

J7604 Acetylcysteine comp unit M 

J7605 Arformoterol non-comp unit M 

J7606 Formoterol fumarate, inh M 

J7607 Levalbuterol comp con M 

J7608 Acetylcysteine non-comp unit M 

J7609 Albuterol comp unit M 

J7610 Albuterol comp con M 

J7611 Albuterol non-comp con M 

J7612 Levalbuterol non-comp con M 

J7613 Albuterol non-comp unit M 

J7614 Levalbuterol non-comp unit M 

J7615 Levalbuterol comp unit M 

J7620 Albuterol ipratrop non-comp M 

J7622 Beclomethasone comp unit M 

J7624 Betamethasone comp unit M 

J7626 Budesonide non-comp unit M 

J7627 Budesonide comp unit M 

J7628 Bitolterol mesylate comp con M 

J7629 Bitolterol mesylate comp unt M 

J7631 Cromolyn sodium noncomp unit M 

J7632 Cromolyn sodium comp unit M 

J7633 Budesonide non-comp con M 

J7634 Budesonide comp con M 

J7635 Atropine comp con M 

J7636 Atropine comp unit M 

J7637 Dexamethasone comp con M 

J7638 Dexamethasone comp unit M 

J7639 Dornase alfa non-comp unit M 

J7640 Formoterol comp unit E

J7641 Flunisolide comp unit M 

J7642 Glycopyrrolate comp con M 

J7643 Glycopyrrolate comp unit M 

J7644 Ipratropium bromide non-comp M 

J7645 Ipratropium bromide comp M 

J7647 Isoetharine comp con M 

J7648 Isoetharine non-comp con M 

J7649 Isoetharine non-comp unit M 

J7650 Isoetharine comp unit M 

J7657 Isoproterenol comp con M 

J7658 Isoproterenol non-comp con M 

J7659 Isoproterenol non-comp unit M 

J7660 Isoproterenol comp unit M 

J7667 Metaproterenol comp con M 

J7668 Metaproterenol non-comp con M 

J7669 Metaproterenol non-comp unit M 

J7670 Metaproterenol comp unit M 

J7674 Methacholine chloride, nebN

J7676 Pentamidine comp unit dose M 

J7680 Terbutaline sulf comp con M 

J7681 Terbutaline sulf comp unit M 

J7682 Tobramycin non-comp unit M 

J7683 Triamcinolone comp con M 

J7684 Triamcinolone comp unit M 
J7685 Tobramycin comp unit M 

J7686 Treprostinil, non-comp unitM

J7699 Inhalation solution for DME M 

J7799 Non-inhalation drug for DME N 

J8498 Antiemetic rectal/supp NOSB

J8499 Oral prescrip drug non chemoE

J8501 Oral aprepitantK 0868

J8510 Oral busulfan

K 1307

J8515 Cabergoline, oral 0.25mgE

J8520 Capecitabine, oral, 150 mgK 7042

J8521 Capecitabine, oral, 500 mgK 0934

J8530 Cyclophosphamide oral 25 MGN

J8540 Oral dexamethasoneN

J8560 Etoposide oral 50 MGK 0802

J8562 Oral fludarabine phosphateG 1339

J8565 Gefitinib oralE

J8597 Antiemetic drug oral NOSN

J8600 Melphalan oral 2 MG

N

J8610 Methotrexate oral 2.5 MGN

J8650 Nabilone oral CH 

E

J8700 TemozolomideK 1086

J8705 Topotecan oral CH K 1238

J8999 Oral prescription drug chemoB

J9000 Doxorubicin hcl injection N 

J9001 Doxorubicin hcl liposome injK 7046

J9010 Alemtuzumab injectionK 9110

J9015 Aldesleukin injectionK 0807

J9017 Arsenic trioxide injectionK 9012

J9020 Asparaginase injectionK 0814

J9025 Azacitidine injectionK 1709

J9027 Clofarabine injection

K 1710

J9031 Bcg live intravesical vacK 0809

J9033 Bendamustine injectionK 9243

J9035 Bevacizumab injection

K 9214

J9040 Bleomycin sulfate injection N 

J9041 Bortezomib injectionK 9207

J9045 Carboplatin injection N 

J9050 Carmustine injectionK 0812

J9055 Cetuximab injection

K 9215

J9060 Cisplatin 10 MG injectionN

J9065 Inj cladribine per 1 MGK 0858

J9070 Cyclophosphamide 100 MG injN

J9098 Cytarabine liposome injK 1166

J9100 Cytarabine hcl 100 MG injN

J9120 Dactinomycin injection K 0752

J9130 Dacarbazine 100 mg inj N 

J9150 Daunorubicin injectionK 0820

J9151 Daunorubicin citrate injK 0821

J9155 Degarelix injection CH K 1296

J9160 Denileukin diftitox injK 1084

J9165 Diethylstilbestrol injection CH 

E

J9171 Docetaxel injection

K 0823

J9175 Elliotts b solution per ml N 

J9178 Inj, epirubicin hcl, 2 mgK 1167

J9181 Etoposide injection N 
J9185 Fludarabine phosphate inj CH N 

J9190 Fluorouracil injectionN

J9200 Floxuridine injectionK 0827

J9201 Gemcitabine hcl injectionK 0828

J9202 Goserelin acetate implantK 0810

J9206 Irinotecan injection CH 

N

J9207 Ixabepilone injectionK 9240

J9208 Ifosfomide injectionK 0831

J9209 Mesna injection

N

J9211 Idarubicin hcl injectionK 0832

J9212 Interferon alfacon-1 inj CH 

N

J9213 Interferon alfa-2a inj CH 

E

J9214 Interferon alfa-2b injK 0836

J9215 Interferon alfa-n3 injK 0865

J9216 Interferon gamma 1-b injK 0838

J9217 Leuprolide acetate suspnsionK 9217

J9218 Leuprolide acetate injecitonK 0861

J9219 Leuprolide acetate implantK 7051

J9225 Vantas implantK 1711

J9226 Supprelin LA implantK 1142

J9230 Mechlorethamine hcl injK 0751

J9245 Inj melphalan hydrochl 50 MGK 0840

J9250 Methotrexate sodium injN

J9260 Methotrexate sodium injN

J9261 Nelarabine injection 

K 0825

J9263 Oxaliplatin

K 1738

J9264 Paclitaxel protein bound

K 1712

J9265 Paclitaxel injection CH 

N

J9266 Pegaspargase injection K 0843

J9268 Pentostatin injectionK 0844

J9270 Plicamycin (mithramycin) injN

J9280 Mitomycin 5 MG injK 1232

J9293 Mitoxantrone hydrochl / 5 MGK 0864

J9300 Gemtuzumab ozogamicin injK 9004

J9302 Ofatumumab injectionG 9260

J9303 Panitumumab injectionK 9235

J9305 Pemetrexed injection

K 9213

J9307 Pralatrexate injection

G 9259

J9310 Rituximab injectionK 0849

J9315 Romidepsin injectionG 9265

J9320 Streptozocin injectionK 0850

J9328 Temozolomide injection CHK 9253

J9330 Temsirolimus injectionK 1168

J9340 Thiotepa injectionK 0851

J9351 Topotecan injection

K 1350

J9355 Trastuzumab injectionK 1613

J9357 Valrubicin injectionK 1235

J9360 Vinblastine sulfate injN

J9370 Vincristine sulfate 1 MG injN

J9390 Vinorelbine tartrate injN

J9395 Injection, Fulvestrant

K 9120

J9600 Porfimer sodium injectionK 0856

J9999 Chemotherapy drugN

K0001 Standard wheelchairY

K0002 Stnd hemi (low seat) whlchrY
K0003 Lightweight wheelchair

Y

K0004 High strength ltwt whlchrY

K0005 Ultralightweight wheelchairY

K0006 Heavy duty wheelchairY

K0007 Extra heavy duty wheelchairY

K0009 Other manual wheelchair/baseY

K0010 Stnd wt frame power whlchrY

K0011 Stnd wt pwr whlchr w controlY

K0012 Ltwt portbl power whlchrY

K0014 Other power whlchr baseY

K0015 Detach non-adjus hght armrstY

K0017 Detach adjust armrest baseY

K0018 Detach adjust armrst upperY

K0019 Arm pad eachY

K0020 Fixed adjust armrest pairY

K0037 High mount flip-up footrestY

K0038 Leg strap eachY

K0039 Leg strap h style eachY

K0040 Adjustable angle footplateY

K0041 Large size footplate eachY

K0042 Standard size footplate eachY

K0043 Ftrst lower extension tubeY

K0044 Ftrst upper hanger bracketY

K0045 Footrest complete assemblyY

K0046 Elevat legrst low extensionY

K0047 Elevat legrst up hangr brackY

K0050 Ratchet assemblyY

K0051 Cam relese assem ftrst/lgrstY

K0052 Swingaway detach footrestY

K0053 Elevate footrest articulateY

K0056 Seat ht <17 or >=21 ltwt wcY

K0065 Spoke protectorsY

K0069 Rear whl complete solid tireY

K0070 Rear whl compl pneum tireY

K0071 Front castr compl pneum tireY

K0072 Frnt cstr cmpl sem-pneum tirY

K0073 Caster pin lock eachY

K0077 Front caster assem completeY

K0098 Drive belt power wheelchairY

K0105 Iv hanger Y 

K0108 W/c component-accessory NOSY

K0195 Elevating whlchair leg restsY

K0455 Pump uninterrupted infusionY

K0462 Temporary replacement eqpmntY

K0552 Supply/ext inf pump syr type

Y

K0601 Repl batt silver oxide 1.5 vY

K0602 Repl batt silver oxide 3 v Y

K0603 Repl batt alkaline 1.5 vY

K0604 Repl batt lithium 3.6 vY

K0605 Repl batt lithium 4.5 vY

K0606 AED garment w elec analysisY

K0607 Repl batt for AEDY

K0608 Repl garment for AEDY

K0609 Repl electrode for AEDY

K0669 Seat/back cus no dmepdac ver

Y
K0672 Removable soft interface LE A 

K0730 Ctrl dose inh drug deliv sys Y 

K0733 12-24hr sealed lead acid Y 

K0738 Portable gas oxygen system Y 

K0739 Repair/svc DME non-oxygen eq Y 

K0740 Repair/svc oxygen equipment

E

K0800 POV group 1 std up to 300lbs Y 

K0801 POV group 1 hd 301-450 lbs Y 

K0802 POV group 1 vhd 451-600 lbs Y 

K0806 POV group 2 std up to 300lbs Y 

K0807 POV group 2 hd 301-450 lbs Y 

K0808 POV group 2 vhd 451-600 lbs Y 

K0812 Power operated vehicle NOC Y 

K0813 PWC gp 1 std port seat/back Y 

K0814 PWC gp 1 std port cap chair Y 

K0815 PWC gp 1 std seat/back Y 

K0816 PWC gp 1 std cap chair Y 

K0820 PWC gp 2 std port seat/back Y 

K0821 PWC gp 2 std port cap chair Y 

K0822 PWC gp 2 std seat/back Y 

K0823 PWC gp 2 std cap chair Y 

K0824 PWC gp 2 hd seat/back Y 

K0825 PWC gp 2 hd cap chair Y 

K0826 PWC gp 2 vhd seat/back Y 

K0827 PWC gp vhd cap chair Y 

K0828 PWC gp 2 xtra hd seat/back Y 

K0829 PWC gp 2 xtra hd cap chair Y 

K0830 PWC gp2 std seat elevate s/b Y 

K0831 PWC gp2 std seat elevate cap Y 

K0835 PWC gp2 std sing pow opt s/b Y 

K0836 PWC gp2 std sing pow opt cap Y 

K0837 PWC gp 2 hd sing pow opt s/b Y 

K0838 PWC gp 2 hd sing pow opt cap Y 

K0839 PWC gp2 vhd sing pow opt s/b Y 

K0840 PWC gp2 xhd sing pow opt s/b Y 

K0841 PWC gp2 std mult pow opt s/b Y 

K0842 PWC gp2 std mult pow opt cap Y 

K0843 PWC gp2 hd mult pow opt s/b Y 

K0848 PWC gp 3 std seat/back Y 

K0849 PWC gp 3 std cap chair Y 

K0850 PWC gp 3 hd seat/back Y 

K0851 PWC gp 3 hd cap chair Y 

K0852 PWC gp 3 vhd seat/back Y 

K0853 PWC gp 3 vhd cap chair Y 

K0854 PWC gp 3 xhd seat/back Y 

K0855 PWC gp 3 xhd cap chair Y 

K0856 PWC gp3 std sing pow opt s/b Y 

K0857 PWC gp3 std sing pow opt cap Y 

K0858 PWC gp3 hd sing pow opt s/b Y 

K0859 PWC gp3 hd sing pow opt cap Y 

K0860 PWC gp3 vhd sing pow opt s/b Y 

K0861 PWC gp3 std mult pow opt s/b Y 

K0862 PWC gp3 hd mult pow opt s/b Y 

K0863 PWC gp3 vhd mult pow opt s/b Y 

K0864 PWC gp3 xhd mult pow opt s/b Y 
K0868 PWC gp 4 std seat/back Y 

K0869 PWC gp 4 std cap chair Y 

K0870 PWC gp 4 hd seat/back Y 

K0871 PWC gp 4 vhd seat/back Y 

K0877 PWC gp4 std sing pow opt s/b Y 

K0878 PWC gp4 std sing pow opt cap Y 

K0879 PWC gp4 hd sing pow opt s/b Y 

K0880 PWC gp4 vhd sing pow opt s/b Y 

K0884 PWC gp4 std mult pow opt s/b Y 

K0885 PWC gp4 std mult pow opt cap Y 

K0886 PWC gp4 hd mult pow s/b Y 

K0890 PWC gp5 ped sing pow opt s/b Y 

K0891 PWC gp5 ped mult pow opt s/b Y 

K0898 Power wheelchair NOC Y 

K0899 Pow mobil dev no dmepdac Y 

L0112 Cranial cervical orthosis

A

L0113 Cranial cervical torticollis

A

L0120 Cerv flexible non-adjustableA

L0130 Flex thermoplastic collar moA

L0140 Cervical semi-rigid adjustabA

L0150 Cerv semi-rig adj molded chnA

L0160 Cerv semi-rig wire occ/mandA

L0170 Cervical collar molded to ptA

L0172 Cerv col thermplas foam 2 piA

L0174 Cerv col foam 2 piece w thorA

L0180 Cer post col occ/man sup adjA

L0190 Cerv collar supp adj cerv baA

L0200 Cerv col supp adj bar & thorA

L0220 Thor rib belt custom fabricaA

L0430 Dewall posture protectorA

L0450 TLSO flex prefab thoracicA

L0452 tlso flex custom fab thoraciA

L0454 TLSO flex prefab sacrococ-T9A

L0456 TLSO flex prefabA

L0458 TLSO 2Mod symphis-xipho preA

L0460 TLSO2Mod symphysis-stern preA

L0462 TLSO 3Mod sacro-scap preA

L0464 TLSO 4Mod sacro-scap preA

L0466 TLSO rigid frame pre soft apA

L0468 TLSO rigid frame prefab pelvA

L0470 TLSO rigid frame pre subclavA

L0472 TLSO rigid frame hyperex preA

L0480 TLSO rigid plastic custom faA

L0482 TLSO rigid lined custom fabA

L0484 TLSO rigid plastic cust fabA

L0486 TLSO rigidlined cust fab twoA

L0488 TLSO rigid lined pre one pieA

L0490 TLSO rigid plastic pre oneA

L0491 TLSO 2 piece rigid shellA

L0492 TLSO 3 piece rigid shellA

L0621 SIO flex pelvisacral prefabA

L0622 SIO flex pelvisacral customA

L0623 SIO panel prefabA

L0624 SIO panel customA

L0625 LO flexibl L1-below L5 preA
L0626 LO sag stays/panels pre-fab

A

L0627 LO sagitt rigid panel prefabA

L0628 LO flex w/o rigid stays preA

L0629 LSO flex w/rigid stays custA

L0630 LSO post rigid panel preA

L0631 LSO sag-coro rigid frame preA

L0632 LSO sag rigid frame custA

L0633 LSO flexion control prefabA

L0634 LSO flexion control customA

L0635 LSO sagit rigid panel prefabA

L0636 LSO sagittal rigid panel cusA

L0637 LSO sag-coronal panel prefabA

L0638 LSO sag-coronal panel customA

L0639 LSO s/c shell/panel prefabA

L0640 LSO s/c shell/panel customA

L0700 Ctlso a-p-l control moldedA

L0710 Ctlso a-p-l control w/ interA

L0810 Halo cervical into jckt vestA

L0820 Halo cervical into body jackA

L0830 Halo cerv into milwaukee typA

L0859 MRI compatible systemA

L0861 Halo repl liner/interface

A

L0970 Tlso corset frontA

L0972 Lso corset frontA

L0974 Tlso full corsetA

L0976 Lso full corsetA

L0978 Axillary crutch extensionA

L0980 Peroneal straps pairA

L0982 Stocking supp grips set of fA

L0984 Protective body sock eachA

L0999 Add to spinal orthosis NOSA

L1000 Ctlso milwauke initial modelA

L1001 CTLSO infant immobilizerA

L1005 Tension based scoliosis orthA

L1010 Ctlso axilla slingA

L1020 Kyphosis padA

L1025 Kyphosis pad floatingA

L1030 Lumbar bolster padA

L1040 Lumbar or lumbar rib padA

L1050 Sternal padA

L1060 Thoracic padA

L1070 Trapezius slingA

L1080 OutriggerA

L1085 Outrigger bil w/ vert extensA

L1090 Lumbar slingA

L1100 Ring flange plastic/leatherA

L1110 Ring flange plas/leather molA

L1120 Covers for upright eachA

L1200 Furnsh initial orthosis onlyA

L1210 Lateral thoracic extensionA

L1220 Anterior thoracic extensionA

L1230 Milwaukee type superstructurA

L1240 Lumbar derotation padA

L1250 Anterior asis padA

L1260 Anterior thoracic derotationA
L1270 Abdominal pad

A

L1280 Rib gusset (elastic) eachA

L1290 Lateral trochanteric padA

L1300 Body jacket mold to patientA

L1310 Post-operative body jacketA

L1499 Spinal orthosis NOSA

L1500 Thkao mobility frameA

L1510 Thkao standing frameA

L1520 Thkao swivel walkerA

L1600 Abduct hip flex frejka w cvrA

L1610 Abduct hip flex frejka covrA

L1620 Abduct hip flex pavlik harneA

L1630 Abduct control hip semi-flexA

L1640 Pelv band/spread bar thigh cA

L1650 HO abduction hip adjustableA

L1652 HO bi thighcuffs w sprdr barA

L1660 HO abduction static plasticA

L1680 Pelvic & hip control thigh cA

L1685 Post-op hip abduct custom faA

L1686 HO post-op hip abductionA

L1690 Combination bilateral HOA

L1700 Leg perthes orth toronto typA

L1710 Legg perthes orth newingtonA

L1720 Legg perthes orthosis trilatA

L1730 Legg perthes orth scottish rA

L1755 Legg perthes patten bottom tA

L1810 Ko elastic with jointsA

L1820 Ko elas w/ condyle pads & joA

L1830 Ko immobilizer canvas longitA

L1831 Knee orth pos locking joint

A

L1832 KO adj jnt pos rigid supportA

L1834 Ko w/0 joint rigid molded toA

L1836 Rigid KO wo jointsA

L1840 Ko derot ant cruciate customA

L1843 KO single upright custom fitA

L1844 Ko w/adj jt rot cntrl moldedA

L1845 Ko w/ adj flex/ext rotat cusA

L1846 Ko w adj flex/ext rotat moldA

L1847 KO adjustable w air chambersA

L1850 Ko swedish typeA

L1860 Ko supracondylar socket moldA

L1900 Afo sprng wir drsflx calf bdA

L1902 Afo ankle gauntletA

L1904 Afo molded ankle gauntletA

L1906 Afo multiligamentus ankle suA

L1907 AFO supramalleolar custom

A

L1910 Afo sing bar clasp attach shA

L1920 Afo sing upright w/ adjust sA

L1930 Afo plasticA

L1932 Afo rig ant tib prefab TCF/=A

L1940 Afo molded to patient plastiA

L1945 Afo molded plas rig ant tibA

L1950 Afo spiral molded to pt plasA

L1951 AFO spiral prefabricated

A

L1960 Afo pos solid ank plastic moA
L1970 Afo plastic molded w/ankle j

A

L1971 AFO w/ankle joint, prefab

A

L1980 Afo sing solid stirrup calfA

L1990 Afo doub solid stirrup calfA

L2000 Kafo sing fre stirr thi/calfA

L2005 KAFO sng/dbl mechanical actA

L2010 Kafo sng solid stirrup w/o jA

L2020 Kafo dbl solid stirrup band/A

L2030 Kafo dbl solid stirrup w/o jA

L2034 KAFO pla sin up w/wo k/a cusA

L2035 KAFO plastic pediatric sizeA

L2036 Kafo plas doub free knee molA

L2037 Kafo plas sing free knee molA

L2038 Kafo w/o joint multi-axis anA

L2040 Hkafo torsion bil rot strapsA

L2050 Hkafo torsion cable hip pelvA

L2060 Hkafo torsion ball bearing jA

L2070 Hkafo torsion unilat rot strA

L2080 Hkafo unilat torsion cableA

L2090 Hkafo unilat torsion ball brA

L2106 Afo tib fx cast plaster moldA

L2108 Afo tib fx cast molded to ptA

L2112 Afo tibial fracture softA

L2114 Afo tib fx semi-rigidA

L2116 Afo tibial fracture rigidA

L2126 Kafo fem fx cast thermoplasA

L2128 Kafo fem fx cast molded to pA

L2132 Kafo femoral fx cast softA

L2134 Kafo fem fx cast semi-rigidA

L2136 Kafo femoral fx cast rigidA

L2180 Plas shoe insert w ank jointA

L2182 Drop lock kneeA

L2184 Limited motion knee jointA

L2186 Adj motion knee jnt lerman tA

L2188 Quadrilateral brimA

L2190 Waist beltA

L2192 Pelvic band & belt thigh flaA

L2200 Limited ankle motion ea jntA

L2210 Dorsiflexion assist each joiA

L2220 Dorsi & plantar flex ass/resA

L2230 Split flat caliper stirr & pA

L2232 Rocker bottom, contact AFOA

L2240 Round caliper and plate attaA

L2250 Foot plate molded stirrup atA

L2260 Reinforced solid stirrupA

L2265 Long tongue stirrupA

L2270 Varus/valgus strap padded/liA

L2275 Plastic mod low ext pad/lineA

L2280 Molded inner bootA

L2300 Abduction bar jointed adjustA

L2310 Abduction bar-straightA

L2320 Non-molded lacerA

L2330 Lacer molded to patient modeA

L2335 Anterior swing bandA

L2340 Pre-tibial shell molded to pA
L2350 Prosthetic type socket molde

A

L2360 Extended steel shankA

L2370 Patten bottomA

L2375 Torsion ank & half solid stiA

L2380 Torsion straight knee jointA

L2385 Straight knee joint heavy duA

L2387 Add LE poly knee custom KAFOA

L2390 Offset knee joint eachA

L2395 Offset knee joint heavy dutyA

L2397 Suspension sleeve lower extA

L2405 Knee joint drop lock ea jntA

L2415 Knee joint cam lock each joiA

L2425 Knee disc/dial lock/adj flexA

L2430 Knee jnt ratchet lock ea jntA

L2492 Knee lift loop drop lock rinA

L2500 Thi/glut/ischia wgt bearingA

L2510 Th/wght bear quad-lat brim mA

L2520 Th/wght bear quad-lat brim cA

L2525 Th/wght bear nar m-l brim moA

L2526 Th/wght bear nar m-l brim cuA

L2530 Thigh/wght bear lacer non-moA

L2540 Thigh/wght bear lacer moldedA

L2550 Thigh/wght bear high roll cuA

L2570 Hip clevis type 2 posit jntA

L2580 Pelvic control pelvic slingA

L2600 Hip clevis/thrust bearing frA

L2610 Hip clevis/thrust bearing loA

L2620 Pelvic control hip heavy dutA

L2622 Hip joint adjustable flexionA

L2624 Hip adj flex ext abduct contA

L2627 Plastic mold recipro hip & cA

L2628 Metal frame recipro hip & caA

L2630 Pelvic control band & belt uA

L2640 Pelvic control band & belt bA

L2650 Pelv & thor control glutealA

L2660 Thoracic control thoracic baA

L2670 Thorac cont paraspinal uprigA

L2680 Thorac cont lat support upriA

L2750 Plating chrome/nickel pr barA

L2755 Carbon graphite laminationA

L2760 Extension per extension perA

L2768 Ortho sidebar disconnectA

L2780 Non-corrosive finishA

L2785 Drop lock retainer eachA

L2795 Knee control full kneecapA

L2800 Knee cap medial or lateral pA

L2810 Knee control condylar padA

L2820 Soft interface below knee seA

L2830 Soft interface above knee seA

L2840 Tibial length sock fx or equA

L2850 Femoral lgth sock fx or equaA

L2861 Torsion mechanism knee/ankleE

L2999 Lower extremity orthosis NOSA

L3000 Ft insert ucb berkeley shellA

L3001 Foot insert remov molded speA
L3002 Foot insert plastazote or eq

A

L3003 Foot insert silicone gel eacA

L3010 Foot longitudinal arch suppoA

L3020 Foot longitud/metatarsal supA

L3030 Foot arch support remov premA

L3031 Foot lamin/prepreg compositeA

L3040 Ft arch suprt premold longitA

L3050 Foot arch supp premold metatA

L3060 Foot arch supp longitud/metaA

L3070 Arch suprt att to sho longitA

L3080 Arch supp att to shoe metataA

L3090 Arch supp att to shoe long/mA

L3100 Hallus-valgus nght dynamic sA

L3140 Abduction rotation bar shoeA

L3150 Abduct rotation bar w/o shoeA

L3160 Shoe styled positioning devA

L3170 Foot plastic heel stabilizerA

L3201 Oxford w supinat/pronat infA

L3202 Oxford w/ supinat/pronator cA

L3203 Oxford w/ supinator/pronatorA

L3204 Hightop w/ supp/pronator infA

L3206 Hightop w/ supp/pronator chiA

L3207 Hightop w/ supp/pronator junA

L3208 Surgical boot each infantA

L3209 Surgical boot each childA

L3211 Surgical boot each juniorA

L3212 Benesch boot pair infantA

L3213 Benesch boot pair childA

L3214 Benesch boot pair juniorA

L3215 Orthopedic ftwear ladies oxf E 

L3216 Orthoped ladies shoes dpth i E 

L3217 Ladies shoes hightop depth i E 

L3219 Orthopedic mens shoes oxford E 

L3221 Orthopedic mens shoes dpth i E 

L3222 Mens shoes hightop depth inl E 

L3224 Woman's shoe oxford braceA

L3225 Man's shoe oxford braceA

L3230 Custom shoes depth inlay A 

L3250 Custom mold shoe remov prost A 

L3251 Shoe molded to pt silicone s A 

L3252 Shoe molded plastazote cust A 

L3253 Shoe molded plastazote cust A 

L3254 Orth foot non-stndard size/w A 

L3255 Orth foot non-standard size/ A 

L3257 Orth foot add charge split s A 

L3260 Ambulatory surgical boot eacE

L3265 Plastazote sandal each A 

L3300 Sho lift taper to metatarsal A 

L3310 Shoe lift elev heel/sole neo A 

L3320 Shoe lift elev heel/sole cor A 

L3330 Lifts elevation metal extens A 

L3332 Shoe lifts tapered to one-ha A 

L3334 Shoe lifts elevation heel /i A 

L3340 Shoe wedge sach A 

L3350 Shoe heel wedge A 
L3360 Shoe sole wedge outside sole A 

L3370 Shoe sole wedge between sole A 

L3380 Shoe clubfoot wedge A 

L3390 Shoe outflare wedge A 

L3400 Shoe metatarsal bar wedge ro A 

L3410 Shoe metatarsal bar between A 

L3420 Full sole/heel wedge btween A 

L3430 Sho heel count plast reinfor A 

L3440 Heel leather reinforced A 

L3450 Shoe heel sach cushion type A 

L3455 Shoe heel new leather standa A 

L3460 Shoe heel new rubber standar A 

L3465 Shoe heel thomas with wedge A 

L3470 Shoe heel thomas extend to b A 

L3480 Shoe heel pad & depress for A 

L3485 Shoe heel pad removable for A 

L3500 Ortho shoe add leather insol A 

L3510 Orthopedic shoe add rub insl A 

L3520 O shoe add felt w leath insl A 

L3530 Ortho shoe add half sole A 

L3540 Ortho shoe add full sole A 

L3550 O shoe add standard toe tap A 

L3560 O shoe add horseshoe toe tap A 

L3570 O shoe add instep extension A 

L3580 O shoe add instep velcro clo A 

L3590 O shoe convert to sof counte A 

L3595 Ortho shoe add march bar A 

L3600 Trans shoe calip plate exist A 

L3610 Trans shoe caliper plate new A 

L3620 Trans shoe solid stirrup exi A 

L3630 Trans shoe solid stirrup new A 

L3640 Shoe dennis browne splint bo A 

L3649 Orthopedic shoe modifica NOS A 

L3650 Shlder fig 8 abduct restrainA

L3660 Abduct restrainer canvas&webA

L3670 Acromio/clavicular canvas&weA

L3671 SO cap design w/o jnts CFA

L3674 SO airplane w/wo joint CFA

L3675 Canvas vest SOA

L3677 SO hard plastic stabilizerA

L3702 EO w/o joints CFA

L3710 Elbow elastic with metal joiA

L3720 Forearm/arm cuffs free motioA

L3730 Forearm/arm cuffs ext/flex aA

L3740 Cuffs adj lock w/ active conA

L3760 EO withjoint, PrefabricatedA

L3762 Rigid EO wo jointsA

L3763 EWHO rigid w/o jnts CFA

L3764 EWHO w/joint(s) CFA

L3765 EWHFO rigid w/o jnts CFA

L3766 EWHFO w/joint(s) CFA

L3806 WHFO w/joint(s) custom fabA

L3807 WHFO,no joint, prefabricatedA

L3808 WHFO, rigid w/o jointsA

L3891 Torsion mechanism wrist/elboE
L3900 Hinge extension/flex wrist/f

A

L3901 Hinge ext/flex wrist fingerA

L3904 Whfo electric custom fittedA

L3905 WHO w/nontorsion jnt(s) CFA

L3906 WHO w/o joints CFA

L3908 Wrist cock-up non-moldedA

L3912 Flex glove w/elastic fingerA

L3913 HFO w/o joints CFA

L3915 WHO w nontor jnt(s) prefabA

L3917 Prefab metacarpl fx orthosis

A

L3919 HO w/o joints CFA

L3921 HFO w/joint(s) CFA

L3923 HFO w/o joints PFA

L3925 FO pip/dip with joint/springA

L3927 FO pip/dip w/o joint/springA

L3929 HFO nontorsion joint, prefabA

L3931 WHFO nontorsion joint prefabA

L3933 FO w/o joints CFA

L3935 FO nontorsion joint CFA

L3956 Add joint upper ext orthosisA

L3960 Sewho airplan desig abdu posA

L3961 SEWHO cap design w/o jnts CFA

L3962 Sewho erbs palsey design abdA

L3964 Seo mobile arm sup att to wcY

L3965 Arm supp att to wc rancho tyY

L3966 Mobile arm supports reclininY

L3967 SEWHO airplane w/o jnts CFA

L3968 Friction dampening arm suppY

L3969 Monosuspension arm/hand suppY

L3970 Elevat proximal arm supportY

L3971 SEWHO cap design w/jnt(s) CFA

L3972 Offset/lat rocker arm w/ elaY

L3973 SEWHO airplane w/jnt(s) CFA

L3974 Mobile arm support supinatorY

L3975 SEWHFO cap design w/o jnt CFA

L3976 SEWHFO airplane w/o jnts CFA

L3977 SEWHFO cap desgn w/jnt(s) CFA

L3978 SEWHFO airplane w/jnt(s) CFA

L3980 Upp ext fx orthosis humeralA

L3982 Upper ext fx orthosis rad/ulA

L3984 Upper ext fx orthosis wristA

L3995 Sock fracture or equal eachA

L3999 Upper limb orthosis NOSA

L4000 Repl girdle milwaukee orthA

L4002 Replace strap, any orthosisA

L4010 Replace trilateral socket brA

L4020 Replace quadlat socket brimA

L4030 Replace socket brim cust fitA

L4040 Replace molded thigh lacerA

L4045 Replace non-molded thigh lacA

L4050 Replace molded calf lacerA

L4055 Replace non-molded calf laceA

L4060 Replace high roll cuffA

L4070 Replace prox & dist uprightA

L4080 Repl met band kafo-afo proxA
L4090 Repl met band kafo-afo calf/

A

L4100 Repl leath cuff kafo prox thA

L4110 Repl leath cuff kafo-afo calA

L4130 Replace pretibial shellA

L4205 Ortho dvc repair per 15 minA

L4210 Orth dev repair/repl minor pA

L4350 Ankle control orthosi prefabA

L4360 Pneumati walking boot prefabA

L4370 Pneumatic full leg splintA

L4380 Pneumatic knee splintA

L4386 Non-pneum walk boot prefabA

L4392 Replace AFO soft interfaceA

L4394 Replace foot drop spintA

L4396 Static AFOA

L4398 Foot drop splint recumbentA

L4631 Afo, walk boot type, cus fabA

L5000 Sho insert w arch toe fillerA

L5010 Mold socket ank hgt w/ toe fA

L5020 Tibial tubercle hgt w/ toe fA

L5050 Ank symes mold sckt sach ftA

L5060 Symes met fr leath socket arA

L5100 Molded socket shin sach footA

L5105 Plast socket jts/thgh lacerA

L5150 Mold sckt ext knee shin sachA

L5160 Mold socket bent knee shin sA

L5200 Kne sing axis fric shin sachA

L5210 No knee/ankle joints w/ ft bA

L5220 No knee joint with artic aliA

L5230 Fem focal defic constant friA

L5250 Hip canad sing axi cons fricA

L5270 Tilt table locking hip singA

L5280 Hemipelvect canad sing axisA

L5301 BK mold socket SACH ft endoA

L5311 Knee disart, SACH ft, endoA

L5321 AK open end SACHA

L5331 Hip disart canadian SACH ftA

L5341 Hemipelvectomy canadian SACHA

L5400 Postop dress & 1 cast chg bkA

L5410 Postop dsg bk ea add cast chA

L5420 Postop dsg & 1 cast chg ak/dA

L5430 Postop dsg ak ea add cast chA

L5450 Postop app non-wgt bear dsgA

L5460 Postop app non-wgt bear dsgA

L5500 Init bk ptb plaster directA

L5505 Init ak ischal plstr directA

L5510 Prep BK ptb plaster moldedA

L5520 Perp BK ptb thermopls directA

L5530 Prep BK ptb thermopls moldedA

L5535 Prep BK ptb open end socketA

L5540 Prep BK ptb laminated socketA

L5560 Prep AK ischial plast moldedA

L5570 Prep AK ischial direct formA

L5580 Prep AK ischial thermo moldA

L5585 Prep AK ischial open endA

L5590 Prep AK ischial laminatedA
L5595 Hip disartic sach thermopls

A

L5600 Hip disart sach laminat moldA

L5610 Above knee hydracadenceA

L5611 Ak 4 bar link w/fric swingA

L5613 Ak 4 bar ling w/hydraul swigA

L5614 4-bar link above knee w/swngA

L5616 Ak univ multiplex sys frictA

L5617 AK/BK self-aligning unit eaA

L5618 Test socket symesA

L5620 Test socket below kneeA

L5622 Test socket knee disarticulaA

L5624 Test socket above kneeA

L5626 Test socket hip disarticulatA

L5628 Test socket hemipelvectomyA

L5629 Below knee acrylic socketA

L5630 Syme typ expandabl wall scktA

L5631 Ak/knee disartic acrylic socA

L5632 Symes type ptb brim design sA

L5634 Symes type poster opening soA

L5636 Symes type medial opening soA

L5637 Below knee total contactA

L5638 Below knee leather socketA

L5639 Below knee wood socketA

L5640 Knee disarticulat leather soA

L5642 Above knee leather socketA

L5643 Hip flex inner socket ext frA

L5644 Above knee wood socketA

L5645 Bk flex inner socket ext fraA

L5646 Below knee cushion socketA

L5647 Below knee suction socketA

L5648 Above knee cushion socketA

L5649 Isch containmt/narrow m-l soA

L5650 Tot contact ak/knee disart sA

L5651 Ak flex inner socket ext fraA

L5652 Suction susp ak/knee disartA

L5653 Knee disart expand wall sockA

L5654 Socket insert symesA

L5655 Socket insert below kneeA

L5656 Socket insert knee articulatA

L5658 Socket insert above kneeA

L5661 Multi-durometer symesA

L5665 Multi-durometer below kneeA

L5666 Below knee cuff suspensionA

L5668 Socket insert w/o lock lowerA

L5670 Bk molded supracondylar suspA

L5671 BK/AK locking mechanismA

L5672 Bk removable medial brim susA

L5673 Socket insert w lock mechA

L5676 Bk knee joints single axis pA

L5677 Bk knee joints polycentric pA

L5678 Bk joint covers pairA

L5679 Socket insert w/o lock mechA

L5680 Bk thigh lacer non-moldedA

L5681 Intl custm cong/latyp insertA

L5682 Bk thigh lacer glut/ischia mA
L5683 Initial custom socket insert

A

L5684 Bk fork strapA

L5685 Below knee sus/seal sleeve

A

L5686 Bk back checkA

L5688 Bk waist belt webbingA

L5690 Bk waist belt padded and linA

L5692 Ak pelvic control belt lightA

L5694 Ak pelvic control belt pad/lA

L5695 Ak sleeve susp neoprene/equaA

L5696 Ak/knee disartic pelvic joinA

L5697 Ak/knee disartic pelvic bandA

L5698 Ak/knee disartic silesian baA

L5699 Shoulder harnessA

L5700 Replace socket below kneeA

L5701 Replace socket above kneeA

L5702 Replace socket hipA

L5703 Symes ankle w/o (SACH) footA

L5704 Custom shape cover BKA

L5705 Custom shape cover AKA

L5706 Custom shape cvr knee disartA

L5707 Custom shape cvr hip disartA

L5710 Kne-shin exo sng axi mnl locA

L5711 Knee-shin exo mnl lock ultraA

L5712 Knee-shin exo frict swg & stA

L5714 Knee-shin exo variable frictA

L5716 Knee-shin exo mech stance phA

L5718 Knee-shin exo frct swg & staA

L5722 Knee-shin pneum swg frct exoA

L5724 Knee-shin exo fluid swing phA

L5726 Knee-shin ext jnts fld swg eA

L5728 Knee-shin fluid swg & stanceA

L5780 Knee-shin pneum/hydra pneumA

L5781 Lower limb pros vacuum pumpA

L5782 HD low limb pros vacuum pumpA

L5785 Exoskeletal bk ultralt materA

L5790 Exoskeletal ak ultra-light mA

L5795 Exoskel hip ultra-light mateA

L5810 Endoskel knee-shin mnl lockA

L5811 Endo knee-shin mnl lck ultraA

L5812 Endo knee-shin frct swg & stA

L5814 Endo knee-shin hydral swg phA

L5816 Endo knee-shin polyc mch staA

L5818 Endo knee-shin frct swg & stA

L5822 Endo knee-shin pneum swg frcA

L5824 Endo knee-shin fluid swing pA

L5826 Miniature knee jointA

L5828 Endo knee-shin fluid swg/staA

L5830 Endo knee-shin pneum/swg phaA

L5840 Multi-axial knee/shin systemA

L5845 Knee-shin sys stance flexionA

L5848 Knee-shin sys hydraul stanceA

L5850 Endo ak/hip knee extens assiA

L5855 Mech hip extension assistA

L5856 Elec knee-shin swing/stance

A

L5857 Elec knee-shin swing only

A
L5858 Stance phase only

A

L5910 Endo below knee alignable syA

L5920 Endo ak/hip alignable systemA

L5925 Above knee manual lockA

L5930 High activity knee frameA

L5940 Endo bk ultra-light materialA

L5950 Endo ak ultra-light materialA

L5960 Endo hip ultra-light materiaA

L5961 Endo poly hip, pneu/hyd/rotA

L5962 Below knee flex cover systemA

L5964 Above knee flex cover systemA

L5966 Hip flexible cover systemA

L5968 Multiaxial ankle w dorsiflexA

L5970 Foot external keel sach footA

L5971 SACH foot, replacementA

L5972 Flexible keel footA

L5973 Ank-foot sys dors-plant flexA

L5974 Foot single axis ankle/footA

L5975 Combo ankle/foot prosthesisA

L5976 Energy storing footA

L5978 Ft prosth multiaxial ankl/ftA

L5979 Multi-axial ankle/ft prosthA

L5980 Flex foot systemA

L5981 Flex-walk sys low ext prosthA

L5982 Exoskeletal axial rotation uA

L5984 Endoskeletal axial rotationA

L5985 Lwr ext dynamic prosth pylonA

L5986 Multi-axial rotation unitA

L5987 Shank ft w vert load pylonA

L5988 Vertical shock reducing pyloA

L5990 User adjustable heel heightA

L5999 Lowr extremity prosthes NOSA

L6000 Par hand robin-aids thum remA

L6010 Hand robin-aids little/ringA

L6020 Part hand robin-aids no fingA

L6025 Part hand disart myoelectricA

L6050 Wrst MLd sck flx hng tri padA

L6055 Wrst mold sock w/exp interfaA

L6100 Elb mold sock flex hinge padA

L6110 Elbow mold sock suspension tA

L6120 Elbow mold doub splt soc steA

L6130 Elbow stump activated lock hA

L6200 Elbow mold outsid lock hingeA

L6205 Elbow molded w/ expand interA

L6250 Elbow inter loc elbow forarmA

L6300 Shlder disart int lock elbowA

L6310 Shoulder passive restor compA

L6320 Shoulder passive restor capA

L6350 Thoracic intern lock elbowA

L6360 Thoracic passive restor compA

L6370 Thoracic passive restor capA

L6380 Postop dsg cast chg wrst/elbA

L6382 Postop dsg cast chg elb dis/A

L6384 Postop dsg cast chg shlder/tA

L6386 Postop ea cast chg & realignA
L6388 Postop applicat rigid dsg on

A

L6400 Below elbow prosth tiss shapA

L6450 Elb disart prosth tiss shapA

L6500 Above elbow prosth tiss shapA

L6550 Shldr disar prosth tiss shapA

L6570 Scap thorac prosth tiss shapA

L6580 Wrist/elbow bowden cable molA

L6582 Wrist/elbow bowden cbl dir fA

L6584 Elbow fair lead cable moldedA

L6586 Elbow fair lead cable dir foA

L6588 Shdr fair lead cable moldedA

L6590 Shdr fair lead cable directA

L6600 Polycentric hinge pairA

L6605 Single pivot hinge pairA

L6610 Flexible metal hinge pairA

L6611 Additional switch, ext powerA

L6615 Disconnect locking wrist uniA

L6616 Disconnect insert locking wrA

L6620 Flexion/extension wrist unitA

L6621 Flex/ext wrist w/wo frictionA

L6623 Spring-ass rot wrst w/ latchA

L6624 Flex/ext/rotation wrist unitA

L6625 Rotation wrst w/ cable lockA

L6628 Quick disconn hook adapter oA

L6629 Lamination collar w/ couplinA

L6630 Stainless steel any wristA

L6632 Latex suspension sleeve eachA

L6635 Lift assist for elbowA

L6637 Nudge control elbow lockA

L6638 Elec lock on manual pw elbowA

L6640 Shoulder abduction joint paiA

L6641 Excursion amplifier pulley tA

L6642 Excursion amplifier lever tyA

L6645 Shoulder flexion-abduction jA

L6646 Multipo locking shoulder jntA

L6647 Shoulder lock actuatorA

L6648 Ext pwrd shlder lock/unlockA

L6650 Shoulder universal jointA

L6655 Standard control cable extraA

L6660 Heavy duty control cableA

L6665 Teflon or equal cable liningA

L6670 Hook to hand cable adapterA

L6672 Harness chest/shlder saddleA

L6675 Harness figure of 8 sing conA

L6676 Harness figure of 8 dual conA

L6677 UE triple control harnessA

L6680 Test sock wrist disart/bel eA

L6682 Test sock elbw disart/aboveA

L6684 Test socket shldr disart/thoA

L6686 Suction socketA

L6687 Frame typ socket bel elbow/wA

L6688 Frame typ sock above elb/disA

L6689 Frame typ socket shoulder diA

L6690 Frame typ sock interscap-thoA

L6691 Removable insert eachA
L6692 Silicone gel insert or equal

A

L6693 Lockingelbow forearm cntrbalA

L6694 Elbow socket ins use w/lock

A

L6695 Elbow socket ins use w/o lck

A

L6696 Cus elbo skt in for con/atyp

A

L6697 Cus elbo skt in not con/atyp

A

L6698 Below/above elbow lock mech

A

L6703 Term dev, passive hand mitt A

L6704 Term dev, sport/rec/work attA

L6706 Term dev mech hook vol open A 

L6707 Term dev mech hook vol closeA

L6708 Term dev mech hand vol openA

L6709 Term dev mech hand vol closeA

L6711 Ped term dev, hook, vol openA

L6712 Ped term dev, hook, vol closA

L6713 Ped term dev, hand, vol openA

L6714 Ped term dev, hand, vol closA

L6721 Hook/hand, hvy dty, vol openA

L6722 Hook/hand, hvy dty, vol closA

L6805 Term dev modifier wrist unitA

L6810 Term dev precision pinch devA

L6881 Term dev auto grasp featureA

L6882 Microprocessor control uplmbA

L6883 Replc sockt below e/w disaA

L6884 Replc sockt above elbow disaA

L6885 Replc sockt shldr dis/intercA

L6890 Prefab glove for term deviceA

L6895 Custom glove for term deviceA

L6900 Hand restorat thumb/1 fingerA

L6905 Hand restoration multiple fiA

L6910 Hand restoration no fingersA

L6915 Hand restoration replacmnt gA

L6920 Wrist disarticul switch ctrlA

L6925 Wrist disart myoelectronic cA

L6930 Below elbow switch controlA

L6935 Below elbow myoelectronic ctA

L6940 Elbow disarticulation switchA

L6945 Elbow disart myoelectronic cA

L6950 Above elbow switch controlA

L6955 Above elbow myoelectronic ctA

L6960 Shldr disartic switch controA

L6965 Shldr disartic myoelectronicA

L6970 Interscapular-thor switch ctA

L6975 Interscap-thor myoelectronicA

L7007 Adult electric handA

L7008 Pediatric electric handA

L7009 Adult electric hookA

L7040 Prehensile actuatorA

L7045 Pediatric electric hookA

L7170 Electronic elbow hosmer switA

L7180 Electronic elbow sequentialA

L7181 Electronic elbo simultaneousA

L7185 Electron elbow adolescent swA

L7186 Electron elbow child switchA

L7190 Elbow adolescent myoelectronA
L7191 Elbow child myoelectronic ct

A

L7260 Electron wrist rotator ottoA

L7261 Electron wrist rotator utahA

L7266 Servo control steeper or equA

L7272 Analogue control unb or equaA

L7274 Proportional ctl 12 volt utaA

L7360 Six volt bat otto bock/eq eaA

L7362 Battery chrgr six volt ottoA

L7364 Twelve volt battery utah/equA

L7366 Battery chrgr 12 volt utah/eA

L7367 Replacemnt lithium ionbatterA

L7368 Lithium ion battery chargerA

L7400 Add UE prost be/wd, ultliteA

L7401 Add UE prost a/e ultlite matA

L7402 Add UE prost s/d ultlite matA

L7403 Add UE prost b/e acrylicA

L7404 Add UE prost a/e acrylicA

L7405 Add UE prost s/d acrylicA

L7499 Upper extremity prosthes NOSA

L7500 Prosthetic dvc repair hourlyA

L7510 Prosthetic device repair repA

L7520 Repair prosthesis per 15 minA

L7600 Prosthetic donning sleeve E 

L7900 Male vacuum erection systemA

L8000 Mastectomy braA

L8001 Breast prosthesis bra & formA

L8002 Brst prsth bra & bilat formA

L8010 Mastectomy sleeveA

L8015 Ext breastprosthesis garmentA

L8020 Mastectomy formA

L8030 Breast prosthes w/o adhesiveA

L8031 Breast prosthesis w adhesiveA

L8032 Reusable nipple prosthesisA

L8035 Custom breast prosthesisA

L8039 Breast prosthesis NOSA

L8040 Nasal prosthesisA

L8041 Midfacial prosthesisA

L8042 Orbital prosthesisA

L8043 Upper facial prosthesisA

L8044 Hemi-facial prosthesisA

L8045 Auricular prosthesisA

L8046 Partial facial prosthesisA

L8047 Nasal septal prosthesisA

L8048 Unspec maxillofacial prosthA

L8049 Repair maxillofacial prosthA

L8300 Truss single w/ standard padA

L8310 Truss double w/ standard padA

L8320 Truss addition to std pad waA

L8330 Truss add to std pad scrotalA

L8400 Sheath below kneeA

L8410 Sheath above kneeA

L8415 Sheath upper limbA

L8417 Pros sheath/sock w gel cushnA

L8420 Prosthetic sock multi ply BKA

L8430 Prosthetic sock multi ply AKA
L8435 Pros sock multi ply upper lm

A

L8440 Shrinker below kneeA

L8460 Shrinker above kneeA

L8465 Shrinker upper limbA

L8470 Pros sock single ply BKA

L8480 Pros sock single ply AKA

L8485 Pros sock single ply upper lA

L8499 Unlisted misc prosthetic serA

L8500 Artificial larynxA

L8501 Tracheostomy speaking valveA

L8505 Artificial larynx, accessoryA

L8507 Trach-esoph voice pros pt inA

L8509 Trach-esoph voice pros md inA

L8510 Voice amplifierA

L8511 Indwelling trach insert

A

L8512 Gel cap for trach voice pros

A

L8513 Trach pros cleaning device

A

L8514 Repl trach puncture dilator

A

L8515 Gel cap app device for trachA

L8600 Implant breast silicone/eqN

L8603 Collagen imp urinary 2.5 mlN

L8604 Dextranomer/hyaluronic acidN

L8606 Synthetic implnt urinary 1mlN

L8609 Artificial corneaN

L8610 Ocular implantN

L8612 Aqueous shunt prosthesisN

L8613 Ossicular implantN

L8614 Cochlear deviceN

L8615 Coch implant headset replaceA

L8616 Coch implant microphone replA

L8617 Coch implant trans coil replA

L8618 Coch implant tran cable replA

L8619 Coch imp ext proc/contr rplcA

L8621 Repl zinc air batteryA

L8622 Repl alkaline batteryA

L8623 Lith ion batt CID,non-earlvl

A

L8624 Lith ion batt CID, ear level

A

L8627 CID ext speech process repl

A

L8628 CID ext controller repl

A

L8629 CID transmit coil and cable

A

L8630 Metacarpophalangeal implantN

L8631 MCP joint repl 2 pc or more

N

L8641 Metatarsal joint implantN

L8642 Hallux implantN

L8658 Interphalangeal joint spacerN

L8659 Interphalangeal joint repl

N

L8670 Vascular graft, syntheticN

L8680 Implt neurostim elctr eachN

L8681 Pt prgrm for implt neurostimA

L8682 Implt neurostim radiofq recN

L8683 Radiofq trsmtr for implt neuA

L8684 Radiof trsmtr implt scrl neuA

L8685 Implt nrostm pls gen sng rec N 

L8686 Implt nrostm pls gen sng non N 

L8687 Implt nrostm pls gen dua rec N 
L8688 Implt nrostm pls gen dua non N 

L8689 External recharg sys internA

L8690 Aud osseo dev, int/ext compN

L8691 Osseointegrated snd proc rplA

L8692 Non-osseointegrated snd procE

L8693 Aud osseo dev, abutmentA

L8695 External recharg sys externA

L8699 Prosthetic implant NOSN

L9900 O&P supply/accessory/serviceN

M0064 Visit for drug monitoring Q3 0607

M0075 Cellular therapyE

M0076 ProlotherapyE

M0100 Intragastric hypothermiaE

M0300 IV chelationtherapyE

M0301 Fabric wrapping of aneurysmE

P2028 Cephalin floculation testA

P2029 Congo red blood testA

P2031 Hair analysisE

P2033 Blood thymol turbidityA

P2038 Blood mucoproteinA

P3000 Screen pap by tech w md supvA

P3001 Screening pap smear by physB

P7001 Culture bacterial urineE

P9010 Whole blood for transfusion R 0950

P9011 Blood split unit R 0967

P9012 Cryoprecipitate each unit R 0952

P9016 RBC leukocytes reduced R 0954

P9017 Plasma 1 donor frz w/in 8 hr R 9508

P9019 Platelets, each unit R 0957

P9020 Plaelet rich plasma unit R 0958

P9021 Red blood cells unit R 0959

P9022 Washed red blood cells unit R 0960

P9023 Frozen plasma, pooled, sd R 0949

P9031 Platelets leukocytes reduced R 1013

P9032 Platelets, irradiated R 9500

P9033 Platelets leukoreduced irrad R 0968

P9034 Platelets, pheresis R 9507

P9035 Platelet pheres leukoreduced R 9501

P9036 Platelet pheresis irradiated R 9502

P9037 Plate pheres leukoredu irrad R 1019

P9038 RBC irradiated R 9505

P9039 RBC deglycerolized R 9504

P9040 RBC leukoreduced irradiated R 0969

P9041 Albumin (human),5%, 50mlK 0961

P9043 Plasma protein fract,5%,50ml R 0956

P9044 Cryoprecipitatereducedplasma R 1009

P9045 Albumin (human), 5%, 250 mlK 0963

P9046 Albumin (human), 25%, 20 mlK 0964

P9047 Albumin (human), 25%, 50mlK 0965

P9048 Plasmaprotein fract,5%,250ml R 0966

P9050 Granulocytes, pheresis unit R 9506

P9051 Blood, l/r, cmv-neg R 1010

P9052 Platelets, hla-m, l/r, unit R 1011

P9053 Plt, pher, l/r cmv-neg, irr R 1020

P9054 Blood, l/r, froz/degly/wash R 1016
P9055 Plt, aph/pher, l/r, cmv-neg R 1017

P9056 Blood, l/r, irradiated R 1018

P9057 RBC, frz/deg/wsh, l/r, irrad R 1021

P9058 RBC, l/r, cmv-neg, irrad R 1022

P9059 Plasma, frz between 8-24hour R 0955

P9060 Fr frz plasma donor retested R 9503

P9603 One-way allow prorated miles

A

P9604 One-way allow prorated tripA

P9612 Catheterize for urine spec A 

P9615 Urine specimen collect multN

Q0035 CardiokymographyX 0100

Q0081 Infusion ther other than che B 

Q0083 Chemo by other than infusion B 

Q0084 Chemotherapy by infusion B 

Q0085 Chemo by both infusion and oB

Q0091 Obtaining screen pap smearT 0191

Q0092 Set up port xray equipmentN

Q0111 Wet mounts/ w preparationsA

Q0112 Potassium hydroxide prepsA

Q0113 Pinworm examinationsA

Q0114 Fern testA

Q0115 Post-coital mucous examA

Q0138 Ferumoxytol, non-esrd CH K 1297

Q0139 Ferumoxytol, esrd useA

Q0144 Azithromycin dihydrate, oralE

Q0163 Diphenhydramine HCl 50mgN

Q0164 Prochlorperazine maleate 5mgN

Q0165 Prochlorperazine maleate10mgN

Q0166 Granisetron hcl 1 mg oral

N

Q0167 Dronabinol 2.5mg oralN

Q0168 Dronabinol 5mg oral

N

Q0169 Promethazine HCl 12.5mg oralN

Q0170 Promethazine HCl 25 mg oralN

Q0171 Chlorpromazine HCl 10mg oralN

Q0172 Chlorpromazine HCl 25mg oralN

Q0173 Trimethobenzamide HCl 250mgN

Q0174 Thiethylperazine maleate10mg

E

Q0175 Perphenazine 4mg oralN

Q0176 Perphenazine 8mg oralN

Q0177 Hydroxyzine pamoate 25mgN

Q0178 Hydroxyzine pamoate 50mgN

Q0179 Ondansetron hcl 8 mg oralN

Q0180 Dolasetron mesylate oralN

Q0181 Unspecified oral anti-emeticE

Q0478 Power adapter, combo vad

A

Q0479 Power module combo vad, rep

A

Q0480 Driver pneumatic vad, rep

A

Q0481 Microprcsr cu elec vad, rep

A

Q0482 Microprcsr cu combo vad, rep

A

Q0483 Monitor elec vad, rep

A

Q0484 Monitor elec or comb vad rep

A

Q0485 Monitor cable elec vad, rep

A

Q0486 Mon cable elec/pneum vad rep

A

Q0487 Leads any type vad, rep only

A

Q0488 Pwr pack base elec vad, rep

A
Q0489 Pwr pck base combo vad, rep

A

Q0490 Emr pwr source elec vad, rep

A

Q0491 Emr pwr source combo vad rep

A

Q0492 Emr pwr cbl elec vad, rep

A

Q0493 Emr pwr cbl combo vad, rep

A

Q0494 Emr hd pmp elec/combo, rep

A

Q0495 Charger elec/combo vad, rep

A

Q0496 Battery elec/combo vad, rep

A

Q0497 Bat clps elec/comb vad, rep

A

Q0498 Holster elec/combo vad, rep

A

Q0499 Belt/vest elec/combo vad rep

A

Q0500 Filters elec/combo vad, rep

A

Q0501 Shwr cov elec/combo vad, rep

A

Q0502 Mobility cart pneum vad, rep

A

Q0503 Battery pneum vad replacemnt

A

Q0504 Pwr adpt pneum vad, rep veh

A

Q0505 Miscl supply/accessory vad

A

Q0506 Lith-ion batt elec/pneum VAD

A

Q0510 Dispens fee immunosupressive

B

Q0511 Sup fee antiem,antica,immuno

B

Q0512 Px sup fee anti-can sub pres

B

Q0513 Disp fee inhal drugs/30 days

B

Q0514 Disp fee inhal drugs/90 days

B

Q0515 Sermorelin acetate injection K 3050

Q1004 Ntiol category 4 E 

Q1005 Ntiol category 5 E 

Q2004 Bladder calculi irrig solN

Q2009 Fosphenytoin inj PEN

Q2017 Teniposide, 50 mgK 7035

Q2026 Radiesse injectionB

Q2027 Sculptra injectionB

Q2035 Afluria vacc, 3 yrs & >, imL

Q2036 Flulaval vacc, 3 yrs & >, imL

Q2037 Fluvirin vacc, 3 yrs & >, imL

Q2038 Fluzone vacc, 3 yrs & >, imL

Q2039 NOS flu vacc, 3 yrs & >, imL

Q2040 Incobotulinumtoxin A

G 9278

Q3001 Brachytherapy RadioelementsB

Q3014 Telehealth facility feeA

Q3025 IM inj interferon beta 1-aK 9022

Q3026 Subc inj interferon beta-1aE

Q3031 Collagen skin test

N

Q4001 Cast sup body cast plasterB

Q4002 Cast sup body cast fiberglasB

Q4003 Cast sup shoulder cast plstrB

Q4004 Cast sup shoulder cast fbrglB

Q4005 Cast sup long arm adult plstB

Q4006 Cast sup long arm adult fbrgB

Q4007 Cast sup long arm ped plsterB

Q4008 Cast sup long arm ped fbrglsB

Q4009 Cast sup sht arm adult plstrB

Q4010 Cast sup sht arm adult fbrglB

Q4011 Cast sup sht arm ped plasterB

Q4012 Cast sup sht arm ped fbrglasB

Q4013 Cast sup gauntlet plasterB
Q4014 Cast sup gauntlet fiberglass

B

Q4015 Cast sup gauntlet ped plsterB

Q4016 Cast sup gauntlet ped fbrglsB

Q4017 Cast sup lng arm splint plstB

Q4018 Cast sup lng arm splint fbrgB

Q4019 Cast sup lng arm splnt ped pB

Q4020 Cast sup lng arm splnt ped fB

Q4021 Cast sup sht arm splint plstB

Q4022 Cast sup sht arm splint fbrgB

Q4023 Cast sup sht arm splnt ped pB

Q4024 Cast sup sht arm splnt ped fB

Q4025 Cast sup hip spica plasterB

Q4026 Cast sup hip spica fiberglasB

Q4027 Cast sup hip spica ped plstrB

Q4028 Cast sup hip spica ped fbrglB

Q4029 Cast sup long leg plasterB

Q4030 Cast sup long leg fiberglassB

Q4031 Cast sup lng leg ped plasterB

Q4032 Cast sup lng leg ped fbrglsB

Q4033 Cast sup lng leg cylinder plB

Q4034 Cast sup lng leg cylinder fbB

Q4035 Cast sup lngleg cylndr ped pB

Q4036 Cast sup lngleg cylndr ped fB

Q4037 Cast sup shrt leg plasterB

Q4038 Cast sup shrt leg fiberglassB

Q4039 Cast sup shrt leg ped plsterB

Q4040 Cast sup shrt leg ped fbrglsB

Q4041 Cast sup lng leg splnt plstrB

Q4042 Cast sup lng leg splnt fbrglB

Q4043 Cast sup lng leg splnt ped pB

Q4044 Cast sup lng leg splnt ped fB

Q4045 Cast sup sht leg splnt plstrB

Q4046 Cast sup sht leg splnt fbrglB

Q4047 Cast sup sht leg splnt ped pB

Q4048 Cast sup sht leg splnt ped fB

Q4049 Finger splint, staticB

Q4050 Cast supplies unlistedB

Q4051 Splint supplies miscB

Q4074 Iloprost non-comp unit doseY

Q4081 Epoetin alfa, 100 units ESRD A 

Q4082 Drug/bio NOC part B drug CAP B 

Q4100 Skin substitute, NOSN

Q4101 ApligrafK 1240

Q4102 Oasis wound matrixK 1241

Q4103 Oasis burn matrix CHN

Q4104 Integra BMWDK 1243

Q4105 Integra DRTK 1244

Q4106 DermagraftK 1245

Q4107 GraftjacketK 1246

Q4108 Integra matrixK 1247

Q4110 PrimatrixK 1248

Q4111 GammagraftK 1252

Q4112 Cymetra injectableK 1249

Q4113 Graftjacket xpressK 1250

Q4114 Integra flowable wound matriK 1251
Q4115 Alloskin

K 1287

Q4116 AllodermK 1270

Q4117 HyalomatrixE

Q4118 Matristem micromatrixK 1342

Q4119 Matristem wound matrixK 1351

Q4120 Matristem burn matrixE

Q4121 TheraskinK 1345

Q5001 Hospice in patient home B 

Q5002 Hospice in assisted living B 

Q5003 Hospice in LT/non-skilled NF B 

Q5004 Hospice in SNF B 

Q5005 Hospice, inpatient hospital B 

Q5006 Hospice in hospice facility B 

Q5007 Hospice in LTCH B 

Q5008 Hospice in inpatient psych B 

Q5009 Hospice care, NOS B 

Q5010 Hospice home care in hospice B 

Q9951 LOCM >= 400 mg/ml iodine,1ml N 

Q9953 Inj Fe-based MR contrast,1ml N 

Q9954 Oral MR contrast, 100 ml N 

Q9955 Inj perflexane lip micros,ml N 

Q9956 Inj octafluoropropane mic,ml N 

Q9957 Inj perflutren lip micros,ml N 

Q9958 HOCM <=149 mg/ml iodine, 1mlN

Q9959 HOCM 150-199mg/ml iodine,1ml N 

Q9960 HOCM 200-249mg/ml iodine,1ml N 

Q9961 HOCM 250-299mg/ml iodine,1ml N 

Q9962 HOCM 300-349mg/ml iodine,1ml N 

Q9963 HOCM 350-399mg/ml iodine,1ml N 

Q9964 HOCM>= 400mg/ml iodine, 1ml N 

Q9965 LOCM 100-199mg/ml iodine,1mlN

Q9966 LOCM 200-299mg/ml iodine,1mlN

Q9967 LOCM 300-399mg/ml iodine,1mlN

Q9968 Visualization adjunct CHN

R0070 Transport portable x-ray B 

R0075 Transport port x-ray multipl B 

R0076 Transport portable EKG B 

V2020 Vision svcs frames purchasesA

V2025 Eyeglasses delux framesE

V2100 Lens spher single plano 4.00A

V2101 Single visn sphere 4.12-7.00A

V2102 Singl visn sphere 7.12-20.00A

V2103 Spherocylindr 4.00d/12-2.00dA

V2104 Spherocylindr 4.00d/2.12-4dA

V2105 Spherocylinder 4.00d/4.25-6dA

V2106 Spherocylinder 4.00d/>6.00dA

V2107 Spherocylinder 4.25d/12-2dA

V2108 Spherocylinder 4.25d/2.12-4dA

V2109 Spherocylinder 4.25d/4.25-6dA

V2110 Spherocylinder 4.25d/over 6dA

V2111 Spherocylindr 7.25d/.25-2.25A

V2112 Spherocylindr 7.25d/2.25-4dA

V2113 Spherocylindr 7.25d/4.25-6dA

V2114 Spherocylinder over 12.00dA

V2115 Lens lenticular bifocalA
V2118 Lens aniseikonic single

A

V2121 Lenticular lens, single

A

V2199 Lens single vision not oth cA

V2200 Lens spher bifoc plano 4.00dA

V2201 Lens sphere bifocal 4.12-7.0A

V2202 Lens sphere bifocal 7.12-20.A

V2203 Lens sphcyl bifocal 4.00d/.1A

V2204 Lens sphcy bifocal 4.00d/2.1A

V2205 Lens sphcy bifocal 4.00d/4.2A

V2206 Lens sphcy bifocal 4.00d/oveA

V2207 Lens sphcy bifocal 4.25-7d/.A

V2208 Lens sphcy bifocal 4.25-7/2.A

V2209 Lens sphcy bifocal 4.25-7/4.A

V2210 Lens sphcy bifocal 4.25-7/ov A 

V2211 Lens sphcy bifo 7.25-12/.25-A

V2212 Lens sphcyl bifo 7.25-12/2.2A

V2213 Lens sphcyl bifo 7.25-12/4.2A

V2214 Lens sphcyl bifocal over 12.A

V2215 Lens lenticular bifocalA

V2218 Lens aniseikonic bifocalA

V2219 Lens bifocal seg width overA

V2220 Lens bifocal add over 3.25dA

V2221 Lenticular lens, bifocal

A

V2299 Lens bifocal specialityA

V2300 Lens sphere trifocal 4.00dA

V2301 Lens sphere trifocal 4.12-7.A

V2302 Lens sphere trifocal 7.12-20A

V2303 Lens sphcy trifocal 4.0/.12-A

V2304 Lens sphcy trifocal 4.0/2.25A

V2305 Lens sphcy trifocal 4.0/4.25A

V2306 Lens sphcyl trifocal 4.00/>6A

V2307 Lens sphcy trifocal 4.25-7/.A

V2308 Lens sphc trifocal 4.25-7/2.A

V2309 Lens sphc trifocal 4.25-7/4.A

V2310 Lens sphc trifocal 4.25-7/>6A

V2311 Lens sphc trifo 7.25-12/.25-A

V2312 Lens sphc trifo 7.25-12/2.25A

V2313 Lens sphc trifo 7.25-12/4.25A

V2314 Lens sphcyl trifocal over 12A

V2315 Lens lenticular trifocalA

V2318 Lens aniseikonic trifocalA

V2319 Lens trifocal seg width > 28A

V2320 Lens trifocal add over 3.25dA

V2321 Lenticular lens, trifocal

A

V2399 Lens trifocal specialityA

V2410 Lens variab asphericity singA

V2430 Lens variable asphericity biA

V2499 Variable asphericity lensA

V2500 Contact lens pmma sphericalA

V2501 Cntct lens pmma-toric/prismA

V2502 Contact lens pmma bifocalA

V2503 Cntct lens pmma color visionA

V2510 Cntct gas permeable sphericlA

V2511 Cntct toric prism ballastA

V2512 Cntct lens gas permbl bifoclA
V2513 Contact lens extended wear

A

V2520 Contact lens hydrophilicA

V2521 Cntct lens hydrophilic toricA

V2522 Cntct lens hydrophil bifoclA

V2523 Cntct lens hydrophil extendA

V2530 Contact lens gas impermeableA

V2531 Contact lens gas permeableA

V2599 Contact lens/es other typeA

V2600 Hand held low vision aidsA

V2610 Single lens spectacle mountA

V2615 Telescop/othr compound lensA

V2623 Plastic eye prosth customA

V2624 Polishing artifical eyeA

V2625 Enlargemnt of eye prosthesisA

V2626 Reduction of eye prosthesisA

V2627 Scleral cover shellA

V2628 Fabrication & fittingA

V2629 Prosthetic eye other typeA

V2630 Anter chamber intraocul lensN

V2631 Iris support intraoclr lensN

V2632 Post chmbr intraocular lensN

V2700 Balance lensA

V2702 Deluxe lens featureE

V2710 Glass/plastic slab off prismA

V2715 Prism lens/esA

V2718 Fresnell prism press-on lensA

V2730 Special base curveA

V2744 Tint photochromatic lens/esA

V2745 Tint, any color/solid/grad

A

V2750 Anti-reflective coatingA

V2755 UV lens/esA

V2756 Eye glass case

E

V2760 Scratch resistant coatingA

V2761 Mirror coating

B

V2762 Polarization, any lens

A

V2770 Occluder lens/esA

V2780 Oversize lens/esA

V2781 Progressive lens per lensB

V2782 Lens, 1.54-1.65 p/1.60-1.79g

A

V2783 Lens, >= 1.66 p/>=1.80 g

A

V2784 Lens polycarb or equal

A

V2785 Corneal tissue processingF

V2786 Occupational multifocal lens

A

V2787 Astigmatism-correct function

E

V2788 Presbyopia-correct function

E

V2790 Amniotic membraneN

V2797 Vis item/svc in other code

A

V2799 Miscellaneous vision serviceA

V5008 Hearing screeningE

V5010 Assessment for hearing aidE

V5011 Hearing aid fitting/checkingE

V5014 Hearing aid repair/modifyingE

V5020 Conformity evaluationE

V5030 Body-worn hearing aid airE

V5040 Body-worn hearing aid boneE
V5050 Hearing aid monaural in ear

E

V5060 Behind ear hearing aidE

V5070 Glasses air conductionE

V5080 Glasses bone conductionE

V5090 Hearing aid dispensing feeE

V5095 Implant mid ear hearing prosE

V5100 Body-worn bilat hearing aidE

V5110 Hearing aid dispensing feeE

V5120 Body-worn binaur hearing aidE

V5130 In ear binaural hearing aidE

V5140 Behind ear binaur hearing aiE

V5150 Glasses binaural hearing aidE

V5160 Dispensing fee binauralE

V5170 Within ear cros hearing aidE

V5180 Behind ear cros hearing aidE

V5190 Glasses cros hearing aidE

V5200 Cros hearing aid dispens feeE

V5210 In ear bicros hearing aidE

V5220 Behind ear bicros hearing aiE

V5230 Glasses bicros hearing aidE

V5240 Dispensing fee bicrosE

V5241 Dispensing fee, monauralE

V5242 Hearing aid, monaural, cicE

V5243 Hearing aid, monaural, itcE

V5244 Hearing aid, prog, mon, cicE

V5245 Hearing aid, prog, mon, itcE

V5246 Hearing aid, prog, mon, iteE

V5247 Hearing aid, prog, mon, bteE

V5248 Hearing aid, binaural, cicE

V5249 Hearing aid, binaural, itcE

V5250 Hearing aid, prog, bin, cicE

V5251 Hearing aid, prog, bin, itcE

V5252 Hearing aid, prog, bin, iteE

V5253 Hearing aid, prog, bin, bteE

V5254 Hearing id, digit, mon, cicE

V5255 Hearing aid, digit, mon, itcE

V5256 Hearing aid, digit, mon, iteE

V5257 Hearing aid, digit, mon, bteE

V5258 Hearing aid, digit, bin, cicE

V5259 Hearing aid, digit, bin, itcE

V5260 Hearing aid, digit, bin, iteE

V5261 Hearing aid, digit, bin, bteE

V5262 Hearing aid, disp, monauralE

V5263 Hearing aid, disp, binauralE

V5264 Ear mold/insertE

V5265 Ear mold/insert, dispE

V5266 Battery for hearing deviceE

V5267 Hearing aid supply/accessoryE

V5268 ALD Telephone AmplifierE

V5269 Alerting device, any typeE

V5270 ALD, TV amplifier, any typeE

V5271 ALD, TV caption decoderE

V5272 TddE

V5273 ALD for cochlear implantE

V5274 ALD unspecifiedE
V5275 Ear impression

E

V5298 Hearing aid nocE

V5299 Hearing serviceB

V5336 Repair communication deviceE

V5362 Speech screeningE

V5363 Language screeningE

V5364 Dysphagia screeningE
Relative Weight Payment Rate 

National 

Unadjusted 

Copayment 

Minimum 

Unadjusted 

Copayment 




1.7462 $121.22

. $24.25

4.5956 $319.03. $63.81

0.9786 $67.93. $13.59

1.4481 $100.53. $20.11

1.4481 $100.53. $20.11

1.4481 $100.53. $20.11

13.4779 $935.64. $187.13

2.8248 $196.10. $39.22

17.1909 $1,193.39. $238.68

13.4779 $935.64. $187.13

1.4481 $100.53. $20.11

20.5401 $1,425.89. $285.18

2.8248 $196.10. $39.22

0.9786 $67.93. $13.59

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

8.6164 $598.15. $119.63

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

8.6164 $598.15. $119.63

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

1.4936 $103.69. $20.74

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

1.4936 $103.69. $20.74

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

8.6164 $598.15. $119.63
17.1909 $1,193.39

. $238.68

17.1909 $1,193.39. $238.68

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

8.6164 $598.15. $119.63

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

8.6164 $598.15. $119.63

4.8763 $338.51. $67.71

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

0.4047 $28.09. $5.62

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.4047 $28.09. $5.62

4.8763 $338.51. $67.71

23.4169 $1,625.60 $350.05 $325.12

4.8763 $338.51. $67.71

1.2139 $84.27 $23.56 $16.86

17.2745 $1,199.20. $239.84

0.9786 $67.93. $13.59

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59
3.2846 $228.02

. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

1.2139 $84.27 $23.56 $16.86

21.8041 $1,513.64. $302.73

47.1841 $3,275.52. $655.11

23.4169 $1,625.60 $350.05 $325.12

4.8763 $338.51. $67.71

0.6739 $46.78. $9.36

0.6739 $46.78. $9.36

0.6739 $46.78. $9.36

0.6739 $46.78. $9.36

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

1.2139 $84.27 $23.56 $16.86

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

1.2139 $84.27 $23.56 $16.86

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61
3.2846 $228.02

. $45.61

1.2139 $84.27 $23.56 $16.86

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

21.8041 $1,513.64. $302.73

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

5.1973 $360.80. $72.16

17.2745 $1,199.20. $239.84

3.2846 $228.02. $45.61
17.2745 $1,199.20

. $239.84

17.2745 $1,199.20. $239.84

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

5.1973 $360.80. $72.16

3.2846 $228.02. $45.61

5.1973 $360.80. $72.16

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

17.2745 $1,199.20. $239.84

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

1.2139 $84.27 $23.56 $16.86

1.2139 $84.27 $23.56 $16.86

23.4169 $1,625.60 $350.05 $325.12

4.8763 $338.51. $67.71

4.8763 $338.51. $67.71

2.8248 $196.10. $39.22

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

0.9786 $67.93. $13.59
3.2846 $228.02

. $45.61

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

23.4169 $1,625.60 $350.05 $325.12

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

0.6739 $46.78. $9.36

0.6739 $46.78. $9.36

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

4.8763 $338.51. $67.71

21.8041 $1,513.64. $302.73

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

17.2745 $1,199.20. $239.84

21.8041 $1,513.64. $302.73

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

17.2745 $1,199.20. $239.84

4.8763 $338.51. $67.71

0.9786 $67.93. $13.59

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74
1.4936 $103.69

. $20.74

1.4936 $103.69. $20.74

0.9786 $67.93. $13.59

0.4047 $28.09. $5.62

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

0.9786 $67.93. $13.59

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

2.8248 $196.10. $39.22

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

1.4936 $103.69. $20.74

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

1.4936 $103.69. $20.74

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

2.8248 $196.10. $39.22

5.3689 $372.71 $91.69 $74.55

5.3689 $372.71 $91.69 $74.55

5.3689 $372.71 $91.69 $74.55

5.3689 $372.71 $91.69 $74.55

5.3689 $372.71 $91.69 $74.55

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.9786 $67.93. $13.59

0.4047 $28.09. $5.62

4.5956 $319.03. $63.81

1.7462 $121.22. $24.25

20.5401 $1,425.89. $285.18

4.5956 $319.03. $63.81

25.8383 $1,793.69. $358.74

8.1415 $565.18. $113.04

15.3594 $1,066.25 $225.55 $213.25

33.8417 $2,349.29 $581.52 $469.86

25.8383 $1,793.69. $358.74

25.8383 $1,793.69. $358.74

25.8383 $1,793.69. $358.74

25.8383 $1,793.69. $358.74

25.8383 $1,793.69. $358.74

17.1909 $1,193.39. $238.68
0.6739 $46.78

. $9.36

61.6690 $4,281.06. $856.22

61.6690 $4,281.06. $856.22

61.6690 $4,281.06. $856.22

25.8383 $1,793.69. $358.74

25.8383 $1,793.69. $358.74

45.0972 $3,130.65 $747.07 $626.13

33.8417 $2,349.29 $581.52 $469.86

33.8417 $2,349.29 $581.52 $469.86

45.0972 $3,130.65 $747.07 $626.13

33.8417 $2,349.29 $581.52 $469.86

45.0972 $3,130.65 $747.07 $626.13

45.0972 $3,130.65 $747.07 $626.13

61.6690 $4,281.06. $856.22

33.8417 $2,349.29 $581.52 $469.86

33.8417 $2,349.29 $581.52 $469.86

45.0972 $3,130.65 $747.07 $626.13

61.6690 $4,281.06. $856.22

25.8383 $1,793.69. $358.74

33.8417 $2,349.29 $581.52 $469.86

61.6690 $4,281.06. $856.22

33.8417 $2,349.29 $581.52 $469.86

33.8417 $2,349.29 $581.52 $469.86

33.8417 $2,349.29 $581.52 $469.86

45.0972 $3,130.65 $747.07 $626.13

33.8417 $2,349.29 $581.52 $469.86

25.8383 $1,793.69. $358.74

8.6164 $598.15. $119.63

8.0353 $557.81. $111.57

21.8041 $1,513.64. $302.73

21.8041 $1,513.64. $302.73

13.4779 $935.64. $187.13

47.1841 $3,275.52. $655.11

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

8.1415 $565.18. $113.04

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

8.0353 $557.81. $111.57

4.8763 $338.51. $67.71
23.4169 $1,625.60 $350.05 $325.12

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

32.4101 $2,249.91 . $449.99

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

4.5956 $319.03 . $63.81

32.4101 $2,249.91 . $449.99

4.9874 $346.23 . $69.25

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

0.6739 $46.78 . $9.36

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

18.6922 $1,297.61 . $259.53

29.0181 $2,014.44 . $402.89

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

21.8041 $1,513.64 . $302.73

21.8041 $1,513.64 . $302.73

17.2745 $1,199.20 . $239.84

17.2745 $1,199.20 . $239.84

32.4101 $2,249.91 . $449.99

5.1973 $360.80 . $72.16

1.4481 $100.53 . $20.11
57.2099 $3,971.51

. $794.31

57.2099 $3,971.51. $794.31

0.6739 $46.78. $9.36

47.1841 $3,275.52. $655.11

22.1674 $1,538.86. $307.78

25.1379 $1,745.07. $349.02

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57
25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57
45.1286 $3,132.83 . $626.57

16.9180 $1,174.45 $277.61 $234.89

8.0353 $557.81 . $111.57

25.1379 $1,745.07 . $349.02

1.0875 $75.49 $24.28 $15.10

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

26.2376 $1,821.41 $371.33 $364.29

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

8.0353 $557.81 . $111.57

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

3.3531 $232.77 . $46.56

8.0353 $557.81 . $111.57

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57
45.1286 $3,132.83 . $626.57

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83 . $626.57

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

1.0875 $75.49 $24.28 $15.10

20.5401 $1,425.89 . $285.18

22.1674 $1,538.86 . $307.78

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

8.0353 $557.81 . $111.57

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

1.4481 $100.53 . $20.11

47.1841 $3,275.52 . $655.11

47.1841 $3,275.52 . $655.11

1.6063 $111.51 . $22.31

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51 . $22.31

1.0875 $75.49 $24.28 $15.10

8.6164 $598.15 . $119.63

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

51.1173 $3,548.56 . $709.72

51.1173 $3,548.56 . $709.72

51.1173 $3,548.56 . $709.72

51.1173 $3,548.56 . $709.72
51.1173 $3,548.56 . $709.72

1.6063 $111.51 . $22.31

4.9874 $346.23 . $69.25

18.6922 $1,297.61 . $259.53

15.5166 $1,077.16 $268.44 $215.44

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

87.5671 $6,078.91 . $1,215.79

87.5671 $6,078.91 . $1,215.79

87.5671 $6,078.91 . $1,215.79

51.1173 $3,548.56 . $709.72

51.1173 $3,548.56 . $709.72
32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86 . $307.78

17.1909 $1,193.39 . $238.68

32.4101 $2,249.91 . $449.99

20.5401 $1,425.89 . $285.18

20.5401 $1,425.89 . $285.18

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

8.6164 $598.15 . $119.63

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

17.1909 $1,193.39 . $238.68

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

47.1841 $3,275.52 . $655.11
22.1674 $1,538.86

. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

8.6164 $598.15. $119.63

23.4169 $1,625.60 $350.05 $325.12

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

130.4476 $9,055.67. $1,811.14

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

67.0623 $4,655.46. $931.10

4.9874 $346.23. $69.25

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

49.4864 $3,435.35. $687.07
1.6063 $111.51

. $22.31

4.9874 $346.23. $69.25

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

49.4864 $3,435.35. $687.07

4.9874 $346.23. $69.25

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

15.5166 $1,077.16 $268.44 $215.44

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

17.2745 $1,199.20. $239.84

1.6063 $111.51. $22.31

20.5401 $1,425.89. $285.18

20.5401 $1,425.89. $285.18

22.1674 $1,538.86. $307.78

32.4101 $2,249.91

. $449.99

32.4101 $2,249.91

. $449.99

17.1909 $1,193.39

. $238.68

17.1909 $1,193.39

. $238.68

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39

. $238.68

17.1909 $1,193.39

. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99
47.1841 $3,275.52

. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

4.8763 $338.51. $67.71

17.1909 $1,193.39. $238.68

15.5166 $1,077.16 $268.44 $215.44

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

41.2971 $2,866.84. $573.37

130.4476 $9,055.67. $1,811.14

60.0335 $4,167.53. $833.51

130.4476 $9,055.67. $1,811.14

41.2971 $2,866.84. $573.37

130.4476 $9,055.67. $1,811.14

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31
67.0623 $4,655.46

. $931.10

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

67.0623 $4,655.46. $931.10

18.6922 $1,297.61. $259.53

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

22.1674 $1,538.86. $307.78

87.5671 $6,078.91. $1,215.79

1.6063 $111.51. $22.31

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

8.6164 $598.15. $119.63

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78
22.1674 $1,538.86

. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

18.6922 $1,297.61. $259.53

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

41.2971 $2,866.84. $573.37

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79
87.5671 $6,078.91

. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

130.4476 $9,055.67. $1,811.14

130.4476 $9,055.67. $1,811.14

60.0335 $4,167.53. $833.51

60.0335 $4,167.53. $833.51

60.0335 $4,167.53. $833.51

130.4476 $9,055.67. $1,811.14

41.2971 $2,866.84. $573.37

41.2971 $2,866.84. $573.37

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29
18.6922 $1,297.61

. $259.53

26.2376 $1,821.41 $371.33 $364.29

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

17.2745 $1,199.20. $239.84

22.1674 $1,538.86. $307.78

1.6063 $111.51. $22.31

1.4481 $100.53. $20.11

13.4779 $935.64. $187.13

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72
17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.1909 $1,193.39. $238.68

4.9874 $346.23. $69.25

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89
29.0181 $2,014.44

. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

41.2971 $2,866.84. $573.37

60.0335 $4,167.53. $833.51

41.2971 $2,866.84. $573.37

60.0335 $4,167.53. $833.51

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31
1.6063 $111.51

. $22.31

18.6922 $1,297.61. $259.53

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

17.4096 $1,208.57 $253.49 $241.72

17.4096 $1,208.57 $253.49 $241.72

1.6063 $111.51. $22.31

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

8.6164 $598.15. $119.63

8.6164 $598.15. $119.63

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

22.1674 $1,538.86. $307.78
22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

8.6164 $598.15 . $119.63

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

47.1841 $3,275.52 . $655.11

47.1841 $3,275.52 . $655.11

47.1841 $3,275.52 . $655.11

47.1841 $3,275.52 . $655.11

87.5671 $6,078.91 . $1,215.79

1.6063 $111.51 . $22.31
15.5166 $1,077.16 $268.44 $215.44

1.6063 $111.51 . $22.31

49.4864 $3,435.35 . $687.07

1.6063 $111.51 . $22.31

1.6063 $111.51 . $22.31

32.4101 $2,249.91 . $449.99

4.9874 $346.23 . $69.25

4.9874 $346.23 . $69.25

1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44

1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44

1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44

1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44

1.6063 $111.51 . $22.31

20.5401 $1,425.89 . $285.18

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

8.6164 $598.15 . $119.63

23.4169 $1,625.60 $350.05 $325.12

19.0626 $1,323.33 . $264.67

19.0626 $1,323.33 . $264.67

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68
17.1909 $1,193.39

. $238.68

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

41.2971 $2,866.84. $573.37

60.0335 $4,167.53. $833.51

41.2971 $2,866.84. $573.37
41.2971 $2,866.84 . $573.37

41.2971 $2,866.84 . $573.37

41.2971 $2,866.84 . $573.37

130.4476 $9,055.67 . $1,811.14

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

4.9874 $346.23 . $69.25

1.6063 $111.51 . $22.31

18.6922 $1,297.61 . $259.53

1.6063 $111.51 . $22.31

1.6063 $111.51 . $22.31

26.2376 $1,821.41 $371.33 $364.29

4.9874 $346.23 . $69.25

1.6063 $111.51 . $22.31

1.6063 $111.51 . $22.31

1.6063 $111.51 . $22.31

49.4864 $3,435.35 . $687.07

1.6063 $111.51 . $22.31

18.6922 $1,297.61 . $259.53

1.6063 $111.51 . $22.31

1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44
1.6063 $111.51 . $22.31

15.5166 $1,077.16 $268.44 $215.44

49.4864 $3,435.35 . $687.07

15.5166 $1,077.16 $268.44 $215.44

22.1674 $1,538.86 . $307.78

1.6063 $111.51 . $22.31

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

20.5401 $1,425.89 . $285.18

32.4101 $2,249.91 . $449.99

22.1739 $1,539.31 $351.47 $307.87

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

8.6164 $598.15 . $119.63

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39 . $238.68

17.1909 $1,193.39 . $238.68

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

22.1674 $1,538.86 . $307.78

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

47.1841 $3,275.52 . $655.11

87.5671 $6,078.91 . $1,215.79

47.1841 $3,275.52 . $655.11

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

22.1674 $1,538.86 . $307.78

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99
32.4101 $2,249.91

. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

41.2971 $2,866.84. $573.37

22.1674 $1,538.86. $307.78

47.1841 $3,275.52. $655.11

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

49.4864 $3,435.35. $687.07

67.0623 $4,655.46. $931.10

49.4864 $3,435.35. $687.07

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

47.1841 $3,275.52. $655.11

87.5671 $6,078.91. $1,215.79

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

67.0623 $4,655.46. $931.10

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

4.9874 $346.23. $69.25

49.4864 $3,435.35. $687.07

67.0623 $4,655.46. $931.10
1.6063 $111.51

. $22.31

18.6922 $1,297.61. $259.53

49.4864 $3,435.35. $687.07

67.0623 $4,655.46. $931.10

67.0623 $4,655.46. $931.10

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

49.4864 $3,435.35. $687.07

49.4864 $3,435.35. $687.07

15.5166 $1,077.16 $268.44 $215.44

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

22.1674 $1,538.86. $307.78

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

1.6063 $111.51. $22.31

13.4779 $935.64. $187.13

22.1674 $1,538.86. $307.78

22.1674 $1,538.86. $307.78

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

19.0626 $1,323.33. $264.67

23.4169 $1,625.60 $350.05 $325.12

23.4169 $1,625.60 $350.05 $325.12

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

19.0626 $1,323.33. $264.67

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87
22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

8.6164 $598.15. $119.63

17.1909 $1,193.39. $238.68

8.6164 $598.15. $119.63

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87
22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

32.5456 $2,259.32 $469.58 $451.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

26.2376 $1,821.41 $371.33 $364.29

67.0623 $4,655.46. $931.10

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

57.2099 $3,971.51. $794.31

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31
26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

18.6922 $1,297.61. $259.53

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

1.6063 $111.51. $22.31

26.2376 $1,821.41 $371.33 $364.29

49.4864 $3,435.35. $687.07

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

1.6063 $111.51. $22.31

15.5166 $1,077.16 $268.44 $215.44

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

57.2099 $3,971.51. $794.31

87.5671 $6,078.91. $1,215.79

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

57.2099 $3,971.51. $794.31

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

22.1739 $1,539.31 $351.47 $307.87

32.4101 $2,249.91. $449.99

1.6063 $111.51. $22.31

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80
1.1378 $78.99

. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

2.7059 $187.84. $37.57

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

1.1378 $78.99. $15.80

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52
29.4235 $2,042.58

. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

87.5671 $6,078.91. $1,215.79

87.5671 $6,078.91. $1,215.79

48.4545 $3,363.71 $804.74 $672.75

87.5671 $6,078.91. $1,215.79

22.1739 $1,539.31 $351.47 $307.87

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

29.4235 $2,042.58. $408.52

48.4545 $3,363.71 $804.74 $672.75
48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

48.4545 $3,363.71 $804.74 $672.75

29.4235 $2,042.58. $408.52

3.3531 $232.77. $46.56

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

8.0353 $557.81. $111.57

45.1286 $3,132.83. $626.57

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

0.6739 $46.78. $9.36

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

3.3531 $232.77. $46.56

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

1.0875 $75.49 $24.28 $15.10

1.0875 $75.49 $24.28 $15.10

1.0875 $75.49 $24.28 $15.10

1.0875 $75.49 $24.28 $15.10

26.9181 $1,868.65. $373.73

26.9181 $1,868.65. $373.73

16.9180 $1,174.45 $277.61 $234.89

1.0875 $75.49 $24.28 $15.10

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57
45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

1.9475 $135.20 . $27.04

1.9475 $135.20 . $27.04

21.3691 $1,483.44 . $296.69

21.3691 $1,483.44 . $296.69

21.3691 $1,483.44 . $296.69

30.2222 $2,098.03 $438.93 $419.61

21.3691 $1,483.44 . $296.69

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

1.0875 $75.49 $24.28 $15.10

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57
2.2773 $158.09 $44.32 $31.62

1.4008 $97.24. $19.45

1.0521 $73.04. $14.61

21.3691 $1,483.44. $296.69

1.9475 $135.20. $27.04

21.3691 $1,483.44. $296.69

1.9475 $135.20. $27.04

21.3691 $1,483.44. $296.69

1.9475 $135.20. $27.04

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

30.2222 $2,098.03 $438.93 $419.61

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

21.3691 $1,483.44. $296.69

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

30.2222 $2,098.03 $438.93 $419.61

21.3691 $1,483.44. $296.69

30.2222 $2,098.03 $438.93 $419.61

1.9475 $135.20. $27.04

21.3691 $1,483.44. $296.69

4.5122 $313.24 $67.83 $62.65

30.2222 $2,098.03 $438.93 $419.61

4.5122 $313.24 $67.83 $62.65

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

29.1250 $2,021.86 $459.92 $404.38
10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

29.1250 $2,021.86 $459.92 $404.38

29.1250 $2,021.86 $459.92 $404.38

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

29.1250 $2,021.86 $459.92 $404.38

10.4123 $722.82 $189.71 $144.57

29.1250 $2,021.86 $459.92 $404.38

29.1250 $2,021.86 $459.92 $404.38

29.1250 $2,021.86 $459.92 $404.38

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

4.5122 $313.24 $67.83 $62.65

0.4224 $29.32 $7.74 $5.87

4.5122 $313.24 $67.83 $62.65

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

10.4123 $722.82 $189.71 $144.57

5.5572 $385.78 . $77.16
9.7281 $675.32 . $135.07

9.7281 $675.32 . $135.07

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

30.6257 $2,126.04 . $425.21

5.5572 $385.78 . $77.16

1.4008 $97.24 . $19.45

13.2460 $919.54 $322.74 $183.91

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

34.9007 $2,422.81 $591.64 $484.57

34.9007 $2,422.81 $591.64 $484.57

34.9007 $2,422.81 $591.64 $484.57

34.9007 $2,422.81 $591.64 $484.57

34.9007 $2,422.81 $591.64 $484.57

34.9007 $2,422.81 $591.64 $484.57
5.5572 $385.78 . $77.16

57.1703 $3,968.76 . $793.76

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

110.9465 $7,701.91 $1,620.86 $1,540.39

110.9465 $7,701.91 $1,620.86 $1,540.39

136.0608 $9,445.34 . $1,889.07

48.5765 $3,372.18 . $674.44

48.5765 $3,372.18 . $674.44

93.4566 $6,487.76 $1,570.21 $1,297.56

100.4629 $6,974.13 . $1,394.83

136.0608 $9,445.34 . $1,889.07

23.2424 $1,613.49 . $322.70

48.5765 $3,372.18 . $674.44

48.5765 $3,372.18 . $674.44

23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

17.2745 $1,199.20 . $239.84

17.2745 $1,199.20 . $239.84

136.0608 $9,445.34 . $1,889.07

379.7887 $26,364.93 . $5,272.99

23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

329.3230 $22,861.60 . $4,572.32
23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

379.7887 $26,364.93 . $5,272.99

78.4050 $5,442.88 . $1,088.58

8.6164 $598.15 . $119.63


5.5572 $385.78 . $77.16

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39
41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

43.1404 $2,994.81 . $598.97

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

41.2260 $2,861.91 $652.56 $572.39

30.7767 $2,136.52 . $427.31
30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

41.2260 $2,861.91 $652.56 $572.39

8.6164 $598.15 . $119.63

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

43.1404 $2,994.81 . $598.97

43.1404 $2,994.81 . $598.97

43.1404 $2,994.81 . $598.97

30.7767 $2,136.52 . $427.31

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

16.7686 $1,164.08 . $232.82

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

30.7767 $2,136.52 . $427.31

2.1881 $151.90 $59.41 $30.38

9.4312 $654.71 . $130.95
30.2967 $2,103.20 . $420.64

23.2424 $1,613.49 . $322.70

23.2424 $1,613.49 . $322.70

0.2717 $18.86 . $3.78

0.2717 $18.86 . $3.78

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

0.9786 $67.93 . $13.59

0.9786 $67.93 . $13.59

0.9786 $67.93 . $13.59

0.9786 $67.93 . $13.59

43.6864 $3,032.71 . $606.55

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

11.7368 $814.77 $189.47 $162.96

11.7368 $814.77 $189.47 $162.96

11.7368 $814.77 $189.47 $162.96

11.7368 $814.77 $189.47 $162.96

32.6016 $2,263.20 . $452.64

32.6016 $2,263.20 . $452.64

32.6016 $2,263.20 . $452.64

11.1622 $774.88 . $154.98

11.1622 $774.88 . $154.98

25.1290 $1,744.46 . $348.90

25.1290 $1,744.46 . $348.90

30.2967 $2,103.20 . $420.64

30.2967 $2,103.20 . $420.64

30.2967 $2,103.20 . $420.64

30.2967 $2,103.20 . $420.64

30.2967 $2,103.20 . $420.64

11.1622 $774.88 . $154.98

11.1622 $774.88 . $154.98

25.1290 $1,744.46 . $348.90

25.1290 $1,744.46 . $348.90

6.3178 $438.58 . $87.72

11.1622 $774.88 . $154.98

25.1290 $1,744.46 . $348.90

11.1622 $774.88 . $154.98

25.1290 $1,744.46 . $348.90

30.2967 $2,103.20 . $420.64
30.2967 $2,103.20 . $420.64

11.1622 $774.88 . $154.98

25.1290 $1,744.46 . $348.90

6.3178 $438.58 . $87.72

11.1622 $774.88 . $154.98

0.6235 $43.28 $12.56 $8.66

0.6235 $43.28 $12.56 $8.66

2.3410 $162.51 . $32.51

25.1290 $1,744.46 . $348.90

11.1622 $774.88 . $154.98

11.1622 $774.88 . $154.98

2.3410 $162.51 . $32.51

0.2717 $18.86 . $3.78

30.2967 $2,103.20 . $420.64

1.7462 $121.22 . $24.25

36.8791 $2,560.15 . $512.03

36.8791 $2,560.15 . $512.03

36.8791 $2,560.15 . $512.03

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

36.8791 $2,560.15 . $512.03

41.2260 $2,861.91 $652.56 $572.39

2.3410 $162.51 . $32.51

36.8791 $2,560.15 . $512.03

43.1404 $2,994.81 . $598.97

114.2626 $7,932.11 . $1,586.43

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

41.2260 $2,861.91 $652.56 $572.39

2.3410 $162.51 . $32.51

30.2967 $2,103.20 . $420.64

16.7686 $1,164.08 . $232.82

16.7686 $1,164.08 . $232.82

30.2967 $2,103.20 . $420.64

104.8857 $7,281.17 . $1,456.24
114.2626 $7,932.11 . $1,586.43

114.2626 $7,932.11 . $1,586.43

114.2626 $7,932.11 . $1,586.43

114.2626 $7,932.11 . $1,586.43

30.2967 $2,103.20 . $420.64

114.2626 $7,932.11 . $1,586.43

65.1118 $4,520.06 . $904.02

114.2626 $7,932.11 . $1,586.43

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

114.2626 $7,932.11 . $1,586.43

114.2626 $7,932.11 . $1,586.43

202.3898 $14,049.90 $5,559.48 $2,809.98

65.1118 $4,520.06 . $904.02

114.2626 $7,932.11 . $1,586.43

114.2626 $7,932.11 . $1,586.43

202.3898 $14,049.90 $5,559.48 $2,809.98

65.1118 $4,520.06 . $904.02

114.2626 $7,932.11 . $1,586.43

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

43.6864 $3,032.71 . $606.55

26.9181 $1,868.65 . $373.73

30.7767 $2,136.52 . $427.31

30.7767 $2,136.52 . $427.31

43.6864 $3,032.71 . $606.55

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

17.1909 $1,193.39 . $238.68

26.9181 $1,868.65 . $373.73

43.6864 $3,032.71 . $606.55

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

43.6864 $3,032.71 . $606.55

43.6864 $3,032.71 . $606.55

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

26.9181 $1,868.65 . $373.73

34.3803 $2,386.68 $598.48 $477.34

0.6235 $43.28 $12.56 $8.66
47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

11.7368 $814.77 $189.47 $162.96

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

3.3671 $233.74 . $46.75

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

3.9075 $271.26 . $54.26

3.9075 $271.26 . $54.26

32.6016 $2,263.20 . $452.64

32.6016 $2,263.20 . $452.64

32.6016 $2,263.20 . $452.64

11.7368 $814.77 $189.47 $162.96

13.4779 $935.64 . $187.13

20.5401 $1,425.89 . $285.18

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

8.1415 $565.18 . $113.04

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

51.2321 $3,556.53 . $711.31

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

47.7164 $3,312.47 $1,001.89 $662.50

71.0451 $4,931.95 $1,236.99 $986.39

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

25.4874 $1,769.34 . $353.87

25.4874 $1,769.34 . $353.87

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

25.4874 $1,769.34 . $353.87
2.5360 $176.05 $42.39 $35.21

3.3671 $233.74 . $46.75

34.9007 $2,422.81 $591.64 $484.57

3.3531 $232.77 . $46.56

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07 . $349.02

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

8.0353 $557.81 . $111.57

8.0353 $557.81 . $111.57

8.0353 $557.81 . $111.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

1.0875 $75.49 $24.28 $15.10

1.4481 $100.53 . $20.11

8.0353 $557.81 . $111.57

0.6739 $46.78 . $9.36

8.0353 $557.81 . $111.57

3.3531 $232.77 . $46.56

3.3531 $232.77 . $46.56

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07 . $349.02

3.3531 $232.77 . $46.56

8.0353 $557.81 . $111.57

16.9180 $1,174.45 $277.61 $234.89

3.3531 $232.77 . $46.56

8.0353 $557.81 . $111.57

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

25.1379 $1,745.07 . $349.02

45.1286 $3,132.83 . $626.57
45.1286 $3,132.83

. $626.57

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

3.3531 $232.77. $46.56

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

4.8763 $338.51. $67.71

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

1.0875 $75.49 $24.28 $15.10

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

1.0875 $75.49 $24.28 $15.10

1.4481 $100.53. $20.11

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

8.0353 $557.81. $111.57

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89
25.1379 $1,745.07

. $349.02

1.0875 $75.49 $24.28 $15.10

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

3.3531 $232.77. $46.56

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

3.3531 $232.77. $46.56

16.9180 $1,174.45 $277.61 $234.89

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

3.3531 $232.77. $46.56

3.3531 $232.77. $46.56

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

8.1415 $565.18. $113.04

25.1379 $1,745.07. $349.02

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

16.9180 $1,174.45 $277.61 $234.89

8.0353 $557.81. $111.57

3.3531 $232.77. $46.56

25.1379 $1,745.07. $349.02
1.0875 $75.49 $24.28 $15.10

3.3531 $232.77. $46.56

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

0.6739 $46.78. $9.36

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

8.0353 $557.81. $111.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

1.0875 $75.49 $24.28 $15.10

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

1.0875 $75.49 $24.28 $15.10

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89
45.1286 $3,132.83

. $626.57

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

25.4890 $1,769.45. $353.89

12.5693 $872.56 $204.51 $174.52

29.0233 $2,014.80. $402.96

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

25.4890 $1,769.45. $353.89

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

8.3787 $581.65 $136.33 $116.33

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

29.0233 $2,014.80. $402.96

25.4890 $1,769.45. $353.89

12.5693 $872.56 $204.51 $174.52

12.5693 $872.56 $204.51 $174.52

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

29.0233 $2,014.80. $402.96

29.0233 $2,014.80. $402.96

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

24.4009 $1,693.91. $338.79

71.0451 $4,931.95 $1,236.99 $986.39
39.0865 $2,713.38 $659.53 $542.68

25.1379 $1,745.07 . $349.02

6.5430 $454.22 . $90.85

6.5430 $454.22 . $90.85

6.5430 $454.22 . $90.85

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

8.3787 $581.65 $136.33 $116.33
86.9786 $6,038.05 . $1,207.61

39.0865 $2,713.38 $659.53 $542.68

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

1.2481 $86.64 $30.47 $17.33

0.6739 $46.78 . $9.36

0.6739 $46.78 . $9.36

0.9478 $65.80 $23.63 $13.16

1.2481 $86.64 $30.47 $17.33

1.2481 $86.64 $30.47 $17.33

2.3410 $162.51 . $32.51

8.3787 $581.65 $136.33 $116.33

12.5693 $872.56 $204.51 $174.52

8.3787 $581.65 $136.33 $116.33

25.4890 $1,769.45 . $353.89

21.8041 $1,513.64 . $302.73

5.1973 $360.80 . $72.16

21.8041 $1,513.64 . $302.73

8.3787 $581.65 $136.33 $116.33
12.5693 $872.56 $204.51 $174.52

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68
21.8041 $1,513.64

. $302.73

21.8041 $1,513.64. $302.73

10.1643 $705.61 $152.78 $141.13

10.1643 $705.61 $152.78 $141.13

10.1643 $705.61 $152.78 $141.13

15.8412 $1,099.70 $239.49 $219.94

15.8412 $1,099.70 $239.49 $219.94

15.8412 $1,099.70 $239.49 $219.94

15.8412 $1,099.70 $239.49 $219.94

29.0233 $2,014.80. $402.96

15.8412 $1,099.70 $239.49 $219.94

15.8412 $1,099.70 $239.49 $219.94

10.1643 $705.61 $152.78 $141.13

10.1643 $705.61 $152.78 $141.13

15.8412 $1,099.70 $239.49 $219.94

29.0233 $2,014.80. $402.96

10.1643 $705.61 $152.78 $141.13

10.1643 $705.61 $152.78 $141.13

29.0233 $2,014.80. $402.96

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

29.0233 $2,014.80. $402.96

6.3178 $438.58. $87.72
26.6476 $1,849.88 $375.24 $369.98

15.3594 $1,066.25 $225.55 $213.25

26.6476 $1,849.88 $375.24 $369.98

26.6476 $1,849.88 $375.24 $369.98

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

16.0235 $1,112.35 . $222.47

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

6.3038 $437.61 . $87.53

11.0219 $765.14 . $153.03

11.0219 $765.14 . $153.03

23.9719 $1,664.13 . $332.83

11.0219 $765.14 . $153.03

11.0219 $765.14 . $153.03

11.0219 $765.14 . $153.03

11.0219 $765.14 . $153.03

23.9719 $1,664.13 . $332.83

23.9719 $1,664.13 . $332.83

29.0233 $2,014.80 . $402.96

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

11.0219 $765.14 . $153.03

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53

6.3038 $437.61 . $87.53
11.0219 $765.14 . $153.03

11.0219 $765.14 . $153.03

6.3038 $437.61 . $87.53

11.0219 $765.14 . $153.03

29.0233 $2,014.80 . $402.96

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

29.0233 $2,014.80 . $402.96

9.3183 $646.88 $186.06 $129.38

9.3183 $646.88 $186.06 $129.38

39.0865 $2,713.38 $659.53 $542.68

24.4472 $1,697.12 . $339.43

32.9730 $2,288.99 . $457.80

0.9786 $67.93 . $13.59

32.9730 $2,288.99 . $457.80

32.9730 $2,288.99 . $457.80

6.1052 $423.82 . $84.77

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

16.0235 $1,112.35 . $222.47

24.4472 $1,697.12 . $339.43

6.1052 $423.82 . $84.77

24.4472 $1,697.12 . $339.43

6.1052 $423.82 . $84.77

24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

6.1052 $423.82 . $84.77

24.4472 $1,697.12 . $339.43

16.0235 $1,112.35 . $222.47

24.4472 $1,697.12 . $339.43

2.0973 $145.59 . $29.12

24.4472 $1,697.12 . $339.43

16.0235 $1,112.35 . $222.47

6.1052 $423.82 . $84.77

24.4472 $1,697.12 . $339.43
24.4472 $1,697.12

. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

6.1052 $423.82. $84.77

24.4472 $1,697.12. $339.43

0.6739 $46.78. $9.36

11.0219 $765.14. $153.03

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

23.9719 $1,664.13. $332.83

11.0219 $765.14. $153.03

23.9719 $1,664.13. $332.83

6.3038 $437.61. $87.53

23.9719 $1,664.13. $332.83

24.4472 $1,697.12. $339.43

32.9730 $2,288.99. $457.80

32.9730 $2,288.99. $457.80

32.9730 $2,288.99. $457.80

24.4472 $1,697.12. $339.43

24.4472 $1,697.12. $339.43

32.9730 $2,288.99. $457.80

32.9730 $2,288.99. $457.80

32.9730 $2,288.99. $457.80

2.8248 $196.10. $39.22

22.0631 $1,531.62. $306.33

1.4936 $103.69. $20.74

22.0631 $1,531.62. $306.33

22.0631 $1,531.62. $306.33

22.0631 $1,531.62. $306.33

6.1052 $423.82. $84.77

24.4472 $1,697.12. $339.43

6.1052 $423.82. $84.77
24.4472 $1,697.12 . $339.43

24.4472 $1,697.12 . $339.43

32.9730 $2,288.99 . $457.80

6.1052 $423.82 . $84.77

9.7281 $675.32 . $135.07

15.3594 $1,066.25 $225.55 $213.25

107.5115 $7,463.45 $1,962.55 $1,492.69

107.5115 $7,463.45 $1,962.55 $1,492.69

39.0865 $2,713.38 $659.53 $542.68

57.1703 $3,968.76 . $793.76

4.5956 $319.03 . $63.81

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

16.2153 $1,125.67 . $225.14

16.2153 $1,125.67 . $225.14

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27
39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

31.2779 $2,171.31 . $434.27

31.2779 $2,171.31 . $434.27

9.7281 $675.32 . $135.07

15.3594 $1,066.25 $225.55 $213.25
4.5956 $319.03 . $63.81

15.3594 $1,066.25 $225.55 $213.25

15.3594 $1,066.25 $225.55 $213.25

15.3594 $1,066.25 $225.55 $213.25

5.5572 $385.78 . $77.16

5.5572 $385.78 . $77.16

9.7281 $675.32 . $135.07

26.6476 $1,849.88 $375.24 $369.98

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

26.6476 $1,849.88 $375.24 $369.98

13.2460 $919.54 $322.74 $183.91

30.6257 $2,126.04 . $425.21

36.8791 $2,560.15 . $512.03

30.6257 $2,126.04 . $425.21

23.2424 $1,613.49 . $322.70

16.2153 $1,125.67 . $225.14

26.6476 $1,849.88 $375.24 $369.98

23.2424 $1,613.49 . $322.70

16.2153 $1,125.67 . $225.14

16.2153 $1,125.67 . $225.14

12.5693 $872.56 $204.51 $174.52
12.5693 $872.56 $204.51 $174.52

24.4472 $1,697.12. $339.43

12.5693 $872.56 $204.51 $174.52

6.3178 $438.58. $87.72

6.3178 $438.58. $87.72

6.3178 $438.58. $87.72

6.3178 $438.58. $87.72

2.0083 $139.42 $52.93 $27.89

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

39.0865 $2,713.38 $659.53 $542.68

26.6476 $1,849.88 $375.24 $369.98
26.2690 $1,823.59 . $364.72

15.3594 $1,066.25 $225.55 $213.25

45.8647 $3,183.93 . $636.79

45.8647 $3,183.93 . $636.79

9.7281 $675.32 . $135.07

26.2690 $1,823.59 . $364.72

17.6738 $1,226.92 . $245.39

26.2690 $1,823.59 . $364.72

7.3594 $510.89 . $102.18

16.2153 $1,125.67 . $225.14

7.3594 $510.89 . $102.18

9.7281 $675.32 . $135.07

1.1699 $81.21 . $16.25

17.6738 $1,226.92 . $245.39

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

2.0973 $145.59 . $29.12

16.2153 $1,125.67 . $225.14
39.0865 $2,713.38 $659.53 $542.68

107.5115 $7,463.45 $1,962.55 $1,492.69

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

7.3594 $510.89 . $102.18

26.2690 $1,823.59 . $364.72

7.3594 $510.89 . $102.18

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

7.3594 $510.89 . $102.18

7.3594 $510.89 . $102.18

7.3594 $510.89 . $102.18

7.3594 $510.89 . $102.18

36.9605 $2,565.80 . $513.16

17.6738 $1,226.92 . $245.39

17.6738 $1,226.92 . $245.39

51.4038 $3,568.45 $997.74 $713.69

57.1703 $3,968.76 . $793.76

57.1703 $3,968.76 . $793.76

1.1699 $81.21 . $16.25

16.2153 $1,125.67 . $225.14

20.1960 $1,402.01 . $280.41
47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

7.3594 $510.89. $102.18

7.3594 $510.89. $102.18

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

7.3594 $510.89. $102.18

7.3594 $510.89. $102.18

17.6738 $1,226.92. $245.39

17.6738 $1,226.92. $245.39

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

7.3594 $510.89. $102.18

26.2690 $1,823.59. $364.72

36.9605 $2,565.80. $513.16

26.2690 $1,823.59. $364.72

20.5401 $1,425.89. $285.18

2.0973 $145.59. $29.12

1.1699 $81.21. $16.25

20.1960 $1,402.01. $280.41

32.9744 $2,289.08 $464.85 $457.82

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72
2.0973 $145.59 . $29.12

0.6739 $46.78 . $9.36

0.6739 $46.78 . $9.36

1.1699 $81.21 . $16.25

2.0973 $145.59 . $29.12

6.3178 $438.58 . $87.72

32.1043 $2,228.68 . $445.74

3.1976 $221.98 . $44.40

3.1976 $221.98 . $44.40

3.1976 $221.98 . $44.40

3.1976 $221.98 . $44.40

3.1976 $221.98 . $44.40

3.1976 $221.98 . $44.40

0.6739 $46.78 . $9.36

1.1699 $81.21 . $16.25

1.1699 $81.21 . $16.25

2.0973 $145.59 . $29.12

1.1699 $81.21 . $16.25

2.0973 $145.59 . $29.12

0.6739 $46.78 . $9.36

45.5816 $3,164.27 $981.50 $632.86

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

7.3594 $510.89 . $102.18

17.6738 $1,226.92 . $245.39

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

7.3594 $510.89 . $102.18

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

17.6738 $1,226.92 . $245.39

7.3594 $510.89 . $102.18

17.6738 $1,226.92 . $245.39

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72
26.2690 $1,823.59

. $364.72

17.6738 $1,226.92. $245.39

36.9605 $2,565.80. $513.16

26.2690 $1,823.59. $364.72

17.6738 $1,226.92. $245.39

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

17.6738 $1,226.92. $245.39

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

36.9605 $2,565.80. $513.16

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

36.9605 $2,565.80. $513.16

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

26.2690 $1,823.59. $364.72

36.9605 $2,565.80. $513.16

36.9605 $2,565.80. $513.16

26.2690 $1,823.59. $364.72

45.8647 $3,183.93. $636.79

45.8647 $3,183.93. $636.79

45.8647 $3,183.93. $636.79

26.2690 $1,823.59. $364.72

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

20.7987 $1,443.85. $288.77
32.1043 $2,228.68

. $445.74

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

103.8680 $7,210.52. $1,442.11

32.1043 $2,228.68. $445.74

103.8680 $7,210.52. $1,442.11

168.5335 $11,699.60. $2,339.92

32.1043 $2,228.68. $445.74

168.5335 $11,699.60. $2,339.92

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

20.7987 $1,443.85. $288.77

32.1043 $2,228.68. $445.74

32.1043 $2,228.68. $445.74

3.1976 $221.98. $44.40

1.1699 $81.21. $16.25

17.6738 $1,226.92. $245.39

20.1960 $1,402.01. $280.41

2.0973 $145.59. $29.12

1.1699 $81.21. $16.25

1.1699 $81.21. $16.25

20.7987 $1,443.85. $288.77

45.8647 $3,183.93. $636.79

45.8647 $3,183.93. $636.79

2.0973 $145.59. $29.12

20.1960 $1,402.01. $280.41

1.1699 $81.21. $16.25

20.7987 $1,443.85. $288.77

20.7987 $1,443.85. $288.77

20.5401 $1,425.89. $285.18

0.9786 $67.93. $13.59

22.0631 $1,531.62. $306.33

0.9786 $67.93. $13.59

22.0631 $1,531.62. $306.33

22.0631 $1,531.62. $306.33

22.0631 $1,531.62. $306.33

17.1909 $1,193.39. $238.68

23.4169 $1,625.60 $350.05 $325.12

34.3803 $2,386.68 $598.48 $477.34
34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

20.5401 $1,425.89 . $285.18

34.3803 $2,386.68 $598.48 $477.34

23.7235 $1,646.89 . $329.38

23.7235 $1,646.89 . $329.38

23.7235 $1,646.89 . $329.38

23.7235 $1,646.89 . $329.38

23.7235 $1,646.89 . $329.38

23.7235 $1,646.89 . $329.38

2.0973 $145.59 . $29.12

34.3803 $2,386.68 $598.48 $477.34

2.0973 $145.59 . $29.12

20.1960 $1,402.01 . $280.41

2.0973 $145.59 . $29.12

1.1699 $81.21 . $16.25

2.0973 $145.59 . $29.12

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

103.8680 $7,210.52 . $1,442.11

168.5335 $11,699.60 . $2,339.92

168.5335 $11,699.60 . $2,339.92

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

168.5335 $11,699.60 . $2,339.92

34.3803 $2,386.68 $598.48 $477.34

168.5335 $11,699.60 . $2,339.92

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34

34.3803 $2,386.68 $598.48 $477.34
3.1976 $221.98

. $44.40

15.3594 $1,066.25 $225.55 $213.25

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

32.9744 $2,289.08 $464.85 $457.82

34.3803 $2,386.68 $598.48 $477.34

32.9744 $2,289.08 $464.85 $457.82

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

47.7164 $3,312.47 $1,001.89 $662.50

71.0451 $4,931.95 $1,236.99 $986.39

39.0865 $2,713.38 $659.53 $542.68

23.7235 $1,646.89. $329.38

4.5956 $319.03. $63.81

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

4.5956 $319.03. $63.81

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

23.7235 $1,646.89. $329.38

13.4779 $935.64. $187.13

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38

32.9744 $2,289.08 $464.85 $457.82

32.9744 $2,289.08 $464.85 $457.82

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

23.7235 $1,646.89. $329.38

23.7235 $1,646.89. $329.38
14.2476 $989.07 . $197.82

14.2476 $989.07 . $197.82

14.2476 $989.07 . $197.82

26.2690 $1,823.59 . $364.72

26.2690 $1,823.59 . $364.72

20.1960 $1,402.01 . $280.41

3.6121 $250.75 . $50.15

111.0864 $7,711.62 . $1,542.33

36.9605 $2,565.80 . $513.16

13.2460 $919.54 $322.74 $183.91

1.1699 $81.21 . $16.25

26.6476 $1,849.88 $375.24 $369.98

1.6099 $111.76 . $22.36

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

22.0631 $1,531.62 . $306.33

22.0631 $1,531.62 . $306.33

3.6121 $250.75 . $50.15

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

1.6099 $111.76 . $22.36

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

7.0332 $488.24 . $97.65

13.4779 $935.64 . $187.13
20.5401 $1,425.89

. $285.18

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47

7.0332 $488.24. $97.65

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47

1.6099 $111.76. $22.36

7.0332 $488.24. $97.65

3.6121 $250.75. $50.15

1.6099 $111.76. $22.36

0.1274 $8.84 $1.85 $1.77

1.6099 $111.76. $22.36

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47

45.5816 $3,164.27 $981.50 $632.86

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

45.5816 $3,164.27 $981.50 $632.86

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86

35.9320 $2,494.40. $498.88

45.5816 $3,164.27 $981.50 $632.86

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

20.7771 $1,442.35. $288.47

35.9320 $2,494.40. $498.88

45.5816 $3,164.27 $981.50 $632.86

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

35.9320 $2,494.40. $498.88

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47

20.7771 $1,442.35. $288.47
3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

45.5816 $3,164.27 $981.50 $632.86

47.7164 $3,312.47 $1,001.89 $662.50

20.7771 $1,442.35 . $288.47

1.6099 $111.76 . $22.36

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

7.0332 $488.24 . $97.65

7.0332 $488.24 . $97.65

20.7771 $1,442.35 . $288.47

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

45.5816 $3,164.27 $981.50 $632.86

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86

45.5816 $3,164.27 $981.50 $632.86
1.6099 $111.76 . $22.36

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

45.5816 $3,164.27 $981.50 $632.86

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

71.0451 $4,931.95 $1,236.99 $986.39

39.0865 $2,713.38 $659.53 $542.68

47.7164 $3,312.47 $1,001.89 $662.50

71.0451 $4,931.95 $1,236.99 $986.39

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

23.1868 $1,609.63 $424.28 $321.93

23.1868 $1,609.63 $424.28 $321.93

23.1868 $1,609.63 $424.28 $321.93

37.9124 $2,631.88 $650.74 $526.38

37.9124 $2,631.88 $650.74 $526.38

23.1868 $1,609.63 $424.28 $321.93

37.9124 $2,631.88 $650.74 $526.38

45.5816 $3,164.27 $981.50 $632.86

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68

23.1868 $1,609.63 $424.28 $321.93

35.9320 $2,494.40 . $498.88

20.7771 $1,442.35 . $288.47

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

39.0865 $2,713.38 $659.53 $542.68
35.9320 $2,494.40 . $498.88

20.7771 $1,442.35 . $288.47

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

35.9320 $2,494.40 . $498.88

35.9320 $2,494.40 . $498.88

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

0.1274 $8.84 $1.85 $1.77

3.6121 $250.75 . $50.15

7.0332 $488.24 . $97.65

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

1.6099 $111.76 . $22.36

1.6099 $111.76 . $22.36

3.6121 $250.75 . $50.15

1.6099 $111.76 . $22.36

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

3.6121 $250.75 . $50.15

35.9320 $2,494.40 . $498.88

47.7164 $3,312.47 $1,001.89 $662.50

47.7164 $3,312.47 $1,001.89 $662.50

20.7771 $1,442.35 . $288.47

1.6099 $111.76 . $22.36

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47
20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

3.6121 $250.75 . $50.15

20.7771 $1,442.35 . $288.47

20.7771 $1,442.35 . $288.47

0.1274 $8.84 $1.85 $1.77

39.0865 $2,713.38 $659.53 $542.68

0.1274 $8.84 $1.85 $1.77

8.0353 $557.81 . $111.57

4.5956 $319.03 . $63.81

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

51.2321 $3,556.53 . $711.31

51.2321 $3,556.53 . $711.31

4.5956 $319.03 . $63.81

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57
23.4169 $1,625.60 $350.05 $325.12

45.1286 $3,132.83 . $626.57

39.0865 $2,713.38 $659.53 $542.68

51.2321 $3,556.53 . $711.31

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

6.3178 $438.58 . $87.72

42.5188 $2,951.66 . $590.34

45.1286 $3,132.83 . $626.57

45.1286 $3,132.83 . $626.57

104.8857 $7,281.17 . $1,456.24

104.8857 $7,281.17 . $1,456.24

37.4067 $2,596.77 . $519.36

37.4067 $2,596.77 . $519.36

19.0626 $1,323.33 . $264.67

12.9066 $895.98 . $179.20
20.7466 $1,440.23 $382.52 $288.05

209.6958 $14,557.08 . $2,911.42

284.8462 $19,774.02 . $3,954.81

31.3873 $2,178.91 $768.94 $435.79

25.1379 $1,745.07 . $349.02

7.5480 $523.98 . $104.80

16.2153 $1,125.67 . $225.14

42.5188 $2,951.66 . $590.34

2.4153 $167.67 . $33.54

12.9066 $895.98 . $179.20

12.9066 $895.98 . $179.20

4.5956 $319.03 . $63.81
7.5480 $523.98

. $104.80

9.7281 $675.32. $135.07

3.9371 $273.31. $54.67

3.9371 $273.31. $54.67

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

12.9066 $895.98. $179.20

12.9066 $895.98. $179.20

37.4067 $2,596.77. $519.36

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

12.9066 $895.98. $179.20

42.5188 $2,951.66. $590.34

51.1173 $3,548.56. $709.72

12.9066 $895.98. $179.20

42.5188 $2,951.66. $590.34

190.0513 $13,193.36. $2,638.68

190.0513 $13,193.36. $2,638.68

37.4067 $2,596.77. $519.36

2.4153 $167.67. $33.54

2.4153 $167.67. $33.54

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

51.1173 $3,548.56. $709.72

19.0626 $1,323.33 . $264.67

19.0626 $1,323.33 . $264.67

19.0626 $1,323.33 . $264.67

62.7889 $4,358.81 . $871.77

86.9786 $6,038.05 . $1,207.61

20.7466 $1,440.23 $382.52 $288.05

20.7466 $1,440.23 $382.52 $288.05

62.7889 $4,358.81 . $871.77

62.7889 $4,358.81 . $871.77

209.6958 $14,557.08 . $2,911.42

31.3873 $2,178.91 $768.94 $435.79

42.5188 $2,951.66 . $590.34

42.5188 $2,951.66 . $590.34

12.9066 $895.98 . $179.20

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

3.9371 $273.31 . $54.67

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

3.9371 $273.31 . $54.67

3.9371 $273.31 . $54.67

3.9371 $273.31 . $54.67

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67

3.9371 $273.31 . $54.67

3.9371 $273.31 . $54.67

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67

7.5480 $523.98 . $104.80

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98 . $104.80

3.9371 $273.31 . $54.67
7.5480 $523.98

. $104.80

3.9371 $273.31. $54.67

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

7.5480 $523.98. $104.80

62.7889 $4,358.81. $871.77

62.7889 $4,358.81. $871.77

62.7889 $4,358.81. $871.77

62.7889 $4,358.81. $871.77

62.7889 $4,358.81. $871.77

2.7693 $192.24 $40.13 $38.45

337.4240 $23,423.97 $9,121.76 $4,684.80

20.7466 $1,440.23 $382.52 $288.05

37.4067 $2,596.77. $519.36

86.9786 $6,038.05. $1,207.61

86.9786 $6,038.05. $1,207.61

86.9786 $6,038.05. $1,207.61

86.9786 $6,038.05. $1,207.61

20.7466 $1,440.23 $382.52 $288.05

209.6958 $14,557.08. $2,911.42

31.3873 $2,178.91 $768.94 $435.79

12.9066 $895.98. $179.20

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

3.9371 $273.31. $54.67

3.9371 $273.31. $54.67

12.9066 $895.98. $179.20

12.9066 $895.98. $179.20

7.5480 $523.98. $104.80

12.9066 $895.98. $179.20

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

12.9066 $895.98. $179.20

12.9066 $895.98. $179.20

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67
19.0626 $1,323.33

. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

37.4067 $2,596.77. $519.36

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

37.4067 $2,596.77. $519.36

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

37.4067 $2,596.77. $519.36

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

19.0626 $1,323.33. $264.67

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

29.0181 $2,014.44. $402.89

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36
37.4067 $2,596.77

. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

37.4067 $2,596.77. $519.36

2.7693 $192.24 $40.13 $38.45

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

27.0493 $1,877.76 $383.45 $375.56

27.0493 $1,877.76 $383.45 $375.56

27.0493 $1,877.76 $383.45 $375.56

40.9376 $2,841.89 $597.36 $568.38

27.0493 $1,877.76 $383.45 $375.56

40.9376 $2,841.89 $597.36 $568.38

20.3065 $1,409.68 $296.20 $281.94

1.4030 $97.40. $19.48

1.4030 $97.40. $19.48

1.4030 $97.40. $19.48

1.4030 $97.40. $19.48

16.8777 $1,171.65. $234.33

4.9132 $341.07. $68.22

22.7865 $1,581.84. $316.37

20.3065 $1,409.68 $296.20 $281.94

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

22.7865 $1,581.84. $316.37

41.3248 $2,868.77. $573.76
7.8512 $545.03 $124.97 $109.01

25.2851 $1,755.29 $415.27 $351.06

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

25.2649 $1,753.89 $511.31 $350.78

1.4030 $97.40. $19.48

8.3090 $576.81. $115.37

16.8777 $1,171.65. $234.33

2.3088 $160.28. $32.06

20.3065 $1,409.68 $296.20 $281.94

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

117.7956 $8,177.37. $1,635.48

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

38.4709 $2,670.65 $800.09 $534.13

7.8512 $545.03 $124.97 $109.01

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

5.5801 $387.37 $104.31 $77.48

5.5801 $387.37 $104.31 $77.48

16.8777 $1,171.65. $234.33

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

16.8777 $1,171.65. $234.33

2.9435 $204.34 $42.27 $40.87

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

41.7832 $2,900.59 $632.65 $580.12

41.7832 $2,900.59 $632.65 $580.12
41.7832 $2,900.59 $632.65 $580.12

25.2649 $1,753.89 $511.31 $350.78

41.3248 $2,868.77. $573.76

41.7832 $2,900.59 $632.65 $580.12

16.8777 $1,171.65. $234.33

2.9435 $204.34 $42.27 $40.87

7.8512 $545.03 $124.97 $109.01

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

7.8512 $545.03 $124.97 $109.01

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

16.8777 $1,171.65. $234.33

25.2649 $1,753.89 $511.31 $350.78

5.5801 $387.37 $104.31 $77.48

5.5801 $387.37 $104.31 $77.48

5.5801 $387.37 $104.31 $77.48

7.8512 $545.03 $124.97 $109.01

5.5801 $387.37 $104.31 $77.48

25.2649 $1,753.89 $511.31 $350.78

7.8512 $545.03 $124.97 $109.01

15.2776 $1,060.57. $212.12

30.7811 $2,136.82 $516.99 $427.37

30.7811 $2,136.82 $516.99 $427.37

30.7811 $2,136.82 $516.99 $427.37

30.7811 $2,136.82 $516.99 $427.37

15.2776 $1,060.57. $212.12

24.0158 $1,667.18 $488.94 $333.44

24.0158 $1,667.18 $488.94 $333.44

24.0158 $1,667.18 $488.94 $333.44

24.0158 $1,667.18 $488.94 $333.44

24.0158 $1,667.18 $488.94 $333.44

2.9435 $204.34 $42.27 $40.87

22.7865 $1,581.84. $316.37

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

3.3278 $231.02. $46.21

22.7865 $1,581.84. $316.37

5.5801 $387.37 $104.31 $77.48

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

22.7865 $1,581.84. $316.37

5.5801 $387.37 $104.31 $77.48
41.3248 $2,868.77

. $573.76

41.3248 $2,868.77. $573.76

22.7865 $1,581.84. $316.37

41.3248 $2,868.77. $573.76

41.3248 $2,868.77. $573.76

22.7865 $1,581.84. $316.37

22.7865 $1,581.84. $316.37

41.3248 $2,868.77. $573.76

4.9132 $341.07. $68.22

5.5801 $387.37 $104.31 $77.48

4.9132 $341.07. $68.22

5.5801 $387.37 $104.31 $77.48

22.7865 $1,581.84. $316.37

4.9132 $341.07. $68.22

4.9132 $341.07. $68.22

4.9132 $341.07. $68.22

22.7865 $1,581.84. $316.37

5.5801 $387.37 $104.31 $77.48

5.5801 $387.37 $104.31 $77.48

20.3065 $1,409.68 $296.20 $281.94

22.7865 $1,581.84. $316.37

4.9132 $341.07. $68.22

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

25.2851 $1,755.29 $415.27 $351.06

3.3278 $231.02. $46.21

15.6140 $1,083.92. $216.79

25.2851 $1,755.29 $415.27 $351.06

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

40.9376 $2,841.89 $597.36 $568.38

20.3065 $1,409.68 $296.20 $281.94

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

40.9376 $2,841.89 $597.36 $568.38

2.3088 $160.28. $32.06

3.3278 $231.02. $46.21

3.3278 $231.02. $46.21

40.9376 $2,841.89 $597.36 $568.38

27.0493 $1,877.76 $383.45 $375.56

40.9376 $2,841.89 $597.36 $568.38

3.3278 $231.02. $46.21
3.3278 $231.02

. $46.21

8.3090 $576.81. $115.37

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

8.3090 $576.81. $115.37

3.3278 $231.02. $46.21

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

1.4030 $97.40. $19.48

3.3278 $231.02. $46.21

8.3090 $576.81. $115.37

20.3065 $1,409.68 $296.20 $281.94

8.3090 $576.81. $115.37

8.3090 $576.81. $115.37

8.3090 $576.81. $115.37

16.8777 $1,171.65. $234.33

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

2.3088 $160.28. $32.06

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

3.3278 $231.02. $46.21

1.4030 $97.40. $19.48

8.3090 $576.81. $115.37

15.6140 $1,083.92. $216.79

20.3065 $1,409.68 $296.20 $281.94

16.8777 $1,171.65. $234.33

8.3090 $576.81. $115.37

0.6929 $48.10. $9.62

27.0493 $1,877.76 $383.45 $375.56
27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

25.2649 $1,753.89 $511.31 $350.78

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

25.2649 $1,753.89 $511.31 $350.78

3.3278 $231.02. $46.21

3.3278 $231.02. $46.21

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

27.0493 $1,877.76 $383.45 $375.56

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

20.3065 $1,409.68 $296.20 $281.94

27.0493 $1,877.76 $383.45 $375.56

20.3065 $1,409.68 $296.20 $281.94

3.3278 $231.02. $46.21

27.0493 $1,877.76 $383.45 $375.56

27.0493 $1,877.76 $383.45 $375.56

27.0493 $1,877.76 $383.45 $375.56

3.3278 $231.02. $46.21

3.3278 $231.02. $46.21

27.0493 $1,877.76 $383.45 $375.56

1.4030 $97.40. $19.48

3.3278 $231.02. $46.21

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

20.3065 $1,409.68 $296.20 $281.94

2.3088 $160.28. $32.06

3.3278 $231.02. $46.21

1.4481 $100.53. $20.11

20.5401 $1,425.89. $285.18

1.4481 $100.53. $20.11

3.3531 $232.77. $46.56

16.9180 $1,174.45 $277.61 $234.89

17.1909 $1,193.39. $238.68

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

17.1909 $1,193.39. $238.68

8.0353 $557.81. $111.57

0.6739 $46.78. $9.36

23.4169 $1,625.60 $350.05 $325.12

0.6739 $46.78. $9.36

0.9786 $67.93. $13.59

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02
45.1286 $3,132.83

. $626.57

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

3.3531 $232.77. $46.56

3.3531 $232.77. $46.56

8.0353 $557.81. $111.57

3.3531 $232.77. $46.56

16.9180 $1,174.45 $277.61 $234.89

16.9180 $1,174.45 $277.61 $234.89

8.0353 $557.81. $111.57

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

16.9180 $1,174.45 $277.61 $234.89

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

130.4476 $9,055.67. $1,811.14

130.4476 $9,055.67. $1,811.14
130.4476 $9,055.67

. $1,811.14

130.4476 $9,055.67. $1,811.14

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

16.9180 $1,174.45 $277.61 $234.89

25.1379 $1,745.07. $349.02

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

395.1320 $27,430.06 $7,545.06 $5,486.02

1.0875 $75.49 $24.28 $15.10

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

45.1286 $3,132.83. $626.57

1.0875 $75.49 $24.28 $15.10

6.9677 $483.70. $96.74

6.9677 $483.70. $96.74

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.3928 $235.53. $47.11

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

0.4650 $32.28. $6.46

0.4650 $32.28. $6.46

0.4650 $32.28. $6.46

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

4.8219 $334.74 $131.90 $66.95

0.6418 $44.55. $8.91

0.4650 $32.28. $6.46

0.6418 $44.55. $8.91

1.2481 $86.64 $30.47 $17.33

1.2481 $86.64 $30.47 $17.33
3.3928 $235.53

. $47.11

0.6418 $44.55. $8.91

3.3928 $235.53. $47.11

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8432 $336.21 $113.59 $67.25

4.8432 $336.21 $113.59 $67.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

4.8219 $334.74 $131.90 $66.95

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.2481 $86.64 $30.47 $17.33

0.6418 $44.55. $8.91

1.2481 $86.64 $30.47 $17.33

0.6418 $44.55. $8.91

3.3928 $235.53. $47.11

3.3928 $235.53. $47.11

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25
4.8432 $336.21 $113.59 $67.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

7.6393 $530.32 $196.43 $106.07

7.6393 $530.32 $196.43 $106.07

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

4.8432 $336.21 $113.59 $67.25

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

6.9677 $483.70. $96.74

6.9677 $483.70. $96.74

6.9677 $483.70. $96.74
6.9677 $483.70

. $96.74

23.0551 $1,600.49. $320.10

23.0551 $1,600.49. $320.10

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8432 $336.21 $113.59 $67.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

3.9868 $276.76 $68.90 $55.36

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91
0.6418 $44.55

. $8.91

0.6418 $44.55. $8.91

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8432 $336.21 $113.59 $67.25

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

0.6418 $44.55. $8.91

1.0831 $75.19. $15.04

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

4.7716 $331.24 $115.09 $66.25

4.8432 $336.21 $113.59 $67.25

5.8040 $402.91 $155.78 $80.59

8.2338 $571.59 $184.21 $114.32

8.2338 $571.59 $184.21 $114.32

4.8219 $334.74 $131.90 $66.95

6.1872 $429.52 $144.34 $85.91

7.6393 $530.32 $196.43 $106.07

3.3928 $235.53. $47.11

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

2.0083 $139.42 $52.93 $27.89

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

2.0083 $139.42 $52.93 $27.89

1.2290 $85.32 $33.87 $17.07

2.0083 $139.42 $52.93 $27.89

1.2290 $85.32 $33.87 $17.07

2.7424 $190.38 $73.61 $38.08

4.2806 $297.16 $95.77 $59.44

1.2290 $85.32 $33.87 $17.07

2.0083 $139.42 $52.93 $27.89

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

1.2290 $85.32 $33.87 $17.07

3.3928 $235.53. $47.11

6.2675 $435.09. $87.02
2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

2.5896 $179.77 $58.44 $35.96

3.3928 $235.53. $47.11

17.6738 $1,226.92. $245.39

17.6738 $1,226.92. $245.39

17.6738 $1,226.92. $245.39

1.0831 $75.19. $15.04

3.3928 $235.53. $47.11

2.5896 $179.77 $58.44 $35.96

4.8219 $334.74 $131.90 $66.95

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

7.6393 $530.32 $196.43 $106.07

0.6739 $46.78. $9.36

3.7294 $258.89. $51.78

3.7294 $258.89. $51.78

3.7294 $258.89. $51.78

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

4.8432 $336.21 $113.59 $67.25

49.6711 $3,448.17. $689.64

29.6734 $2,059.93. $411.99

49.6711 $3,448.17. $689.64

49.6711 $3,448.17. $689.64

29.6734 $2,059.93. $411.99

49.6711 $3,448.17. $689.64

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99

29.6734 $2,059.93. $411.99
29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

6.2675 $435.09 . $87.02

6.2675 $435.09 . $87.02

6.2675 $435.09 . $87.02

6.2675 $435.09 . $87.02

1.0831 $75.19 . $15.04

29.6734 $2,059.93 . $411.99

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

29.6734 $2,059.93 . $411.99

9.4312 $654.71 . $130.95

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

9.4312 $654.71 . $130.95

29.6734 $2,059.93 . $411.99

9.4312 $654.71 . $130.95

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

29.6734 $2,059.93 . $411.99

1.0831 $75.19 . $15.04

2.1881 $151.90 $59.41 $30.38

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

30.7767 $2,136.52 . $427.31
1.2481 $86.64 $30.47 $17.33

0.6418 $44.55. $8.91

3.3928 $235.53. $47.11

6.2675 $435.09. $87.02

1.0831 $75.19. $15.04

3.3928 $235.53. $47.11

3.3928 $235.53. $47.11

1.2481 $86.64 $30.47 $17.33

1.5453 $107.27 $35.74 $21.46

1.2481 $86.64 $30.47 $17.33

1.5453 $107.27 $35.74 $21.46

4.8219 $334.74 $131.90 $66.95

0.6418 $44.55. $8.91

0.8995 $62.44 $22.26 $12.49

2.9435 $204.34 $42.27 $40.87

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

0.2717 $18.86. $3.78

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

2.1881 $151.90 $59.41 $30.38

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49
0.8995 $62.44 $22.26 $12.49

3.1535 $218.92 . $43.79

3.1535 $218.92 . $43.79

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

2.1881 $151.90 $59.41 $30.38

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

0.8995 $62.44 $22.26 $12.49

1.5324 $106.38 $36.83 $21.28

0.8995 $62.44 $22.26 $12.49

2.1881 $151.90 $59.41 $30.38

0.6739 $46.78 $0.00 $0.00

0.8995 $62.44 $22.26 $12.49

3.3928 $235.53 . $47.11

3.3928 $235.53 . $47.11

0.6418 $44.55 . $8.91

0.6418 $44.55 . $8.91
0.6418 $44.55

. $8.91

1.0831 $75.19. $15.04

1.0831 $75.19. $15.04

1.0831 $75.19. $15.04

0.6418 $44.55. $8.91

1.0215 $70.91 $0.00 $0.00

1.5453 $107.27 $0.00 $0.00

1.0215 $70.91 $0.00 $0.00

0.4570 $31.72 $0.00 $0.00

0.6418 $44.55. $8.91

1.0831 $75.19 $0.00 $0.00

4.8219 $334.74 $131.90 $66.95

1.4946 $103.76 $34.39 $20.76

3.7009 $256.92 $86.44 $51.39

3.7009 $256.92 $86.44 $51.39

13.2460 $919.54 $322.74 $183.91

1.4946 $103.76 $34.39 $20.76

1.4946 $103.76 $34.39 $20.76

13.2460 $919.54 $322.74 $183.91

1.4946 $103.76 $34.39 $20.76

1.4946 $103.76 $34.39 $20.76

3.7009 $256.92 $86.44 $51.39

3.7009 $256.92 $86.44 $51.39

1.4946 $103.76 $34.39 $20.76

3.7009 $256.92 $86.44 $51.39

3.7009 $256.92 $86.44 $51.39

1.4946 $103.76 $34.39 $20.76

2.7910 $193.75 $64.95 $38.75

2.7910 $193.75 $64.95 $38.75

2.7910 $193.75 $64.95 $38.75

1.4946 $103.76 $34.39 $20.76

3.7009 $256.92 $86.44 $51.39

1.4946 $103.76 $34.39 $20.76

106.1294 $7,367.50. $1,473.50

1.4946 $103.76 $34.39 $20.76

1.3628 $94.61. $18.93

1.3628 $94.61. $18.93

1.3628 $94.61. $18.93

1.3628 $94.61. $18.93

1.3628 $94.61. $18.93

1.3628 $94.61. $18.93

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

2.3680 $164.39. $32.88

6.4422 $447.22. $89.45
2.3680 $164.39

. $32.88

2.3680 $164.39. $32.88

5.6094 $389.40. $77.88

14.2952 $992.37. $198.48

14.2952 $992.37. $198.48

18.7001 $1,298.16. $259.64

18.7001 $1,298.16. $259.64

5.6094 $389.40. $77.88

5.6094 $389.40. $77.88

5.6094 $389.40. $77.88

5.6094 $389.40. $77.88

5.6094 $389.40. $77.88

2.3680 $164.39. $32.88

4.7014 $326.37. $65.28

4.7014 $326.37. $65.28

4.7014 $326.37. $65.28

4.7014 $326.37. $65.28

4.7014 $326.37. $65.28

12.4760 $866.08. $173.22

9.8659 $684.89 $258.98 $136.98

9.8659 $684.89 $258.98 $136.98

9.8659 $684.89 $258.98 $136.98

1.3628 $94.61. $18.93

4.7014 $326.37. $65.28

1.5133 $105.05 $26.88 $21.01

1.5133 $105.05 $26.88 $21.01

1.5133 $105.05 $26.88 $21.01

3.1750 $220.41 $65.46 $44.09

3.1750 $220.41 $65.46 $44.09

1.8660 $129.54 $46.52 $25.91

1.8660 $129.54 $46.52 $25.91

4.0374 $280.28 $85.03 $56.06

4.0374 $280.28 $85.03 $56.06

4.0374 $280.28 $85.03 $56.06

3.1750 $220.41 $65.46 $44.09

6.9811 $484.63. $96.93

1.8660 $129.54 $46.52 $25.91

3.7132 $257.77 $91.24 $51.56

3.7132 $257.77 $91.24 $51.56

3.7132 $257.77 $91.24 $51.56

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53

6.3038 $437.61. $87.53
6.3038 $437.61

. $87.53

3.7132 $257.77 $91.24 $51.56

2.5360 $176.05 $42.39 $35.21

2.5360 $176.05 $42.39 $35.21

3.7132 $257.77 $91.24 $51.56

3.7132 $257.77 $91.24 $51.56

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

4.1587 $288.70 $90.78 $57.74

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

2.5360 $176.05 $42.39 $35.21

2.5360 $176.05 $42.39 $35.21

2.5360 $176.05 $42.39 $35.21

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.4576 $240.03 $87.01 $48.01

3.5140 $243.94 $93.91 $48.79

3.5140 $243.94 $93.91 $48.79

3.5140 $243.94 $93.91 $48.79

3.5140 $243.94 $93.91 $48.79

3.5140 $243.94 $93.91 $48.79

3.5140 $243.94 $93.91 $48.79

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

2.4220 $168.14 $38.85 $33.63

9.7483 $676.73. $135.35

9.7483 $676.73. $135.35

9.7483 $676.73. $135.35

9.7483 $676.73. $135.35

2.4220 $168.14 $38.85 $33.63

2.4220 $168.14 $38.85 $33.63

2.4220 $168.14 $38.85 $33.63

13.2711 $921.28. $184.26

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67
4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

13.2711 $921.28. $184.26

13.2711 $921.28. $184.26

4.2252 $293.31 $93.33 $58.67

4.2252 $293.31 $93.33 $58.67

2.8425 $197.33 $71.16 $39.47

4.5059 $312.80 $120.71 $62.56

4.5059 $312.80 $120.71 $62.56

2.8425 $197.33 $71.16 $39.47

2.8425 $197.33 $71.16 $39.47

4.5059 $312.80 $120.71 $62.56

2.8425 $197.33 $71.16 $39.47

2.8425 $197.33 $71.16 $39.47

2.8425 $197.33 $71.16 $39.47

4.5059 $312.80 $120.71 $62.56

2.8425 $197.33 $71.16 $39.47

3.3656 $233.64 $70.43 $46.73

8.7081 $604.52. $120.91

3.3656 $233.64 $70.43 $46.73

8.7081 $604.52. $120.91

8.7081 $604.52. $120.91

14.6171 $1,014.72. $202.95

3.3656 $233.64 $70.43 $46.73

8.7081 $604.52. $120.91

8.7081 $604.52. $120.91

3.3656 $233.64 $70.43 $46.73

8.7081 $604.52. $120.91

8.7081 $604.52. $120.91

3.3656 $233.64 $70.43 $46.73

3.3656 $233.64 $70.43 $46.73

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

2.5360 $176.05 $42.39 $35.21

1.5133 $105.05 $26.88 $21.01

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.5715 $317.35 $81.14 $63.47

4.0374 $280.28 $85.03 $56.06

6.9811 $484.63. $96.93

6.9811 $484.63. $96.93

6.9811 $484.63. $96.93

13.7263 $952.88. $190.58

6.9811 $484.63. $96.93

6.9811 $484.63. $96.93

6.9811 $484.63. $96.93

2.5360 $176.05 $42.39 $35.21

14.6171 $1,014.72. $202.95

14.6171 $1,014.72. $202.95
14.6171 $1,014.72

. $202.95

14.6171 $1,014.72. $202.95

14.6171 $1,014.72. $202.95

14.6171 $1,014.72. $202.95

1.5133 $105.05 $26.88 $21.01

3.2808 $227.75 $78.13 $45.55

3.2808 $227.75 $78.13 $45.55

4.0894 $283.89. $56.78

3.2808 $227.75 $78.13 $45.55

4.0894 $283.89. $56.78

4.0894 $283.89. $56.78

3.2808 $227.75 $78.13 $45.55

3.2808 $227.75 $78.13 $45.55
0.1639 $11.38

. $2.28

0.1639 $11.38. $2.28








0.5225 $36.27 $10.78 $7.26

0.1639 $11.38

. $2.28

0.5225 $36.27 $10.78 $7.26

0.1639 $11.38. $2.28
0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

0.2109 $14.64

. $2.93

0.3580 $24.85. $4.97

0.3580 $24.85. $4.97

0.1103 $7.66 $2.16 $1.54

0.1103 $7.66 $2.16 $1.54

0.1103 $7.66 $2.16 $1.54

0.6541 $45.41. $9.09

0.2109 $14.64. $2.93

0.1103 $7.66 $2.16 $1.54

0.1103 $7.66 $2.16 $1.54

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.3580 $24.85. $4.97

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.6541 $45.41. $9.09

0.6541 $45.41. $9.09

0.6541 $45.41. $9.09

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.3580 $24.85. $4.97

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93

0.3580 $24.85. $4.97
0.2109 $14.64

. $2.93

0.6541 $45.41. $9.09

0.3580 $24.85. $4.97

0.2109 $14.64. $2.93

0.2109 $14.64. $2.93



0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.1639 $11.38 . $2.28

0.5225 $36.27 $10.78 $7.26

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.1639 $11.38 . $2.28

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

0.1639 $11.38 . $2.28
0.1639 $11.38

. $2.28

0.1639 $11.38. $2.28

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.1639 $11.38. $2.28

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.1639 $11.38. $2.28

0.2464 $17.11 $5.17 $3.43

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

2.3755 $164.91. $32.99

2.3755 $164.91. $32.99

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.1639 $11.38. $2.28

0.8204 $56.95 $15.56 $11.39

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39
0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.1639 $11.38 . $2.28

0.1639 $11.38 . $2.28

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.1639 $11.38 . $2.28

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.2464 $17.11 $5.17 $3.43

0.5225 $36.27 $10.78 $7.26

0.5225 $36.27 $10.78 $7.26

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39
0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

0.1639 $11.38 . $2.28

$112.16 . $22.44

$159.86 . $31.98

$154.18 . $30.84

$129.48 . $25.90

0.3780 $26.24 . $5.25

0.3780 $26.24 . $5.25

0.3780 $26.24 . $5.25

0.3780 $26.24 . $5.25

$112.46 . $22.50
$190.82 . $38.17

$107.83 . $21.57

$100.56 . $20.12

$104.49 . $20.90

$83.39 . $16.68

$100.16 . $20.04

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06
1.0957 $76.06 . $15.22

1.0957 $76.06 . $15.22

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.0957 $76.06 . $15.22

1.0957 $76.06 . $15.22

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.5885 $110.27 . $22.06

1.8739 $130.09 . $26.02

1.8739 $130.09 . $26.02

0.7798 $54.13 $11.54 $10.83

0.7798 $54.13 $11.54 $10.83

0.7798 $54.13 $11.54 $10.83

1.0430 $72.41 . $14.49

1.5885 $110.27 . $22.06

2.6231 $182.10 . $36.42

2.6231 $182.10 . $36.42

5.9679 $414.29 . $82.86

1.5885 $110.27 . $22.06

1.0957 $76.06 . $15.22

1.1699 $81.21 . $16.25

5.9462 $412.79 . $82.56

2.4718 $171.59 . $34.32
4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

1.7147 $119.03 $33.57 $23.81

4.1026 $284.80 $83.23 $56.96

1.7147 $119.03 $33.57 $23.81

1.7147 $119.03 $33.57 $23.81

10.1643 $705.61 $152.78 $141.13

12.5693 $872.56 $204.51 $174.52

3.1976 $221.98. $44.40

1.1699 $81.21. $16.25

3.1976 $221.98. $44.40

1.7147 $119.03 $33.57 $23.81

1.7147 $119.03 $33.57 $23.81

1.7147 $119.03 $33.57 $23.81

1.4647 $101.68. $20.34

1.4647 $101.68. $20.34

1.0430 $72.41. $14.49

1.0430 $72.41. $14.49

15.6140 $1,083.92. $216.79

15.6140 $1,083.92. $216.79

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62
0.6929 $48.10

. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.2717 $18.86. $3.78

0.2717 $18.86. $3.78

1.4030 $97.40. $19.48

2.3088 $160.28. $32.06

2.3088 $160.28. $32.06

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

2.3088 $160.28. $32.06

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

1.4030 $97.40. $19.48

1.4030 $97.40. $19.48

1.4030 $97.40. $19.48

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

1.4030 $97.40. $19.48

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

1.4030 $97.40. $19.48

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

0.6929 $48.10. $9.62

3.3531 $232.77. $46.56

1.0521 $73.04. $14.61

0.9462 $65.69 $17.10 $13.14

1.8827 $130.70 $27.10 $26.14

1.8827 $130.70 $27.10 $26.14
1.8827 $130.70 $27.10 $26.14

0.9462 $65.69 $17.10 $13.14

0.9462 $65.69 $17.10 $13.14

1.8827 $130.70 $27.10 $26.14

0.9462 $65.69 $17.10 $13.14

0.9462 $65.69 $17.10 $13.14

1.8827 $130.70 $27.10 $26.14

1.8827 $130.70 $27.10 $26.14

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

1.2340 $85.66 $18.14 $17.14

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

1.2340 $85.66 $18.14 $17.14

1.2340 $85.66 $18.14 $17.14

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

1.2340 $85.66 $18.14 $17.14

0.4896 $33.99 $7.06 $6.80

1.6976 $117.85 $23.61 $23.57

0.4896 $33.99 $7.06 $6.80

0.4896 $33.99 $7.06 $6.80

1.6976 $117.85 $23.61 $23.57

1.2340 $85.66 $18.14 $17.14

1.2340 $85.66 $18.14 $17.14

0.4896 $33.99 $7.06 $6.80

2.6231 $182.10. $36.42

2.6231 $182.10. $36.42

1.1945 $82.92. $16.59

0.9462 $65.69 $17.10 $13.14

0.9462 $65.69 $17.10 $13.14

0.4896 $33.99 $7.06 $6.80

1.6976 $117.85 $23.61 $23.57

1.6976 $117.85 $23.61 $23.57

1.6976 $117.85 $23.61 $23.57

1.6976 $117.85 $23.61 $23.57
1.2340 $85.66 $18.14 $17.14

1.2340 $85.66 $18.14 $17.14

1.6976 $117.85 $23.61 $23.57

1.2340 $85.66 $18.14 $17.14

0.4896 $33.99 $7.06 $6.80

2.2773 $158.09 $44.32 $31.62

2.2773 $158.09 $44.32 $31.62

5.3123 $368.78 $94.48 $73.76

5.3123 $368.78 $94.48 $73.76

41.2260 $2,861.91 $652.56 $572.39

16.7686 $1,164.08 . $232.82

2.3410 $162.51 . $32.51

79.9047 $5,546.98 . $1,109.40

79.9047 $5,546.98 . $1,109.40

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

104.8857 $7,281.17 . $1,456.24

104.8857 $7,281.17 . $1,456.24

65.1118 $4,520.06 . $904.02

65.1118 $4,520.06 . $904.02

0.3895 $27.04 . $5.41

2.5348 $175.97 $40.87 $35.20

2.5348 $175.97 $40.87 $35.20

2.5348 $175.97 $40.87 $35.20
0.2717 $18.86 . $3.78

0.9478 $65.80 $23.63 $13.16

0.9478 $65.80 $23.63 $13.16

11.3894 $790.65 $268.73 $158.13

0.9478 $65.80 $23.63 $13.16

1.6659 $115.65 . $23.13

0.2717 $18.86 . $3.78

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.2717 $18.86 . $3.78

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

8.1675 $566.99 $133.61 $113.40

5.5306 $383.93 . $76.79

5.5306 $383.93 . $76.79

5.5306 $383.93 . $76.79

3.1535 $218.92 . $43.79

8.1675 $566.99 $133.61 $113.40

5.5306 $383.93 . $76.79

5.5306 $383.93 . $76.79

8.1675 $566.99 $133.61 $113.40

8.1675 $566.99 $133.61 $113.40

5.5306 $383.93 . $76.79

8.1675 $566.99 $133.61 $113.40

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80
39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

16.7686 $1,164.08 . $232.82

16.7686 $1,164.08 . $232.82

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

39.2392 $2,723.99 $838.04 $544.80

166.2005 $11,537.64 . $2,307.53

166.2005 $11,537.64 . $2,307.53

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

9.6404 $669.24 . $133.85

52.8540 $3,669.12 . $733.83

52.8540 $3,669.12 . $733.83

52.8540 $3,669.12 . $733.83

9.6404 $669.24 . $133.85

52.8540 $3,669.12 . $733.83

133.7624 $9,285.79 . $1,857.16

133.7624 $9,285.79 . $1,857.16

4.2610 $295.80 $100.24 $59.16
0.3895 $27.04

. $5.41

0.7369 $51.16 $13.76 $10.24

0.5148 $35.74 $8.67 $7.15

0.7369 $51.16 $13.76 $10.24

0.5148 $35.74 $8.67 $7.15

1.6659 $115.65. $23.13

0.9478 $65.80 $23.63 $13.16

0.9478 $65.80 $23.63 $13.16

0.9648 $66.98 $13.49 $13.40

0.9648 $66.98 $13.49 $13.40

0.9478 $65.80 $23.63 $13.16

1.5324 $106.38 $36.83 $21.28

2.1881 $151.90 $59.41 $30.38

2.1881 $151.90 $59.41 $30.38

2.1881 $151.90 $59.41 $30.38

0.8995 $62.44 $22.26 $12.49

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

1.3711 $95.18 $36.80 $19.04

0.9478 $65.80 $23.63 $13.16

1.5324 $106.38 $36.83 $21.28

1.5324 $106.38 $36.83 $21.28

2.1881 $151.90 $59.41 $30.38

1.3711 $95.18 $36.80 $19.04

2.1881 $151.90 $59.41 $30.38

1.3711 $95.18 $36.80 $19.04

1.5324 $106.38 $36.83 $21.28

2.1881 $151.90 $59.41 $30.38

1.3711 $95.18 $36.80 $19.04

2.1881 $151.90 $59.41 $30.38

2.1881 $151.90 $59.41 $30.38

2.1881 $151.90 $59.41 $30.38

1.3711 $95.18 $36.80 $19.04

2.1881 $151.90 $59.41 $30.38

2.1881 $151.90 $59.41 $30.38

0.9478 $65.80 $23.63 $13.16

1.3711 $95.18 $36.80 $19.04

3.0221 $209.79. $41.96

3.0221 $209.79. $41.96

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

2.6420 $183.41 $37.27 $36.69

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

1.4008 $97.24. $19.45
2.6420 $183.41 $37.27 $36.69

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.8927 $61.97 $20.93 $12.40

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.8927 $61.97 $20.93 $12.40

0.8927 $61.97 $20.93 $12.40

0.7369 $51.16 $13.76 $10.24

0.4224 $29.32 $7.74 $5.87

0.8927 $61.97 $20.93 $12.40

2.6420 $183.41 $37.27 $36.69

0.4224 $29.32 $7.74 $5.87

1.4008 $97.24. $19.45

0.6739 $46.78. $9.36

0.6739 $46.78. $9.36

1.4008 $97.24. $19.45

3.0221 $209.79. $41.96

0.4224 $29.32 $7.74 $5.87

0.4224 $29.32 $7.74 $5.87

0.4224 $29.32 $7.74 $5.87

0.8927 $61.97 $20.93 $12.40

2.6420 $183.41 $37.27 $36.69

0.7369 $51.16 $13.76 $10.24

0.8927 $61.97 $20.93 $12.40

0.7369 $51.16 $13.76 $10.24

0.7369 $51.16 $13.76 $10.24

0.9478 $65.80 $23.63 $13.16

0.8927 $61.97 $20.93 $12.40

2.6420 $183.41 $37.27 $36.69

0.9478 $65.80 $23.63 $13.16

0.9478 $65.80 $23.63 $13.16

0.7369 $51.16 $13.76 $10.24

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

0.7369 $51.16 $13.76 $10.24

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

0.4731 $32.84. $6.57

1.3506 $93.76. $18.76

1.3506 $93.76. $18.76

0.4731 $32.84. $6.57

2.6420 $183.41 $37.27 $36.69
0.8927 $61.97 $20.93 $12.40

4.1026 $284.80 $83.23 $56.96

0.3780 $26.24 . $5.25

0.3780 $26.24 . $5.25

0.5280 $36.65 . $7.33

0.5280 $36.65 . $7.33

1.0547 $73.22 . $14.65

1.0547 $73.22 . $14.65

0.5280 $36.65 . $7.33

0.5280 $36.65 . $7.33

0.3780 $26.24 . $5.25

0.5280 $36.65 . $7.33

1.3506 $93.76 . $18.76

0.4731 $32.84 . $6.57

1.9242 $133.58 . $26.72

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

1.1945 $82.92 . $16.59

11.3894 $790.65 $268.73 $158.13

2.3958 $166.32 $53.48 $33.27

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

2.6231 $182.10 . $36.42

2.3958 $166.32 $53.48 $33.27

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59

1.1945 $82.92 . $16.59
1.1945 $82.92

. $16.59

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

1.1945 $82.92. $16.59

1.1945 $82.92. $16.59

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

1.1945 $82.92. $16.59

1.1945 $82.92. $16.59

1.1945 $82.92. $16.59

2.6231 $182.10. $36.42

2.6231 $182.10. $36.42

2.6231 $182.10. $36.42

1.1945 $82.92. $16.59

1.1945 $82.92. $16.59

2.6231 $182.10. $36.42

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

0.6352 $44.10. $8.82

1.1945 $82.92. $16.59

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

1.1945 $82.92. $16.59

11.3894 $790.65 $268.73 $158.13

2.3958 $166.32 $53.48 $33.27

2.6231 $182.10. $36.42

2.6231 $182.10. $36.42

46.8279 $3,250.79. $650.16

12.4513 $864.37. $172.88

12.4513 $864.37. $172.88

1.1945 $82.92. $16.59

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.6659 $115.65. $23.13

1.1945 $82.92. $16.59

1.6659 $115.65. $23.13

1.9117 $132.71. $26.55

1.9117 $132.71. $26.55

0.6352 $44.10. $8.82

2.6231 $182.10. $36.42

2.6231 $182.10. $36.42
1.1945 $82.92

. $16.59

1.1945 $82.92. $16.59

2.6658 $185.06. $37.02

2.6658 $185.06. $37.02

1.3767 $95.57. $19.12

1.3767 $95.57. $19.12

1.3767 $95.57. $19.12

2.6658 $185.06. $37.02

2.6658 $185.06. $37.02

2.6658 $185.06. $37.02

2.6658 $185.06. $37.02

0.4940 $34.29. $6.86

0.4940 $34.29. $6.86

0.4940 $34.29. $6.86

0.4940 $34.29. $6.86

0.4940 $34.29. $6.86

1.0547 $73.22. $14.65

0.3780 $26.24. $5.25

1.9117 $132.71. $26.55

0.3780 $26.24. $5.25

0.5280 $36.65. $7.33

1.9117 $132.71. $26.55

0.5280 $36.65. $7.33

0.3780 $26.24. $5.25

0.3780 $26.24. $5.25

0.5280 $36.65. $7.33

0.5280 $36.65. $7.33

0.5280 $36.65. $7.33

0.3780 $26.24. $5.25

0.5280 $36.65. $7.33

0.5280 $36.65. $7.33

0.5280 $36.65. $7.33

1.9117 $132.71. $26.55

1.9117 $132.71. $26.55

1.0547 $73.22. $14.65

3.0395 $211.00. $42.20

0.5280 $36.65. $7.33

3.0395 $211.00. $42.20

1.0547 $73.22. $14.65

1.0547 $73.22. $14.65

3.0395 $211.00. $42.20

1.0547 $73.22. $14.65

3.0395 $211.00. $42.20

1.9117 $132.71. $26.55

1.9117 $132.71. $26.55

3.0395 $211.00. $42.20

1.9117 $132.71. $26.55
1.9117 $132.71 . $26.55

0.6235 $43.28 $12.56 $8.66

1.0547 $73.22 . $14.65

0.3780 $26.24 . $5.25

1.4936 $103.69 . $20.74

1.4936 $103.69 . $20.74

1.4936 $103.69 . $20.74

0.5025 $34.88 . $6.98

0.5025 $34.88 . $6.98

0.5025 $34.88 . $6.98

2.9704 $206.21 . $41.25

1.4936 $103.69 . $20.74

1.4936 $103.69 . $20.74

1.4936 $103.69 . $20.74

0.4047 $28.09 . $5.62

1.4936 $103.69 . $20.74
1.4936 $103.69 . $20.74

0.9786 $67.93 . $13.59

0.9786 $67.93 . $13.59

1.4936 $103.69 . $20.74

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49

0.3234 $22.45 . $4.49
0.1274 $8.84 $1.85 $1.77

0.6235 $43.28 $12.56 $8.66

0.6941 $48.18 . $9.64

1.0430 $72.41 . $14.49

1.4647 $101.68 . $20.34

1.9242 $133.58 . $26.72

2.4718 $171.59 . $34.32

0.6941 $48.18 . $9.64

1.0430 $72.41 . $14.49

1.0430 $72.41 . $14.49

1.4647 $101.68 . $20.34

1.9242 $133.58 . $26.72
0.7290 $50.61 $12.12 $10.13

1.2424 $86.25 $20.73 $17.25

1.9769 $137.24 $33.86 $27.45

3.1815 $220.86 $48.11 $44.18

4.7283 $328.24 $72.57 $65.65

6.8172 $473.25 $104.95 $94.65
0.2941 $20.42 . $4.09

0.2941 $20.42 . $4.09

1.0430 $72.41 . $14.49

1.0430 $72.41 . $14.49

2.2773 $158.09 $44.32 $31.62
0.8204 $56.95 $15.56 $11.39

0.8204 $56.95 $15.56 $11.39

46.8279 $3,250.79 . $650.16

46.8279 $3,250.79 . $650.16

6.4422 $447.22 . $89.45

25.2649 $1,753.89 $511.31 $350.78

41.3248 $2,868.77 . $573.76

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08
0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

0.0776 $5.39 $2.02 $1.08

25.2649 $1,753.89 $511.31 $350.78

2.9435 $204.34 $42.27 $40.87

0.6739 $46.78 . $9.36

39.0865 $2,713.38 $659.53 $542.68

39.0865 $2,713.38 $659.53 $542.68

3.3531 $232.77 . $46.56

87.5671 $6,078.91 . $1,215.79

87.5671 $6,078.91 . $1,215.79

2.5348 $175.97 $40.87 $35.20

0.6929 $48.10 . $9.62

9.8659 $684.89 $258.98 $136.98

1.4936 $103.69 . $20.74

22.7865 $1,581.84 . $316.37

22.7865 $1,581.84 . $316.37

41.7832 $2,900.59 $632.65 $580.12

41.7832 $2,900.59 $632.65 $580.12

0.6929 $48.10 . $9.62

0.6352 $44.10 . $8.82

32.4101 $2,249.91 . $449.99

32.4101 $2,249.91 . $449.99

0.6739 $46.78 . $9.36

0.6929 $48.10 . $9.62

0.2717 $18.86 . $3.78

0.2717 $18.86 . $3.78

0.2717 $18.86 . $3.78
0.2717 $18.86

. $3.78

1.2340 $85.66 $18.14 $17.14

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

7.5480 $523.98. $104.80

2.7693 $192.24 $40.13 $38.45

2.7693 $192.24 $40.13 $38.45

32.4101 $2,249.91. $449.99

32.4101 $2,249.91. $449.99

0.3895 $27.04. $5.41

0.5148 $35.74 $8.67 $7.15

0.5148 $35.74 $8.67 $7.15

0.6739 $46.78. $9.36

6.3038 $437.61. $87.53

7.5480 $523.98. $104.80

3.9371 $273.31. $54.67

7.5480 $523.98. $104.80

3.9371 $273.31. $54.67

0.6739 $46.78. $9.36

104.8857 $7,281.17. $1,456.24

104.8857 $7,281.17. $1,456.24

104.8857 $7,281.17. $1,456.24

104.8857 $7,281.17. $1,456.24

0.3895 $27.04. $5.41

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

4.1026 $284.80 $83.23 $56.96

1.4008 $97.24. $19.45

2.6420 $183.41 $37.27 $36.69

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

26.2376 $1,821.41 $371.33 $364.29

16.0235 $1,112.35. $222.47

29.1250 $2,021.86 $459.92 $404.38

10.4123 $722.82 $189.71 $144.57

10.4123 $722.82 $189.71 $144.57

25.2649 $1,753.89 $511.31 $350.78


















$17.58 . $3.52

0.2868 $19.91 . $3.99

$13.26 . $2.66

$32,078.39 . $6,415.68

$29,460.02 . $5,892.01
$162.87 . $32.58

$154.15 . $30.83

$641.83 . $128.37

$7,555.71 . $1,511.15
1.4834 $102.98

. $20.60

1.0120 $70.25. $14.05

3.1681 $219.93. $43.99

0.4486 $31.14. $6.23

232.3017 $16,126.38 . $3,225.28

0.7908 $54.90 . $10.98

0.3438 $23.87 . $4.78

0.5112 $35.49 . $7.10

0.6225 $43.21 . $8.65

0.4992 $34.65 . $6.93

1.0610 $73.65 . $14.73

0.9263 $64.30 . $12.86

1.6922 $117.47 . $23.50

1.0735 $74.52 . $14.91

0.6225 $43.21 . $8.65

0.3438 $23.87 . $4.78

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07
8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

8.1207 $563.74 $166.16 $112.75

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

6.1872 $429.52 $144.34 $85.91

4.8219 $334.74 $131.90 $66.95

7.6393 $530.32 $196.43 $106.07

3.0395 $211.00 . $42.20

$18.71 . $3.75

$6.03 . $1.21

$121.80 . $24.36

$0.15 . $0.03

$1.47 . $0.30

$37.29 . $7.39

$14.52 . $2.88

$32,860.00 . $6,510.00

$2,111.36 . $418.29

$636.00 $0.00 $0.00

$135.05 . $26.76

$14.83 . $2.94

$1.39 . $0.28

$901.00 . $178.50

$304.75 . $60.38

$0.72 . $0.14

$11.09 . $2.22

$11.59 . $2.32

$19.17 . $3.84

$4.35 . $0.86

32.9730 $2,288.99 . $457.80

25.4890 $1,769.45 . $353.89

6.1052 $423.82 . $84.77

25.8383 $1,793.69 . $358.74

8.0353 $557.81 . $111.57

13.2460 $919.54 $322.74 $183.91

51.1173 $3,548.56 . $709.72
5.1973 $360.80 . $72.16

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71
9.5583 $663.54

. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54. $132.71
9.5583 $663.54 . $132.71
9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71
9.5583 $663.54

. $132.71

9.5583 $663.54. $132.71
9.5583 $663.54

. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54. $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71
9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71

9.5583 $663.54 . $132.71










0.3780 $26.24 $0.00 $0.00

0.3780 $26.24 $0.00 $0.00

0.3780 $26.24 $0.00 $0.00

0.6941 $48.18 $0.00 $0.00

5.4345 $377.26 $0.00 $0.00

8.3174 $577.39 $0.00 $0.00

2.2553 $156.56 . $31.32

1.4030 $97.40 . $19.48

0.6929 $48.10 . $9.62

2.2553 $156.56 . $31.32

8.3174 $577.39 $0.00 $0.00

0.4047 $28.09 . $5.62

0.6418 $44.55 $0.00 $0.00
1.3160 $91.36 . $18.28

46.8279 $3,250.79 . $650.16

1.9242 $133.58 . $26.72

4.9132 $341.07 . $68.22

0.4224 $29.32 $7.74 $5.87

0.4224 $29.32 $7.74 $5.87

0.4224 $29.32 $7.74 $5.87

0.6941 $48.18 . $9.64

1.0430 $72.41 . $14.49

0.9786 $67.93 . $13.59

1.9242 $133.58 . $26.72

1.9242 $133.58 . $26.72

12.4513 $864.37 . $172.88

5.9462 $412.79 . $82.56

7.5480 $523.98 . $104.80
104.4584 $7,251.50 . $1,450.30

104.4584 $7,251.50 . $1,450.30

0.6739 $46.78 . $9.36

0.6739 $46.78 . $9.36

11.3894 $790.65 $268.73 $158.13

11.3894 $790.65 $268.73 $158.13

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

46.8279 $3,250.79 . $650.16

35.2457 $2,446.76 . $489.36

0.6739 $46.78 . $9.36

2.1881 $151.90 $59.41 $30.38

0.6941 $48.18 . $9.64

0.5673 $39.38 . $7.88

0.8183 $56.81 . $11.37

1.3027 $90.43 . $18.09

1.9652 $136.42 . $27.29

3.7640 $261.30 . $52.26

1.3711 $95.18 $0.00 $0.00

11.6401 $808.06 . $161.62

0.4940 $34.29 . $6.86

0.4940 $34.29 . $6.86

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

2.3958 $166.32 $53.48 $33.27

1.4647 $101.68 $0.00 $0.00

0.3895 $27.04 . $5.41

32.4101 $2,249.91 . $449.99

2.3755 $164.91 . $32.99

$350.00 . $70.00

$450.00 . $90.00
$650.00 . $130.00

0.9648 $66.98 $13.49 $13.40

0.9648 $66.98 $13.49 $13.40

0.5308 $36.85 . $7.37

0.2941 $20.42 $0.00 $0.00

0.2941 $20.42 $0.00 $0.00

22.9208 $1,591.16 . $318.24





0.3780 $26.24 $0.00 $0.00

$20.26 . $4.06

$515.32 . $103.07

$2.67 . $0.54
$394.16 . $78.84

$89.99 . $18.00

$133.65 . $26.73

$41.19 . $8.24

$314.05 . $62.81

$39.24 . $7.85

$35.86 . $7.18

$155.84 . $31.17

$3.79 . $0.76

$8.76 . $1.76

$13.74 . $2.75

$14.77 . $2.96

$23.38 . $4.68

$1.29 . $0.26

$200.54 . $40.11

$72.18 . $14.44

$2,027.27 . $405.46

$2.54 . $0.51

$5.38 . $1.08

$7.41 . $1.49

$10.33 . $2.07

$16.29 . $3.26

$27.53 . $5.45

$43.78 . $8.76
$192.07 . $38.42

$12.13 . $2.43

$87.45 . $17.49

$1.78 . $0.36

$3.99 . $0.80

$740.09 . $148.02

$37.51 . $7.43

$5.06 . $1.02

$2,395.22 . $479.05

$99.76 . $19.96

$922.07 . $184.42

$0.45 . $0.09

$2.98 . $0.60

$9.57 . $1.92

$30.71 . $6.15
$583.90 . $116.78

$274.42 . $54.89

$272.64 . $54.53

$82.68 . $16.54

$275.28 . $54.54

$183.71 . $36.75

$20.31 . $4.07

$94.03 . $18.81

$147.14 . $29.43

$203.01 . $40.61

$238.72 . $47.75

$376.20 . $75.24

$6.76 . $1.36

$1.71 . $0.35

$13.06 . $2.62

$338.26 . $67.66

$34.45 . $6.89

$17.91 . $3.59

$7.15 . $1.43

$179.06 . $35.82

$36.91 . $7.39

$7.11 . $1.43

$30.62 . $6.13

$55.80 . $11.16
$37.67 . $7.54

$62.51 . $12.51

$57.07 . $11.42

$35.04 . $7.01

$57.07 . $11.42

$95.57 . $19.12

$95.59 . $19.12

$94.82 . $18.97

$8.33 . $1.67

$222.97 . $44.60

$71.52 . $14.31

$144.36 . $28.88

$129.32 . $25.87

$446.45 . $89.29

$58.90 . $11.78

$11.59 . $2.32

$41.19 . $8.24

$197.14 . $39.43

$359.59 . $71.92

$29.92 . $5.99

$25.08 . $5.02

$299.56 . $59.92

$547.54 . $109.51
$33.99 . $6.80

$20.18 . $4.04

$1.02 . $0.21

$6.48 . $1.30

$2.77 . $0.56

$9.88 . $1.98

$43.93 . $8.79

$113.48 . $22.70

$240.88 . $48.18

$20.64 . $4.13

$2.70 . $0.54

$11.15 . $2.23

$6.45 . $1.29

$18.51 . $3.71

$1,002.20 . $200.44

$242.67 . $48.54

$2,527.87 . $505.58

$158.76 . $31.76
$278.36 . $55.68

$3.93 . $0.79

$12.50 . $2.50

$27.03 . $5.41

$88.57 . $17.72

$56.35 . $11.27

$157.23 . $31.45

$398.10 . $79.62

$183.08 . $36.62

$51.36 . $10.28

$24.81 . $4.97

$82.16 . $16.44

$5.09 . $1.02

$18.83 . $3.77

$23.63 . $4.73

$4.93 . $0.99

$44.84 . $8.97

$23.62 . $4.73

$26.97 . $5.40

$56.09 . $11.22

$1,332.35 . $266.47

$47.57 . $9.52

$39.22 . $7.85

$1.96 . $0.39

$51.95 . $10.39
$1,034.03 . $206.81

$1.22 . $0.25

$8.83 . $1.77

$3.47 . $0.69

$60.08 . $12.02

$3.17 . $0.64

$30.91 . $6.19

$193.59 . $38.72

$82.18 . $16.44

$63.60 . $12.72

$112.30 . $22.25

$449.09 . $89.82

$349.88 . $69.32

$9.55 . $1.91

$6.02 . $1.21

$219.00 . $43.80

$218.47 . $43.70
$70.14

. $13.90

$1.05. $0.21

$0.90. $0.18

$0.87. $0.18

$1.50. $0.30

$0.87. $0.18

$1.17. $0.24

$1.09. $0.22

$0.88. $0.18

$0.85. $0.17

$1.13. $0.23

$101.40. $20.28

$2.48. $0.50

$1.57. $0.32

$138.70. $27.74

$68.27. $13.66

$16,640.00. $3,328.00

$18,980.00. $3,796.00

$194.17. $38.84

$88.80. $17.76

$147.16. $29.44

$167.00. $33.40

$11.81. $2.37

$25.55. $5.06

$104.77. $20.96

$542.36. $108.48

$1,112.14. $222.43

$387.17. $77.44

$516.41. $103.29
$136.85 . $27.37
$5.90

. $1.18

$3.59. $0.72

$6.81. $1.37

$22.48. $4.50

$34.34. $6.87

$79.44. $15.74

$9.31. $1.87

$76.40. $15.28

$504.27. $100.86

$577.60. $115.52

$915.45. $183.09

$40.13. $8.03

$62.07. $12.42

$5.16. $1.04

$114.37. $22.88

$114.38. $22.88

$18.15. $3.63

$58.72. $11.75

$39.60. $7.92

$172.56. $34.52

$49.52. $9.91

$23.59. $4.72

$479.02. $95.81

$529.42. $105.89

$13.16. $2.64

$56.58. $11.32

$2.79. $0.56

$1,559.54. $311.91

$20.84. $4.17

$1.87. $0.38
$36.60

. $7.32

$111.40. $22.28

$195.16. $39.04

$62.53. $12.51

$31.21. $6.25

$46.43. $9.29

$16.19. $3.24

$20.87. $4.18

$549.62. $109.93

$210.96. $42.20

$4.88. $0.98

$4,728.88. $945.78

$3,223.57. $644.72

$15,184.53. $3,036.91

$154.88. $30.98

$1,272.01. $254.41

$110.19. $22.04

$8.36. $1.68

$9.21. $1.85

$2,675.40. $535.08

$1,068.16. $213.64

$20.36. $4.08

$33.95. $6.79

$2,637.02. $527.41

$45.41. $9.00

$85.62. $17.13

$51.37. $10.28

$165.63. $32.81

$599.16. $119.84

$219.30. $43.45

$264.81. $52.97

$4.86. $0.98

$49.87. $9.98

$106.54. $21.31

$19.30. $3.86

$69.06. $13.82

$946.64. $189.33

$81.81. $16.37

$3,017.82. $603.57


















1.9242 $133.58

. $26.72

2.7926 $193.86. $38.78

2.2455 $155.88. $31.18

1.0975 $76.19. $15.24

2.8046 $194.70. $38.94

1.0927 $75.86. $15.18

1.2522 $86.93. $17.39

1.9703 $136.78. $27.36

2.1382 $148.43. $29.69

4.0969 $284.41. $56.89

1.0221 $70.95. $14.19

1.7459 $121.20. $24.24

2.1768 $151.11. $30.23

2.0418 $141.74. $28.35

6.0636 $420.94. $84.19

7.5524 $524.29. $104.86

7.5964 $527.34. $105.47

9.9046 $687.58. $137.52

3.3729 $234.15. $46.83

3.4728 $241.08. $48.22

3.7077 $257.39. $51.48

$20.37. $4.08

0.2513 $17.45. $3.49

1.1839 $82.19. $16.44

$67.07. $13.42

$29.16. $5.84

$70.39. $14.08

1.2214 $84.79. $16.96

22.1451 $1,537.31. $307.47

2.7475 $190.73. $38.15

11.4189 $792.70. $158.54

8.6696 $601.84. $120.37

1.8650 $129.47. $25.90
5.7123 $396.55 . $79.31

2.1603 $149.97 . $30.00

6.2606 $434.61 . $86.93

4.0635 $282.09 . $56.42

1.0092 $70.06 . $14.02

1.2624 $87.64 . $17.53

2.5348 $175.97 $40.87 $35.20

0.1274 $8.84 $0.00 $0.00

$0.69 . $0.14
$1.76 . $0.36

$316.52 . $63.31

$5.57 . $1.10

$220.75 . $44.15
$34.06

. $6.82

$4.68. $0.94

$15.45. $3.09

$10.95. $2.19

$39.39. $7.88

$92.79. $18.56

$20.95. $4.19

$31.67. $6.34

$7.17. $1.44

$334.07. $66.82

$334.07. $66.82

$972.75. $194.55
$6.07

. $1.22

$31.11. $6.23

$3.13. $0.63

$6.04. $1.21

$20.32. $4.07